Do patient characteristics,disease, or treatment explain social inequality in survival from colorectal cancer?

This paper investigates the association between individually measured socioeconomic status (SES) and all-cause survival in colorectal cancer patients, and explores whether factors related to the patient, the disease, or the surgical treatment mediate the observed social gradient.     

基于十年随访的心血管代谢性危险因素聚集与社区≥55岁人群全因死亡风险关系的队列研究

背景 心血管代谢性危险因素聚集（CRFC）是老年人常见的健康问题,目前相关研究主要集中在流行病学分布特征的描述,有关CRFC与人群全因死亡风险的研究鲜有报道。目的 探讨CRFC与社区≥55岁人群全因死亡风险的关系,为开展≥55岁人群社区保健提供参考。方法 于2011年9—11月采用典型抽样法选取宁夏回族自治区吴忠市和银川市5个社区的1 046名≥55岁人群作为研究对象,对其开展一般情况问卷调查、体格检查、超声检查、实验室检查和CRFC评价[纳入中心性肥胖、高胆固醇血症、高三酰甘油血症、高低密度脂蛋白血症、低高密度脂蛋白血症、高血压、糖尿病、高尿酸血症、非酒精性脂肪性肝病（NAFLD）共计9项心血管代谢性危险因素后,控制一般情况变量,通过构建多因素Cox比例风险回归模型,估计各个心血管代谢性危险因素的回归系数β,以回归系数β为权重将所有心血管代谢性危险因素的评分相加得出心血管代谢危险因素危险总评分],将心血管代谢危险因素危险总评分按照四分位数分为三组：P75组;分别于2017年,2019年和2021年通过面访和死因监测系统搜索的方式完成随访。采...     

山西营养与慢性病家庭队列人群体质指数与死亡率的关系

目的 分析山西营养与慢性病家庭队列人群BMI与总死亡率的关系。方法 以"2002年中国居民营养与健康状况调查"山西省调查人群为基线建立队列，于2015年12月至2016年3月对研究对象进行随访调查，对逝者进行死因回顾调查。2002年基线信息完整的≥ 18岁研究对象7 007人，随访到5 360人，随访率为76.5%。将研究对象按BMI分为8组，计算死亡率，以死亡率最低组作为参照，采用Cox比例风险回归模型估计全人群、分性别、年龄（≥ 60岁、<60岁）的各组死亡风险比（HR）及95% CI，模型调整基线年龄、性别、吸烟、饮酒、文化程度等因素，并进行敏感性分析。结果 共随访67 129人年，平均随访12.5年，死亡615人，队列总死亡率为916/10万人年。BMI为26.0~27.9 kg/m²组死亡率最低，以该组为参照组，多因素调整后，BMI<18.5、18.5~19.9、22.0~23.9和≥ 30.0 kg/m²组的死亡风险明显升高，调整HR值（95% CI）分别为1.90（1.26~2.86）、1.68（1.15~2.45）、1.49（1.08~2.06）和1.72（1.07~2.76）。对于≥ 60岁老年人，BMI<18.5 kg/m²组的死亡风险明显升高，调整HR值（95% CI）为1.94（1.20~3.15）。结论 BMI ≤ 19.9、22.0~23.9及≥ 30.0 kg/m²均会增加全因死亡风险。除关注肥胖外，低体重营养不良造成的老年人高死亡风险应特别引起重视。     

Moderate alcohol consumption and lower total mortality risk: Justified doubts or established facts?

For almost a century, the scientific community is aware of the J-shaped curve between alcohol consumption and all-cause mortality. Moderate drinkers seem to live longer than both abstainers and heavy drinkers. These epidemiological observations regarding moderate alcohol consumption and beneficial health effects have been incessantly scrutinised for confounding and bias. This viewpoint discusses previous and recent criticisms regarding the J-shaped curve between alcohol consumption and total mortality risk. The controversies regarding the J-shaped curve between alcohol consumption and mortality are ongoing, as well as the debate among scientists in this area of research, resulting in conflicting messages in media and in different alcohol guidelines. Although it appears quite difficult to come up with a position statement only based on the currently available scientific data, it is imperative to fairly inform the public, without creating confusion and, worst case, disbelief in science.     

Fitness vs. Fatness on All-Cause Mortality: A Meta-Analysis

The purpose of this study was to quantify the joint association of cardiorespiratory fitness (CRF) and weight status on mortality from all causes using meta-analytical methodology. Studies were included if they were (1) prospective, (2) objectively measured CRF and body mass index (BMI), and (3) jointly assessed CRF and BMI with all-cause mortality. Ten articles were included in the final analysis. Pooled hazard ratios were assessed for each comparison group (i.e. normal weight-unfit, overweight-unfit and -fit, and obese-unfit and -fit) using a random-effects model. Compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. Overweight and obese-fit individuals had similar mortality risks as normal weight-fit individuals. Furthermore, the obesity paradox may not influence fit individuals. Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.     

Association Between Serum Albumin Level and All-Cause Mortality in Patients With Chronic Kidney Disease: A Retrospective Cohort Study

BackgroundThe association between serum albumin and all-cause mortality (ACM) in patients with chronic kidney disease (CKD) is presently unclear.MethodsThe study subjects included 201 patients diagnosed with CKD, eliminating those with end-stage renal disease, who were admitted to our hospital from January 2014 to January 2015. The patients were divided into 4 groups according to serum albumin level (Q1: 1.60–3.88 g/dL; Q2: 3.89–4.13 g/dL; Q3: 4.14–4.43 g/dL, and Q4: 4.44–5.51 g/dL). The clinical outcome was ACM, and the difference was compared using odds ratio (OR) and 95% confidence interval (CI).ResultsAfter a median follow-up of 1480 days, 32 patients died (15.92%). The ACM was found to be 28.00%, 20.00%, 8.00%, and 7.84% in the 4 groups (P = 0.012). Pearson correlation analysis revealed a positive association between the serum albumin level and glomerular filtration rate (GFR) (r = 0.22, P = 0.001). Once the potential confounding factors were adjusted, the results indicated that decreased serum albumin was a risk factor for ACM (Q2 vs Q1: OR = 0.50, 95% CI: 0.17–1.47; Q3 vs Q1: OR = 0.12, 95% CI: 0.03–0.48; Q4 vs Q1: OR = 0.26, 95% CI: 0.07–0.98). The receiver operating characteristic curve indicated that the optimum threshold of serum albumin to predict ACM was 4 g/dL, and the area under the curve was 0.69 (95% CI: 0.60–0.79).ConclusionsDecreased serum albumin is a risk factor for ACM in patients with CKD, with the optimal threshold being 4 g/dL.     

Association of weight-adjusted-waist index with all-cause and cardiovascular mortality in China: A prospective cohort study

Background and aimsAs a new simple anthropometric index, the weight-adjusted-waist index (WWI) appears to be superior to body mass index (BMI) and waist circumference (WC) in assessing both muscle and fat mass. We aimed to explore the association of WWI with all-cause and cardiovascular mortality in southern China.Methods and resultsA total of 12,447 participants (mean age, 59.0 ± 13.3 years; 40.6% men) in Jiangxi Province from the China Hypertension Survey study were included. WWI was defined as WC divided by the square root of weight. The outcome was all-cause and cardiovascular mortality. During a median follow-up of 5.6 years, 838 all-cause deaths occurred, with 390 cardiovascular deaths. Overall, there was a nonlinear positive relationship of WWI with all-cause and cardiovascular mortality. Accordingly, compared with participants in quartiles 1–3 (<11.2 cm/√kg), a significant higher risk of all-cause mortality (HR: 1.36, 95% CI: 1.17, 1.58) and cardiovascular mortality (HR: 1.43, 95% CI: 1.15, 1.77) were found in quartile 4 (≥11.2 cm/√kg). Further adjustment for BMI and WC did not substantially alter the results. No significant interactions were found in any of the subgroups (sex, age, area, physical activity, current smoking, current alcohol drinking, hypertension, and stroke).ConclusionHigher WWI levels (≥11.2 cm/√kg) were associated with increased the risk of all-cause and cardiovascular mortality in southern China. These findings, if confirmed by further studies, suggested that WWI may serve as a simple and effective anthropometric index in clinical practice.     

High leptin status indicates an increased risk of mortality and heart failure in stable coronary artery disease

Background and aimsLeptin is an adipocyte-derived peptide involved in energy homeostasis and body weight regulation. The position of leptin in cardiovascular pathophysiology remains controversial. Some studies suggest a detrimental effect of hyperleptinemia on the cardiovascular (CV) system, while others assume the role of leptin as a neutral or even protective factor. We have explored whether high leptin affects the mortality and morbidity risk in patients with stable coronary heart disease.Methods and resultsWe followed 975 patients ≥6 months after myocardial infarction or coronary revascularization in a prospective study. All-cause or cardiovascular death, non-fatal cardiovascular events (recurrent myocardial infarction, stroke, or any revascularization), and hospitalizations for heart failure (HF) we used as outcomes.High serum leptin concentrations (≥18.9 ng/mL, i.e., 4th quartile) were associated with worse survival, as well as with a higher incidence of fatal vascular events or hospitalizations for HF. Even after full adjustment for potential covariates, high leptin remained to be associated with a significantly increased 5-years risk of all-cause death [Hazard risk ratio (HRR) 2.10 (95%CIs:1.29–3.42), p < 0.003], CV death [HRR 2.65 (95%CIs:1.48–4.74), p < 0.001], and HF hospitalization [HRR 1.95 (95% CIs:1.11–3.44), p < 0.020]. In contrast, the incidence risk of non-fatal CV events was only marginally and non-significantly influenced [HRR 1.27 (95%CIs:0.76–2.13), p = 0.359].ConclusionsHigh leptin concentration entails an increased risk of mortality, apparently driven by fatal CV events and future worsening of HF, on top of conventional CV risk factors and the baseline status of left ventricular function.