Introduction Metabolic syndrome (MetS) poses a significant public health challenge among employed adults. Lifestyle modifications have been shown to be effective in preventing the onset and progression of MetS in employed adults, and the widespread adoption of mobile and wearable technologies introduces an appealing approach to mHealth lifestyle interventions. When widely implementing smartphone-based interventions for employed adults, enhancing equitable access and promoting wearable device use for those with MetS is a more cost-effective way to reduce health disparities, particularly in resource-limited settings. However, relevant evidence is currently lacking.Objective This study aims to design an mHealth-based Healthy Lifestyle Promotion (MYLIFE) trial, a three-arm randomised controlled trial (RCT), to evaluate the effectiveness of a smartphone-based lifestyle intervention and a combined smartphone-based lifestyle intervention with intensive intervention for MetS individuals using wearable devices, in reducing MetS risk among employed adults.Methods and analysis This is a three-arm, parallel, single-blind, cluster RCT with a 12-week intervention and a total follow-up of 1 year. The trial will recruit 120 workplaces from the Chinese Cohort of Working Adults in a 1:1:1 ratio to either a control group or one of two intervention groups. Within these workplaces, a total of at least 348 eligible participants will be enrolled. The regular mHealth group will receive smartphone-based intervention. The intensive mHealth group will receive smartphone-based intervention for all participants, and an additional wearable device-intensive intervention for those with MetS. The primary outcome is the Chinese MetS Z score at 12 weeks. Secondary outcomes include MetS Z score, prevalence of MetS, specific MetS components, questionnaire-based indicators, and clinical outcomes at 12 weeks and 1 years. The main analysis will follow the intention-to-treat principle, using mixed-effects models to assess between-group differences in outcomes.Ethics and dissemination The protocol has been approved by the Ethics Committee of the West China School of Public Health and the West China Fourth Hospital, Sichuan University (Gwll2025024). The findings will be published in peer-reviewed journals and presented at scientific conferences.Trial registration number ChiCTR2500101904.

Abstract Background Osteoporosis and bone loss (OP&BL) are major public health challenges, especially in high-altitude environments with chronic hypoxia. Current diagnostic methods, based on low-altitude populations, are impractical for large-scale screening in resource-limited, high-altitude settings. This study developed a machine learning-based predictive model for OP&BL by integrating oral microbiota data with clinical and questionnaire variables. Methods We analyzed data from 560 Tibetan adults residing at high altitudes. Bone health status (OP&BL vs. normal) was determined by dual-energy X-ray absorptiometry. Oral microbiota profiles were characterized via 16 S rRNA sequencing. After feature selection using elastic net regression, five machine learning models, namely Logistic Regression (LR), Naïve Bayes (NB), Random Forest (RF), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGB), were trained (60%, 337/560) and validated (40%, 223/560). Results Feature selection identified nine predictors: Age, Gender, BMI, oral microbial genera Abiotrophia, Frequency of spicy food consumption (H23), Tooth brushing frequency (J5), Frequency of sweet-drink consumption (J3b), Current marital status (Separated/Divorced, A5_3), and frequency of numbing food consumption (H27). The LR model demonstrated good and stable performance with an AUC of 0.885 (95% CI: 0.823–0.937) on the test set, along with good calibration and the highest net clinical benefit. SHAP analysis indicated that oral factors Abiotrophia and Tooth brushing frequency together accounted for nearly 10% of the model’s total predictive contribution. Conclusions We developed a machine learning model integrating oral microbiota and clinical data for predicting OP&BL in people living above 3500 m. This model could offer a promising non-invasive tool for early screening in resource-limited settings and highlights the potential role of oral factors in high-altitude bone health.

To investigate the presence and clinical impact of response shift (RS) on longitudinal patient-reported outcome (PRO) assessment among older people living with HIV/AIDS (PLWHA), and to evaluate how not accounting for RS may affect the interpretation of changes in PRO at both domain and item levels. A two-wave longitudinal survey with a 3-month interval was conducted among older PLWHA (baseline n = 1245; follow-up rate 84.90

Postmenopausal osteoporosis (PMOP) has high morbidity and devastating complications. However, few studies explored the modifying role of different types of physical activity (PA) in the associations between the number of pregnancies as well as livebirths and the odds of PMOP. This study aimed to investigate the associations of the number of pregnancies and livebirths with PMOP odds. This study used the baseline of the China Multi-Ethnic Cohort study, and a total of 27,459 postmenopausal women were recruited. Bone mineral density and quantitative ultrasound index were measured by quantitative ultrasound bone densitometer. Number of pregnancies and number of livebirths were collected by questionnaires. PA was classified into occupational, transportation, housework, and leisure PA. Logistic regression and multiple linear regression were used to analyze the associations between the number of pregnancies and livebirths and PMOP odds. The modifying effects of PA and its domain-specific types in the associations were analyzed by interaction analysis. A total of 1,539 (5.6

Blue space has been considered a key environmental determinant of metabolic health worldwide. However, the existing relevant studies have focused on only water quantity. Here we investigate the associations of water quantity and quality with metabolic syndrome (MetS) and the underlying potential mechanisms. Our results show that, within 1-km buffer zones around the participants' residence, a higher MetS risk was associated with lower water area percentage (odds ratio of 0.942 (0.895 to 0.992)) and higher frequency of appearance of black-odorous water (FABOW) (odds ratio of 1.220 (1.062 to 1.402)). At large spatial scales (3-5 km), FABOW reversed protective effects of water area percentage when water quality was poor. The association between higher FABOW and MetS risk was mediated partly by reduced moderate-to-vigorous physical activity at small scales (1-2 km) and by elevated particulate matter with aerodynamic diameter <2.5 & micro;m concentration at large scales (3-5 km). This study underscores the importance of considering water quality in assessing the health effects of blue space, advancing the progress towards several sustainable development goals (for example, good health and wellbeing, clean water and sanitation and sustainable cities and communities).

Background: While long-term exposure to air pollutants may increase the risk of non-alcoholic fatty liver disease (NAFLD), the relative contributions of different air pollutants and the role of particulate matter (PMx) size remain elusive. We investigated independent and joint effects of long-term exposure to PM of different sizes (PM1, PM2.5, PM10, PM1-2.5, and PM2.5-10) and gaseous pollutants (NO2, SO2, and CO) on NAFLD incidence, as well as the impact of different PM2.5 components. Methods: This prospective study included 31,105 participants from the Chinese Cohort of Working Adults (CCWA). Newly diagnosed cases of NAFLD were identified through ultrasound-based diagnosis of hepatic steatosis during physical examination. Logistic regression was employed to estimate associations of individual air pollutants and PM2.5 components with NAFLD. Weighted Quantile Sum (WQS) regression assessed the joint effect of air pollutants and their relative contribution to the joint effect. Stratified analyses by demographic, behavioral, and health factors were also conducted. Results: Each interquartile increase in the exposure to individual air pollutants and PM2.5 components was associated with a higher incidence of NAFLD. PM1-2.5 showed the strongest positive association (OR: 1.21, 95 % CI: 1.15-1.28). Among PM2.5 components, organic matter (OM) had the highest independent effect (OR: 1.19, 95 % CI: 1.12-1.26). Among all included pollutants, PM1-2.5 contributed most (71 %) to the joint effect on the NAFLD incidence at follow-up, followed by PM1 (16 %) and NO2 (13 %); of the PM2.5 components, OM contributed the most (56 %). Effects of air pollutants on the NAFLD incidence were more pronounced in men and smokers. Conclusion: Long-term exposure to PM1-2.5 within the PM2.5 size range most importantly affects new-onset NAFLD, and within PM2.5 components OM appears to be the most relevant contributor. This study may provide valuable insights into implementing preventive strategies for NAFLD.

The population-wide lifecourse cohort in Chibi (PowerCC) is the first city-wide, whole-population lifecourse cohort study in China, established to facilitate the precise prediction of disease risks at the individual level and cost-effective resource allocation at the societal level. It employs a data integration platform that, using ID numbers via application programming interfaces, links all sources/systems of dynamic health-related information of all residents in Chibi City (Hubei Province) and synchronizes the database on a regular basis. PowerCC contains basic health profiles, hospital records and health check-up records of all residents from healthcare facilities, follow-up information of those with hypertension/diabetes and a geriatric survey among all aged ≥55 years. As of the end of 2024, the 484,249 residents aged from birth to 105 years (51.61% being male) were included in PowerCC. Here we describe the rationale, design, data sources and maintenance of PowerCC, as well as disease prevalence, health status of all residents, utilization and costs of healthcare resources, and living conditions and needs of the elderly in Chibi. By providing a complete set of electronic health records for each individual, PowerCC enables the coordination of multiple stakeholders for precision health management and the researchers to conduct lifecourse research with unbiased samples. PowerCC is a city-wide, whole-population lifecourse cohort in China that uses a unified, ID-linked platform to integrate longitudinal electronic health records, including hospital data, routine health checks, chronic disease follow-up and geriatric surveys, for nearly half a million residents of Chibi from birth to old age.

Background:The impact of moderate drinking on the risk of liver fibrosis in non-alcoholic fatty liver disease (NAFLD) remains controversial worldwide. Notably, China, with the fastest-growing incidence of NAFLD and the highest number of alcohol-attributable deaths globally, has relatively few studies addressing this issue. This study aimed to explore the association between alcohol consumption and liver fibrosis in Chinese men with metabolic dysfunction-associated steatotic liver disease (MASLD). Methods:We recruited 4,683 male employees diagnosed with MASLD from southwest China, including 4,287 with pure MASLD and 396 with metabolic and alcohol-related liver disease (MetALD) who consumed increased alcohol (30-60 g/d). Advanced fibrosis was defined as a fibrosis-4 index (FIB-4) ≥ 2.67, and FIB-4 ≥ 1.30 indicated an intermediate/high probability of hepatic fibrosis. Logistic regression models were used to assess the association between alcohol consumption and hepatic fibrosis, and analyze the modification effect of body mass index (BMI) and waist-to-hip ratio (WHR) on the association. Propensity score matching method was used to test the robustness of the regression results. Results:Compared with non-drinkers, both moderate (OR = 3.02, 95% CI: 1.16-10.31) and increased alcohol consumption (OR = 4.64, 95% CI: 1.60-16.82) were significantly associated with an increased risk of advanced fibrosis in males with MASLD. Additionally, moderate (OR = 1.33, 95% CI: 1.07-1.66) and increased drinking (OR = 1.74, 95% CI: 1.28-2.34) were associated with intermediate/high probability of hepatic fibrosis, with similar results from logistic regression analysis in propensity score-matched cases. Trend analysis revealed the risk of hepatic fibrosis increased with increasing alcohol intake (FIB-4 ≥ 1.30, p for trend < 0.001; FIB-4 ≥ 2.67, p for trend = 0.007). Further subgroup analysis showed that the association between moderate drinking and intermediate/high probability of hepatic fibrosis was predominantly observed in males with BMI ≥ 23 kg/m2 (OR = 1.35, 95% CI: 1.08-1.69) and those with WHR ≥ 0.9 (OR = 1.40, 95% CI: 1.11-1.78). Conclusion:In China, moderate alcohol intake may heighten the risk of hepatic fibrosis in males with MASLD who are overweight/obese or have abdominal obesity. Moreover, males with MetALD may have a higher risk of fibrosis compared to those with pure MASLD.

Background:Fertility desire-based service guided by behavioral theory is a potential strategy to mitigate the HIV transmission risk, while related evidence remains scarce. We examined the long-term effect of theory-guided fertility desire-based services on HIV seroconversion between seropositive and seronegative partners in areas with high HIV prevalence and a cultural emphasis on fertility in China.Methods:We established a retrospective cohort by recruiting 8653 seropositive partners with seronegative partners between January 1, 2009, and December 31, 2020, in Liangshan, China. The differences in HIV seroconversion between partners who received fertility desire-based services guided by the extended Information-Motivation-Behavioral Skills model and those who did not were estimated, based on multivariable and inverse probability weighting adjusted multivariable Cox regression models. Subgroup analysis was conducted based on participants' demographic and HIV-related characteristics.Results:Among the 8653 HIV-seropositive partners, 7958 (92.0%) and their seronegative partners received fertility desire-based services. At the end of the 12-year follow-up, 18 seronegative partners who did not receive fertility desire-based services experienced HIV seroconversion (incidence density: 7.4/1000 person-years), while 98 seronegative partners receiving such services exhibited HIV seroconversion (3.4/1000 person-years). Fertility desire-based services significantly reduced the risk of HIV seroconversion according to multivariable (HR = 0.32, 95% CI: 0.19 to 0.53) and inverse probability weighting-adjusted multivariable Cox regression models (HR = 0.48, 95% CI: 0.27 to 0.84). The effect of fertility desire-based services was more pronounced in men and those older than 40 years.Conclusions:Fertility desire-based services based on the extended Information-Motivation-Behavioral Skills model may help reduce the HIV transmission risk between seropositive and seronegative partners in areas with high HIV prevalence.

Background:Hyperuricemia is a recognized predictor of hypertension. However, the consistent link between elevated serum uric acid (SUA) levels and hypertension risk across different age groups, especially in males, remains a subject of debate. This study aimed to examine the association between SUA trajectories and the risk of new-onset hypertension, focusing on age-group disparities. Methods:We conducted a longitudinal study of 4,221 male employees from Southwestern China, initially free of hypertension, over a 4-year period (2018-2021). All employees underwent annual physical examinations each year. Incident hypertension was defined as newly detected blood pressure ≥140/90 mmHg, or the initiation of anti-hypertensive medication. We employed group-based trajectory modeling to identify the trajectory patterns of SUA levels over the study period. Logistic regression was used to assess the association between these SUA trajectories and the risk of developing hypertension. Additionally, subgroup analyses were conducted by stratifying participants into young (<45 years) and middle-aged (≥45 years) groups, with sensitivity analyses conducted using additional cutoffs of 40 and 50 years. Results:Four distinct SUA trajectories were identified: low (21.18%), moderate-low (45.44%), moderate-high (28.26%), and high (5.12%). The 4-year cumulative incidence of hypertension was 13.2%. Compared to the low SUA trajectory, the high SUA trajectory was independently associated with an increased risk of developing hypertension (OR = 2.22, 95% CI 1.43-3.43). The risk of developing hypertension increased significantly with higher SUA trajectories (P for trend = 0.003), and this dose-response relationship was modified by age (P for interaction = 0.026). In male employees under 45 years, the high SUA trajectory was associated with a higher risk of hypertension (OR = 1.78, 95% CI 1.04-3.07) compared to the low SUA trajectory, while no significant association was found in male employees over 45 years (OR = 2.22, 95% CI 0.89-5.33). Sensitivity analyses showed a significant association in males <40 years (OR = 2.17), a borderline association in those aged 40-49 (OR = 2.07, P = 0.053), but none in those ≥50 (OR = 1.22). Conclusion:Persistently high SUA levels may elevate hypertension risk in males, particularly younger individuals. Age-specific management of SUA may be necessary for hypertension prevention, with early intervention in young men likely yielding greater benefits than in middle-aged men.

Gut microbiota affects host health and disease. Large-scale cohorts have explored the interactions between the microbiota, host, and environment to reveal the disease-associated microbiota variation. A population-level gut metagenomic cohort is still rare in China. Here, we performed metagenomic sequencing on fecal samples from the CMEC Microbiome Project in Southwest China. In this study, we identified host socioeconomics, diet, lifestyle, and medical measurements that were significantly associated with microbiome function and composition. We revealed extensive novel associations between the host microbiome and common metabolic disorders. Our results provide new insight into associations of gut microbiota with metabolic disorders so as to support the translation of gut microbiome findings into potential clinical practice.

Objectives: Human behaviors and blood pressure (BP) are closely intertwined, affecting health. However, few studies have demonstrated their complex relationships. Using network analysis, we aimed to untangle the intricate and potential causal relationships between BP and human instinctive behaviors, identifying potential action points for hypertension prevention and control. Study design: Cohort study. Methods: This study is based on two-wave data from 11,277 Chinese adults in the China Multi-Ethnic Cohort (CMEC) and an independent validation cohort of 21,947 adults from the Chinese Cohort of Working Adults (CCWA). We conducted a cross-sectional network analysis to estimate the interrelationships between measured BP and self-reported physical activity (PA), diet, and sleep. The centrality of each variable within the network was estimated using strength centrality index. Additionally, we performed a longitudinal network analysis to infer the potential causal relationships between BP and human instinctive behaviors in participants with normal or above-normal BP. Results: The network models suggested that BP exhibited negative associations with the dietary score (edge weight: -0.09) and sleep duration (-0.05). Non-sedentary behavior and dietary score were the most central variables, strongly connecting BP and other lifestyles. Higher BP predicted a poorer dietary score (beta = -0.21) in participants with above-normal BP. The effect of BP on dietary score was replicated in the validation cohort and validated by linear regression analysis. Conclusions: Non-sedentary behaviors and dietary behaviors may be the potential action points in promoting healthy behaviors and contributing to BP management. It is essential to manage individuals' BP status, nonsedentary behaviors, and dietary behaviors to disrupt malignant cycles.

The COVID-19 pandemic has impacted all sectors of society, with effects that have been acutely experienced at the local, national, regional, and global levels. This study examined the heterogeneous impacts of and vulnerability to COVID-19 for promoting urban sustainability and resilience. We performed a scoping review on the basis of the relevant literature from the Web of Science and PubMed, and a national survey conducted among a total of 5,376 participants in early 2020. The survey adopted a repeated cross-sectional design to study changes in residents’ risk perception of COVID-19 across the three stages (21–23 January, 27–28 February, and 24–27 March), using a snowball sampling method to recruit 2,144, 2,021, and 1,211 participants, respectively. This study revealed that the spatial, social, economic, and health impacts of COVID-19 have not been distributed evenly among populations, with specific individuals and communities more vulnerable than others. Among the determinants of these inequalities are socioeconomic status, housing arrangements, and working requirements, which influence the extent to which people can safely adhere to stay-at-home and social distancing policies and how they perceive risks. Additionally, racial/ethnic minorities face differing risks, in part because of socioeconomic factors but also because some groups experience higher shares of comorbidities. Moreover, overall, these risk factors are the healthcare systems meant to shield individuals and communities from pandemic impacts, which, however, have become increasingly taxed due to the sudden influx of patients and the resultant shortages of resources – including crucial personal protective equipment to minimize interpersonal transmission. Understanding the heterogeneous impacts of and vulnerability to COVID-19 could inform the design of environmentally sustainable and socially resilient cities, making them better equipped to encounter future epidemics. This study would help us identify more effective and equitable solutions to the ongoing challenges of the pandemic, promoting sustainability and resilience at multiple societal levels.

Air pollutants have been known as the most persistent environmental risk factors of elevated blood pressure (BP). However, most of the existing studies measured resting BP only, which is not accurate as ambulatory BP. This study investigated the effects of short-term exposure to air pollutants on ambulatory BP. Wearable devices were used to measure personal ambulatory systolic BP (ASBP) and diastolic BP (ADBP) and movement trajectories of 172 participants for one week, with a 1-min interval. Daily concentrations of the six major air pollutants were estimated at a spatial resolution of 1 km. Linear mixed-effect models and distributed lag non-linear models estimated the associations between air pollutant exposure and ambulatory BP. ASBP was positively associated with PM2.5 (β = 0.010 [95

Whether the role of gut microbial features lies in the pathways from lifestyles to dyslipidemia remains unclear. In this cross-sectional study, we conducted a metagenome-wide association analysis and fecal metabolomic profiling in 994 adults from the China Multi-Ethnic cohort. A total of 26 microbial species were identified as mediators between lifestyle factors and risk for dyslipidemia. Specifically, the abundance of [Ruminococcus] gnavus mediated the associations between lifestyles and risks for dyslipidemia, elevated low-density lipoprotein cholesterol, elevated total cholesterol, and elevated triglycerides. [Ruminococcus] gnavus, Alistipes shahii, and Lachnospira eligens were replicated to be associated with dyslipidemia in an external validation cohort. The potential metabolic pathways included arachidonic acid, bile acid, and aromatic amino-acid metabolism.

Physical activity (PA) engagement can improve bone mineral density (BMD), while how varying PA patterns affect BMD in adults and the potential mechanisms remain unclear. This study investigated the associations between PA trajectories and BMD and examined whether skeletal muscle and body fat partially explained these associations. In total, 393 participants from the Healthy Lifestyle Promotion Cohort completed three waves of surveys from 2018 to 2023. PA trajectories were identified using an optimal Latent Class Trajectory Modeling method. Areal BMD (aBMD) at the hip and volumetric BMD (vBMD) at the lumbar spine were derived from Quantitative Computed Tomography, and skeletal muscle index (SMI) and percent body fat (PBF) were measured using multi-frequency bioelectrical impedance analysis. The associations between PA trajectories and current BMD were estimated by regression models, and indirect associations through SMI and PBF were determined using a regression-based mediation analysis. Four PA trajectories were observed, including steady low-PA (44.53

BACKGROUND:Circadian syndrome (CircS) may be closely linked to lifestyle, psychological, and occupational factors, but evidence is lacking. This study aimed to explore complex associations between lifestyle, psychological and occupational factors and CircS among employed people in southwestern China. METHODS:In this study, network analysis was used to identify complex associations between lifestyle, psychological and occupational factors and CircS in employed people from the Chinese Cohort of Working Adults (CCWA). The centrality of each variable was estimated by strength centrality index, which was calculated by the sum of edge weights connected to the variable. Bridge in the network was identified as the variables in the top 80 th percentile of overall bridge strength, which was defined as the most strongly connected variables across lifestyle, psychological and occupational factors and CircS. The differences were assessed in network structures between subgroups divided by the median score of the variable with the strongest bridge strengthen. RESULTS:Among 31,105 participants from CCWA, 5213 (16.76%) had CircS. In the constructed network, anxiety (edge weights: 0.28), smoking (edge weights: 0.15), drinking (edge weights: 0.10), perceived noise at work (edge weights: 0.08), and implicit health attitude (edge weights: -0.02) were directly related to CircS, with 83.31% of the variance for CircS explained by these neighboring factors. Anxiety was the most central variable (strength centrality: 1.20) in the network and the strongest bridge (bridge strength: 0.84) connecting all domains of variables. A stronger association between anxiety and CircS was observed in the network of participants with more severe anxiety (edge weight: 0.23) than those with less severe anxiety (edge weight: 0.03). CONCLUSION:Anxiety had the strongest association with CircS and was the central factor with the highest strength centrality, also the bridge with the highest bridge strength in the network.