Zhangling Chen’s research while affiliated with The Second Xiangya Hospital of Central South University and other places

Background The American Heart Association recently released an updated algorithm for evaluating cardiovascular health (CVH), Life's Essential 8 (LE8). However, few studies have examined the association of LE8 with risk of cardiovascular disease (CVD) and mortality among individuals with chronic kidney disease (CKD). We investigated whether LE8 was associated with subsequent risk of CVD and mortality in the Chinese population of adults with CKD. Methods This prospective study included 18,716 adults (55.4 ± 14.0 years, 77.9 % men) with CKD free of CVD at baseline from the Kailuan study. A LE8 score (range 0–100 points) was constructed based on diet, physical activity, smoking, sleep duration, body mass index, blood lipids, blood glucose, and blood pressure. Incident CVD and mortality were identified by electronic health records and registers. Multivariable Cox regression models were used to compute hazard ratios (HRs) and 95 % confidence intervals (CIs). Results During a median follow-up of 14.0 and 14.4 years, 2117 cases of CVD and 4190 deaths were documented. After adjusting for potential confounders, comparing the high LE8 score (80–100 points) to the low LE8 score (<50 points), the multivariable HRs (95 % CIs) were 0.28 (0.20, 0.40) for CVD, 0.14 (0.06, 0.34) for myocardial infarction, 0.35 (0.25, 0.50) for total stroke, and 0.68 (0.56, 0.83) for all-cause mortality, respectively. Conclusions Among patients with CKD, greater adherence to CVH, as defined by LE8, was significantly associated with a lower risk of CVD and all-cause mortality.

Aims/hypothesis Existing evidence on the relationship between intake of monounsaturated fatty acids (MUFAs) and type 2 diabetes is conflicting. Few studies have examined whether MUFAs from plant or animal sources (MUFA-Ps and MUFA-As, respectively) exhibit differential associations with type 2 diabetes. We examined associations of intakes of total MUFAs, MUFA-Ps and MUFA-As with type 2 diabetes risk. Methods We used data from 51,290 women in the Nurses’ Health Study (1990–2016), 61,703 women in the Nurses’ Health Study II (1991–2017) and 29,497 men in the Health Professionals Follow-up Study (1990–2016). Using food frequency questionnaires and food composition tables, we calculated MUFA-P and MUFA-A intakes every 4 years and modelled their associations with type 2 diabetes using Cox regression models. Results During 3,268,512 person-years of follow-up, we documented 13,211 incident type 2 diabetes cases. After multivariate adjustment, total MUFA intake was associated with higher type 2 diabetes risk, with HR for Q5 vs Q1 of 1.10 (95% CI 1.01, 1.22). MUFA-Ps and MUFA-As demonstrated divergent associations, with HRs of 0.87 (95% CI 0.81, 0.94) and 1.34 (1.23, 1.45), respectively. In substitution analyses, HRs were 0.92 (95% CI 0.86, 0.99) for replacing 2% of energy from trans fatty acids or 0.72 (0.66, 0.78) and 0.82 (0.77, 0.88) for replacing 5% from MUFA-As and 5% from the sum of saturated fatty acids and MUFA-As with MUFA-Ps, respectively. Substituting MUFA-As for saturated fatty acids and refined carbohydrates was associated with a 43% and 33% higher risk, respectively. Conclusions/interpretation Higher intake of MUFA-Ps was associated with lower type 2 diabetes risk, whereas increased intake of MUFA-As was associated with higher risk. Replacing saturated fatty acids, trans fatty acids and MUFA-As with MUFA-Ps may be beneficial for type 2 diabetes prevention. Graphical Abstract

Background: Obesity is one of the major risk factors for cardiovascular disease (CVD), body roundness index (BRI) is more comprehensive in assessing fat distribution than traditional measurements. However, evidence regarding the association between BRI and the risk of CVD was limited, particularly in American people. This current study aimed to investigate the association between BRI and the risk of CVD among US adults. Hypothesis: We hypothesized that higher BRI was associated with a higher risk of CVD. Methods: A total of 21,852 participants were included in the National Health and Nutrition Examination Surveys from 6 survey cycles (2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016 and 2017-2018). Weighted multivariate logistic regression was carried out to examine the relationship between BRI and the risk of CVD. Restricted cubic spline (RCS) curves were employed to analyze nonlinear relationships. Results: Among 21,852 US adults, the mean (SD) age was 47.5 (17.3) years, 10,669 (48.8%) were female, and 1886 were diagnosed with CVD. In the weighted multi-variable logistic regression model with adjustment for demographics, lifestyle, economic status and dietary factors, higher BRI was significantly associated with a substantially higher risk of CVD. Compared with the participants in the lowest quartile of BRI, those in the highest quartile of BRI had a higher CVD, with OR and 95%CI of 2.47 (1.92-3.17). Furthermore, the RCS demonstrated a linear dose-response relationship between BRI and CVD (P non-linearity =0.29). Conclusion: This national cohort study found a higher BRI was associated with a higher risk of CVD among US adults. BRI may provide a new perspective for CVD prevention among adults.

Background: The association between oxidative stress score (OBS) and hypertension remains unclear in the US population. Hypothesis: We hypothesized that higher OBS was associated with a lower risk of hypertension. Methods: A total of 22,938 adults (mean age: 47.2 years) were enrolled from 8 survey cycles of NHANES (2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016 and 2017-2018). The total OBS consisted of the dietary OBS and the lifestyle OBS, based on 16 dietary components (including dietary iron, zinc, total fat, copper, selenium, magnesium, calcium, vitamin C, E, B6 and B12, total folate, carotene, niacin, riboflavin, and fiber) and 4 lifestyle components (including body mass index, alcohol, smoking, and physical activity). Weighted multivariate logistic regression was used to investigate the association between OBS and hypertension, and restricted cubic spline (RCS) assessed the nonlinear relationship. Results: In the multivariate-adjusted model, a substantially inverse association was observed between total OBS and risk of hypertension. Comparing the extreme quartile groups, the OR and 95% CI were 0.62 (0.52-0.73). Furthermore, higher dietary OBS and lifestyle OBS were similarly associated with a lower risk of hypertension (OR (95%CI): 0.78(0.66,0.93); 0.38(0.33,0.44), respectively). The RCS exhibited a nonlinear dose-response association between total OBS and hypertension ( P non-linearity < 0.001). Conclusion: These findings support the potential beneficial role of OBS for the prevention of hypertension in adults.

Background and Aims: Plant-based diets have been associated with a lower risk of total mortality among generally health populations. However, the associations of plant-based diets with total mortality remain unclear among older people with cardiometabolic diseases, who have an elevated risk of mortality. Methods: We prospectively followed 4,485 participants (mean age: 84 years) from the China Prospective Longitudinal Survey of Health and Longevity (2006-2018), who had cardiometabolic disease in 2006. Dietary data were collected at baseline using a food-frequency questionnaire. Using these data, we created an overall plant-based diet index (PDI), in which plant-based foods received positive scores while animal foods (meat, fish and aquatic products, eggs, milk, animal fats) received reversed scores accordingly. We also created a healthful plant-based diet index (hPDI), where healthy plant-based foods (whole grains, vegetables, vegetable oils, fresh fruits, legumes, beans, garlic, nuts, tea) received positive scores, while less healthy plant-based foods (refined grains, pickles, sugar, preserved vegetables) and animal-based foods were given reversed scores. In addition, an unhealthful plant-based diet index (uPDI) was created by assigning positive scores to less healthy plant-based foods while reverse scores to healthy plant-based foods and animal-based foods. We used Cox proportional hazards regression to compute hazard ratios (HRs) and 95% CIs for total mortality, with adjustment for demographics, dietary and lifestyle factors, and medical history. Results: During a 12 years of follow-up, 2,881 deaths were recorded. A higher score from PDI and hPDI was associated with a lower risk total mortality among participants with cardiometabolic diseases (HR and 95% CI for extreme quintiles of PDIs: 0.85, 95% CI 0.75–0.96, P trend < 0.001; hPDI: 0.84 (0.74–0.94), P trend < 0.001). A higher uPDI score was associated with a higher total mortality among participants with cardiometabolic diseases (uPDI: 1.28 (1.13-1.47), P trend < 0.001). These results were consistent in subgroup analyses by age, sex, smoking status, alcohol consumption, education level, physical activity, and BMI. Conclusion: Our study suggests that among older Chinese participants with cardiometabolic diseases, adherence to an overall plant-based diet or a healthful plant-based diet, is associated with a lower total mortality, while an unhealthful plant-based diet was associated with a higher total mortality.

Background and Aims: High neutrophil counts, an easily accessible inflammation biomarker, has been linked to risk of cardiovascular disease (CVD), and mortality, but with mixed results. We aimed to summarize published associations between neutrophil counts with risk of CVD and all-cause and cause-specific mortality among generally healthy populations. Methods: We searched Medline, Embase, Web of Science, and Cochrane CENTRAL databases until March 2024. Random effect meta-analysis was conducted to calculate pooled risk ratios (RRs) and 95% confidence intervals (95%CIs) for highest versus lowest categories of neutrophil counts in relation to risk of CVD and all-cause and cause-specific mortality among general healthy populations. Linear and non-linear dose-response analyses were also performed. Results: Our systematic review and meta-analysis included 22 prospective cohort studies. During a median/mean follow-up period of 3.8 to 18.3 years, 73,934 CVD events and 80,317 deaths occurred among 1,962,191 participants. Higher neutrophil counts were associated with a higher risk of CVD incidence and all-cause mortality, CVD mortality, and non-CVD mortality. The pooled RRs (95%CIs) of highest versus lowest categories of neutrophil counts were 1.32 (1.20, 1.45) for risk of CVD incidence, 1.61 (1.23, 2.11) for all-cause mortality, 1.71 (1.45, 2.01) for CVD mortality, and 1.68 (1.17, 2.40) for non-CVD mortality. Further, per 1 SD increase of neutrophil counts was associated with a 4%, 12%, 14%, and 24% higher risk for CVD events, all-cause mortality, CVD mortality, and non-CVD mortality, respectively. In addition, a secondary dose-response analysis revealed a non-linear association of neutrophil counts with risk of CVD events (P non-linearity = 0.01), but a linear positive association with CVD mortality (P non-linearity = 0.87). The pooled associations of neutrophil counts with CVD risk, and all-cause, CVD, and non-CVD mortality did not differ by age, sex, region, and follow-up duration. Conclusions: Higher neutrophil counts were associated with a substantially higher risk of CVD events and all-cause, CVD, and non-CVD mortality.

Background Artificially sweetened beverages (ASB) are consumed globally, but their impact on overall health remains uncertain. We summarized published associations between ASB intake with all-cause and cause-specific mortality. Methods We searched Medline, Embase, Web of Science, and Cochrane CENTRAL databases until August 2023. Random effect meta-analysis was conducted to calculate pooled risk ratios (RRs) and 95% confidence intervals (95%CIs) for highest versus lowest categories of ASB consumption in relation to all-cause and cause-specific mortality. Linear and non-linear dose-response analyses were also performed. Results Our systematic review and meta-analysis included 11 prospective cohort studies. During a median/mean follow-up period of 7.0 to 28.9 years, 235,609 deaths occurred among 2,196,503 participants. Intake of ASB was associated with higher risk of all-cause and CVD mortality with pooled RRs (95%CIs) of highest vs. lowest intake categories of 1.13 (1.06, 1.21) (I² = 66.3%) for all-cause mortality and 1.26 (1.10, 1.44) (I² = 52.0%) for CVD mortality. Dose-response analysis revealed a non-linear association of ASB with all-cause mortality (pnon−linearity = 0.01), but a linear positive association with CVD mortality (pnon−linearity = 0.54). No significant association was observed for ASB intake and cancer mortality. Moreover, a secondary meta-analysis demonstrated that replacing 1 serving/day of sugary sweetened beverages (SSB) with ASB was associated with 4–6% lower risk of all-cause and CVD mortality. Per NutriGrade, the evidence quality for associations between ASB intake with all-cause and CVD mortality was moderate. Conclusions Higher intake of ASB was associated with higher risk of all-cause and CVD mortality, albeit a lower risk than for SSB. Systematic review registration PROSPERO registration no. CRD42022365701.