Current evidence remains limited regarding associations between serum indirect bilirubin (IBIL) levels and chronic kidney disease (CKD) risk, particularly in gender-stratified analyses. This study investigated the gender-specific relationship between serum IBIL and CKD incidence. Using data from a prospective cohort in northwestern China, we followed 25,684 CKD-free participants. Cox proportional hazards models and restricted cubic spline regression were employed to assess IBIL-CKD associations. The discriminatory performance of IBIL was evaluated through ROC curve analysis. Robustness of results was examined via subgroup and sensitivity analyses. Over 122,401.17 person-years of follow-up, 1,219 incident CKD cases were identified. Adjusted hazard ratios (95

With the rapid development of global metal exposure, while there is evidence indicating the toxicity of individual metals, the combined impact of mixed exposure of multiple metals on primary liver cancer (PLC) risks remains inadequately characterized. Therefore, we conducted this nested case-control study within the Jinchang cohort, including 129 incidents of PLC cases after 10 years of follow-up and 387 healthy controls matched by propensity score matching methods. Our findings showed that long-term exposure of chromium (Cr, Q2: OR = 10.63, 95% CI: 4.21-26.81; Q3: OR = 5.42, 95% CI: 2.14-13.70), zinc (Zn, Q2: OR = 2.37, 95% CI: 1.10-5.11; Q3: OR = 2.79, 95% CI: 1.32-5.88; Q4: OR = 2.83, 95% CI: 1.33-5.98), iron (Fe, Q4: OR = 0.26, 95% CI: 0.12-0.60), and aluminum (Al, Q4: OR = 0.26, 95% CI: 0.11-0.64) was identified as key contributing factors of the incidents of PLC. Serum Cr exhibited a nonlinear relationship with PLC risk (ρoverall < 0.001, ρnonlinear < 0.001), whereas Zn demonstrated a near-linear positive trend (ρoverall = 0.023, ρnonlinear = 0.395). In contrast, Fe, lithium (Li), and Al showed inverse associations with PLC incidence. Sensitivity analyses further confirmed these relationships. Additionally, significant interactions were observed among serum Cr, Zn, Fe, and Al in modulating PLC risk (ρinteraction < 0.05). These results highlighted the complex dose-dependent effects and interactions of multimetal exposures in the PLC pathogenesis and underscored the need for further mechanistic investigations.

Background Current evidence remains limited regarding associations between serum indirect bilirubin (IBIL) levels and chronic kidney disease (CKD) risk, particularly in gender-stratified analyses. This study investigated the gender-specific relationship between serum IBIL and CKD incidence. Methods Using data from a prospective cohort in northwestern China, we followed 25,684 CKD-free participants. Cox proportional hazards models and restricted cubic spline regression were employed to assess IBIL-CKD associations. The predictive capacity of IBIL was evaluated through ROC curve analysis. Robustness of results was examined via subgroup and sensitivity analyses. Results Over 122,401.17 person-years of follow-up, 1,219 incident CKD cases emerged. Adjusted hazard ratios (95% CIs) for CKD were 0.794 (0.676–0.932) overall and 0.713 (0.589–0.862) among males. Area under the curve (AUC) values were 0.710 (0.704–0.715; p < 0.001) overall, 0.710 (0.703–0.718; p < 0.001) for males, and 0.679 (0.670–0.688; p < 0.001) for females. A linear dose-response pattern was observed exclusively in males. Results remained consistent across subgroup and sensitivity analyses. Conclusions Our findings demonstrate an inverse association between serum IBIL levels and CKD risk, with particular clinical relevance in male populations. These results suggest serum IBIL could function as a valuable biomarker for early CKD detection in males.

Background As persistent organic pollutants (POPs), perfluoroalkyl substances (PFAS) may potentially impact human health. Our study aimed to investigate the prospective association between PFAS exposure and the incidence risk of breast cancer in females. Methods By fully following the Jinchang Cohort after a decade, we conducted this nested case-control study with 135 incidence cases of breast cancer (BC) and 540 bias-paired controls. The PFAS levels were tested by baseline serum samples. Conditional logistic regression and a restricted cubic spline model were employed to investigate the BC incidence risks and the dose-response associated with single PFAS component exposure. Furthermore, the Quantile g-computation model (Qgc), random forest model (RFM), and bayesian kernel machine regression models (BKMR) were integrated to estimate the mixed effects of PFAS exposure on the incidence risk of BC. Results Exposures to specific PFAS components were positively associated with an increased incidence risk of breast cancer. By grouping the study population into different baseline menopausal statuses, PFHxS, PFNA, PFBA, PFUdA, PFOS, and PFDA demonstrated a similarly positive correlation with BC incidence risks. However, the increased incidence risks of BC associated with PFOA, PFOS, PFUdA, and 9CL-PF3ONS exposure were exclusively found in the premenopausal population. Both BKMR and Qgc revealed that exposure to mixed PFAS was associated with an increased risk of breast cancer, with Qgc specifically indicating an odds ratio (OR) of 2.21 (95% CI: 1.53, 3.19). Random forests showed that PFBA, PFOS, PFHxS, and PFDA emerged as predominant factors potentially influencing breast cancer incidence. Conclusion Our findings suggest a strong association between PFAS exposure and the incidence of breast cancer. Premenopausal women should exercise more caution regarding PFAS exposure.

Objective To understand the incidence of carotid atherosclerosis(CAS)and the association of CAS with stroke incidence in an occupational population of the Jinchang Cohort,and to provide an evidence for the prevention and treatment of CAS and stroke.Methods The analysis included 6 262 employees of a nonferrous metal company who participated in the Jinchang Cohort Study and had complete information from the baseline examination,including carotid color Doppler ultrasound,from June 2011 to December 2013 and two rounds of follow-up in 2015 and 2017.The cumulative incidence rates of CAS,carotid intima-media thickening,carotid atherosclerotic plaque,and stroke were calculated among the employees during the follow-up period.A multivariate unconditional logistic regression model was used to analyze the factors associated with CAS,carotid intima-media thickening,and carotid atherosclerotic plaque.A multivariate Cox proportional hazards regression model was used to analyze the risk of stroke incidence and its influencing factors in individuals with CAS,carotid intima-media thickening,and carotid atherosclerotic plaque.Results During the initial follow-up of a mean of 1.71±0.55 years(ranging from 0.08 to 3.75 years),a total of 1 147 cases of CAS,287 cases of carotid intima-media thickening,and 860 cases of carotid atherosclerotic plaque were observed,with cumulative incidence rates of 18.32％,4.58％,and 13.73％,respectively.The results of multivariate unconditional logistic regression analysis showed that age≥45 years,smoking,hypertension,diabetes,abnormal total cholesterol(TC),working as a cadre or technical personnel,and internal staff were risk factors for CAS in the occupational population;whereas education level of college or above was a protective factor;age≥45 years,working as a cadre or technical personnel,smoking,having high-sugar diet,and hypertension were risk factors for carotid intima-media thickening,whereas female gender was a protective factor;females,age≥45 years,working as internal staff,hypertension,diabetes,and abnormal TC were risk factors for carotid atherosclerotic plaque,whereas college education or higher was a protective factor.At the second follow-up of a mean of 2.67±0.55 years(ranging from 0.06 to 4.37 years),a total of 240 stroke cases were identified,with a cumulative incidence of 3.83％.The numbers of stroke cases in subjects with CAS,carotid intima-media thickening,and carotid atherosclerotic plaque were 104,19,and 85,with cumulative stroke incidences of 9.07％,6.62％,and 9.88％,respectively.The results of the multivariate Cox proportional hazards regression model analysis showed that after adjusting for gender,age,education level,occupation,smoking,alcohol consumption,physical activity,high-salt diet,high-fat diet,high-sugar diet,hypertension,diabetes,hyperuricemia,body mass index(BMI),abnormal TC,abnormal triglycerides(TG),abnormal high-density lipoprotein cholesterol(HDL-C),abnormal low-density lipoprotein cholesterol(LDL-C),and reduced glomerular filtration rate,the risk of stroke was significantly increased in the individuals with CAS(hazard ratio[HR]=1.421,95％confiidence interval[95％CI]:1.030-1.961)compared with those without CAS.The results also showed that,age≥45 years,high-salt diet,and overweight were risk factors for stroke incidence in the individuals with CAS;females and hyperuricemia were risk factors for stroke incidence in individuals with carotid intima-media thickening;and high school or technical secondary school education,high-salt diet,and overweight were risk factors for stroke incidence in individuals with carotid atherosclerotic plaque.Conclusion The cumulative incidence of both CAS and stroke was high during follow-up in the occupational population of the Jinchang Cohort Study and in the occupational population,the individuals with CAS had a higher risk of stroke,and older age,high-salt diet,and overweight were the main risk factors for stroke in the individuals with CAS.

OBJECTIVE:There is an urgent need for novel biomarkers that are inexpensive, effective and easily accessible to complement the early diagnosis of hepatocellular carcinoma. This study aimed to analyze the relationship between serum gamma-glutamate-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index, fibrosis index based on four factors and the risk of hepatocellular carcinoma, and to determine the optimal cut-offs for predicting hepatocellular carcinoma.METHODS:Based on a prospective cohort study, 44 215 participants who were cancer-free at baseline (2011-13) were included in the study. Cox proportional hazard models and receiver operating characteristics curves were used to analyze the diagnostic value and optimal cut-off value of gamma-glutamyl-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index and fibrosis index based on four factors in predicting hepatocellular carcinoma patients.RESULTS:Gamma-glutamyl-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index and fibrosis index based on four factors can be used as early independent predictors of hepatocellular carcinoma risk. The risk of hepatocellular carcinoma in the fourth quantile of gamma-glutamyl-transpeptidase to platelet ratio and alkaline phosphatase-to-platelet ratio index was 4.04 times (hazard ratio = 4.04, 95% confidence interval: 2.09, 7.80) and 2.59 times (hazard ratio = 2.59, 95% confidence interval: 1.45, 4.61), respectively, compared with the first quantile. With fibrosis index based on four factors first quantile as a reference, fibrosis index based on four factors fourth quantile had the highest risk (hazard ratio = 18.58, 95% confidence interval: 7.55, 45.72). Receiver operating characteristic results showed that fibrosis index based on four factors had a stronger ability to predict the risk of hepatocellular carcinoma (area under curve = 0.81, 95% confidence interval: 0.80, 0.81), and similar results were shown for gender stratification. In the total population, the optimal cut-off values of gamma-glutamyl-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index and fibrosis index based on four factors were 0.208, 0.629 and 1.942, respectively.CONCLUSIONS:Gamma-glutamyl-transpeptidase to platelet ratio, alkaline phosphatase-to-platelet ratio index and fibrosis index based on four factors were independent predictors of hepatocellular carcinoma risk. Amongst them, fibrosis index based on four factors shows a stronger predictive ability for hepatocellular carcinoma risk, and gamma-glutamyl-transpeptidase to platelet ratio and alkaline phosphatase-to-platelet ratio index can be used as complementary indicators.

Extensive research has established the link between PM2.5 exposure and blood pressure (BP) levels among normal individuals. However, the association between PM2.5 components and BP levels in hypertensive patients has not been fully explored. In this study, 12 971 hypertensive cases from Jinchang cohort (in Jinchang City, China) with nearly 9 years of follow-up were enrolled. Based on the linear mixed-effect model, the effects of fine particulate matter (PM2.5) and five major components [sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), black carbon (BC) and organic matter (OM)]on BP [systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP)]were evaluated by single-component model, component-joint model and component-residual model, respectively. A positive correlation was found between PM2.5 as well as its components (SO42-, NO3-, NH4+, BC and OM) exposure and BP levels. The effects of SO42-, BC and OM on BP were observed to be the most robust among the three models. Based on the results of interaction effects and stratified analysis, the effect of BC exposure on SBP, and the effect of PM2.5 and its five components on PP were greater in female than in males. Compared with elderly hypertensive patients, OM had more significant effects on SBP, DBP and MAP in young and (or) middle-aged hypertensive patients. During the heating season, the effect of PM2.5 and its components on BP was grater compared to the non-heating season. Meanwhile, PM2.5 and its components have a greater influence on BP in patients with hypertension combined with diabetes. Therefore, the findings suggested that both PM2.5 exposure and its components had a significant effect on BP in patients with hypertension. Women and young and middle-aged hypertensive patient were the sensitive population. The implementation of source control and reduction of PM2.5 emission (mainly for SO42-, BC and OM) may be of great significance to control BP level and could reduce the risk of cardiovascular disease in patients with hypertension.

Objective Previous studies on the association between lipid profiles and chronic kidney disease (CKD) have yielded inconsistent results and no defined thresholds for blood lipids. Methods A prospective cohort study including 32,351 subjects who completed baseline and follow-up surveys over 5 years was conducted. Restricted cubic splines and Cox models were used to examine the association between the lipid profiles and CKD. A regression discontinuity design was used to determine the cutoff value of lipid profiles that was significantly associated with increased the risk of CKD. Results Over a median follow-up time of 2.2 (0.5, 4.2) years, 648 (2.00%) subjects developed CKD. The lipid profiles that were significantly and linearly related to CKD included total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C, and TG/HDL-C, whereas lowdensity lipoprotein cholesterol (LDL-C) and LDL-C/HDL-C were nonlinearly correlated with CKD. TC, TG, TC/HDL-C, and TG/HDL-C showed an upward jump at the cutoff value, increasing the risk of CKD by 0.90%, 1.50%, 2.30%, and 1.60%, respectively, whereas HDL-C showed a downward jump at the cutoff value, reducing this risk by 1.0%. Female and participants with dyslipidemia had a higher risk of CKD, while the cutoff values for the different characteristics of the population were different. Conclusion There was a significant association between lipid profiles and CKD in a prospective cohort from Northwest China, while TG, TC/HDL-C, and TG/HDL-C showed a stronger risk association. The specific cutoff values of lipid profiles may provide a clinical reference for screening or diagnosing CKD risk.

Per- and poly-fluoroalkyl substances (PFAS) have been reported to have hepatotoxic effects. However, it is unclear whether they are linked to non-alcoholic fatty liver disease (NAFLD). This nested case-control study focused on the epidemiological links between PFAS and the prevalence of NAFLD. We selected 476 new cases of NAFLD and 952 age- and sex-matched controls from the Jinchang cohort population between 2014 and 2019. Serum concentrations of PFAS were measured using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Only PFAS with a detection rate of ≥ 90 % were included for analysis, which included PFPeA, PFOA, PFNA, PFHxS, PFOS, and 9Cl-PF3ONS. The relationship between single and co-exposure to PFAS and the occurrence of NAFLD was evaluated using conditional logistic regression, Quantile g-computation (QgC), and Bayesian kernel machine regression (BKMR) model. Logistic regression indicated that PFPeA, PFOA, and 9Cl-PF3ONS were positive correlation with the incidence of NAFLD after adjusting for confounders, with odds ratios (OR) and 95 % confidence interval (CI) of 3.13 (95 % CI: 2.53, 3.86), 1.39 (95 % CI: 1.12, 1.73), and 1.41 (95 % CI: 1.20, 1.66), respectively. PFNA, PFHxS, and PFOS were nonlinearly and negatively associated with the incidence of NAFLD, with OR (95 % CI) of 0.53 (0.46, 0.62), 0.83 (0.73, 0.95), and 0.52 (0.44, 0.61), respectively. QgC showed a significant joint effect of PFAS on NAFLD onset (OR: 1.52, 95 % CI: 1.24, 1.88). BKMR showed a weak positive trend between PFAS mixtures and NAFLD incidence. Positive correlations were primarily driven by PFPeA and 9Cl-PF3ONS, while negative correlations were mainly influenced by PFNA and PFOS. The BKMR model also suggested that there was an interaction between PFOS and PFNA and other four PFAS compounds. In conclusion, our findings suggest that individual and co-exposure to PFAS is associated with a risk of NAFLD onset.

AbstractBackgroundStudies have found that the ratio of total cholesterol to high‐density lipoprotein cholesterol (TC/HDL‐C) was associated with the development of chronic kidney disease (CKD). However, the relationship in different genders was rarely discussed. The aim of this study was to explore this relationship and assess its predictive power for both males and females.MethodsBased on a prospective cohort platform in northwest China, 32,351 participants without CKD were collected in the baseline and followed up for approximately 5 years. Cox proportional hazard model and restricted cubic spline regression analysis were performed to investigate the association between TC, HDL‐C, TC/HDL‐C and CKD in adult female and male. The clinical application value of the indicators in predicting CKD was evaluated by the receiver operator characteristic curve.ResultsDuring a mean follow‐up of 2.2 years, 484 males and 164 females developed CKD. After adjusted for relevant confounders, for every one standard deviation increase in TC, HDL‐C and TC/HDL‐C, the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for CKD were 1.17 (1.05–1.31), 0.84 (0.71–0.99), and 1.15 (1.06–1.25) for males, 0.94 (0.78–1.13), 0.58 (0.35–0.95), and 1.19 (1.01–1.40) for females, respectively. The results also showed that TC, HDL‐C, and TC/HDL‐C were associated with CKD in a linear dose–response relationship. The TC/HDL‐C had the largest area under the curve (AUC) compared to TC and HDL‐C, and the AUC among the females was larger than that among males.ConclusionsThe TC/HDL‐C was significantly associated with CKD in adult males and females and has better clinical value in predicting CKD than TC and HDL‐C, especially in females.

BACKGROUND AND AIMS:Whether the new standard of metabolic dysfunction-associated fatty liver disease (MAFLD) has more pronounced clinical and population screening diagnostic value than nonalcoholic fatty liver disease (NAFLD) is unclear. This study evaluated the utility of MAFLD and NAFLD for predicting major cardiovascular disease (CVD) risk. METHODS AND RESULTS:A prospective cohort study approach was utilized to collect 19,399 study participants without CVD at baseline who completed follow-up from the Jinchang cohort platform during 2011-2017. According to clinical ultrasonic diagnosis results and disease diagnosis criteria, the baseline population was divided into MAFLD, NAFLD, Both-FLD and No-FLD groups. Based on the multifactorial Cox proportional risk model to analyze the relationship between three kinds of patients and CVD, the score prediction model of CVD was constructed with reference to the Framingham Risk Score (FRS) and the model was evaluated. Compared with No-FLD, the HRs and 95 % CIs for the risk of CVD development in patients with NAFLD, MAFLD, and Both-FLD were 1.54 (1.34-1.76), 1.57 (1.37-1.79), and 1.62 (1.41-1.87), in that order. The scoring model showed a range of 5.90%-84.59 % risk of CVD in the three groups. As the risk score increased, the risk of developing CVD gradually increased. Evaluation metrics of all three models in the training set and validation set showed that the models have good prediction efficacy. CONCLUSION:In terms of CVD risk and prognosis, MAFLD had no advantage over NAFLD. However, Both-FLD was found to predict a higher risk of CVD and to have superior predictive efficacy.

[目的]探索常规循环肝功能标志物与结直肠癌发病风险的关系.[方法]采用巢式病例对照研究,剔除基线慢性结肠炎、肠息肉和恶性肿瘤患者及基本资料不全者,以金昌队列3次随访期间新发结直肠癌患者145例为病例组,以随访未发生结直肠癌的人群作为对照来源,根据同期随访、基线年龄±2岁和同性别进行1∶4个体匹配,获得对照组580名,最终纳入725名研究对象.通过条件Lo-gistic 回归分析探究常规循环肝功能标志物与结直肠癌发病风险的关系,计算比值比(odds ratio,OR)及其95％置信区间(confidence interval,CI),采用限制性立方样条分析相关因素与结直肠癌发病的剂量-反应关系.[结果]研究对象平均年龄为61.24岁,男性占比71.72％.多因素条件Logistic回归分析结果显示,在调整混杂因素后,发现总胆红素第2四分位数组研究对象发生结直肠癌的风险是第1四分位数组的0.490倍(OR=0.490,95％CI:0.273～0.879),处于白蛋白第2、3、4四分位数组的研究对象发生结直肠癌的风险分别较处于第1四分位数组的研究对象降低41.6％(OR=0.584,95％CI:0.342～0.996)、42.9％(OR=0.571,95％CI:0.337～0.970)和 42.7％(OR=0.573,95％CI:0.330～0.996).对结直肠癌发病部位进行分区,以白蛋白第1四分位数组为对照,第3、4四分位数组的个体发生结肠癌的风险分别降低 66.6％(OR=0.334,95％CI:0.139～0.804)和 80.7％(OR=0.193,95％CI:0.066～0.566).未发现白蛋白与直肠癌发病风险之间具有统计学意义.白蛋白与结直肠癌发病风险之间存在明显的负向线性剂量-反应关系(P总趋势＜0.050,P非线性=0.191),结直肠癌发病风险随白蛋白的升高而降低.[结论]白蛋白和总胆红素水平的升高与结直肠癌发病风险降低相关,且白蛋白与结直肠癌的发病风险存在剂量-反应关系.白蛋白与结肠癌发病风险存在较强的负相关性,而与直肠癌不存在关联.

目的 基于队列入群研究心源性猝死(sudden cardiac death,SCD)的影响因素,为SCD的预防和病因学研究提供科学依据.方法 采用巢式病例对照研究的方法,以金昌队列2011-2019年三次随访新发52例SCD者为病例组,按照年龄(±2岁)及同性别1∶4个体匹配的方法,以同期随访未发生SCD者的208例为对照组.用条件logistic回归分析模型分析金昌队列人群发生SCD的影响因素,并通过限制性立方样条(restricted cubic spline,RCS)模型拟合SCD发病风险的剂量-反应关系曲线.结果 多因素条件logistic回归分析模型分析结果显示:三酰甘油(triglycerides,TG)(OR=2.94,95％CI:1.15～7.51)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)(OR=2.70,95％CI:1.18～6.22)、糖尿病(OR=5.59,95％CI:1.79～17.46)和心电图异常(OR=5.54,95％CI:2.11～14.56)是SCD的危险因素;文化程度在高中及以上(OR=0.33,95％CI:0.12～0.88)是SCD的保护因素.RCS结果显示:空腹血糖(fasting plasma glucose,FPG)、TG与SCD发病风险间呈正向线性剂量-反应关系(P总趋势＜0.05,P非线性＞0.05).结论 TG、LDL-C、糖尿病、心电图异常和文化程度与SCD的发生有关且FPG、TG与SCD的发生风险间存在线性剂量-反应关系.

AIM:Chronic kidney disease (CKD) is increasingly recognized as a global health issue. There is a paucity of published data on the prevalence and risk factors of CKD in less-developed regions. This study aims to evaluate and update the prevalence and risk factors of CKD in a city of Northwestern China.METHODS:Based on a prospective cohort study, a cross-sectional baseline survey was conducted between 2011 and 2013. The data on the epidemiology interview, physical examination, and clinical laboratory test were all collected. In this study, 41,222 participants were selected from 48,001 workers in the baseline after excluding objects with incomplete information. The crude and standardized prevalence of CKD were calculated. An unconditional logistic regression model was used to analyze the risk factors associated with CKD among male and female.RESULTS:One thousand seven hundred eighty-eight people were diagnosed with CKD, including 1180 males and 608 females. The crude prevalence of CKD was 4.34% (4.78% males and 3.68% females). The standardized prevalence was 4.06% (4.51% males and 3.60% females). The prevalence of CKD increased with age and was higher in males than in females. In multivariable logistic regression, CKD was significantly associated with the increasing age, drinking, never or occasionally exercise, overweight or obesity, being unmarried, diabetes, hyperuricemia, dyslipidemia and hypertension.CONCLUSION:In this study, the prevalence of CKD was lower than that of the national cross-sectional study. Lifestyle, hypertension, diabetes, hyperuricemia and dyslipidemia were the main risk factors of CKD. The prevalence and risk factors differ between male and female.

Although numerous evidences suggest that zinc may have a beneficial impact on preventing and treating diabetes, findings from the population studies are inconclusive. To address this gap, we conducted a nested case-control study, employing restricted cubic splines and a conditional logistic regression model to explore the association between serum zinc levels and the risk of diabetes. We also assessed potential effect modifications through stratified analyses and examined the mediating effects of metabolic indicators using a multiclass mediation effect model. We measured baseline serum zinc concentrations using Inductively Coupled Plasma Mass Spectrometry in a cohort of 2156 participants, including 1078 individuals with diabetes and 1078 matched controls. Our findings revealed a 51 % increased risk of diabetes when comparing the highest quartile (Q4) to the lowest quartile (Q1) of serum zinc levels (Odds Ratio [95 % Confidence Interval]: 1.51 [1.09, 2.09]). There was a positive linear dose-response relationship between serum zinc and diabetes risk (P overall ≤0.01, P nonlinear = 0.20). Effect modifications were evident between serum zinc and factors such as educational attainment, body mass index, alcohol index, family history of diabetes, history of hypertension, coronary heart disease, and stroke, all of which influenced the risk of diabetes (all P-interaction <0.05). Moreover, our study identified significant indirect effects of triglycerides levels on diabetes risk for participants in the third (Q3) and fourth (Q4) quartiles of serum zinc, with mediation proportions of 19.23 % and 19.28 %, respectively. A significant indirect effect of alanine aminotransferase on diabetes risk was found for those in the Q4 of serum zinc, with a mediation proportion of 12.05 %. Considering these findings, it is advisable to conduct testing for serum zinc level and exercise caution when considering zinc supplementation. Furthermore, our results emphasized the necessity for additional validation through large-sample prospective population studies and experimental research.

Aims To quantify the trajectories from normoglycaemia to pre-diabetes, subsequently to type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), and cardiovascular death, and the effects of risk factors on the rates of transition. Methods and results We used data from the Jinchang Cohort of 42 585 adults aged 20-88 free of coronary heart disease (CHD) and stroke at baseline. A multistate model was applied for analysing the progression of CVD and its relation to various risk factors. During a median follow-up of 7 years, 7498 participants developed pre-diabetes, 2307 developed T2DM, 2499 developed CVD, and 324 died from CVD. Among 15 postulated transitions, transition from comorbid CHD and stroke to cardiovascular death had the highest rate (157.21/1000 person-years), followed by transition from stroke alone to cardiovascular death (69.31/1000 person-years) and transition from pre-diabetes to normoglycaemia (46.51/1000 person-years). Pre-diabetes had a sojourn time of 6.77 years, and controlling weight, blood lipids, blood pressure, and uric acid within normal limits may promote reversion to normoglycaemia. Among transitions to CHD alone and stroke alone, transition from T2DM had the highest rate (12.21/1000 and 12.16/1000 person-years), followed by transition from pre-diabetes (6.81/1000 and 4.93/1000 person-years) and normoglycaemia (3.28/1000 and 2.39/1000 person-years). Age and hypertension were associated with an accelerated rate for most transitions. Overweight/obesity, smoking, dyslipidaemia, and hyperuricaemia played crucial but different roles in transitions. Conclusion Pre-diabetes was the optimal intervention stage in the disease trajectory. The derived transition rates, sojourn time, and influence factors could provide scientific support for the primary prevention of both T2DM and CVD. Lay summary Former single-outcome studies on the relationship between glycaemia and cardiovascular disease (CVD) may ignore the complexity and multi-transformations across the multiple stages from normoglycaemia to CVD in real-world setting. We aimed to quantify the trajectories from normoglycaemia to pre-diabetes, subsequently to type 2 diabetes, CVD, and cardiovascular death.Pre-diabetes was the optimal intervention stage in the disease trajectory.Transitions from CVD to death had much higher rates than other transitions.Age and hypertension were associated with an accelerated rate for most transitions. Overweight/obesity, smoking, dyslipidaemia, and hyperuricaemia played crucial but different roles in transitions.

Background and aims: Studies have shown that elevated serum uric acid (SUA) may increase the risk of coronary heart disease (CHD). However, it is still disputable how mediate ef-fects between metabolic diseases and hyperuricemia affect the incidence of CHD. This study aimed to explore whether metabolic diseases may mediate the connection from hyperuricemia at baseline to the elevated incidence risk of CHD during follow-ups. Methods and Results: Based on the Jinchang cohort, 48 001 subjects were followed for 9 years be-tween June 2011 and December 2019. Multivariate-adjusted Cox regression models were applied to estimate hazard ratios (HRs) of CHD with 95% confidence intervals (CIs). Significantly increased risks of CHD were observed in hyperuricemia (HR:1.46, 95%CI:1.2 8, 1.67) when compared with normouricemia population. The mediating effect model further demonstrated that metabolic diseases could mediate the association between hyperuricemia and CHD patho-genesis, partially for the combined metabolic diseases with mediation effects of 45.12%, 25.24% for hypertension, 28.58% for overweight or obese status, 29.05% for hypertriglyceridemia, 6.70% for hypercholesterolemia, 3.52% for low high density lipoprotein cholesterol (HDL-C), and 6.51% for high low density lipoprotein cholesterol (LDL-C), respectively. Conclusions: Hyperuricemia significantly increased the risk of incident CHD, and this association was partly mediated by metabolic diseases. & COPY; 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Ital-ian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Currently few studies have explored the relationship between exposure to gaseous pollutants and metabolic health indicators in patients, especially in patients with metabolic syndrome (Mets). This study collected 15,520 patients with Mets in a prospective cohort of nearly 50,000 people with 7 years of follow-up from 2011 to 2017, and matched air pollutants and meteorological data during the same period. The mixed effects model was used to analyze the relationship between different short exposure windows (1-week, 1-month, 2-month, and 3-month) of gaseous pollutants (SO2, NO2, and O3) and the metabolic health indicators of patients after controlled the confounding factors. Stratified analysis was performed by demographic characteristics and behavioral factors. The effects of gaseous pollutants on patients with different Met components were also analyzed. The results showed that the short-term exposure to SO2, NO2, and O3 had a certain effect on the metabolic health indicators of patients with Mets in different exposure windows, and with the extension of the exposure window period, the effects increased. The stratified analysis showed that gender, age, and life behaviors might modify these detrimental effects. In addition, the effects of gaseous pollutants on metabolic health indicators in G4 and G7 were more obvious than other Met components, and the effects of gaseous pollutants on the level of LDL-C were found to be statistically significant in most components. Therefore, patients with Mets should pay more attention to the influence of gaseous pollutants to take appropriate protection to reduce potential health risk.

目的 了解金昌队列随访人群2011-2020年循环系统疾病死亡率及早死概率的变化趋势,为制定循环系统疾病的防控策略提供依据.方法 收集金昌队列随访人群2011年1月1日-2020年12月31日死于循环系统疾病的相关数据,通过计算粗死亡率(CDR)、年龄标化死亡率(ASMR)、早死概率等指标分析该人群循环系统疾病的10年死亡率和早死概率的变化趋势.结果 金昌队列随访人群2011-2020年因循环系统疾病死亡1 387例,CDR 为 283.22/10 万,ASMR 为 161.80/10 万,循环系统疾病 10 年 CDR 呈上升趋势(APC=10.02％,t=5.80,P＜0.01).金昌队列随访人群2011-2020年循环系统疾病核心病种为脑卒中和冠心病,CDR分别为128.44/10万和84.33/10万,ASMR分别为73.02/10万和47.88/10万,此2种疾病死亡数占循环系统疾病死亡数的75.13％,其中冠心病10年CDR呈上升趋势(APC=17.90％,t=5.83,P＜0.01).金昌队列随访人群2011-2020年循环系统疾病的早死概率为1.46％,其中脑卒中为1.21％,冠心病为1.03％.结论 金昌队列随访人群2011-2020年循环系统疾病死亡率有所上升,核心病种为脑卒中和冠心病,其中冠心病的死亡率及早死概率上升明显.

目的 了解金昌队列人群脑卒中的发病状况,探讨糖尿病及FPG与脑卒中发病之间的联系,为有效控制糖尿病、预防脑卒中的发生提供科学依据.方法 以金昌队列为研究平台,采用前瞻性队列研究的方法分析糖尿病及FPG水平与脑卒中发病风险间的关系,运用限制样条法拟合FPG水平与脑卒中发病风险间的剂量反应关系.结果 本研究共纳入32736例研究对象,平均随访2.2年后,脑卒中累积发病率为8.77‰,其中糖尿病组脑卒中发病率为23.38‰,高于对照组发病率6.67‰.调整混杂因素后,糖尿病患者和空腹血糖受损人群中脑卒中的发病风险分别是对照组的2.257倍(HR=2.257,95％ CI:1.658～3.072,P＜0.001)和1.396倍(HR=1.396,95％CI:1.039～1.877,P=0.027).以FPG＜ 5.6 mmol/L作为对照组,控制混杂因素后,总人群中FPG≥5.6 mmol/L组和FPG≥6.1 mmol/L组脑卒中的发病风险分别增加48.1％(HR=1.481,95％CI:1.040～2.108,P=0.030)和49.3％(HR=1.493,95％ CI:1.044～2.136,P=0.028);当FPG≥7.0 mmol/L时,男性和女性脑卒中的发病风险分别是对照组的1.614倍(HR=1.614,95％ CI:1.068～2.438)和2.742倍(HR=2.742,95％ CI:1.355～5.547).在总人群和女性中FPG与脑卒中发病风险间呈非线性剂量反应关系,男性中FPG与脑卒中发病风险间呈线性剂量反应关系.结论 糖尿病是脑卒中的独立危险因素,且FPG水平与脑卒中的发病风险间存在剂量反应关系.