Mortality burden of protein-energy malnutrition associated with ambient temperature in China: a nationwide case-crossover study.

IF 6.5 1区医学 Q1 NUTRITION & DIETETICS

American Journal of Clinical Nutrition Pub Date : 2025-06-06 DOI:10.1016/j.ajcnut.2025.06.002

Yulin Zhuo, Jiangmei Liu, Jianxiong Hu, Jinlei Qi, Guanhao He, Peng Yin, Tao Liu, Yingyin Liu, Yi Lin, Mengen Guo, Fengrui Jing, Ziqiang Lin, Jinling You, Wenjun Ma, Maigeng Zhou

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引用次数: 0

Abstract

Background: In the context of global warming, the health effects of non-optimum temperatures have attracted increasing attention. Studies have shown that high temperatures increase risk of hospitalization for protein-energy malnutrition (PEM), yet the impact of non-optimum temperatures on PEM mortality is unknown.

Objectives: This study aims to quantitatively assess risk and burden of PEM-related mortality associated with short-term temperature exposure across 31 provinces in China.

Methods: We collected mortality and meteorological data from 1 January, 2013, to 31 December, 2022, in 31 provinces of mainland China. Based on time-stratified case-crossover design, we integrated logistic model with distributed lag nonlinear model to assess the association between non-optimum temperatures and PEM-related mortality. Subgroup analyses were performed by age, sex, type of PEM, and province to identify vulnerable populations.

Results: A total of 197,406 PEM-related deaths were recorded during 2013-2022. The exposure-response curves were inversely J-shaped with higher effect for low temperature than high temperature. Nationally, we estimated that 17.03% [95% empirical confidence intervals (eCI): 14.59%, 19.17%] of PEM mortality was attributable to non-optimum temperatures. Subgroup analyses suggested that the attributable fraction of PEM mortality resulting from non-optimum temperatures was more prominent in males (17.69%; 95% eCI: 13.57%, 21.48%), the older adults ≥65 y (17.44%; 95% eCI: 14.84%, 19.80%), and non-severe PEM (17.45%; 95% eCI: 14.30%, 20.56%). In terms of spatial disparities, the top provinces with higher AFs were Anhui (27.63%; 95% eCI: 20.31%, 33.80%), Xinjiang (22.73%; 95% eCI: -0.14%, 39.55%), and Hubei (22.05%; 95% eCI: 12.36%, 29.87%).

Conclusions: Findings from this nationwide study suggest that both heat and cold are associated with increased risks and burden of PEM-related deaths. These findings underscore the necessity of targeted interventions to reduce the PEM-related mortality burden associated with ambient temperature.

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中国蛋白质-能量营养不良与环境温度相关的死亡率负担：一项全国病例交叉研究。

背景：在全球变暖的背景下，非最适温度对健康的影响越来越受到关注。研究表明，高温会增加因蛋白质能量营养不良（PEM）住院的风险，但非最佳温度对PEM死亡率的影响尚不清楚。目的：定量评估中国31个省份与短期温度暴露相关的pem相关死亡率的风险和负担。方法：收集2013年1月1日至2022年12月31日中国大陆31个省份的死亡率和气象数据。基于时间分层病例交叉设计，我们将logistic模型与分布滞后非线性模型（DLNM）相结合，评估非最佳温度与pms相关死亡率之间的关系。按年龄、性别、PEM类型和省份进行亚组分析，以确定易感人群。研究结果：2013-2022年期间共记录了197,406例pms相关死亡。暴露-响应曲线呈反j型，低温效应大于高温效应。在全国范围内，我们估计17.03%（95% eCI: 14.59%, 19.17%）的PEM死亡率可归因于非最佳温度。亚组分析表明，非最佳温度导致的PEM死亡比例在男性（17.69%,95% eCI: 13.57%, 21.48%）、老年人（17.44%,95% eCI: 14.84%, 19.80%）和非严重PEM （17.45%, 95% eCI: 14.30%, 20.56%）中更为突出。在空间差异上，AFs较高的省份依次为安徽（27.63%,95% eCI: 20.31%, 33.80%）、新疆（22.73%,95% eCI: -0.14%, 39.55%）和湖北（22.05%,95% eCI: 12.36%, 29.87%）。结论：这项全国性研究的结果表明，热和冷都与ppm相关死亡的风险和负担增加有关。这些发现强调了有针对性的干预措施的必要性，以减少与环境温度相关的pme相关死亡率负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Clinical Nutrition 医学-营养学

CiteScore

12.40

自引率

4.20%

发文量

332

审稿时长

38 days

期刊介绍： American Journal of Clinical Nutrition is recognized as the most highly rated peer-reviewed, primary research journal in nutrition and dietetics.It focuses on publishing the latest research on various topics in nutrition, including but not limited to obesity, vitamins and minerals, nutrition and disease, and energy metabolism. Purpose: The purpose of AJCN is to: Publish original research studies relevant to human and clinical nutrition. Consider well-controlled clinical studies describing scientific mechanisms, efficacy, and safety of dietary interventions in the context of disease prevention or health benefits. Encourage public health and epidemiologic studies relevant to human nutrition. Promote innovative investigations of nutritional questions employing epigenetic, genomic, proteomic, and metabolomic approaches. Include solicited editorials, book reviews, solicited or unsolicited review articles, invited controversy position papers, and letters to the Editor related to prior AJCN articles. Peer Review Process: All submitted material with scientific content undergoes peer review by the Editors or their designees before acceptance for publication.