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doi: 10.3967/bes2026.016
Objective To examine the associations of sleep duration and physical activity (PA) with central obesity among Chinese adults. Methods Based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project, 175,373 observations from 106,518 participants were included. Generalized estimating equations quantified the associations of sleep duration and PA with waist circumference (WC) and central obesity. Stratified and joint analyses were performed to evaluate combined effects, and an isotemporal substitution model was used to assess substitution effects. Results Suboptimal sleep duration (< 7 h/day or ≥ 9 h/day) and inadequate PA were associated with higher WC and an increased risk of central obesity. Compared with optimal sleep duration (7 – < 9 h/day), both longer (≥ 9 h/day) and shorter (< 7 h/day) sleep durations were associated with increased WC (0.27 cm [95% confidence interval (CI): 0.18, 0.35] and 0.15 cm [95% CI: 0.04, 0.27], respectively) and a higher risk of central obesity (odds ratio, 1.09 [95% CI: 1.07, 1.12] and 1.05 [95% CI: 1.02, 1.08], respectively). Joint analyses revealed that individuals with inadequate PA and short sleep duration had the highest WC and highest risk of central obesity. Among individuals sleeping > 8 h/day, substituting 30 min/day of sleep with moderate-to-vigorous PA significantly reduced the risk of central obesity. Conclusion Suboptimal sleep duration has a detrimental effect on central obesity, and adequate PA can mitigate this effect. The impact of reallocating sleep duration varies by sleep duration, highlighting the need to optimize both PA and sleep patterns in China.
Objective To investigate the joint effect of free fatty acid (FFA) and the triglyceride-glucose (TyG) index on the prognosis of overweight and obese coronary artery disease (CAD) patients. Methods A total of 5,887 patients were enrolled in this study. Restricted cubic spline analyses were used to assess the dose-response relationship of FFA and TyG with major adverse cardiovascular and cerebrovascular events (MACCE). Mediation analysis was used to examine whether TyG mediated the association between FFA and MACCE. Kaplan-Meier survival curves were used to compare the cumulative incidence of events. Multivariable Cox models were used to explore the independent association between Low-/High-FFA and Low-/High-TyG on outcomes. Results FFA and TyG were independent predictors of MACCE. TyG mediated 10.7% of the association between FFA and MACCE. Patients with high FFA and TyG levels exhibited a markedly higher MACCE risk (adjusted hazard ratio: 1.951, 95% confidence interval: 1.533–2.484; P < 0.001), with a significant interaction between FFA and TyG. Among patients with elevated FFA levels, MACCE increased progressively across higher TyG tertiles (P for trend = 0.001). Conclusions FFA and the TyG index independently predict adverse outcomes in overweight or obese CAD patients, with the TyG index mediating the relationship between FFA and MACCE. Their combined assessment enhances the risk stratification in this population.
Objective Dyslipidemia has been linked to increased arterial stiffness. However, few studies have comprehensively assessed the cumulative effects of lipid profiles on arterial stiffness. Methods Based on the initial recruitment of 7,134 participants from the China-PAR cohort, we finally included 6,717 participants with up to four repeated lipid measurements between baseline (1998–2008) and the most recent follow-up (2018–2020). Cumulative exposure to total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and remnant cholesterol (RC) was estimated using the area under the curve method. Arterial stiffness was measured in 2018–2020 using the arterial pressure-volume index (API) and the arterial velocity-pulse index (AVI), which reflect the stiffness of peripheral and central arteries, respectively. Results Participants (mean age: 51.4 ± 10.3 years) included 2,598 men (38.68%), with a mean cumulative lipid exposure duration of 14.02 years. Cumulative TG, HDL-C, and RC were significantly associated with API levels, with adjusted βs (95% confidence intervals [CIs]) of 2.31 (1.53, 3.08), −1.14 (−2.24, −0.04), and 2.39 (1.52, 3.25), respectively, for the highest quartile compared with the lowest quartile. Restricted cubic splines showed nonlinear associations of cumulative TG and RC with API and a linear association for HDL-C (all P < 0.05). For AVI, only cumulative HDL-C showed a significant inverse association, with an adjusted β (95% CI) of −1.16 (−2.12, −0.21) for the highest quartile, and a nonlinear association was observed (P < 0.05). Conclusion Long-term cumulative TG and RC were associated with increased peripheral arterial stiffness but not central arterial stiffness, and cumulative HDL-C was negatively associated with both peripheral and central arterial stiffness. These findings underscore the importance of long-term TG and RC control along with maintaining adequate HDL-C levels.
Objective The cardiovascular impact of earthquakes remains poorly understood, particularly regarding subclinical vascular diseases in women. This study examined the association between seismic exposure and the progression of carotid atherosclerosis in northern Chinese adults. Methods A totally of 7,412 individuals were enrolled, including survivors of the 1976 Tangshan earthquake (magnitude 7.8) and unexposed controls. Carotid atherosclerosis was assessed using bilateral ultrasonography. Multivariate logistic regression accounted for sociodemographic, clinical, and lifestyle covariates. Results Among females, earthquake exposure was associated with significantly higher atherosclerosis prevalence (44.9% vs. 33.1% in males), with elevated adjusted odds (OR = 2.32, 95% CI: 1.78–3.02, P < 0.001). No significant association was observed in males after full adjustment. In women, CVD risk increased twofold (95% CI: 1.66–2.55, P < 0.001), with gradients by age (≥ 65 years: HR = 3.98, P < 0.001), education (elementary: HR = 4.00, P < 0.001), and income (low-income: HR = 2.74, P < 0.001). Proximity to the epicenter further amplified the CVD risk (log-rank P < 0.0001). Conclusion Seismic exposure independently predicts accelerated carotid atherosclerosis and cardiovascular risk in women, underscoring the need to elucidate sex-specific mechanisms and develop targeted interventions for post-disaster populations.
Objective This study aimed to investigate the role of circulating inflammatory cytokines in the pathway linking cerebral small vessel disease (CSVD) to cognitive impairment (CI), and to further elucidate the neuroimaging mechanism of CSVD-driven inflammatory cytokines on cognitive function. Methods We conducted a two-step, two-sample Mendelian randomization (MR) analysis to evaluate the causal effect of CSVD on circulating inflammatory cytokines and CSVD-driven inflammatory cytokines on the risk of CI. Using a separate two-sample MR analysis, we explored the potential mechanisms by which these inflammatory cytokines affect cognition, with cytokines identified as mediators between CSVD and CI treated as exposure and brain structural imaging as outcomes. Results Genetically predicted CSVD was causally associated with the levels of 11 circulating inflammatory cytokines. Among these CSVD-driven inflammatory cytokines, growth-regulated oncogene alpha (GROα) was associated with poorer verbal and numerical reasoning, stem cell factor (SCF) was associated with better working memory, and tumor necrosis factor-alpha (TNF-α) was associated with reduced processing speed. SCF mediated the association between small-vessel ischemic stroke and numeric memory performance, with a mediation effect of 10%. Furthermore, circulating SCF levels showed causal relationships with the volumes of multiple brain regions within the default mode network and with the integrity of seven white matter tracts. Conclusion SCF, GROα, and TNF-α play important roles in the pathway linking CSVD to CI. Circulating SCF may influence cognitive function by modulating brain volume and white matter integrity.
Objective This study aimed to investigate the association between exposure to mixtures of environmental endocrine-disrupting chemicals (EDCs) and metabolic dysfunction-associated steatotic liver disease (MASLD) and to assess the potential mediating role of iron metabolism. Methods A total of 6,989 adults from the China Health and Nutrition Survey (2015 cycle) were included. The serum concentrations of 22 EDCs were measured. Logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models were used to evaluate the association between EDC exposure and risk of MASLD. Mediation analyses were performed to assess the mediating role of serum ferritin (SF). Results Eight EDCs were positively associated with MASLD. The WQS regression model identified six major contributors, including β-hexachlorocyclohexane, p,p’-DDT, monoethyl phthalate, acenaphthene, perfluorooctanoic acid, and perfluoro-n-pentanoic acid, in mixture effects. The BKMR model demonstrated that higher levels of EDC mixture were associated with an increased risk of MASLD. Subgroup analyses suggested stronger correlations in males and in individuals aged < 65 years. SF was estimated to mediate 11.2%–32.1% of the association between key EDCs and MASLD. Conclusion Exposure to EDC mixtures was associated with an increased risk of MASLD, with iron metabolism playing a notable mediating role. Reducing the exposure to key EDCs may help alleviate the burden of MASLD.
Objective To investigate the association between urinary cobalt levels and all-cause and cause-specific mortality in older Chinese adults. Methods This study enrolled older adults (≥ 60 years) from two cohorts. Urinary cobalt concentrations were quantified using inductively coupled plasma mass spectrometry. Mortality outcomes were ascertained by linking them to the Chinese Disease Surveillance Point System. Cox proportional hazards models were used to evaluate the association between urinary cobalt and mortality, and subgroup analyses were performed to identify vulnerable populations. Results A total of 9,727 participants were followed for an average of 4.754 years, during which 2,745 deaths were recorded. Participants with the highest urinary cobalt concentration had a 29% greater all-cause mortality risk (HR: 1.292, 95% CI: 1.155–1.445) than those in the lowest quartile, along with significantly elevated mortality from cardiovascular (24.8%), neurological (137.1%). Subgroup analyses revealed that female, Han Chinese individuals, and rural residents were more susceptible to the effects of cobalt. Conclusion Cobalt exposure was associated with elevated all-cause, cardiovascular, and neurological mortality in older adults, with female, Han ethnicity, and rural residents being vulnerable groups. These findings provide population-based evidence for clinical management and policy revisions regarding cobalt exposure.
With the rapid aging of China’s population, the number of adults aged ≥ 80 years is rising, and their nutritional status and weight management have attracted growing attention. Body mass index (BMI) is a commonly used indicator for assessing body weight and nutritional status. However, existing BMI standards were mainly developed for the general adult population, and their applicability to the oldest old population remains uncertain. To provide guidance for BMI evaluation and weight management among the oldest old population in China, the National Health Commission issued the standard “Appropriate body mass index range and weight management standards for the oldest old (WS/T 868-2025)”. Based on evidence from prospective cohort studies including the Chinese Longitudinal Healthy Longevity Survey and the Healthy Aging and Biomarkers Cohort Study, the standard recommends an appropriate BMI range of 22.0–26.9 kg/m2 for adults aged ≥ 80 years and provides recommendations regarding BMI measurement, weight monitoring, and individualized weight management. The implementation of this standard provides scientific evidence for weight evaluation and health management in the oldest old population and contributes to promoting healthy aging.
This population-based cross-sectional study aimed to examine the associations of unhealthy diet and insufficient physical activity (PA) with anxiety and depressive symptoms among Chinese adults aged 18–60 years. Data were derived from the 2022–2023 Psychology and Behavior Investigation of Chinese Residents (PBICR) Project, a large cross-sectional survey conducted in China. After exclusions, 14,358 adults were included in this study. Dietary risk factors were summed into a 0–5 score. PA was measured by the International Physical Activity Questionnaire (IPAQ-7, short form). Anxiety and depressive symptoms were defined as the Generalized Anxiety Disorder Scale (GAD-7) ≥ 10 and Patient Health Questionnaire-9 (PHQ-9) ≥ 10, respectively. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using ordered logistic regression; dose-response was examined with restricted cubic splines. Overall, 1,879 participants (13.09%) self-reported anxiety and 3,084 (21.48%) self-reported depressive symptoms. A monotonic dose-response relationship was observed between the number of unhealthy dietary behaviors and both outcomes. Compared with participants reporting no unhealthy dietary behaviors, those reporting 1, 2, 3, 4, and 5 behaviors had progressively higher odds of anxiety (aOR = 1.47, 2.03, 2.75, 4.59, and 8.37) and depression (aOR = 1.53, 2.14, 2.84, 5.59, and 16.46). Physical activity level was not significantly associated with either anxiety or depressive symptoms after adjustment for covariates. The strong relationship between cumulative unhealthy dietary behaviors and mental health symptoms highlights the potential importance of dietary interventions for preventing anxiety and depression.
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