To explore the impact of baseline lung function on the trajectory of frailty over time. Lung function could be considered a vital predictor of the development and progression of frailty among older adults. Managing and maintaining lung function early may have a positive effect on the robust status and quality of later life. To investigate the effect of baseline lung function on the trajectory of frailty over time. This longitudinal study included 3,658 adults aged 60 and over (average age 70.4 years old and 46.4

Gender differences in depression trajectories and their effects on cognitive function are poorly understood. This article aims to identify depression trajectories in both genders and further explore the association of depression trajectories with executive and memory functions by gender. A total 3990 participants aged 50 years or older with repeated measurements from waves 1 to 7 (wave 3 excluded) of the Study of the Survey of Health, Ageing and Retirement in Europe (SHARE) were included. Group-based trajectory modeling (GBTM) was conducted to identify the optimal number of depression trajectories. Generalized estimating equation (GEE) models were used to examine the relation of depression trajectories to cognitive function after stratification by gender. Three distinct depression trajectories were identified in both genders, but the patterns of trajectories among genders were nonidentical. The trajectories of depression in males were characterized by non-low, moderate, persistent depressive symptoms but with an unstable trend, while in females, they were characterized by non-low, moderate, persistent-depressive symptoms and with a worsening trend. The prevalence of persistent high depression in women (20.08%) was higher than that in men (3.13%). Moderate and persistent high depression trajectories were negatively associated with episodic memory (beta =-0.53 and-0.72, respectively, p < 0.001) and verbal fluency in females (beta =-0.96 and-1.47, p=0.01 and < 0.001, respectively). Older women had a greater frequency of developing depression than older men. Gender differences in depression trajectories existed. Moderate and persistent high depression trajectories exerted a negative effect on some domains of cognitive impairment only in females.

Objective: To investigate the association of urinary incontinence with depressive symptoms, and to explore the mediating effect of functional limitations on this association. Methods: This cross-sectional study included 7039 adults aged 50 and over from the English Longitudinal Study of Aging (Wave 8). Urinary incontinence was defined as whether the participants experienced urinary incontinence in the past 12 months. Depressive symptoms were assessed based on the Center for Epidemiologic Studies -Depression Scale. Functional limitations included disability of activities of daily living, instrumental activities of daily living, mobility and large muscle groups limitation of the participants. Logistic regression based on Karlson/Holm/Breen (KHB) method was applied to estimate the association of urinary incontinence with depressive symptoms and explore the mediating effect of functional limitations. Results: Urinary incontinence was significantly associated with increased risk of depressive symptoms after controlling covariates (odds ratio = 1.75, 95 % confidence interval: 1.45-2.11). Functional limitations explained 36.96 % of this association. Conclusion: Urinary incontinence might be associated with an increased risk of depressive symptoms among middle-aged and older adults and functional limitations partially mediate this association. Improving physically functional capacity might play an important role in preventing and managing depressive symptoms in elderly people with urinary incontinence.

Background We aimed to investigate the associations of various genetic variants in the nicotine metabolism pathway with smoking cessation (SC) in the Chinese Han population. Method A case-control study was conducted where 363 successful smoking quitters were referred to as cases, and 345 failed smoking quitters were referred to as controls. A total of 42 genetic variants in 10 genes were selectedand genotyped. The weighted gene score was applied to analyze the whole gene effect. Logistic regression was used to explore associations of each genetic variant and gene score with smoking cessation. Results Our study found that the variants CYP2A6∗4, rs11726322, rs12233719, and rs3100 were associated with a higher probability of quitting smoking, while rs3760657 was associated with a lower probability of quitting smoking. Moreover, the gene scores of CYP2D6, FMO3, UGT2B10, UGT1A9, UGT2B7, and UGT2B15 were shown to exert a positive effect, while the gene score of CYP2B6 was detected to exert a negative effect on successful smoking cessation. Conclusion This study revealed that genetic variants in the nicotine metabolic pathway were associated with smoking cessation in the Chinese Han population.

Objectives: The present study aimed to explore the interaction between grip strength and physical activity on depression, and investigate the association of physical activity with the change in depression by different grip strength groups among middle-aged and older European adults. Methods: A total of 13936 participants aged 50 years or older from the Survey of Health, Ageing and Retirement in Europe 2007-2017 were included in this study. Group-based trajectory modeling was used to identify the low, middle and high group of grip strength by gender. Generalized estimated equations were fitted to analyze the interaction effect. Results: Significant interactions between grip strength group and physical inactivity were found (O interaction= 16.70, p<0.001). Significant interactions between physical inactivity and time on depression were identified in low (b interaction= 22.15, p<0.001) and moderate (j interaction= 22.85, p<0.001) grip strength, but a similar result was not found in high grip strength (e interaction= 3.20, p=0.526). Participants in the physical inactivity group had higher depression scores in the low and moderate grip strength group. Conclusions: Grip strength and physical inactivity have interaction with depression. Lower grip strength and insufficient physical activity could increase depressive symptoms. People with lower grip strength and physical inactivity should pay special attention to the prevention of depression.

Single measurements of waist circumference (WC) can predict the incident hypertension, while dynamic change patterns of WC during young adulthood and their association with the incidence of hypertension are poorly demonstrated. This study aimed to identify the longitudinal WC trajectories during young adulthood and explore their association with the risk of incident hypertension. We utilized the data from the China Health and Nutrition Survey (1993–2015) and included 6604 participants aged 18–50 years with repeated WC measurements of 3–8 times and information on incident hypertension. The group-based trajectory model was used to identify WC trajectories. Cox proportional hazard model was conducted to evaluate the association of WC trajectories with the risk of incident hypertension. We identified four distinct WC trajectories during young adulthood. Participants with the low-increasing and the moderate-increasing trajectories had increasing but normal WC, while those with the high-increasing and the sharp-increasing trajectories developed from non-abdominal obesity to abdominal obesity. Compared with the low-increasing trajectory, the adjusted hazard ratios (95% confidence intervals) were 1.48 (1.16–1.89), 2.50 (1.84–3.40), and 3.86 (2.40–6.21) for the moderate-increasing, the high-increasing, and the sharp-increasing trajectories, respectively. After further excluding participants with obesity at baseline, this association did not alter substantially. The gender-specific trajectory analyses yielded similar results. WC trajectories during young adulthood were significantly associated with the risk of incident hypertension in Chinese. Moreover, even the increasing WC trajectory within the normal range during young adulthood might increase the risk of hypertension.

目的 采用两样本孟德尔随机化方法探索肺功能与新型冠状病毒肺炎(COVID-19)病死风险之间的因果关联.方法 对基于全基因关联研究(GWAS)的汇总数据进行二次数据分析.利用大样本GWAS汇总数据,选择与肺功能密切关联的遗传位点作为工具变量,分别用逆方差加权法、MR-Egger回归和加权中位数法做两样本孟德尔随机化分析,以OR值评价肺功能与COVID-19病死风险之间的因果关系.结果 共纳入287个单核苷酸多态性作为工具变量,MR-Egger回归结果表明基因多效性不会对结果造成偏倚(P=0.107).逆方差加权法结果显示,肺功能每增加一个标准差,会导致COVID-19患者病死风险降低62％(OR=0.38,95％CI:0.18～0.80).MR-Egger回归也得到了相似的结果(OR=0.08,95％CI:0.01～0.61).加权中位数法结果显示肺功能与COVID-19病死风险之间关联无统计学意义(OR=0.44,95％CI:0.14～1.42).结论 肺功能与COVID-19病死风险之间可能存在负向因果关联.

Objective: To explore the relationship between age at menarche and general obesity (based on BMI) and central obesity (based on WC or WHtR) in middle-aged and elderly women in China. Methods: A total of 6 363 women from the China Health and Retirement Longitudinal Study were included. Restricted cubic splines based on binary logistic regressions were used to analyze the relationship between age at menarche and the risk of obesity. Age at menarche was divided into four groups: ≤13, 14- (control group), 16- , and ≥18 years old. Binary logistic regressions were applied to analyze the relationship between the continuous or grouped variable of age at menarche and the risk of obesity. Results: After adjusting potential confounders, the age at menarche showed a negative linear relationship with the risk of general obesity and central obesity. The risk for obesity based on BMI, WC and WHtR significantly decreased by 6% (OR=0.94, 95%CI: 0.90-0.99), 4% (OR=0.96, 95%CI: 0.92-1.00), and 6% (OR=0.94, 95%CI: 0.90-0.99) for each 1 year increase in age at menarche. Compared with participants who had menarche at age 14- years old, the risk for obesity based on BMI (OR=0.71, 95%CI: 0.55-0.91), WC (OR=0.75, 95%CI: 0.62-0.92) and WHtR (OR=0.76, 95%CI: 0.61-0.96) significantly decreased by 29%, 25%, and 24% in participants who had menarche at age ≥18 years old. Conclusions: There was a negative linear relationship between age at menarche and the risk for general obesity and central obesity in middle-aged and elderly women in China. Older age at menarche might be negatively associated with risk for obesity in middle-aged and elderly women.

目的 探究血清尿酸(serum uric acid,SUA)在脂肪摄入水平与肾功能损伤关系中的中介效应.方法 对来自2009年中国健康与营养调查(China Health and Nutrition Survey,CHNS)的8187名具有完整血液检测信息的成人进行分析.肾功能损伤定义为肾小球滤过率(esti-mated glomerular filtration rate,eGFR) ＜60 ml/(min/1.73m2).通过计算脂肪摄入量占总能量摄入量的百分比来评估脂肪摄入水平.使用基于二分类Logistic回归分析模型的限制性立方样条(re-strictive cubic spline,RCS)探究脂肪摄入水平与肾功能损伤之间的剂量反应关系.采用Karlson-Holm-Breen分解方法中的Logistic回归进行中介分析.结果 脂肪摄入水平与肾功能损伤呈线性正相关(β=0.015,95％ CI:0.007～0.023,P＜0.001).SUA的中介作用占脂肪摄入水平对肾功能损伤总效应的13.33％(P=0.014).结论 在中国成年人中,脂肪摄入水平增加可能会增加肾功能损伤的风险,其可能通过引起SUA水平升高而导致肾脏损害的发生.

BACKGROUND:Haemorrhagic fever with renal syndrome (HFRS) is climate sensitive. HFRS-weather associations have been investigated by previous studies, but few of them looked into the interaction of meteorological factors on HFRS in different climate zones. OBJECTIVE:We aim to explore the interactions and marginal effects of meteorological factors on HFRS in China. METHODS:HFRS surveillance data and meteorological data were collected from 254 cities during 2006-2016. A monthly time-series study design and generalized estimating equation models were adopted to estimate the interactions and marginal effects of meteorological factors on HFRS in different climate zones of China. RESULTS:Monthly meteorological variables and the number of HFRS cases showed seasonal fluctuations and the patterns varied by climate zone. We found that maximum lagged effects of temperature on HFRS were 1-month in temperate zone, 2-month in warm temperate zone, 3-month in subtropical zone, respectively. There is an interaction effect between mean temperature and precipitation in temperate zone, while in warm temperate zone the interaction effect was found between mean temperature and relative humidity. CONCLUSION:The interaction effects and marginal effects of meteorological factors on HFRS varied from region to region in China. Findings of this study may be helpful for better understanding the roles of meteorological variables in the transmission of HFRS in different climate zones, and provide implications for the development of weather-based HFRS early warning systems.

Objective: The aim of this study was to assess the association of early menopause with diabetes and the mediating effect of abdominal obesity. Methods: This cross-sectional study was conducted among 5,693 participants. The data from the second follow-up (2015) of the China Health and Retirement Longitudinal Study were used. Participants self-reported their age at menopause and were divided into three age groups (<45, 45-54, and >54 years) according to the 10th, 10th to 90th, and 90th percentiles, with a menopausal age of 45 to 54 years serving as reference. The total effect was decomposed into direct and indirect (mediating) effects using logistic regression based on the Karlson-Holm-Breen method. Results: Compared to the menopausal age of 45 to 54 years, early menopause (<45 years) was associated with diabetes (odds ratio = 2.19, 95% CI: 1.29-3.69) among Chinese women. The mediating effect of early menopause (<45 years) on diabetes was 4.98% (P = 0.321) for abdominal obesity. Conclusions: Early menopause may be associated with diabetes among Chinese women. Moreover, the mediating effect of abdominal obesity makes up a small percentage and has no statistical significance. Further studies are needed to examine other mechanisms behind the association of early menopause with diabetes.

Objective: This study aimed to assess the relationship between waist-to-height (WHtR) and estimated glomerular filtration rate (eGFR) in men, non-menopausal, and postmenopausal women among middle-aged and elderly Chinese. Methods: This study analyzed the data of 7,807 participants in a cross-sectional survey, ie, the third wave of the China Health and Retirement Longitudinal Study. Restrictive cubic-spline regression with three knots was used to assess the dose-response association of WHtR with eGFR. Piecewise linear regression models were further established to calculate the slope of each segment and their 95% confidence interval (CI). Results: After adjusting for potential confounders, an inverse L-shaped dose-response relationship was found between WHtR and eGFR among men (P-nonlinear = 0.024, threshold = 0.513) and postmenopausal women (P-nonlinear = 0.009, threshold = 0.503). The slopes on the right sides of the threshold were statistically significant among men (beta(2) = -33.77, 95% CI: -53.23 to -14.31) and postmenopausal women (beta(2) = -36.53, 95% CI: -49.71 to -23.35), respectively. A weak negative linear relationship existed between WHtR and eGFR in non-menopausal women. Conclusions: The relationship between WHtR and eGFR tended to be inverse-L-shaped in men and postmenopausal women, but may vary with postmenopausal status in women.

PURPOSE:The aim was to investigate whether serum uric acid (SUA) was associated with incident hypercholesterolaemia and hypertriglyceridaemia in middle-aged and older Chinese. METHODS:This prospective cohort study used data from the China Health and Retirement Longitudinal Study. A total of 6,063 participants were included, who were free of hypercholesterolaemia and hypertriglyceridaemia at baseline (2011) and were followed until 2015. Natural cubic spline models were conducted to investigate the dose-response association of SUA with incident hypercholesterolaemia and hypertriglyceridaemia. Moreover, SUA was categorized into four groups according to gender-specific quartiles. Log-binomial regression was performed to explore the association of SUA with hypercholesterolaemia and hypertriglyceridaemia, with the quartile 1 as a reference. RESULTS:After full adjustment, we observed a positive linear dose-response relationship between SUA and hypercholesterolaemia and hypertriglyceridaemia. Compared with the quartile 1 of SUA, the adjusted risk ratios (95% confidence interval) of hypertriglyceridaemia were 1.15 (0.95-1.39), 1.23 (1.02-1.49) and 1.31 (1.08-1.59) for quartile 2-4 (p-value for trend = .004), respectively. Whereas, we failed to find SUA significantly associated with hypercholesterolaemia. Sex-stratified analyses indicated that the association of SUA with hypertriglyceridaemia was more evident in the female. CONCLUSIONS:These findings suggest that SUA may be positively associated with incident hypertriglyceridaemia. KEY MESSAGES The natural cubic spline model showed a positive linear dose-response relationship between serum uric acid levels and hypertriglyceridaemia. Compared with the quartile 1 of SUA, the adjusted risk ratios (95% confidence interval) of hypertriglyceridaemia were 1.15 (0.95-1.39), 1.23 (1.02-1.49) and 1.31 (1.08-1.59) for quartile 2-4 (p-value for trend = .004), respectively. Sex-stratified analyses indicated that the association of serum uric acid with hypertriglyceridaemia was more evident in the female.

For assessing the effect and threshold of PM2.5 on mortality in highly polluted areas and further studying the standard applicability, daily data on meteorological factors, air pollutants, and mortality were obtained in Jinan, China, from 2011 to 2017. A generalized additive model (GAM) and a distributed lag non-linear model (DLNM) were employed to assess the nonlinearity and the hysteresis of associations. We further explored the breakpoints to evaluate the existence of the threshold. The correlation between mortality and PM2.5 was nonlinear. The impact of average PM2.5 on non-accidental mortality (RR = 1.11; 95% CI = 1.06, 1.16), cardiovascular disease (CVD) mortality (RR = 1.17; 95% CI = 1.10, 1.24), and respiratory disease (RD) mortality (RR = 1.17; 95% CI = 1.10, 1.24) reached the highest in the current day (lag 0). The excess risks of PM2.5 at secondary standard level to non-accidental, CVD, and RD mortality are 8.79% (95% CI = 3.84, 13.98), 14.41% (95% CI = 7.79, 21.43), 15.35% (95% CI = 1.76, 30.74), respectively. The saturation points exist in highly polluted areas. Above the saturation points of 247 μg/m3 for non-accidental mortality, 245 μg/m3 for CVD mortality, and 250 μg/m3 for RD mortality, the model of all three relationships presented a harvesting effect. This study underscores the necessity of the ongoing efforts of reducing particulate air pollution and the adjustment of the standards in seriously polluted areas to adapt to regional conditions. At the same time, for highly polluted areas, it is advocated to strengthen personal protection to decrease the saturation point and control the concentration of pollutants as much as possible, which will substantially save more cost that benefits the public.

Objective: The aim of this paper was to identify shapes of the curves between weekly working hours (WWH) and mental health status (MHS) and determine WWH for the best MHS in 13 occupations. Methods: This cross-sectional study applied public data of the 2015 to 2016 California Health Interview Survey. Restricted cubic spline regression was used to determine non-linear trends. Results: A statistically significant nearly V-shaped curve was demonstrated between WWH and MHS in total population, men and management, business and finance occupations. WWH for the best MHS were 42, 45, and 46 hours, respectively. Conclusion: These results suggest MHS be susceptible to WWH in total population, men and management, business and finance occupations. WWH for the best MHS for relevant populations could provide evidence for better work hours regulations in California.

Objective For assessing the nonlinearity and delayed effect of temperature on incidence of tuberculosis and effect modification by meteorology factors, daily data on meteorological factors, air pollutants and incidence were obtained in Jinan, China, from 2012 to 2015.Methods A distributed lag non-linear model (DLNM) combined with quasi-Poisson regression model was employed to assess the associations. We further built a series of weather-stratified models to assess the effect modification by meteorological factors.Results The correlation between tuberculosis cases and daily average temperature (Tmean) was negatively nonlinear with a delayed effect. At the current day (lag 0), the increase of Tmean decreased the risk of tuberculosis incidence; over lag 0-70 days, the decrease of low Tmean and the increase of the high Tmean both indicated the increased risk of TB. The cold temperature showed an immediate effect at the current day, with a harvesting effect in the following days. The effect modifications by relative humidity, wind speed and sunshine duration were observed. Conclusion The cold effect accelerates the onset of potentially infected people in the short term. It is necessary to consider effect modification by meteorological factors in assessing temperature effects on incidence of tuberculosis. Which might shed light on the strategy of tuberculosis prevention and control.

Background Several studies have revealed conflicting results regarding the relationship between serum uric acid (SUA) and blood glucose concentrations. The aim of this study was to identify the shape of the curve between SUA and either fasting plasma glucose (FPG) or HbA1c in diabetic and non-diabetic participants. Methods This cross-sectional study of the relationship between SUA and diabetes and non-diabetes was conducted in 10 266 participants. Data from the national baseline survey of the China Health and Retirement Longitudinal Study (CHARLS; 2011-12) were used. Restrictive cubic spline regression and two piecewise linear regression models were used to detect non-linear trends and calculate the slope of each segment. Results After adjusting for all confounding factors in all subjects, an L-shaped relationship was found between FPG and SUA in males (beta(2) = 3.47, P < 0.01) and females (beta(2) = 5.84, P < 0.01), as well as between HbA1c and SUA in males (beta(2) = 0.10, P = 0.03) and females (beta(2) = 0.12, P = 0.02). In non-diabetic individuals, there was a positive linear correlation between FPG and SUA in females (beta = 0.62, P = 0.02). After a diagnosis of diabetes, a negative linear relationship was found between SUA and blood glucose in males, and a nearly L-shaped curve was found in females. Conclusions An L-shaped association was found between SUA and blood glucose in both genders. Stratified analysis revealed an L-shaped curve only in diabetic females. Further studies are warranted to investigate the mechanisms of the association between uric acid and blood glucose levels.

Objective:To assess the effect of treatment on limiting weight gain in abstainers using and not using varenicline and during the nontreatment phase. Methods:The PubMed, Medline, EMBASE and Cochrane Library databases were searched to identify relevant studies published in English or Chinese. A meta-analysis was performed to calculate pooled weighted mean differences (WMDs) in weight gain in smokers after smoking cessation between varenicline and control groups and their corresponding 95% CIs. The I2 statistic was used to measure heterogeneity. Publication bias was evaluated using Egger's regression asymmetry test. Results:A total of 10 studies were included. The WMD in weight gain in abstainers between varenicline and control groups was -0.23 kg (95% CI: -0.36 to -0.09, P < 0.05). Moreover, the result of the subgroup analysis by timepoint of weight measurement indicated that the WMD in weight gain in smokers after smoking cessation between varenicline and control groups after the 12-week treatment phase was -0.23 kg (95% CI: -0.37 to -0.08, P < 0.05), and the WMD observed during the nontreatment follow-up phase was -0.69 kg (95% CI: -2.15 to 0.77, P > 0.05). In addition, the result of the subgroup analysis by type of control showed that the WMD in weight gain in abstainers from smoking between the varenicline and placebo groups was -0.29 kg (95% CI: -0.46 to -0.12, P < 0.05), and the WMD between the varenicline and other control groups was -0.20 kg (95% CI: -0.77 to 0.37, P > 0.05). Conclusion:Varenicline was associated with a modest limitation in weight gain in smokers after smoking cessation; however, the impact of varenicline use was not long-term, and, in fact, no different from that of the placebo treatment.

BackgroundOnly a few studies have investigated the effects of daytime napping on diabetes, and these studies have reported conflicting results. The aim of the present study was to examine whether daytime napping is associated with a higher risk of prediabetes and diabetes. MethodsThe present cross-sectional study of napping duration in relation to prediabetes and diabetes was conducted in 12277 participants. Data from the first wave (2011) of the China Health and Retirement Longitudinal Study were used. Daytime napping was divided into four groups: no napping (reference) and napping for 1-30, 31-90, and >90min. Multinomial logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). ResultsIndividuals who reported taking daily afternoon naps accounted for 53.39% of all participants. Nappers had a higher prevalence of prediabetes and diabetes than non-nappers. Compared with the reference group, the weighted fully adjusted ORs (95% CI) were 1.36 (1.10-1.68) and 1.61 (1.22-2.13) for napping >90min in prediabetic and diabetic patients, respectively. ConclusionsLong daytime napping duration was positively associated with prediabetes and diabetes. Further physiological and cohort studies are needed to confirm these results and elucidate potential mechanisms.

INTRODUCTION:Previous studies have found serotonergic pathway genes have inhibitory effects on dopamine system which may influence smoking addiction. This study examined the associations of serotonergic pathway genes (serotonergic receptor genes, solute carrier family 6 member4 and tryptophan hydroxylase gene) with smoking cessation.MATERIALS AND METHODS:Male current and former smokers (n=819) were recruited from 17 villages of three counties in Shandong province, China. DNA was extracted from the blood samples. Eleven single nucleotide polymorphisms (SNPs) in serotonergic pathway genes were genotyped. Multiple logistic regression was used to assess associations between SNPs and smoking cessation. Pearson's χ2 test was performed to explore associations of haplotypes with smoking cessation. Multiple logistic regression was used to detect the interaction between SNPs on smoking cessation.RESULTS:In multiple logistic regression, rs1042173 of Solute carrier family 6 member 4 was significantly related to smoking cessation in additive and dominant model (p=0.03 and 0.02, respectively). Rs4570625 of tryptophan hydroxylase 2 was significantly associated with smoking cessation in dominant model (p=0.03). Nine significant interactions were detected between SNPs in serotonergic pathway genes.CONCLUSIONS:The present study reveals that serotonergic pathway genes were significantly related to smoking cessation. Future research should expand upon these findings to confirm them.