Yijing Cheng

Background/Objectives: To examine the association between metabolic dysfunction–associated fatty liver disease (MAFLD) and bone mineral density in school-aged children. To investigate the association between metabolic dysfunction-associated fatty liver disease (MAFLD) and bone mineral density among school-aged children using a propensity score-matched study design. Methods: A cross-sectional analysis was performed using baseline data from the Beijing Children and Adolescents Health Cohort, with samples collected between September 2022 and May 2023. The study included 5170 children aged 7–18 years. Standardized questionnaires collected behavioral, lifestyle, and dietary data. Anthropometric measurements (height, weight, waist circumference) were obtained to calculate body mass index (BMI). Fasting venous blood samples were analyzed for glucose and lipid profiles. Clinical assessments included pubertal development evaluation, abdominal ultrasound for hepatic steatosis, oscillometric blood pressure measurement, quantitative ultrasound for calcaneal bone mineral density (BMD), and bioelectrical impedance analysis for body fat percentage. MAFLD was diagnosed as hepatic steatosis combined with metabolic abnormalities (assessed via BMI, blood glucose, lipid levels, and blood pressure). Propensity score matching (PSM) was conducted at a 1:3 ratio between the MAFLD and non-MAFLD groups, matching on age, sex, and pubertal stage. Multiple linear regression, conditional logistic regression, and quantile regression (10th–90th percentiles) were used to analyze the association between MAFLD and BMD. Results: Of 5170 participants, 579 had MAFLD and were matched to 1737 non-MAFLD controls (standardized mean differences < 0.001). Children with MAFLD had higher BMI, body fat percentage, and waist circumference, and lower BMD versus controls. Multiple linear regression confirmed a significant negative association between MAFLD and BMD, which was stronger in boys and mid-pubertal children. Conditional logistic regression analyses further showed that boys with MAFLD had a higher risk of reduced BMD. The odds ratios were 1.77 (95% CI: 1.14–2.75) overall, 2.74 (95% CI: 1.56–4.81) among those aged 12–14 years, 1.81 (95% CI: 1.04–3.17) in mid-puberty, and 2.27 (95% CI: 1.17–4.40) in late puberty. Quantile regression revealed the strongest associations between MAFLD and BMD at the 40th–75th percentiles (regression coefficients: −9.5 to −6.7). Conclusions: MAFLD was associated with lower bone mineral density in children, with the strongest associations observed in the lower-to-middle range. Boys, children in mid-puberty, and those with obesity may represent particularly vulnerable groups with respect to bone health in the presence of MAFLD. This highlights the importance of early MAFLD identification and targeted interventions to mitigate long-term skeletal risks. Prospective studies are needed to clarify the causal pathways between MAFLD and pediatric bone health, and future research should integrate multiple factors to elucidate the underlying mechanisms.

Background: There is limited research providing an overall understanding of bone mineral density (BMD) changes throughout different stages of life. This study aimed to investigate the pattern of BMD changes across childhood, adolescence, adulthood, and old age, as well as exploring the critical time of peak BMD (PBMD). Methods: Participants of three major ethnicities from National Health and Nutrition Examination Survey 1999 to 2018 were involved: 46,381 and 20,944 participants aged 8–85 years old were included in the Lumbar spine BMD (LSBMD) and femoral neck BMD (FNBMD) studies, respectively. BMD was measured using dual-energy X-ray absorptiometry. The generalized additive model was used to construct smoothed percentile curves. Results: Both males and females experienced a sharp increase in LSBMD during puberty, with females reaching their PBMD earlier than males. Females’ LSBMD remained higher than males’ before the age of approximately 50, except for Non-Hispanic Blacks. For males, LSBMD reached a plateau at around 30 years old after reaching the peak value. Females exhibited two peak points on the fitted curves, with the second PBMD occurring around 36–37 years old. Ethnic variations were observed, with Non-Hispanic Blacks displaying the highest BMD levels at all ages. Non-Hispanic Whites and Mexican Americans had lower BMD levels, with Mexican Americans generally exhibiting the lowest BMD. FNBMD reached its peak earlier than LSBMD, and males consistently had higher FNBMD than females. Conclusions: This nationally representative study contributes to the understanding of BMD changes across the lifespan, and might provide guidance for bone health interventions in different population groups.

The aim of the study was to investigate the association between serum ferritin and hypertension among American adults from National Health and Nutrition Examination Survey (NHANES) 1999 to 2018. A total of 16,125 participants were included. Weighted logistic regression and subgroup analyses were performed to explore the association. We found that serum ferritin was closely correlated to hypertension. Individuals with high serum ferritin were more likely to have higher systolic or diastolic blood pressure (SBP, DBP) than those with lower serum ferritin. Restricted cubic spline showed a significant non-linear association between serum ferritin and SBP/DBP. Higher level of serum ferritin (Q3 74.1–147 μg/L and Q4 > 147 μg/L) was found to have positive association with high SBP [Q3 (OR: 1.246, 95% CI:1.020–1.523), Q4 (OR: 1.354, 95% CI:1.096–1.674)], and hypertension [Q3 (OR: 1.283, 95% CI:1.099–1.499), Q4 (OR: 1.424, 95% CI:1.197–1.63)] in the whole population. In people aged between 20 and 60, subjects with high serum ferritin were significantly associated with a higher risk of hypertension, but in those over 60, the relationship between serum ferritin level and hypertension is negative. A non-linear association between serum ferritin and SBP, as well as DBP, was discovered. There was age difference in association between serum ferritin and hypertension in American adults, and further researches were needed to understand the mechanisms behind the difference.

There are few studies on lead’s effect on bone mineral density (BMD) in childhood. In this study, we examined the association between lead exposure and BMD among 13,951 children and adolescents aged 8–19 years from NHANES 1999–2006 and 2011–2018. The whole blood lead levels (BLLs) were used as lead exposure biomarkers, and total BMD, subtotal BMD, lumbar spine BMD and limb BMD were used as outcome variables. The survey weighted multivariable generalized additive models (GAMs) with smoothing terms were used to explore the association between blood lead levels and BMDs, adjusted for age, sex, race/ethnicity, height, weight, family-income-to-poverty ratio and blood cadmium. Subgroup analyses stratified by sex and bony sites were further performed. We found an N-shaped curve association between BLLs and total BMD, subtotal BMD and limb BMD for males and females, whereas the association between BLLs and lumbar spine BMD was only significantly negative for females. The findings suggested that lead exposure had different effects on BMD of different bony sites (highly cortical or trabecular regions) in childhood and adolescence and had different effects on the same bone among different ages population and/or at different levels.

Background: Trends of asthma mortality vary widely all over the world, while the trends in China over the past 15 years are unknown. The aim of this study was to assess the trends of asthma mortality in China. Methods: Asthma deaths and demographic characteristics were collected from National Death Cause Datasets of Disease Surveillance System between 2004 and 2019. The data were analyzed with joinpoint regression analysis and age-period-cohort (APC) analysis for the mortality rate due to asthma in China. Results: Asthma mortality declined from 2.4 (95% confidence interval (CI): 2.3–2.5) per 100,000 in 2004 to 1.6 (95% CI: 1.5–1.7) per 100,000 in 2019. Age-adjusted asthma mortality rates decreased for men and women in urban and rural areas from 2004 through 2019. The decreasing trend of the mortality rate has slowed down substantially during 2007 and 2009. After that, the decreasing trend has stabilized. The asthma mortality rates generally have a positive relationship with the age of the population when controlling for period and cohort. The period trend decreased and then increased when controlling for age and cohort. Conclusions: We should pay more attention to asthma management plans or treatment for aging people who are facing higher risk of asthma death.

Objective: To determine whether a bi-directional relationship exists between depression and HF within a single population of individuals receiving primary care services, using longitudinal electronic health records (EHRs). Methods: This retrospective cohort study utilized EHRs for adults who received primary care services within a large healthcare system in 2006. Validated EHR-based algorithms identified 10,649 people with depression (depression cohort) and 5,911 people with HF (HF cohort) between January 1, 2006 and December 31, 2018. Each person with depression or HF was matched 1:1 with an unaffected referent on age, sex, and outpatient service use. Each cohort (with their matched referents) was followed up electronically to identify newly diagnosed HF (in the depression cohort) and depression (in the HF cohort) that occurred after the index diagnosis of depression or HF, respectively. The risks of these outcomes were compared (vs. referents) using marginal Cox proportional hazard models adjusted for 16 comorbid chronic conditions. Results: 2,024 occurrences of newly diagnosed HF were observed in the depression cohort and 944 occurrences of newly diagnosed depression were observed in the HF cohort over approximately 4–6 years of follow-up. People with depression had significantly increased risk for developing newly diagnosed HF (HR 2.08, 95% CI 1.89–2.28) and people with HF had a significantly increased risk of newly diagnosed depression (HR 1.34, 95% CI 1.17–1.54) after adjusting for all 16 comorbid chronic conditions. Conclusion: These results provide evidence of a bi-directional relationship between depression and HF independently of age, sex, and multimorbidity from chronic illnesses.

Frailty and decreased physical performance are associated with poor outcomes after kidney transplant. Less is known about their relationship with pretransplant outcomes. The aim of this study was to characterize associations between frailty and physical performance with death on the kidney transplant waiting list. Since December 2014, high-risk kidney transplant candidates at our center (age > 59, diabetic and/or history of >3 years dialysis) have undergone frailty and physical performance testing using Fried Criteria and the Short Physical Performance Battery. Between December 2014 and November 2016, 272 high-risk candidates underwent testing and were approved for transplant. Both frailty and physical performance score were significantly associated with death on the waiting list (hazard ratio [HR]: 6.7, confidence interval [CI]: 1.5-30.1; P = .01; HR: 0.8 per 1-point increase, CI: 0.7-1.0; P = .02, respectively). The relationship between frailty, physical performance score, and death on the waiting list appeared to be independent of age, diabetes, or duration of dialysis. Frailty and decreased physical performance appear to be independently associated with increased mortality on the kidney transplant waiting list. Further studies are needed to determine whether improving frailty and physical performance prior to transplant can decrease waiting list mortality.