Nutrition Metabolism and Cardiovascular Diseases最新文献

Background and aims: We aimed to investigate associations between age at diagnosis of type 2 diabetes and the relative and absolute risk of four common comorbidities: obesity, hypertension, depression, and anxiety.

Methods and results: We used primary and secondary care data from England to conduct a matched cross-sectional study of individuals aged 16-50 years (N = 108,061 with a new diagnosis of type 2 diabetes; 829,946 without type 2 diabetes). Morbidity risk was estimated using multivariable generalised linear models. Adjusted risk ratios (RRs) indicated a higher risk of all studied comorbidities in individuals with vs without type 2 diabetes at all diagnostic ages, with RRs progressively decreasing with older age at diagnosis (from 13.8 at 16-27 years to 5.7 at 48-50 years, for obesity; from 28.9 to 3.2, for hypertension; from 4.4 to 2.5, for depression; and from 4.3 to 2.2, for anxiety). The estimated total number of morbidities among individuals aged 16 years with vs without type 2 diabetes were 85.2 (95 % CI: 83.3-87.0) and 7.1 (95 % CI: 6.9-7.3) per 100 individuals, respectively. Corresponding estimates at 50 years of age were 92.0 (91.3-92.8) and 24.8 (24.6-25.0).

Conclusion: The substantially higher burden of MLTCs in young individuals with vs without type 2 diabetes emphasises the need for multidisciplinary patient care and management in individuals diagnosed with type 2 diabetes in early adulthood.

Background and aim: The study investigates mortality related to obesity and other metabolic disorders during the pandemic, comparing findings from two large European regions.

Methods and results: All death certificates of residents aged 45-84 years in Veneto (Italy) and Bavaria (Germany) were extracted from January 2020 to December 2022. The proportion of deaths reporting obesity, diabetes, and hypertension was computed both for all-cause and for COVID-19 deaths. The prevalence of mention of metabolic disorders was compared between deaths attributed to COVID-19 and all other deaths by means of Odds Ratios (OR) with 95 % Confidence Intervals (CI) estimated by conditional logistic regression stratified by age, sex, and year of death. Overall 81,125 deaths in Veneto (8.5 % attributed to COVID-19) and 253,862 in Bavaria (5.9 % from COVID-19) were investigated. At least one metabolic disorder was mentioned in 35.8 % of all COVID-19 deaths in Veneto and 26.7 % in Bavaria. Obesity-related deaths sharply peaked in each epidemic wave in both regions, with a less marked pattern for hypertensive diseases and diabetes. The association with COVID-19 increased with the number of reported metabolic disorders, was stronger among younger ages and in Veneto. Estimated OR for COVID-19 death among decedents aged 45-64 years with two/three vs. no metabolic disorder were 4.24 (CI 3.33-5.40) in Veneto and 2.14 (1.83-2.51) in Bavaria.

Conclusion: The strong association between deaths from COVID-19 and number of metabolic disorders among younger ages highlights the need for prioritizing preventive interventions for obesity and associated metabolic conditions.

Background and aim: Body roundness index (BRI), an innovative anthropometric measure assessing visceral fat, has demonstrated utility in predicting cardiometabolic risk. However, its association with stroke risk across blood-pressure strata remains unclear.

Methods and results: The sample comprised 12,316 CHARLS participants aged ≥45 years without prior stroke. The association between the BRI and incident stroke was evaluated using Cox proportional hazards models. To strengthen the validity of the findings, additional analyses were performed, including propensity score matching (PSM), subgroup analyses, and sensitivity tests. Furthermore, the discriminative capacity of BRI for predicting stroke events was assessed using receiver operating characteristic (ROC) curve analysis. Increased stroke risk was significantly connected to a higher BRI. Following PSM, fully adjusted models indicated that a unit rise in log (BRI) was tied to a 19 % increase in stroke risk (HR = 1.79, 95 % CI: 1.37-2.34, P < 0.001). After stratification by blood pressure status, the association between BRI and stroke risk was most pronounced among individuals with prehypertension (HR = 2.60, 95 %CI: 1.49-4.54; P < 0.001) and those with hypertension (HR = 1.65, 95 %CI: 1.17-2.33; P = 0.004). By contrast, among participants with normal blood pressure (NBP), no statistically significant association was observed following PSM. The reliability of the findings was supported by subgroup and sensitivity analyses. The ROC analysis demonstrated that the BRI had moderate predictive accuracy for stroke, notably in individuals with NBP, with an area under the curve of 0.672.

Conclusions: Elevated BRI is independently associated with a greater risk of stroke, particularly in individuals with prehypertension or hypertension.

Background and aims: Insulin resistance (IR) and hepatic fibrosis are significant yet underexplored synergistic risk factors for cardiovascular events in coronary artery disease (CAD). We investigated the interaction between the triglyceride-glucose (TyG) index and liver fibrosis scores (FIB-4, BARD) for risk prediction.

Methods and results: Within a prospective cohort of 14,660 CAD patients, we performed a data-driven phenotypic stratification using K-means clustering-an unsupervised machine learning algorithm-to deconvolute heterogeneous metabolic profiles. Subsequently, Cox regression models were employed to evaluate associations of these phenotypes, along with continuous and tertiled TyG, FIB-4, and BARD scores, with incident cardiovascular events (a composite of cardiovascular mortality, nonfatal myocardial infarction, or stroke). The analysis identified three mechanistically distinct metabolic subtypes. During a median follow-up of 3 years, 463 cardiovascular events occurred (overall event rate: 3.16 %). The "metabolic-fibrosis mixed" subtype exhibited the highest risk (adjusted HR = 1.71, 95 %CI:1.34-2.19), with an event rate of 4.40 % (183/4159) compared to 2.43 % (116/4782) in the low-risk subtype. Both the TyG index (HR = 1.52, 95 %CI:1.40-1.65) and BARD score were independent predictors. A significant multiplicative interaction existed between TyG and BARD (P = 0.041). Additive interaction analysis confirmed synergy, with a relative excess risk (RERI) of 1.42 when both biomarkers were elevated. Risk escalated nonlinearly once TyG exceeded 9.0, potentiated by fibrosis.

Conclusion: IR and hepatic fibrosis synergistically increase cardiovascular risk in CAD patients. Combining TyG and BARD scores with metabolic subtyping enhances risk stratification, potentially guiding targeted interventions.

Background and aims: Night Eating Syndrome (NES) is a disordered eating pattern characterized by evening hyperphagia and nocturnal eating episodes. While NES has been extensively studied in obese and psychiatric populations, its presence in liver transplant (LT) recipients remains unexplored. Hence, we aimed to assess NES prevalence in a real-life cohort of LT recipients with type 2 diabetes and/or overweight or obesity.

Methods and results: The Night Eating Questionnaire (NEQ) was administered to 101 LT recipients attending a nutritional-metabolic outpatient clinic, and clinical data were collected. Inclusion criteria were age >18 years, liver transplantation, and presence of type 2 diabetes and/or BMI >25 kg/m². Patients with recent psychiatric diagnoses or unstable psychotropic medication were excluded. NES was identified in 5 % of participants. Obesity was significantly associated with nocturnal awakenings unrelated to urination (p = 0.008). NES symptoms such as insomnia, evening eating urges, and depressive mood were also reported by a substantial subset of patients.

Conclusions: NES is present among LT recipients and appears more prevalent in those with obesity and disrupted sleep patterns. Given the metabolic and psychological vulnerability of this population, NES may represent an under recognized barrier to optimal post-transplant care. These findings support incorporating psycho-nutritional screening tools in transplant follow-up protocols.

Background and aims: Metabolic and bariatric surgery (MBS) is an effective long-term treatment for obesity but is also associated with nutritional deficiencies and risk of recurrent weight gain (RWG). Anaemia is a common complication, particularly after Roux-en-Y gastric bypass (RYGB). Long-term comparative data on anaemia and clinical outcomes after MBS are limited. This study aimed to evaluate anaemia, nutritional deficiencies, weight trajectories, and late clinical deterioration (defined as either RWG >30 % from the initial weight loss or exacerbation of an obesity-related comorbidity) five years after RYGB, sleeve gastrectomy (SG), or medical treatment (MT).

Methods and results: This prospective, non-randomized cohort study included 971 adults with obesity (BMI ≥35 kg/m²) from the BASUN study. Participants underwent RYGB (n = 388), SG (n = 201), or MT (n = 382). Hematologic parameters, supplement use, weight outcomes, and obesity-related complications (using medication data as surrogate markers) were assessed at baseline and five years. Follow-up data were available for 538 participants. Anaemia prevalence increased significantly in the RYGB group (3.0 %-12.2 %, p < 0.05), especially among women. No significant differences in anaemia or iron deficiency were found between supplement users and non-users in either surgery group. Late clinical deterioration occurred in 23.5 % of the MT group, 10.0 % of the RYGB group, and 13.5 % of the SG group.

Conclusions: Anaemia and iron deficiency increased five years post-RYGB, regardless of supplement use, suggesting current iron supplementation regimens may be inadequate. Alternative strategies are needed. A substantial proportion of patients experienced late clinical deterioration, highlighting the importance of long-term follow-up after obesity treatment.

Trial registration: March 03, 2015; NCT03152617.

Background and aims: While body mass index (BMI) is the most used measure of adiposity, it does not account for fat distribution. Novel indices, such as A Body Shape Index (ABSI) and Body Roundness Index (BRI), may better reflect cardiometabolic risk. However, their association with subclinical cardiac damage, particularly left ventricular hypertrophy (LVH), remains unclear. The aim of this study was to evaluate the association between novel adiposity indices (ABSI and BRI) and left ventricular mass (LVM) assessed by echocardiography in a large cohort of patients with hypertensive.

Methods and results: We conducted a cross-sectional study including 724 hypertensive adults who underwent standardized anthropometric and echocardiographic assessments. Adiposity indices (BMI, waist circumference, ABSI, and BRI) were calculated, and left ventricular mass was indexed to body surface area and height^2.7. Correlations and multivariate analyses were performed, and receiver operating characteristic (ROC) curves were used to assess diagnostic performance. All adiposity indices were significantly higher in individuals with LVH. BRI showed the strongest correlation with LVMH^2.7 (r = 0.423), particularly in women. In multivariate analysis, BRI remained significantly associated with LVMH^2.7 in both sexes, while ABSI was not independently associated in men. ROC curve analysis demonstrated that BRI had the highest diagnostic accuracy for identifying LVH, outperforming BMI and ABSI, especially when LVH was defined using LVMH^2.7.

Conclusions: BRI outperformed traditional and novel adiposity indices in identifying LVH in hypertensive patients, particularly when LVM was indexed to height^2.7. Given its superior diagnostic performance, BRI may represent a valuable tool in cardiovascular risk stratification, though further studies are warranted.

Background and aim: We aimed to assess the sex-specific associations of different measures of body size, composition, and fat distribution with data from an oral glucose tolerance test (OGTT) and to compare their effect sizes in a population-based study.

Methods and result: sCross-sectional data of 3628 (1898 women, 52 %) subjects aged between 20 and 84 years were taken from the Study of Health in Pomerania (SHIP-Trend-0). We investigated associations of markers from body anthropometry, bioelectrical impedance analysis, and magnetic resonance imaging with markers from an OGTT including fasting glucose, fasting insulin, the homeostasis model assessment-insulin resistance index, 2-h post-load (glucose and insulin) and glucose tolerance categories. For this, we used linear and multinomial logistic regression models stratified by sex and adjusted for confounding. All body composition markers were significantly associated with all OGTT parameters in both sexes. In women, visceral adipose tissue and liver fat content were most strongly associated with the OGTT parameters, while in men, the waist-to-height ratio showed the strongest association. Relative fat-free mass was the only marker, which was inversely associated with the OGTT parameters in both men and women. Overall, the associations of all body composition markers wee more pronounced in men than in women.

Conclusions: Our study highlights that associations between body composition markers and OGTT parameters differ between men and women with a tendency of stronger associations in men than in women. Sex-specific body composition markers may have to be considered in clinical practice to predict future prediabetes and type 2 diabetes.