BMC Medicine最新文献

{"title":"Cancer incidence inconsistency between UK Biobank participants and the population: a prospective cohort study.","authors":"Chenxi Li, Gillian S Dite, Tuong L Nguyen, John L Hopper, Shuai Li","doi":"10.1186/s12916-025-03998-z","DOIUrl":"10.1186/s12916-025-03998-z","url":null,"abstract":"<p><strong>Background: </strong>While the UK Biobank has been widely used for cancer research, its representativeness of the population in terms of cancer incidence has not been thoroughly investigated.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of 466,163 UK Biobank participants who were cancer-free at recruitment. Standardised incidence ratios (SIRs) were calculated for all cancers combined and for 25 cancers, by comparing incidences for the participants with the UK national incidences. Variations in SIR by age, sex and deprivation measures were investigated.</p><p><strong>Results: </strong>Over a median follow-up period of 12 years, 47,535 participants had a cancer diagnosis. The SIR for all cancers combined was 0.90 (95% CI: 0.89, 0.91). The SIR increased with age and deprivation (P = 10^-9). The SIRs of 17 cancers differed from 1 (Bonferroni-adjusted P < 0.05): for prostate cancer and melanoma the SIRs were 1.2 and for the other 15 cancers the SIRs ranged from 0.43 to 0.93. The SIRs of 13 cancers differed by deprivation: the greater the deprivation, the lower the SIRs for prostate cancer and melanoma, and the higher the SIRs for the other 11 cancers.</p><p><strong>Conclusions: </strong>The overall cancer incidence was 10% lower for the UK Biobank participants compared with the population, with most cancers having a lower incidence that increased with deprivation. Irrespective of their causes, the inconsistencies could bias UK Biobank research results related to absolute cancer risks, such as the development and/or validation of cancer risk models and penetrance estimates for cancer susceptibility genes.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"181"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of celiac disease on a gluten-free diet: a multicenter prospective quasi-experimental clinical study.","authors":"Sara Gómez-Aguililla, Sergio Farrais, Natalia López-Palacios, Beatriz Arau, Carla Senosiain, María Corzo, Nora Fernandez-Jimenez, Ángela Ruiz-Carnicer, Fernando Fernández-Bañares, Bárbara P González-García, Eva Tristán, Ana Montero-Calle, María Garranzo-Asensio, Isabel Casado, Mar Pujals, Juana María Hernández, Jorge Infante-Menéndez, Garbiñe Roy, Carolina Sousa, Concepción Núñez","doi":"10.1186/s12916-025-04008-y","DOIUrl":"10.1186/s12916-025-04008-y","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing celiac disease (CD) in individuals adhering to a gluten-free diet (GFD) presents significant challenges. Current guidelines recommend a gluten challenge (GC) lasting at least 6-8 weeks, which has several limitations. Our aim was to compare four approaches previously proposed for diagnosing CD on a GFD: IL-2 serum levels, gut-homing CD8⁺ T cells, % TCRγδ⁺ intraepithelial lymphocytes (IELs), and UBE2L3 gene expression. Additionally, we evaluated the CD8⁺ T-cell-based method with a 3-day GC against the standard GC protocol.</p><p><strong>Methods: </strong>We conducted a multicenter prospective quasi-experimental clinical study. Two subsets of individuals were considered: (1) 20 patients with CD previously diagnosed and 15 non-CD controls, to evaluate the first aim; (2) 41 individuals with uncertain diagnosis who were on a GFD and required GC following current clinical guidelines, to assess the second aim. All participants underwent a 3-day GC (10 g gluten/day).</p><p><strong>Results: </strong>Among CD patients and non-CD controls, the sensitivity and specificity of IL-2, gut-homing CD8⁺ T cells, and UBE2L3 were 82.4% and 83.3%, 88.2% and 100%, and 52.9% and 100%, respectively. The percentage of TCRγδ⁺ IELs showed 88.2% sensitivity. In the uncertain diagnosis group, a CD8⁺ T-cell positive response was observed in 8 of the 41 subjects.</p><p><strong>Conclusions: </strong>The percentage of TCRγδ⁺ IELs and the analysis of IL-2 levels and gut-homing CD8⁺ T cells are promising diagnostic methods for CD on a GFD. Notably, our results suggest that the CD8⁺ T-cell assay may provide a consistent and reliable alternative to the extended GC, eliminating the need for invasive procedures to obtain duodenal samples and prolonged gluten ingestion. However, further research with larger cohorts are necessary to validate these findings and establish their definitive clinical utility.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"182"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut virome and its implications in the pathogenesis and therapeutics of inflammatory bowel disease.","authors":"Yushan Wu, Rui Cheng, Hao Lin, Lili Li, Yongbin Jia, Anna Philips, Tao Zuo, Hu Zhang","doi":"10.1186/s12916-025-04016-y","DOIUrl":"10.1186/s12916-025-04016-y","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) refers to chronic, recurrent inflammatory intestinal disorders, primarily including Crohn's disease (CD) and Ulcerative colitis (UC). Numerous studies have elucidated the importance of the gut microbiome in IBD. Recently, numerous studies have focused on the gut virome, an intriguing and enigmatic aspect of the gut microbiome. Alterations in the composition of phages, eukaryotic viruses, and human endogenous retroviruses that occur in IBD suggest potential involvement of the gut virome in IBD. Nevertheless, the mechanisms by which it maintains intestinal homeostasis and interacts with diseases are only beginning to be understood. Here, we thoroughly reviewed the composition of the gut virome in both healthy individuals and IBD patients, emphasizing the key viruses implicated in the onset and progression of IBD. Furthermore, the complex connections between the gut virome and the intestinal barrier, immunity, and gut microbiome were dissected to advance the interpretation of IBD pathogenesis. The updated discussion of the evidence regarding the gut virome will advance our knowledge in gut virome and chronic gastrointestinal diseases. Targeting the gut virome is a promising avenue for IBD treatment in future.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"183"},"PeriodicalIF":7.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Language complexity of patient-physician chat communication on hypertension control: results of the cluster-randomised PIA study.","authors":"Simon-Konstantin Thiem, Lucas Küppers, Benjamin Aretz, Arezoo Bozorgmehr, Arian Karimzadeh, Frauke Leupold, Birgitta Weltermann","doi":"10.1186/s12916-025-04006-0","DOIUrl":"10.1186/s12916-025-04006-0","url":null,"abstract":"<p><strong>Background: </strong>High language complexity impairs patients' understanding and medical outcomes. While messengers accelerate communication, the language complexity of chats between patients and providers is poorly studied. This study analyses language complexity and communication characteristics of chat data from the PIA study, which significantly improved blood pressure control after 6 to 12 months.</p><p><strong>Methods: </strong>The cluster-randomised controlled PIA study enrolled 848 hypertension patients (412 intervention, 436 control) from 64 German general practices. The PIA technology enabled a secured communication of blood pressure readings, medication plans and messages. The chats were analysed regarding frequency, length, response time and content. Language complexity was measured using the Flesch index with seven levels from 'hard' to 'very simple'. The study is registered in the German Clinical Trials Register (DRKS00012680).</p><p><strong>Results: </strong>In total, 4231 messages were sent between 24 general practitioners and 363 patients of the intervention arm between 09/20 and 09/21: 22% messages (n = 941) were automated (new medication plan or prescription available), while 78% were non-automated (n = 3290), with 41.1% of these messages originating from patients and 58.9% from practices. The average chat dialogue lasted 176.8 days (SD 9.8). Patients' messages had a mean of 22.6 words (SD 22.6) compared to 16.8 (SD 19.4) by practices. Most messages (88.92%) from practices and 51.9% from patients addressed medication or treatments. Simple or very simple language was used in 90.5% of the messages both by patients and by physicians regardless of sociodemographic characteristics. BP improved with increased frequency of messages (p < 0.001).</p><p><strong>Conclusions: </strong>This communication showed a remarkably low language complexity by physicians and patients and better control with more messages. The results support the use of digital communication for topics such as chronic hypertension care.</p><p><strong>Trial registration: </strong>German Clinical Trials Register, DRKS00012680. Registered May 10th, 2019, https://www.drks.de/drks_web/setLocale_EN.do .</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"174"},"PeriodicalIF":7.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal radial access to prevent radial artery occlusion for STEMI patients (RAPID III): a randomized controlled trial.","authors":"Zixuan Li, Yujie Wang, Jiahui Song, Senhu Wang, Yuntao Wang, Yongxia Wu, Haotian Wang, Zijing Liu, Rui Yan, Guangyao Zhai, Jincheng Guo","doi":"10.1186/s12916-025-04005-1","DOIUrl":"10.1186/s12916-025-04005-1","url":null,"abstract":"<p><strong>Background: </strong>Compared with conventional transradial access (TRA), distal radial access (DRA) is rarely used for percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) and may be beneficial to prevent radial artery occlusion (RAO). We aimed to evaluate the incidence of RAO between DRA and TRA 24 h after primary PCI in patients with STEMI.</p><p><strong>Methods: </strong>This is a single-center, open-label, prospective, randomized controlled trial conducted at Beijing Luhe Hospital, China, between January 2022 and July 2023. Five hundred and twenty patients (mean age: 61.3 ± 13.0 years; 81% male) with STEMI were randomly assigned to the DRA (n = 260) or TRA (n = 260) group. Primary PCI was performed using the radial artery access assigned study group. The primary endpoint was the rate of RAO assessed using Doppler ultrasound 24 h after primary PCI. Secondary outcomes included time taken for sheath insertion, access success rate, hemostasis time, fluoroscopy time, radiation dosage, and access-related complications.</p><p><strong>Results: </strong>The incidence of RAO was significantly lower in the DRA group than that in the TRA group (1.9% vs. 8.5%, P = 0.001). Access was successful in 94.6% of patients, and the crossover rate was 5.4% in both groups. The median time taken for sheath insertion was significantly longer (133 s vs. 114 s, P = 0.009), whereas the mean hemostasis time was shorter (209 ± 71 min vs. 372 ± 70 min, P < 0.001) in the DRA group. The incidence of modified Early Discharge After Transradial Stenting of Coronary Arteries (mEASY) ≥ II hematoma was lower in the DRA group (0.8% vs. 3.5%, P = 0.033). However, there was no significant difference in fluoroscopy time, radiation dosage, or access-related complications.</p><p><strong>Conclusions: </strong>In patients with STEMI undergoing primary PCI, compared with TRA, DRA prevented RAO 24 h postoperatively and was associated with shorter hemostasis time and a lower incidence of mEASY ≥ II hematoma.</p><p><strong>Trial registration: </strong>Clinical Trials.gov Identifier: NCT05461781.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"173"},"PeriodicalIF":7.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influential drivers of the cost-effectiveness of respiratory syncytial virus vaccination in European older adults: a multi-country analysis.","authors":"Xiao Li, Lander Willem, Caroline Klint Johannesen, Arantxa Urchueguía-Fornes, Toni Lehtonen, Richard Osei-Yeboah, Heini Salo, Alejandro Orrico-Sánchez, Javier Díez-Domingo, Mark Jit, Joke Bilcke, Harish Nair, Philippe Beutels","doi":"10.1186/s12916-025-03970-x","DOIUrl":"10.1186/s12916-025-03970-x","url":null,"abstract":"<p><strong>Background: </strong>We aimed to identify influential drivers of the cost-effectiveness of older adult respiratory syncytial virus (RSV) vaccination in Denmark, Finland, the Netherlands and Valencia-Spain.</p><p><strong>Methods: </strong>A static multi-cohort model was parameterised using country- and age-specific hospitalisations using three approaches: (A) the International Classification of Diseases (ICD)-coded hospitalisations, (B) laboratory RSV-confirmed hospitalisations and (C) time-series modelling (TSM). Plausible hypothetical RSV vaccine characteristics were derived from two protein subunit vaccines for adults aged ≥60 years. A full incremental analysis was conducted by comparing three RSV vaccination strategies: (1) in adults aged ≥60 years (\"60y+\"); (2) in adults aged ≥65 years (\"65y+\"); (3) in adults aged ≥75 years (\"75y+\") to \"no intervention\" and to each other. Both costs and quality-adjusted life-years (QALYs) were discounted at country-specific discount rates and the analysis was conducted from both the healthcare payers' and societal perspectives. Value of information, probabilistic sensitivity and scenario analyses identified influential drivers.</p><p><strong>Results: </strong>Besides vaccine price, the hospitalisation estimates were most influential: (A) Using adjusted RSV-ICD-coded hospitalisations at a vaccine price of €150 per dose, no intervention was cost-effective up to willingness-to-pay (WTP) values of €150,000 per QALY gained in Denmark and the Netherlands, and up to €124,000 per QALY gained in Finland. (B) Using the adjusted RSV-confirmed dataset, the findings were consistent in Denmark and comparable in Finland. In Spain-Valencia, the 75y+ strategy became cost-effective at WTP >€55,000. (C) Using TSM-based estimates, the 75y+ strategy was cost-effective at WTP >€45,000, >€101,000, >€41,000 and >€114,000 in Denmark, Finland, the Netherlands and Spain-Valencia, respectively. Sensitivity analyses showed that the (in-hospital) case fatality ratio and the specification of its age dependency were both influential. Duration of protection was found more influential than a variety of plausible waning patterns over the duration of protection.</p><p><strong>Conclusions: </strong>Data gaps and uncertainties on the RSV-related burden in older adults persist and influence the cost-effectiveness of RSV vaccination. More refined age- and country-specific data on the RSV attributable burden are crucial to aid decision making.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"170"},"PeriodicalIF":7.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk associated with ultra-processed food intake on depressive symptoms and mental health in older adults: a target trial emulation.","authors":"Belayneh Mengist, Mojtaba Lotfaliany, Julie A Pasco, Bruno Agustini, Michael Berk, Malcolm Forbes, Melissa M Lane, Suzanne G Orchard, Joanne Ryan, Alice J Owen, Robyn L Woods, John J McNeil, Mohammadreza Mohebbi","doi":"10.1186/s12916-025-04002-4","DOIUrl":"10.1186/s12916-025-04002-4","url":null,"abstract":"<p><strong>Background: </strong>Longitudinal cohort studies across the lifespan suggest an association between ultra-processed food (UPF) and depression. However, the effect of UPF on depression and mental health in older adults has not been determined. Therefore, this study investigated the effect of UPF on depressive symptoms and mental health in community-dwelling older adults.</p><p><strong>Methods: </strong>A pragmatic target trial was designed and emulated using the ASPirin in Reducing Events in the Elderly longitudinal data. Participants were community-dwelling older adults (≥ 70 years) in Australia. We specified and emulated the protocol of a two-arm randomised pragmatic clinical trial using the level of UPF consumption as the intervention. Greater than or equal to 4 servings of UPF per day was considered the intervention, with less than 4 servings per day the control. Dietary consumption was assessed using a mail-based diet screening questionnaire, and the level of food processing was classified based on the NOVA classification. The study outcomes were depressive symptoms, defined as a score of ≥ 8 on the Center for Epidemiological Studies Depression 10-item scale, and general mental health, defined by the mental component summary score of the Short Form-12. We applied inverse probability treatment weighting to balance confounders. Marginal structural models were employed to estimate the population-level average effect of intervention using generalised estimated equations.</p><p><strong>Results: </strong>A total of 11,192 participants (3415 intervention and 7777 control) were eligible for the emulation. High UPF consumption at time zero was associated with an increased risk of depressive symptoms at follow-ups (RR: 1.10; CI: 1.04-1.18). The finding was consistent with sensitivity analyses; after excluding participants on antidepressants at time zero, the risk of depressive symptoms in the intervention group was increased by 11% compared to the control (RR: 1.11; 95% CI: (1.04-1.20)). Consumption of UPF adversely affected the mental component quality of life (β: - 0.40; CI: - 0.65 to - 0.15).</p><p><strong>Conclusions: </strong>A higher level of UPF consumption was associated with a higher risk of depressive symptoms and adversely affected mental health among older adults.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"172"},"PeriodicalIF":7.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing novel \"Smell-Aids\" to improve olfactory function in post COVID-19 era.","authors":"Veronica L Formanek, Barak M Spector, Gabriela Zappitelli, Zhenxing Wu, Kai Zhao","doi":"10.1186/s12916-025-03999-y","DOIUrl":"10.1186/s12916-025-03999-y","url":null,"abstract":"<p><strong>Background: </strong>Eyeglasses, hearing aids, etc., all serve to enhance the sensory stimuli to enable patients to see or hear things that they would not otherwise be able to, but we have no equivalent technology for olfaction, a pressing issue in the post-COVID era.</p><p><strong>Methods: </strong>We attempt to invent \"Smell-Aids\" by non-invasively enhancing intranasal odorant delivery to the olfactory epithelium, using two prototypes: (a) a nasal foam plug with a diagonal channel embedded to direct air/odor flow upwards to the olfactory region; (b) a clip (similar to what synchronized swimmers use) pinching a critical nasal valve region that may intensify the nasal airflow vortex to the olfactory region.</p><p><strong>Results: </strong>We first tested these prototypes in counter-balanced orders on 58 healthy subjects, where their measured odor detection thresholds to phenylethyl alcohol significantly improved with both prototypes in subjects with normal smell function (baseline: 8-16.5, n = 30, 12.49 ± 2.8, plug: 14.42 ± 4.9, pinch: 14.73 ± 5.4, p < 0.05), but not in subjects with \"super\" sensitivity at baseline (> 16.5, n = 28). Next, we tested the prototypes on 54 patients with confirmed olfactory losses (age 21-80 years, median 54.5), the majority of whom (37/54 = 69%) were post-COVID long haulers (infected 12/15/2019 to 10/4/23; persisted 30 to 1260 days, median 22 months). The remaining non-COVID smell losses (n = 17) span significantly longer from 5 months to 27 years (median 8.5 years). The 9-item NIH toolbox odor identification score significantly improved after application of both smell aids (baseline: 4.30 ± 2.27, plug 5.11 ± 2.32, pinch 4.82 ± 2.06, mixed model p < 0.05), especially among the non-COVID cohort. For COVID long haulers, only the nasal plug remained effective (p < 0.05). Subgroup analysis was performed on patients who reported diminished (hyposmia/anosmia 38/54) vs distorted smell (parosmia/phantosmia 27/54, n = 11 reported both) and showed that the nasal plug remains effective for both cohorts (p < 0.05) while the pinch is only effective for the hypo/anosmia cohort (p < 0.05).</p><p><strong>Conclusions: </strong>These results preliminarily demonstrated the novelty of improving olfactory function through different peripheral mechanisms for different patient and normative cohorts and may one day lead to an effective over-the-counter smell aid. Enhancing olfactory functions in healthy and patient cohorts through improving intranasal air and odorant delivery.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05920330.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"169"},"PeriodicalIF":7.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Life's Essential 8 with incidence of heart failure modified by depressive symptoms: a prospective cohort study from UK Biobank.","authors":"Wei Hu, Chun-Hua Zhao, Jia-Ning Wang, Zhen-Zhen Shen, Ge Tian, Yue-Qing Huang, Bao-Peng Liu, Cun-Xian Jia","doi":"10.1186/s12916-025-04011-3","DOIUrl":"10.1186/s12916-025-04011-3","url":null,"abstract":"<p><strong>Background: </strong>The Life's Essential 8 (LE8) proposed by the American Heart Association for assessing cardiovascular health (CVH) has been demonstrated to be associated with cardiovascular disease, but rarely includes heart failure (HF), and the role of psychological factors has not been considered. We aimed to prospectively investigate the independent, joint, and interactive associations of LE8 and depressive symptoms with HF incidence.</p><p><strong>Methods: </strong>A total of 336,939 participants recruited from UK Biobank without HF, coronary heart disease, and stroke were included in the cohort study. The LE8 score consisted of four behavioral (diet, physical activity, nicotine exposure, and sleep) and four biological factors (glucose, blood lipids, blood pressure, and body mass index) and was classified into three levels: low, moderate, and high CVH. Depressive symptoms at baseline were identified by self-report and linkage to medical records. Incident HF cases during follow-up were extracted through primary care, hospital admissions, self-reports, and death registrations. Cox proportional hazard models were conducted to examine the associations of LE8 and depressive symptoms with HF incidence, with findings presented as hazard ratios (HRs) (95% confidence interval, CI).</p><p><strong>Results: </strong>A total of 9379 (2.8%) participants developed HF during a median follow-up of 13.6 years. Compared with low-CVH individuals, the multivariate-adjusted HRs with 95% CI for incident HF were 0.596 (0.565-0.629) and 0.458 (0.408-0.514) in those with moderate and high CVH, respectively. Per standard deviation increment in LE8 was associated with a 25.5% (HR = 0.745; 95% CI: 0.729-0.762) lower risk of HF. The stratification analysis indicated that the detrimental effect of low CVH on HF was more pronounced in participants with depressive symptoms compared to those without, with a significant multiplicative interaction (P for multiplicative interaction = 0.016). The joint test showed that the lowest risk of HF was observed in participants with high CVH and no depressive symptoms (HR = 0.344; 95% CI: 0.295-0.401), which may be attributed to a significant additive interaction observed.</p><p><strong>Conclusions: </strong>The cohort study revealed that LE8-defined CVH not only could predict the incidence of HF, but also mitigate the increased risk of HF attributable to depressive symptoms. Achieving the high LE8 scores recommended by the AHA to improve CVH will be beneficial in reducing the population burden of HF, especially among patients with depressive symptoms.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"175"},"PeriodicalIF":7.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between urbanization levels and frailty among middle-aged and older adults in China: evidence from the CHARLS.","authors":"Xinlan Xie, Jiaqun Que, Linsu Sun, Tao Sun, Feng Yang","doi":"10.1186/s12916-025-03961-y","DOIUrl":"10.1186/s12916-025-03961-y","url":null,"abstract":"<p><strong>Background: </strong>Rapid urbanization is underway in China. However, the impact of urbanization on frailty remains unclear. This study aims to investigate the relationship between urbanization and frailty among middle-aged and older adults.</p><p><strong>Methods: </strong>We analyzed nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2018. After applying inclusion and exclusion criteria, 10,758 non-frail individuals at baseline were analyzed. The exposure of interest was the comprehensive urbanization level. Urbanization level (0.072-0.689) was assessed using the entropy method. Frailty was assessed using the frailty index (FI), which ranges from 0 to 100. Frailty was defined as FI ≥ 25, and the urbanization-frailty association was assessed using - the restricted cubic spline (RCS) expressions and Cox proportional hazards models. Least absolute shrinkage and selection operator (LASSO) regression were employed to evaluate major factors associated with frailty.</p><p><strong>Results: </strong>The results revealed a U-shaped nonlinear association between urbanization level and frailty incidence, with a turning point at 0.3 (P_nonlinear < 0.001). In the Cox model, for urbanization scores below 0.3, each ten-percentile increase was associated with an HR of 0.871 (95% CI 0.843-0.900, P < 0.05). Conversely, scores at or above 0.3 had an HR of 1.178 (95% CI 1.053-1.319, P < 0.05) per ten-percentile increase. In the subgroup analysis of participants with urbanization scores below 0.3, there was a significant interaction between current work status and subgroups with dyslipidemia. LASSO regression showed that, for urbanization scores < 0.3, total retail sales (coefficient =  - 0.129) and per capita income (coefficient =  - 0.071) were most protective against frailty. For scores ≥ 0.3, key urbanization factors associated with increased frailty risk included the number of college students per 10,000 people (coefficient = 0.080) and the proportion of built-up land in the urban area (coefficient = 0.060).</p><p><strong>Conclusions: </strong>Urbanization level had U-shaped association with frailty incidence. Factors such as total retail sales of consumer goods per capita, per capita disposable income of urban residents, and the number of college students per 10,000 people may be key in formulating a strategy for frailty prevention.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"171"},"PeriodicalIF":7.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}