Search Results (2,014)

Background: Robust evidence demonstrates that tobacco use acts as a causal and, therefore, modifiable risk factor for the development of type 2 diabetes mellitus (T2DM). However, its specific population-level impact in Mexico has not yet been quantified. Objective: This study aimed to estimate the population attributable fraction (PAF) of T2DM associated with tobacco use among Mexican adults, utilizing data from the 2021 National Health and Nutrition Survey (ENSANUT). Methods: A nested case–control analysis was conducted within the complex sampling design of the ENSANUT. Adults aged 20 years or older were included. Cases were defined as individuals with a self-reported medical diagnosed T2DM diagnosis; controls were individuals without T2DM. Exposure status was categorized as current person who smokes, former person who smokes, and never person who smokes. A logistic regression model was employed, adjusting for key covariates including age, sex, socioeconomic status, and comorbidities. The PAF was subsequently calculated using the Miettinen formula. Results: The adjusted PAF for T2DM attributable to smoking was 10.1% (95% CI: 4.07–14.97). This finding suggests that approximately one in eight T2DM cases could be prevented through the elimination of tobacco use. The association was more pronounced among men and individuals with a history of heavy tobacco use. Conclusion: The estimated PAF for T2DM due to tobacco use underscores the significant contribution of policies established within the WHO Framework Convention on Tobacco Control to the prevention of chronic diseases. The implementation and strengthening of such policies, including increased tobacco taxes, comprehensive smoking bans in public places, on-package warnings, and advertising prohibitions, would prove highly beneficial. These findings show a strong population-level association between tobacco use and T2DM, but causality cannot be established. Future longitudinal studies in Mexico are needed to confirm these results. Full article

Exposure to environmental pollutants, including toxic metals, volatile organic compounds (VOCs), and per- and polyfluoroalkyl substances (PFAS), has been increasingly linked to impaired kidney function. However, the combined effects of these exposures, along with essential elements, on kidney health remain poorly understood. This study aimed to evaluate the independent and cumulative or mixture effects of toxic metals (cadmium, lead, and mercury), essential elements (iron, manganese, and selenium), PFAS (PFOA and PFOS), and VOCs (m-/p-xylene and o-xylene) on kidney function as measured by estimated glomerular filtration rate (eGFR). Using data from the National Health and Nutrition Examination Survey (NHANES), we applied multiple imputation to address missing data and implemented statistical techniques, including Bayesian Kernel Machine Regression (BKMR), quantile g-computation, and Weighted Quantile Sum Regression (WQSR) to assess complex exposure–response relationships, including non-linear, potential synergistic, and antagonistic effects. The results indicated that several exposures were correlated, particularly o-xylene with m-/p-xylene (r = 0.77), Cd with Pb (r = 0.46), and PFOS with PFOA (r = 0.61). eGFR was negatively associated with Pb, PFOS, PFOA, and Hg. In the BKMR analysis, overall posterior inclusion probabilities (PIPs) highlighted PFOS, Cd, Se, Mn, and Fe as the most influential exposures. Quantile g-computation highlighted Cd and Mn as major contributors, while WQSR modeling confirmed Mn as a key contributor. The findings underscore the importance of considering complex interactions in environmental exposure assessments. While essential elements may offer protective effects, toxic metals, PFAS, and VOCs remain critical contributors to kidney dysfunction. These insights highlight the need for integrative risk assessment approaches and public health strategies aimed at mitigating harmful exposures while promoting optimal nutrient balance. Full article

Background: Energy-dense non-essential snacks are subject to 8% excise tax in Mexico. Objectives: To model the impact on diet quality of (1) replacing energy-dense snacks with pistachios and (2) adding small amounts of pistachios to the diet. Methods: Data came from the Mexico National Health and Nutrition survey (ENSANUT, by its Spanish acronym) 2012 (n = 7132) and 2016 (n = 14,764). Dietary intakes were collected using a semi-quantitative food frequency questionnaire. Substitution analyses replaced energy-dense snack foods with equicaloric amounts of pistachios (Model 1) or with mixed nuts/seeds (Model 2). Additional analyses (Model 3) added small amounts of pistachios (10–28 g) to the daily diet. Added sugars, sodium, and saturated fat along with protein fiber, vitamins, and minerals were the main nutrients of interest. Dietary nutrient density was assessed using the Nutrient-Rich Food (NRF9.3) Index. Separate modeling analyses were performed for ENSANUT 2012 and 2016 and for children and adults. Results: Energy-dense foods, mostly sweet, accounted for about 20% of daily energy. Modeled diets with pistachios and mixed nuts/seeds were much lower in added sugars (<8% of dietary energy) and in sodium (<550 mg/day) and were higher in protein, fiber, mono- and polyunsaturated fats, potassium, and magnesium (p < 0.05). Significant improvements in dietary quality held across all socio-demographic strata. Adding small amounts of pistachios (10–28 g) to the diet (Model 3) increased calories but also led to better diets and higher NRF9.3 dietary nutrient density scores. Conclusions: Modeled diets with pistachios replacing energy-dense snack foods had less added sugars and sodium and more protein, fiber, vitamins, and minerals. Adding small amounts of pistachios also led to better diets. Pistachios are a healthy snack and can be an integral component of healthy diets. Full article

Background/Objectives: Osteoporosis represents a major yet underdiagnosed public health concern in developing countries, including Tunisia. Limited awareness, delayed diagnosis, and suboptimal adoption of preventive strategies contribute to increased risk of fragility fractures in aging populations. This study aimed to assess post-pandemic knowledge, attitudes, and preventive practices regarding osteoporosis in the Tunisian general population. Methods: A cross-sectional survey was conducted between February and April 2024 in six randomly selected community pharmacies in Tunis. Adults ≥ 40 years old completed a validated 31-item questionnaire assessing socio-demographic factors, osteoporosis knowledge, risk factors, screening practices, and preventive behaviors. A total of 160 fully completed questionnaires were analyzed using SPSS v22. Results: Only 60.6% of respondents reported awareness of osteoporosis. Knowledge levels were significantly higher in men (8.37 vs. 7.40; p = 0.043), urban residents (8.22 vs. 7.21; p = 0.036), participants with higher education (8.73 vs. 7.00; p < 0.001), those with a family history (8.58 vs. 7.49; p = 0.033), and individuals already diagnosed (9.19 vs. 7.63; p = 0.025). Screening rates were low: only 11.3% had ever undergone DXA testing, despite 18.8% reporting prior fractures. Preventive behaviors were inadequate: 80% did not supplement calcium, 88.1% did not use vitamin D, and 58.8% did not engage in <30 min of daily activity. Osteoporosis was reported by 13.1% of participants and 95.2% of diagnosed cases received treatment, predominantly bisphosphonates (75%). Comorbidities were significantly associated with osteoporosis (24.5% vs. 7.5%; p = 0.003). Conclusions: This study reveals suboptimal awareness, limited access to screening, and insufficient preventive behaviors regarding osteoporosis in Tunisia. Targeted educational initiatives, expansion of DXA availability, adoption of national osteoporosis guidelines, and multidisciplinary stakeholder involvement are critical to improve early detection, prevention, and management in the aging Tunisian population. Furthermore, promoting balanced nutrition that includes calcium- and vitamin D-rich foods, along with appropriate dietary supplementation when needed, is an essential preventive strategy to support optimal bone health and reduce osteoporosis risk in the general population. Full article

Falls are a major cause of morbidity in aging populations; this study examined physical, psychological, and lifestyle correlates of falls among older Korean adults. Using 2022 KNHANES data, we conducted a cross-sectional analysis of adults aged ≥65 years (n = 612). Fall in the past year was the outcome; multivariable logistic regression and ROC analyses evaluated candidate predictors. Lower weekly working hours (<12) (OR = 3.11, 95% CI 1.23–7.88), insufficient physical activity (<150 min/week) (2.49, 1.03–5.99), reduced grip strength (<15 kg) (2.23, 1.14–4.35), low diastolic blood pressure (<69 mmHg) (2.06, 1.09–3.89), elevated LDL cholesterol (≥150 mg/dL) (3.06, 1.49–6.28), and depressive symptoms (PHQ-9 ≥ 3) (3.02, 1.52–6.00) were independently associated with higher fall odds. Age ≥ 75 years, alcohol use, anxiety (GAD-7 ≥ 3), vitamin D ≤ 3 ng/mL, and vitamin E ≤ 7 mg/L were not significant in adjusted models. Discrimination was modest across individual markers (AUCs 0.55–0.65); model fit was acceptable (Nagelkerke R² = 0.262; Hosmer–Lemeshow p = 0.318). These findings suggest that screening for low muscle strength, depressive symptoms, hypotension, and high LDL cholesterol—alongside promoting physical activity and social engagement through work—may help identify and manage fall risk in community-dwelling older adults. Causal inference is not supported due to the cross-sectional design. Full article

Background/Objectives: Non-restorative sleep (NRS)—a subjective feeling of unrefreshing/insufficient rest despite adequate sleep duration—an important sleep-quality indicator is associated with depression and mortality. We examined whether insoluble dietary fiber intake is associated with NRS in Japanese adults, after adjusting for socioeconomic, lifestyle, and dietary factors. Methods: Using cross-sectional data from 5034 adult (≥20 years) respondents of the National Health and Nutrition Surveys (2014 and 2018), Japan, self-assessed NRS (coded as 1, absence as 0) was analyzed with insoluble fiber intake (g/1000 kcal) modeled as a continuous variable; logistic regression analyses with progressive adjustments included Model 1, adjusted for sex, age, and body mass index; Model 2, comprising socioeconomic and lifestyle factors; Model 3, adjusted for sleep duration; and Model 4, which included dietary energy, protein, fat, vitamin D, and magnesium. Results: Among 19.3% of participants with NRS, the median (interquartile range) insoluble dietary fiber intake was 5.45 (4.10–6.97) g/1000 kcal, with higher NRS prevalence among younger adults (<60 years), non-drinkers (no habitual alcohol consumption), and individuals with short sleep (<6 h). Higher insoluble dietary fiber intake was consistently associated with a lower NRS likelihood, before and after adjustment for potential confounders. In the fully adjusted model, younger age (<60 years), no habitual alcohol consumption, and short sleep (<6 h) were independently associated with greater odds of NRS. Conclusions: Higher insoluble dietary fiber density correlated with lower odds of NRS, indicating a significant association, rather than causation, that warrants longitudinal clarification of the temporal relationship between dietary fiber intake and perceived sleep restorativeness. Full article

Background/Objectives: Dietary quality is a driver of metabolic dysfunction-associated steatotic liver disease (MASLD). Men and women often have different levels of adherence to medical advice, but the effect of gender on adherence to dietary advice as a function of awareness of MASLD is understudied. We aim to investigate the differences in diet quality between men and women who are aware of their diagnosis of MASLD compared to their undiagnosed counterparts. Methods: We utilized the National Health and Nutrition Examination Survey 2017–2020 to identify a nationally representative sample of subjects with MASLD, 127 of whom reported a diagnosis of MASLD (diagnosed MASLD), and 1703 of whom did not report an existing diagnosis of MASLD but met criteria of the disease based on vibration-controlled transient elastography results and cardiometabolic criteria (undiagnosed MASLD). Results: In a gender-stratified analysis of diet quality as a function of reported MASLD diagnosis, women with diagnosed MASLD were more likely than women with undiagnosed MASLD to consume less added sugar and more total and whole fruits. Women with diagnosed MASLD had a 3.06 higher healthy eating index score than undiagnosed women, after adjusting for confounders such as demographics, comorbidities, lifestyle behaviors, and metabolic risk factors. In men, total diet quality did not differ based on awareness of MASLD diagnosis. Conclusions: Women with diagnosed MASLD have superior diets compared to their undiagnosed counterparts. Gender-specific approaches to counseling and prospective studies that investigate causes of gender-driven differences in dietary behavior in the context of MASLD are needed. Full article

Background/Objectives: This study investigated the association between physical activity (PA) levels and the risk of chronic diseases in Korean adults with sleep deficiency (SD). Methods: Data were obtained from the Korea National Health and Nutrition Examination Survey (2016–2021; n = 31,338). SD was defined as less than 7 h of sleep per night. The PA levels were categorized as low, moderate, or high. Multivariable logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI) for various chronic diseases, adjusting for demographic and lifestyle covariates. Results: High PA levels were associated with lower odds of abdominal obesity (OR = 0.855, 95% CI = 0.782–0.934, p < 0.001), hypertension (OR = 0.787, 95% CI = 0.657–0.942, p < 0.01), diabetes mellitus (OR = 0.743, 95% CI = 0.622–0.887, p < 0.01), and metabolic syndrome (OR = 0.706, 95% CI = 0.586–0.850, p < 0.001). Moderate PA showed similar but weaker associations. Conversely, high PA levels were associated with higher odds of depression (OR = 1.474, 95% CI = 1.123–1.935, p < 0.01). Subgroup analyses indicated that the protective effects of PA were stronger among women, non-smokers, and individuals with obesity. Conclusions: Among adults with SD, moderate-to-vigorous PA is associated with a lower odds of several metabolic disorders, including abdominal obesity, diabetes, and metabolic syndrome. This highlights the importance of regular PA in maintaining metabolic health. However, a positive association between high PA and depression should warrant further investigation, as reverse causality or residual confounding may explain this association. Full article

Background: Ageism and age-related discrimination are growing public health concerns that can have detrimental effects on the health of older adults. However, their association with nutritional health remains unexplored. This study explored the association between age discrimination and nutritional risk among older adults in Republic of Korea. Methods: This study is a cross-sectional analysis of the 2023 National Survey of Older Korean. 9951 adults aged ≥ 65 years from the 2023 National Survey of Older Koreans. Age discrimination was assessed based on the reported experiences in six everyday settings: public transportation; commercial facilities; public institutions; healthcare facilities; workplaces; and family. Nutritional status was measured using the Nutrition Screening Initiative and categorized into low; moderate; and high nutritional risk groups. Multinomial logistic regression models were used to determine the association between age discrimination and nutritional risk and estimate odds ratios and 95% confidence intervals (CIs). Results: The mean age of participants was 74.0 years. Among the participants, 73.7% reported no age discrimination, whereas 15.4%, 6.0%, and 4.9% experienced age discrimination in one; two; and three or more settings, respectively. After adjusting for socio-demographic characteristics and health factors, compared to individuals who did not experience age discrimination, those who experienced discrimination in one, two, or three or more dimensions had 1.40-fold (95% CI: 1.17–1.69), 1.46-fold (95% CI: 1.13–1.89), and 1.89-fold (95% CI: 1.44–2.48) higher odds of being at high nutritional risk, respectively. Conclusion: Age discrimination exposure may be a risk factor for poor nutritional health in older adults. Policy efforts are needed to reduce age-related discrimination and stigmatization and promote equitable conditions for healthy aging. Full article

Objectives: This study aims to explore the relationship between dental caries and unemployment among U.S. adults who have engaged in illicit drug use, such as cocaine, heroin, and methamphetamine. Methods: The National Health and Nutrition Examination Survey (2015–2018) data were analyzed. The independent variable was severe dental caries (defined as DMFT > 13.99), and the dependent variable was employment status. The sample was categorized into non-users, current users (used in the past year), and former users (used prior to the past year). Covariates included age, education, race, gender, smoking status, family income-to-federal poverty level ratio, and health insurance status. Logistic regression with survey weights was applied to assess associations between severe dental caries and employment status. Results: The total sample (n = 5476) represented 131,848,604 U.S. adults aged 18–59 years, with 4% current users and 12% former users of the specified drugs. Among current users, those with severe caries had higher odds of unemployment (OR = 2.6, p = 0.025) compared to those without severe caries. No significant association was found between severe caries and employment status among former users after controlling for covariates. Conclusions: The study underscores a significant association between severe dental caries and unemployment among U.S. adults who have used illicit drugs in the past year. These findings suggest a potential need for targeted oral health interventions in this population to improve economic well-being. Future research should focus on longitudinal studies to establish causality and explore mechanisms through which dental health may impact employment prospects. Full article

We examine access to U.S. welfare programs—Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP)—as primary prevention strategies against adverse childhood experiences (ACEs). Using the University of Kentucky’s National Welfare Data and National Survey of Children’s Health (2016–2022), we estimate two-way fixed effects models linking state-level access rates to child-level ACE incidence. TANF access predicts reduced parental mental illness (fully adjusted β = −5.40, 95% CI: −8.80, −2.00), and parental incarceration in the model adjusted for state-level factors (β = −4.44, 95% CI: −8.84, −0.05), though the latter attenuates with child-level covariate adjustment. Unexpectedly, SNAP access correlates with slight increases in neighborhood violence exposure (fully adjusted β = 0.95, 95% CI: 0.39, 1.51) and parental substance use (crude β = 0.48, 95% CI: 0.04, 0.93) in crude models. Robustness checks show greater TANF access is associated with fewer total ACEs (β = −0.27, 95% CI: −0.46, −0.07). Results suggest that welfare programs hinge on broader social contexts; TANF access appears protective, while SNAP findings diverge from prior research, likely reflecting measurement or contextual limitations that merit careful further investigation, rather than overinterpretations of program harm. Full article

Phase angle (PhA) is a widely used bioimpedance index associated with cell mass, membrane integrity, skeletal muscle mass and quality, and body fluid distribution. This study aims to investigate the relationship between PhA and body fat, which is poorly defined in the current literature. The analysis involved 1533 adults of both sexes from the National Health and Nutrition Examination Survey. Anthropometry, bioimpedance analysis, and dual-energy X-ray absorptiometry were used to estimate body mass index (BMI), PhA (at 50 kHz), and body fat, respectively. Non-linear cubic spline regression models were applied to examine the associations between PhA and fat mass (FM), BMI, fat mass index (FMI), and FM%. The relationship between PhA and body fat was non-linear. An initial positive slope was observed with FM, FMI and BMI, followed by a decline, whereas FM% exhibited a flatter initial pattern before decreasing. Men showed more pronounced flection points, at lower fat levels (FM: 23 kg; FMI: 9 kg/m²; BMI: 37 kg/m²; FM%: 25.5%) than women (FM: 34 kg; FMI: 16 kg/m²; BMI: 32 kg/m²; FM%: 42.5%). Although most associations were significant, the explained variance of the relationships was lower than 10%. In conclusion, this study demonstrates a weak and non-linear relationship between PhA and body fat. This suggests that PhA variability is predominantly influenced by factors other than fat, a point that warrants consideration in both clinical and routine practice. Full article

Background/Objectives: Major depressive disorder (MDD) and metabolic syndrome (MetS) are highly prevalent, bidirectionally linked conditions. Individuals with MetS are at increased risk of developing depression, while depression predisposes to metabolic dysfunction. Evidence suggests that comorbid MDD and MetS present a distinct psychopathological profile, with neurovegetative symptoms such as fatigue, sleep disturbances, and appetite dysregulation being more prominent. This study aimed to determine whether depressive symptom structures differ between MDD patients with and without MetS, applying Bayesian network methods to uncover probabilistic dependencies that may inform precision psychiatry. Methods: Data were drawn from 1779 adults with ICD-10-diagnosed MDD in the 2013–2020 National Health and Nutrition Examination Survey (NHANES). Using standard metabolic criteria, participants were categorized as MetS (n = 315) or non-MetS (n = 1464). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9). Directed Acyclic Graphs (DAGs) were estimated via a hill-climbing algorithm with 5000 bootstrap replications to ensure network stability. Results: MetS patients displayed a denser and more interconnected symptom network. Fatigue (PHQ4) emerged as a central hub linking sleep, appetite, cognition, and functional impairment. In contrast, non-MetS patients showed a more fragmented network dominated by affective symptoms (low mood, anhedonia) and negative self-cognitions. Conclusions: Depressive symptoms propagate differently depending on metabolic status. These results highlight the value of personalized medicine approaches, advocating for treatment strategies that address neurovegetative dysfunctions in MDD with MetS and affective-cognitive symptoms in non-MetS. Aligning interventions with individual symptom architectures and metabolic profiles may enhance therapeutic precision and improve clinical outcomes. Full article

Background: Vitamin B12 deficiency, hyperhomocysteinemia, and diabetes are emerging determinants of cardiovascular risk, particularly among women. Early detection and treatment represent an important public health opportunity to reduce the burden of disease and promote health equity. Objective: We aimed to quantify the prevalence of vitamin B12 deficiency, hyperhomocysteinemia, and diabetes, and to evaluate the potential impact of detecting and addressing these conditions on reducing CVD risk in adult Mexican women. Methods: We analyzed data from 1197 women aged 20–49 years from Mexico’s 2022–2023 National Health and Nutrition Survey (ENSANUT). Serum vitamin B12, folate, and homocysteine were quantified, and 10-year CVD risk was estimated using Framingham and Globorisk models. Population-attributable fractions and cost–benefit analyses were used to assess preventable CVD cases and the economic feasibility of nationwide vitamin B12 supplementation. Results: Nationwide, 37.2% of women have vitamin B12 deficiency, and 30.6% have borderline levels. In Southern Mexico, the prevalence of vitamin B12 deficiency is higher, reaching 52.4%. Elevated homocysteine levels were detected in 12.3% of women. The predicted number of preventable CVD cases ranged from 10,000 to 14,000, and the benefit–cost ratio exceeded 1, supporting economic feasibility. Conclusions: Vitamin B12 deficiency and hyperhomocysteinemia are very common among Mexican women and are associated with an increased cardiovascular risk, especially in those aged 40 to 49. The analysis showed that implementing a national vitamin B12 supplementation strategy could be a cost-effective preventive measure, with a benefit–cost ratio ranging from 1.93 in the base case to 2.98 when broader societal savings are taken into account. These findings highlight the potential of targeted nutritional interventions to reduce the burden of cardiovascular disease in women. Full article

Background/Objectives: Cardiometabolic risk clustering (CMRC), the coexistence of multiple risk factors, markedly increases the risk of cardiovascular disease and diabetes. While obesity is central, the independent roles of vitamin D status and systemic inflammation remain unclear. This study examined determinants of CMRC in middle-aged Korean adults, focusing on vitamin D and C-reactive protein (CRP). Methods: Cross-sectional data were analyzed from 2062 adults aged 40–64 years in the 2023 Korea National Health and Nutrition Examination Survey. CMRC was defined as ≥3 of abdominal obesity, hypertension, diabetes, hypertriglyceridemia, and low high-density lipoprotein cholesterol. Serum 25-hydroxyvitamin D [25(OH)D], CRP, lifestyle behaviors, and covariates were assessed. Complex-sample logistic regression identified factors associated with CMRC. Results: CMRC prevalence was 16.5%. Older age (OR = 1.04, 95% CI: 1.02–1.06), current smoking (OR = 1.76, 95% CI: 1.26–2.45), elevated CRP (1–3 mg/L: OR = 1.40, 95% CI: 1.04–1.87; ≥3 mg/L: OR = 1.63, 95% CI: 1.00–2.66), and obesity (OR = 8.29, 95% CI: 6.12–11.21) increased CMRC risk. Protective factors included male sex (OR = 0.60, 95% CI: 0.45–0.81), sufficient vitamin D (≥20 ng/mL: OR = 0.76, 95% CI: 0.58–0.99), and meeting World Health Organization physical activity guidelines (OR = 0.71, 95% CI: 0.55–0.92). Conclusions: These survey-weighted associations may help identify at-risk mid-life adults at the population level and motivate longitudinal evaluation of vitamin D deficiency and inflammation in risk assessment and targeted prevention. Full article