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Original Article
The Impacts of Major Chronic Diseases on Changes in Healthy Life Expectancy Among Older Adults in China from 2011 to 2020
Xiang Cui, Fangchao Liu, Shenying Fang, Zixing Zhang, Jianli Wang, Jian Liao, Dongfeng Gu
, Available online  , doi: 10.3967/bes2025.064
  Objectives  This study aimed to quantify the impact of major chronic diseases on changes in healthy life expectancy (HLE) from 2011 to 2020 in China using an age-specific disability weights (DW) estimation method.  Methods  HLE at age 60 (HLE60) was used as the indicator of HLE in China. Cause-specific mortality rates were obtained from the cause-of-death database of the National Health Commission. Self-reported disease and disability status were derived from the China Health and Retirement Longitudinal Study. A total of 55,861 participants were included for DW estimation. Rates of disability, which was assessed using the Activities of Daily Living questionnaires, were estimated using data from 5,465 participants in 2011 and 9,910 participants in 2020. Age-specific DWs were calculated using a Bayesian logistic regression model. Changes in HLE60 were decomposed into mortality and disability effects by cause, based on the estimated DWs.  Results  HLE60 in China increased by 0.83 years from 2011 to 2020. Ischemic heart disease (IHD) contributed the most to the decline in HLE60, remaining the leading cause of reduction in terms of mortality effects. Diabetes showed the greatest impact on HLE60 due to disability, followed by stroke. The largest sex disparities in HLE60 were associated with disability from arthritis.  Conclusion  HLE60 in China improved from 2011 to 2020 and IHD remained the leading contributor to its decline, particularly through increased mortality. Disabilities related to diabetes, stroke, and arthritis had significant negative impacts. These findings highlight the need to strengthen integrated chronic disease prevention and rehabilitation services at community health centers.
Chromosome 8 open reading frame 76 (C8orf76) co-expressed with cyclin-dependent kinase 4 (CDK4) as a prognostic indicator of colorectal cancer
Shang Guo, Chengcheng Liu, Zifeng Zhao, Zhongxin Li, Xia Jiang, Zengren Zhao
, Available online  , doi: 10.3967/bes2024.177
  Objective  To explore the correlation between chromosome 8 open reading frame 76 (C8orf76) and cyclin-dependent kinase 4 (CDK4) and the potential predictive effect of C8orf76 and CDK4 on the prognosis of colorectal cancer (CRC).  Methods  We constructed a protein-protein interaction network of C8orf76-related genes and analyzed the prognostic signatures of C8orf76 and CDK4. Clinicopathological features of C8orf76 and CDK4 were visualized using a nomogram.  Results  C8orf76 and CDK4 levels were positively correlated in two independent human CRC cohorts (n = 83 and n = 597). A consistent positive correlation was observed between C8orf76 and CDK4 expression in the CRC cell lines. The nomogram included prognostic genes (C8orf76 and CDK4) and pathological N and M stages. The concordance index (C-index) in our cohort was 0.776, which suggests that the ability of the indicators to predict the overall survival of patients with CRC in our cohort was strong.  Conclusions  We found that C8orf76 was positively correlated with CDK4 in both the cohorts as well as in CRC cell lines. Therefore, C8orf76 and CDK4 can be used as potential biomarkers to predict the prognosis of CRC.
The Association between Serum Chloride Levels and Prognosis in Patients with Hepatic Coma in the Intensive Care Unit.
Shuxing Wei, Xiya Wang, Yuan Du, Ying Chen, Jinlong Wang, Yue Hu, Wenqing Ji, Xingyan Zhu, Xue Mei, Da Zhang
, Available online  , doi: 10.3967/bes2025.092
  Objective  To explore the relationship between serum chloride levels and prognosis in intensive care unit (ICU) patients with hepatic coma.  Methods  We analyzed 545 ICU patients with hepatic coma from the MIMIC-IV database. Associations between serum chloride levels and 28-day and 1-year mortality were assessed using restricted cubic splines (RCS), Kaplan-Meier (KM) curves, and Cox regression. Subgroup analyses, external validation, and mechanistic studies were also conducted.  Results  A total of 545 patients were included. RCS analysis revealed a U-shaped association between serum chloride levels and mortality in hepatic coma patients. KM curves indicated lower survival rates among patients with low chloride levels (<103 mmol/L). Low chloride levels were independently linked to increased 28-day and 1-year all-cause mortality. In multivariate models, the hazard ratio (HR) for 28-day mortality in the low chloride group was 1.424 (95% CI: 1.041-1.949), while the adjusted HR for 1-year mortality was 1.313 (95% CI: 1.026-1.679). Subgroup analyses and External validation supported these findings. Cytological experiments suggest that low chloride may activate the phosphorylation of the NF-κB signaling pathway, promote the expression of pro-inflammatory cytokines, and reduce neuronal cell viability.  Conclusions  Low serum chloride is independently associated with increased mortality in hepatic coma patients.
Plasma Metabolites Mediate the Associations of Gut Microbial Diversity with Ambulatory Blood Pressure and its Variability
Zhenghao Tang, Zhennan Lin, Jianxin Li, Fangchao Liu, Jie Cao, Shufeng Chen, Keyong Huang, Hongfan Li, Dongsheng Hu, Jianfeng Huang, Dongfeng Gu, Xiangfeng Lu
, Available online  , doi: 10.3967/bes2025.089
  Objective  Evidence suggests that depleted gut microbial α-diversity is associated with hypertension; however, whether metabolic markers affect this relationship remains unknown. We aimed to determine the potential metabolites mediating the associations of α-diversity with blood pressure (BP) and BP variability (BPV).  Methods  Metagenomics and plasma targeted metabolomics were conducted on 523 Chinese participants from the MetaSalt study. The 24-hour, daytime, and nighttime BP and BPV were calculated based on ambulatory BP measurements. Linear mixed models were used to characterize the relationships between α-diversity (Shannon and Chao1 index) and BP indices. Mediation analyses were performed to assess the contribution of metabolites to the observed associations. The influence of key metabolites on hypertension was further evaluated in a prospective cohort of 2,169 participants.  Results  Gut microbial richness (Chao1) was negatively associated with 24-hour systolic BP, daytime systolic BP, daytime diastolic BP, 24-hour systolic BPV, and nighttime systolic BPV (P < 0.05). Moreover, 26 metabolites were strongly associated with richness (Bonferroni P < 0.05). Among them, four key metabolites (imidazole propionate, 2-hydroxy-3-methylbutyric acid, homovanillic acid, and hydrocinnamic acid) mediated the associations between richness and BP indices (proportions of mediating effects: 14.1–67.4%). These key metabolites were also associated with hypertension in the prospective cohort. For example, each 1-standard deviation unit increase in hydrocinnamic acid significantly reduced the risk of prevalent (OR [95% CI] = 0.90 [0.82, 0.99]; P = 0.03) and incident hypertension (HR [95% CI] = 0.83 [0.71, 0.96]; P = 0.01).  Conclusion  Our results suggest that gut microbial richness correlates with lower BP and BPV, and that certain metabolites mediate these associations. These findings provide novel insights into the pathogenesis and prevention of hypertension.
Associations of Exposure to Typical Environmental Organic Pollutants with Cardiopulmonary Health and the Mediating Role of Oxidative Stress: A Randomized Crossover Study
Ning Gao, Bin Wang, Ran Zhao, Han Zhang, Xiaoqian Jia, Tianxiang Wu, Mengyuan Ren, Lu Zhao, Jiazhang Shi, Jing Huang, Shaowei Wu, Guofeng Shen, Bo Pan, Mingliang Fang
, Available online  , doi: 10.3967/bes2025.087
  Objective  The study aim was to investigate the effects of exposure to multiple environmental organic pollutants on cardiopulmonary health with a focus on the potential mediating role of oxidative stress.  Methods  A repeated-measures randomized crossover study involving healthy college students in Beijing was conducted. Biological samples, including morning urine and venous blood, were collected to measure concentrations of 29 typical organic pollutants, including hydroxy polycyclic aromatic hydrocarbons (OH-PAHs), bisphenol A and its substitutes, phthalates and their metabolites, parabens, and five biomarkers of oxidative stress. Health assessments included blood pressure measurements and lung function indicators.  Results  Urinary concentrations of 2-hydroxyphenanthrene (2-OH-PHE) (β = 4.35% (95% confidence interval (CI): 0.85%, 7.97%)), 3-hydroxyphenanthrene (β = 3.44% (95% CI: 0.19%, 6.79%)), and 4-hydroxyphenanthrene (4-OH-PHE) (β = 5.78% (95% CI: 1.27%, 10.5%)) were significantly and positively associated with systolic blood pressure. Exposures to 1-hydroxypyrene (1-OH-PYR) (β = 3.05% (95% CI: −4.66%, −1.41%)), 2-OH-PHE (β = 2.68% (95% CI: −4%, −1.34%)), and 4-OH-PHE (β = 3% (95% CI: −4.68%, −1.29%)) were negatively associated with the ratio of forced expiratory volume in the first second to forced vital capacity. These findings highlight the adverse effects of exposure to multiple pollutants on cardiopulmonary health. Biomarkers of oxidative stress, including 8-hydroxy-2'-deoxyguanosine and extracellular superoxide dismutase, mediated the effects of multiple OH-PAHs on blood pressure and lung function.  Conclusion  Exposure to multiple organic pollutants can adversely affect cardiopulmonary health. Oxidative stress is a key mediator of the effects of OH-PAHs on blood pressure and lung function.
Relationship between Coarse Cereal Consumption and Body Fat Percentage among Chinese School-aged Children
Tingting Gao, Wei Cao, Titi Yang, Peipei Xu, Juan Xu, Qian Gan, Hongliang Wang, Hui Pan, Yingying Zhao, Kai You, Qingbin Xing, Wenhua Zhao, Zhenyu Yang, Qian Zhang
, Available online  , doi: 10.3967/bes2025.086
  Objective  The rising prevalence of childhood obesity is closely associated with suboptimal dietary patterns. To address this public health concern, we conducted a comprehensive study to examine the association between coarse cereal consumption and body fat percentage (BFP) in Chinese children and adolescents.  Methods  The study included 48,305 children aged 6–17 years from 28 districts/counties in 14 provinces across seven regions of China (24,152 girls and 24,153 boys). BFP was examined using bioelectrical impedance analysis in the early morning. Coarse cereal consumption was assessed using a Food Frequency Questionnaire and categorized into three groups: 0 g/d/1000 kcal, 0–10 g/d/1000 kcal, and > 10 g/d/1000 kcal (daily consumption of coarse cereals × 1000/total energy consumption). Quantile regression model was used to analyze the association between coarse cereals and BFP, adjusting for potential confounders such as age, pubertal development stage, urban/rural and regional factors, total daily dietary energy consumption, sedentary time, moderate-to-high physical activity, household income, parental education, and consumption of other foods.  Results  Boys aged 6–10, 11–14, and 15–17 years had median daily coarse cereal consumptions of 6.6 g, 7.1 g, and 5.7 g, with BFP of 19.6%, 19.5%, and 17.5% (all P < 0.05). Girls in the same age groups showed consumption of 7.1 g, 8.4 g, and 6.7 g, with BFP of 20.3%, 26.4%, and 31.0% (all P < 0.05). The quantile regression results for boys showed that daily consumption of coarse cereals was significantly correlated with their BFP in the 0.15, 0.25, and 0.50 quartiles, with regression coefficients of −0.257, −0.221, and −0.330, respectively, after adjusting for potential confounders (P < 0.05). For girls, there was a significant correlation with PBF at the 0.05, 0.15, 0.25, 0.50, 0.75, and 0.85 quartiles, with regression coefficients of −0.258, −0.366, −0.372, −0.431, −0.472, and −0.503 (P < 0.05 for all).  Conclusions  Coarse cereals consumption among Chinese children and adolescents remains relatively low. Higher consumption was inversely associated with BFP in children aged 6–17 years. Future interventional studies should assess how increased coarse cereal consumption prevents childhood obesity.
Dissecting the Causal Association between Body Fat Mass and Obsessive-compulsive Disorder: A Two-sample Mendelian Randomization Study
Meiling Hu, Zhennan Lin, Hongwei Liu, Yunfeng Xi, Youxin Wang
, Available online  , doi: 10.3967/bes2025.069
Objective Previous studies link lower body mass index (BMI) with increased obsessive-compulsive disorder (OCD) risk, yet other body mass indicators may offer superior prediction. We dissected the causal association between body fat mass (FM) and OCD.Methods Summary statistics from genome-wide association studies of European ancestry were utilized to conduct two-sample Mendelian randomization analysis. Heterogeneity, horizontal pleiotropy, and sensitivity analyses were performed to assess the robustness.Results The inverse variance weighting method demonstrated that a genetically predicted decrease in FM was causally associated with an increased OCD risk [odds ratio (OR) = 0.680, 95% confidence interval (CI): 0.528–0.875, P = 0.003]. Similar estimates were obtained using the weighted median approach (OR = 0.633, 95% CI: 0.438–0.915, P = 0.015). Each standard deviation increases in genetically predicted body fat percentage corresponded to a reduced OCD risk (OR = 0.638, 95% CI: 0.455–0.896, P = 0.009). The sensitivity analysis confirmed the robustness of these findings with no outlier instrument variables identified.Conclusion The negative causal association between FM and the risk of OCD suggests that the prevention or treatment of mental disorders should include not only the control of BMI but also fat distribution and body composition.
Does Prenatal SARS-CoV-2 Infection Exacerbate Postpartum Lower Urinary Tract Symptoms? A Multicenter Retrospective Cohort Study
Yuhan Lyu, Min Li, Huiqing Yao, Tianzi Gai, Lin Liang, Su Pan, Pingping Li, Yaxin Liang, Yue Yu, Xiaomei Wu
, Available online  , doi: 10.3967/bes2025.065
  Objective  Coronavirus disease 2019 (COVID-19) can result in fatigue and post-exertional malaise; however, whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exacerbates lower urinary tract symptoms (LUTS) is unclear. This study investigated the association between prenatal SARS-CoV-2 infection and postpartum LUTS.  Methods  A multicenter, retrospective cohort study was conducted at two tertiary hospitals in China from November 1, 2022, to November 1, 2023. Participants were classified into infected and uninfected groups based on SARS-CoV-2 antigen results. LUTS prevalence and severity were assessed using self-reported symptoms and the Incontinence Impact Questionnaire-Short Form (IIQ-7). Pelvic floor muscle activity was measured using electromyography following the Glazer protocol. Group comparisons were performed to evaluate the association of SARS-CoV-2 infection with LUTS and electromyography parameters, with stratified analyses conducted using SPSS version 26.0.  Results  Among 3,652 participants (681 infected, 2,971 uninfected), no significant differences in LUTS prevalence or IIQ-7 scores were observed. However, SARS-CoV-2 infection was an independent factor influencing the electromyographic activity of the pelvic floor muscles (mean tonic contraction amplitudes), regardless of delivery mode (P = 0.001).  Conclusion  Prenatal SARS-CoV-2 infection was not significantly associated with an increased risk of postpartum LUTS but independently altered pelvic floor muscle electromyographic activity, suggesting potential neuromuscular effects.
National Trends in Influenza Vaccination Rates in South Korea Before and During the COVID-19 Pandemic, 2011–2022
Kyeongeun Kim, Kyeongmin Lee, Yejun Son, Seoyoung Park, Raphael Udeh, Jiseung Kang, Hayeon Lee, Soeun Kim, Jaeyu Park, Hyeon Jin Kim, Damiano Pizzol, Lee Smith, Jiyoung Hwang, Dong Keon Yon
, Available online  , doi: 10.3967/bes2025.061
  Objective  Despite the global decrease in influenza infections during the coronavirus disease 2019 (COVID-19) pandemic, seasonal influenza remains a significant health issue. South Korea, known for its robust pandemic response and high influenza vaccination rates, offers a unique context for examining changes in vaccination trends during the pandemic. Using nationally representative data, we aimed to understand the impact of the pandemic on influenza vaccination behavior over a 12-year period and to identify vulnerable groups.  Methods  We analyzed influenza vaccination rates in South Korea between 2011–2022, focusing on pandemic-related impacts. The data of 2,426,139 adults (≥ 19 years) from the Korea Community Health Survey were used to assess demographic and sociological factors influencing vaccination behaviors.  Results  We observed an increase in influenza vaccination rates during the pre-COVID-19 period from 2011–2013 (weighted prevalence: 46.68% [95% confidence interval (CI): 46.55–46.82]) to 2017–2019 (weighted prevalence: 52.50% [95% CI: 52.38–52.63]). However, a significant decline was observed in 2022, the late-COVID-19 pandemic period (weighted prevalence: 55.78% [95% CI: 55.56–56.01]), compared with the mid-pandemic period in 2021 (weighted prevalence: 59.12% [95% CI: 58.91– 59.32]), particularly among populations traditionally prioritized for influenza vaccination, including older adults (≥ 65 years) and patients with chronic diseases and low educational and income levels.  Conclusion  The influenza vaccination rate in South Korea was significantly affected by the COVID-19 pandemic, showing a notable decrease among vulnerable demographic groups. This suggests the need for targeted public health strategies to address vaccine hesitancy and improve vaccination rates, particularly among high-risk populations.
(Meta)transcriptomic Insights into the Role of Ticks in Poxvirus Evolution and Transmission: A Multicontinental Analysis
Yuxi Wang, Jingjing Hu, Jingjing Hou, Xiaojie Yuan, Weijie Chen, Yanjiao Li, Qile Gao, Yue Pan, Shuiping Lu, Qi Chen, Siru Hu, Zhongjun Shao, Chenglong Xiong
, Available online  , doi: 10.3967/bes2025.062
  Objective  Poxviruses are zoonotic pathogens that infect humans, mammals, vertebrates, and arthropods. However, the specific role of ticks in transmission and evolution of these viruses remains unclear.  Methods  Transcriptomic and metatranscriptomic raw data from 329 sampling pools of seven tick species across five continents were mined to assess the diversity and abundance of poxviruses. Chordopoxviral sequences were assembled and subjected to phylogenetic analysis to trace the origins of the unblasted fragments within these sequences.  Results  Fifty-eight poxvirus species, representing two subfamilies and 20 genera, were identified, with 212 poxviral sequences assembled. A substantial proportion of AT-rich fragments were detected in the assembled poxviral genomes. These genomic sequences contained fragments originating from rodents, archaea, and arthropods.  Conclusion  Our findings indicate that ticks play a significant role in the transmission and evolution of poxviruses. These viruses demonstrate the capacity to modulate virulence and adaptability through horizontal gene transfer, gene recombination, and gene mutations, thereby promoting co-existence and co-evolution with their hosts. This study advances understanding of the ecological dynamics of poxvirus transmission and evolution and highlights the potential role of ticks as vectors and vessels in these processes.
Sex-specific Association of Telomere Length with Individualized Expected Years of Life Lost among 203,731 Males and 241,668 Females
Feifei Xu, Chenjie Li, Yifan Wang, Xiao Wang, Yumnah Babar, Shuang Liang, Fan Yang, Zhazheng He, Honggang Yi, Juncheng Dai
, Available online  , doi: 10.3967/bes2025.053
  Objective  Telomere length is a key aging biomarker, but its sex-specific impact on individualized life expectancy remains uncertain. This study explores sex differences in leukocyte telomere length (LTL) and individualized expected years of life lost (YLL).  Methods  A prospective cohort of 445,399 participants (203,731 males and 241,668 females) from the UK Biobank was analyzed. LTL values were log-transformed, and YLL was calculated using life tables. Multiple linear regression was applied to examine sex-specific associations.  Results  In males, each standard deviation (S.D.) increase in LTL was linked to a 0.965-year decrease in YLL (95% CI: –1.025, –0.900; P < 0.001). In females, longer LTL was related to a 0.102-year increase in YLL (95% CI: 0.057, 0.146; P < 0.001). Among postmenopausal females, LTL showed a protective effect similar to that in males (0.387-year decrease, 95% CI: −0.446, –0.328; P < 0.001), while premenopausal females exhibited a detrimental association (0.705-year increase, 95% CI: 0.625, 0.785; P < 0.001). Comparable trends were observed across major aging-related diseases, pointing to a consistent biological pattern.  Conclusion  The influence of LTL on life expectancy varies significantly by sex, with protective associations seen in males and postmenopausal females. This suggests hormonal involvement in telomere dynamics. The results support integrating sex-specific perspectives into aging and telomere research and clinical practice.
Association of Longitudinal Change in Fasting Blood Glucose with Risk of Cerebral Infarction in a Patients with Diabetes
Taiyang Luo, Xuan Deng, Xueyu Chen, Yuhe Liu, Shuohua Chen, Haoran Sun, Ziwei Yin, Shouling Wu, Yong Zhou, Xingdong Zheng
, Available online  , doi: 10.3967/bes2025.052
  Objective  To investigate the association between long-term glycemic control and cerebral infarction risk in patients with diabetes through a large-scale cohort study.  Methods  This prospective, community-based cohort study included 12,054 patients with diabetes. From 2006 to 2012, 38,272 fasting blood glucose (FBG) measurements were obtained from these participants. FBG trajectory patterns were generated using latent mixture modelling. Cox proportional hazards models were applied to assess the subsequent risk of cerebral infarction associated with different FBG trajectory patterns.  Results  At baseline, the mean age of the participants was 55.2 years. Four distinct FBG trajectories were identified based on FBG concentrations and their changes over the 6-year follow-up period. After a median follow-up of 6.9 years, 786 cerebral infarction events were recorded. Different trajectory patterns were associated with significantly varied outcome risks (Log-Rank P < 0.001). Compared with the low-stability group, Hazard Ratio (HR) adjusted for potential confounders were 1.37 for the moderate-increasing group, 1.23 for the elevated-decreasing group, and 2.08 for the elevated-stable group.  Conclusion  Sustained high FBG levels were found to play a critical role in the development of ischemic stroke among patients with diabetes. Controlling FBG levels may reduce the risk of cerebral infarction.
Analysis of Tongue and Face Image Features of Anemic Women and Construction of Risk-Screening Model
Hongyuan Fu, Yi Chun, Yahan Zhang, Yu Wang, Yulin Shi, Tao Jiang, Xiaojuan Hu, Liping Tu, Yongzhi Li, Jiatuo Xu
, Available online  , doi: 10.3967/bes2025.047
  Objective   To identify the key features of facial and tongue images associated with anemia in female populations, establish anemia risk-screening models, and evaluate their performance.  Methods   A total of 533 female participants (anemic and healthy) were recruited from Shuguang Hospital. Facial and tongue images were collected using the TFDA-1 tongue and face diagnosis instrument. Color and texture features from various parts of facial and tongue images were extracted using Face Diagnosis Analysis System (FDAS) and Tongue Diagnosis Analysis System version 2.0 (TDAS v2.0). Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for feature selection. Ten machine learning models and one deep learning model (ResNet50V2 + Conv1D) were developed and evaluated.  Results   Anemic women showed lower a-values, higher L- and b-values across all age groups. Texture features analysis showed that women aged 30–39 with anemia had higher angular second moment (ASM)and lower entropy (ENT) values in facial images, while those aged 40–49 had lower contrast (CON), ENT, and MEAN values in tongue images but higher ASM. Anemic women exhibited age-related trends similar to healthy women, with decreasing L-values and increasing a-, b-, and ASM-values. LASSO identified 19 key features from 62. Among classifiers, the Artificial Neural Network (ANN) model achieved the best performance [area under the curve (AUC): 0.849, accuracy: 0.781]. The ResNet50V2 model achieved comparable results [AUC: 0.846, accuracy: 0.818].  Conclusion   Differences in facial and tongue images suggest that color and texture features can serve as potential TCM phenotype and auxiliary diagnostic indicators for female anemia.
Deciphering the Role of VIM, STX8, and MIF in Pneumoconiosis Susceptibility: A Mendelian Randomization Analysis of the Lung-Gut Axis and Multi-Omics Insights from European and East Asian Populations
Chenwei Zhang, Binbin Wan, Yukai Zhang, Tao Xiong, Yishan Li, Xuesen Su, Gang Liu, Yangyang Wei, Yuanyuan Sun, Jingfen Zhang, Xiao Yu, Yiwei Shi
, Available online  , doi: 10.3967/bes2025.028
  Background  Pneumoconiosis, a lung disease caused by irreversible fibrosis, represents a significant public health burden. This study investigates the causal relationships between gut microbiota, gene methylation, gene expression, protein levels, and pneumoconiosis using a multi-omics approach and Mendelian randomization (MR).  Methods  We analyzed gut microbiota data from MiBioGen and Esteban et al. to assess their potential causal effects on pneumoconiosis subtypes (asbestosis, silicosis, and inorganic pneumoconiosis) using conventional and summary-data-based MR (SMR). Gene methylation and expression data from Genotype-Tissue Expression and eQTLGen, along with protein level data from deCODE and UK Biobank Pharma Proteomics Project, were examined in relation to pneumoconiosis data from FinnGen. To validate our findings, we assessed self-measured gut flora from a pneumoconiosis cohort and performed fine mapping, drug prediction, molecular docking, and Phenome-Wide Association Studies to explore relevant phenotypes of key genes.  Results  Three core gut microorganisms were identified: Romboutsia (OR = 0.249) as a protective factor against silicosis, Pasteurellaceae (OR = 3.207) and Haemophilus parainfluenzae (OR = 2.343) as risk factors for inorganic pneumoconiosis. Additionally, mapping and quantitative trait loci analyses revealed that the genes VIM, STX8, and MIF were significantly associated with pneumoconiosis risk.  Conclusions  This multi-omics study highlights the associations between gut microbiota and key genes (VIM, STX8, MIF) with pneumoconiosis, offering insights into potential therapeutic targets and personalized treatment strategies.
Generalized Functional Linear Models: Efficient Modeling for High-dimensional Correlated Mixture Exposures
Bingsong Zhang, Haibin Yu, Xin Peng, Haiyi Yan, Siran Li, Shutong Luo, Renhuizi Wei, Zhujiang Zhou, Yalin Kuang, Yihuan Zheng, Chulan Ou, Linhua Liu, Yuehua Hu, Jindong Ni
, Available online  , doi: 10.3967/bes2025.024
  Objective  Humans are exposed to complex mixtures of environmental chemicals and other factors that can affect their health. Analysis of these mixture exposures presents several key challenges for environmental epidemiology and risk assessment, including high dimensionality, correlated exposure, and subtle individual effects.  Methods  We proposed a novel statistical approach, the generalized functional linear model (GFLM), to analyze the health effects of exposure mixtures. GFLM treats the effect of mixture exposures as a smooth function by reordering exposures based on specific mechanisms and capturing internal correlations to provide a meaningful estimation and interpretation. The robustness and efficiency was evaluated under various scenarios through extensive simulation studies.  Results  We applied the GFLM to two datasets from the National Health and Nutrition Examination Survey (NHANES). In the first application, we examined the effects of 37 nutrients on BMI (2011–2016 cycles). The GFLM identified a significant mixture effect, with fiber and fat emerging as the nutrients with the greatest negative and positive effects on BMI, respectively. For the second application, we investigated the association between four perfluoroalkyl substances (PFAS) and gout risk (2007–2018 cycles). Unlike traditional methods, the GFLM indicated no significant association, demonstrating its robustness to multicollinearity.  Conclusion  GFLM framework is a powerful tool for mixture exposure analysis, offering improved handling of correlated exposures and interpretable results. It demonstrates robust performance across various scenarios and real-world applications, advancing our understanding of complex environmental exposures and their health impacts on environmental epidemiology and toxicology.
Re-exploration for Dietary Iodine Intake in Chinese Adults Using the Obligatory Iodine Loss Hypothesis
Xiaobing Liu, Jun Wang, Yajie Li, Hongxing Tan, Deqian Mao, Yanyan Liu, Weidong Li, Wei Yu, Junan Yan, Jianhua Piao, Chongzheng Guo, Xiaoli Liu, Xiaoguang Yang
, Available online  , doi: 10.3967/bes2025.017
  Objective  This study aimed to explore minimum iodine excretion and to build a dietary iodine recommendation for Chinese adults using the obligatory iodine loss hypothesis.  Methods  Data from 171 Chinese adults (19–21 years old) were collected and analyzed based on three balance studies in Shenzhen, Yinchuan, and Changzhi. The single exponential equation was accordingly used to simulate the trajectory of 24 h urinary iodine excretion as the low iodine experimental diets offered (iodine intake: 11−26 μg·day−1) and to further deduce the dietary reference intakes (DRIs) for iodine, including estimated average requirement (EAR) and recommended nutrient intake (RNI).  Results  The minimum iodine excretion was estimated as 57, 58, and 51 μg·day−1 in three balance studies, respectively. Moreover, it was further suggested as 57, 58, and 51 μg·day−1 for iodine EAR, and 80, 81, and 71 μg·day−1 for iodine RNI or expressed as 1.42, 1.41, and 1.20 μg·day−1·kg−1 of body weight.  Conclusion  The iodine DRIs for Chinese adults were established based on the obligatory iodine loss hypothesis, which provides scientific support for the amendment of nutrient requirements.
Letter
Association between PM2.5 Chemical Constituents and Preterm Birth: The Undeniable Role of Preconception H19 Gene Variation
Yalong Wang, Panpan Sun, Xinying Wang, Junxi Zhang, Xiangyu Yu, Jian Chai, Ruo Du, Wenyi Liu, Fangfang Yu, Yue Ba, Guo Yu Zhou
, Available online  , doi: 10.3967/bes2025.076
Association Between Urinary Phthalate and Bisphenol Exposures and Obesity Based on Body Mass Index and Waist Circumference
Xin Peng, Bingsong Zhang, Zixuan Chen, Hongyuan Qi, Ying Zhu, Guoxiao Liang, Zhigang Huang
, Available online  , doi: 10.3967/bes2025.088
MYCN-Mediated Transcriptional Activation of IDH2 Enhances Proliferation, Migration, and Invasion in Cervical Squamous Cell Carcinoma through the HIF1-α Pathway
Xiaojuan Liu, Hui Ma, Xiaoyan Li, Chunxing Ma, Lisha Shu, Huiying Zhang
, Available online  , doi: 10.3967/bes2025.075
Validation and Reproducibility of an Iodine-Specific Food Frequency Questionnaire for Evaluating Dietary Iodine Intake in the Elderly Population of Gansu Province, China
Qi Jin, Tao Wang, Meina Ji, Jizun Wang, Xing Ma, Xinyi Wang, Jiaqi Wang, Hexi Zhang, Yanling Wang, Wenxing Guo, Wanqi Zhang
, Available online  , doi: 10.3967/bes2025.074
Review
Climate-sensitive infectious diseases under global climate change
Qiao Liu, Min Liu, Jue Liu
, Available online  , doi: 10.3967/bes2025.077
Climate and weather significantly influence the duration, timing, and intensity of disease outbreaks, reshaping the global landscape of infectious diseases. Rising temperatures and shifts in precipitation patterns driven by climate change can directly impact the survival and reproduction of pathogens and vector organisms. Moreover, climate change is expected to exacerbate extreme weather events, including floods and droughts, which can disrupt infrastructure and increase the risk of water- and foodborne diseases. There are potential shifts in the temporal and spatial patterns of infectious disease transmission owing to climate change. Furthermore, climate change may alter the epidemiology of vaccine-preventable diseases. These climatic variations not only affect the ecological characteristics of pathogens and vectors but also indirectly influence human behaviors and socioeconomic conditions, further amplifying disease transmission risks. Addressing this challenge requires an interdisciplinary collaboration and comprehensive public health strategies. This review aims to synthesize the current evidence on the impact of climate change on climate-sensitive infectious diseases and elucidate the underlying mechanisms and transmission pathways. Additionally, we explored adaptive policy strategies to mitigate the public health burden of infectious diseases in the context of climate change, offering insights for global health governance and disease control efforts.
Oringinal Article
Effectiveness of Pentavalent Rotavirus Vaccine — a Propensity Score Matched Test Negative Design Case-Control Study Using Medical Big Data in Three Provinces of China
Yuexin Xiu, Lin Tang, Fuzhen Wang, Lei Wang, Zhen Li, Jun Liu, Dan Li, Xueyan Li, Yao Yi, Fan Zhang, Lei Yu, Jingfeng Wu, Zundong Yin
, Available online  , doi: 10.3967/bes2025.056
  Objective   The objective of our study was to evaluate the vaccine effectiveness (VE) of the pentavalent rotavirus vaccine (RV5) among < 5-year-old children in three provinces of China during 2020-2024 via a propensity score-matched test-negative case-control study.  Methods   Electronic health records and immunization information systems were used to obtain data on acute gastroenteritis (AGE) cases tested for rotavirus (RV) infection. RV-positive cases were propensity score matched with RV-negative controls for age, visit month, and province.  Results   The study included 27,472 children with AGE aged 8 weeks to 4 years at the time of AGE diagnosis; 7.98% (2,192) were RV-positive. The VE (95% confidence interval, CI) of 1-2 and 3 doses of RV5 against any medically attended RV infection (inpatient or outpatient) was 57.6% (39.8%, 70.2%) and 67.2% (60.3%, 72.9%), respectively. Among children who received the 3rd dose before turning 5 months of age, 3-dose VE decreased from 70.4% (53.9%, 81.1%) (<5 months since the 3rd dose) to 63.0% (49.1%, 73.0%) (≥ 1 year since the 3rd dose). The three-dose VE rate was 69.4% (41.3%, 84.0%) for RVGE hospitalization and 57.5% (38.9%, 70.5%) for outpatient-only medically attended RVGE.  Conclusions   Three-dose RV5 VE against rotavirus gastroenteritis (RVGE) in children aged < 5 years was higher than 1-2-dose VE. Three-dose VE decreased with time since the 3rd dose in children who received the 3rd dose before turning five months of age, but remained above 60% for at least one year. VE was higher for RVGE hospitalizations than for medically attended outpatient visits.
Original Articles
Anthropometric Obesity Measures and Diabetes Progression from Prediabetes in Older Adults: A Comparison of American Diabetes Association and World Health Organization Criteria
Xiujuan Zhang, Huijie An, Virginia Byers Kraus, Xin Gao, Yunfan Li, Bowen Wang, Zhaoxue Yin
, Available online  , doi: 10.3967/bes2025.090
  Background  This study examined the associations between obesity indices and the risk of diabetes progression from prediabetes in the older adults, comparing the difference in using ADA and WHO criteria.   Methods  Data were obtained from the Healthy Aging Evaluation Longitudinal Study in China. Among participants without diabetes at baseline, prediabetes was classified based on fasting plasma glucose using both ADA and WHO criteria. Body mass index (BMI) and waist circumference (WC) were categorized by data distribution and diagnostic cut-off values, respectively. Cox proportional hazards regression models estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for obesity-related indices and diabetes progression from prediabetes.   Results  Among 1127 participants classified as prediabetic by ADA criteria, 474 also met WHO criteria. Under ADA-defined prediabetes, the highest WC quartile (≥93cm) was significantly associated with increased diabetes risk with aHR 1.93 (1.06, 3.53, P<0.05), while BMI-related and cut-off-based abdominal obesity showed no significant associations (P>0.05). Under WHO-defined prediabetes, both the high tertile of WC (≥90cm) and general obesity (BMI ≥28.0 kg/m²) were significantly associated with progression to diabetes (P<0.05), with aHR 2.13 (1.06, 4.27) and 2.44 (1.19, 5.01), respectively. However, cut-off-based abdominal obesity and the high BMI tertile (≥25.75 kg/m²) were not significantly associated with progression to obesity (P>0.05).   Conclusion  : Elevated WC, rather than BMI-based indices or cut-off-based abdominal obesity, was significantly associated with progression to diabetes using ADA-defined prediabetes criteria. However, both evaluated WC and general obesity predicted progression to diabetes under WHO criteria.