BACKGROUND:Depression and cognitive decline are both major health problems worldwide. This study aims to investigate the effects of depressive symptoms and its joint function with lifestyles on cognitive function among the Chinese populations. METHODS:This research included two cross-sectional studies from Hubei (n = 7756) and Shanghai (n = 4751), China. The depressive symptoms were surveyed by the 15-item Geriatric Depression Scale (GDS-15), and cognitive function was assessed by the Mini-mental State Examination (MMSE). RESULTS:We observed significant association between depression and decreased MMSE score [β (95%CI) = -0.70 (-0.97, -0.42) and -3.15 (-3.59, -2.70) in Hubei and Shanghai, respectively] and elevated risk of MCI [OR (95%CI) = 1.59 (1.20, 2.08) and 2.75 (2.06, 3.66), respectively] in both populations. Additionally, individuals who reported physically active, kept an optimal sleep duration, and higher healthy lifestyle score (HLS) exhibited a better cognition in both populations. More importantly, the adverse associations between depressive symptoms and cognition were diminished among subjects adopting five types of healthy lifestyles (HLS = 5) [Hubei: β (95%CI) = -0.20 (-0.82, 0.41) and OR (95%CI) =0.82 (0.24, 2.12), P-int = 0.047 and 0.046; Shanghai: β (95%CI) = -0.80 (-1.70, 0.10) and OR (95%CI) =1.85 (0.53, 5.06), P-int < 0.001 and 0.151]. Furthermore, we observed joint effects of non-depressed status with healthy lifestyles on cognition. CONCLUSION:Depressive symptoms are associated with impaired cognitive function and this association could be attenuated by healthy lifestyles.

Objective To investigate associations of ideal cardiovascular health behaviors with arterial stiffness and its progression in adults for providing a reference to the prevention and treatment of cardiovascular diseases.Methods A questionnaire survey,physical examination,laboratory tests,and brachial-ankle pulse wave velocity(baPWV)measure-ment were conducted among 5 536 adult physical examinees recruited through convenient sampling in a general hospital located in Wuhan city,Hubei province from August 2018 to May 2019.The evaluation of cardiovascular health behavior was performed using an integrated overall score that encompassed smoking,dietary pattern,exercise routine,body mass index(BMI),blood pressure,fasting plasma glucose,and total cholesterol level.Among the surveyed participants who had complete information and no history of cardiovascular disease at baseline(n=2 683),a follow-up baPWV measurement was conducted approximately two years later from June 2019 to February 2022.From this follow-up group of individuals with valid data for both baPWV measurements and baseline values below or equal to 1400 cm/s(n=372),an analysis was conducted to investigate factors influencing the progression of arterial stiffness.An unconditional multivariate logistic regression model was employed to explore the correlations between ideal cardiovascular health behaviors and arterial hardening as well as its progression.Results Among the 2 683 individuals without a history of cardiovascular disease at baseline survey,34.03％,48.16％,and 17.81％were assessed as having ideal,general,and poor cardiovascular health behaviors or factors respectively,while 31.83％were detected with arterial stiffness indicated by baPWV ≥ 1 400 cm/s.In contrast,among the 372 individuals with the two baPWV measurements and without baseline arterial stiffness(baPWV＜1 400 cm/s),the proportions of having ideal,general,and poor cardiovascular health behaviors were 43.55％,42.74％,and 13.71％respectively;meanwhile,progressive arterial stiffness was observed in approximately one-fifth of them according to elevated baPWV values(≥1 400 cm/s).After adjusting for confounding factors such as gender,age,education level and family history of cardiovascular disease using multivariate logistic regression analysis method,the results showed that compared to those with poor cardiovascular health behavior or factors,individuals who had ideal or general cardiovascular health behavior had significantly decreased risk of developing arterial stiffness with odds ratios(OR)being equal to 0.28(95％confidence interval[95％CI]:0.21-0.37)and 0.64(95％CI:0.51-0.81),respectively.Further adjustment for baseline baPWV values revealed that the risk of progressive arterial stiffness significantly decreased(OR=0.29,95％CI:0.11-0.73)in individuals who had ideal rather than poor cardiovascular health behaviors.Conclusion The ideal cardiovascular health behavior and factor scores exhibit a significant negative correlation with the occurrence and progression of arterial stiffness among Chinese adults.Moreover,early intervention aimed at promoting ideal cardiovascular health behavior and factors has the potential to effectively delay the onset and development of arterial stiffness.

Epidemiological evidence regarding the relationships of organophosphate esters (OPEs) with metabolic syndrome (MetS) and its underlying mechanism was largely unknown. This study sought to estimate the correlations of individual OPEs and their mixture with MetS risk, while also evaluating the potential mediation of oxidative stress and inflammation biomarkers. We measured urinary OPE metabolites, urinary biomarkers of oxidative stress, and serum biomarkers of inflammation among 694 adults based on a case-control design. Our findings revealed positive correlations between urinary 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate (BCIPHIPP) and bis(2-butoxyethyl) phosphate (BBOEP) and elevated odds of MetS risk. Bayesian kernel machine regression (BKMR) and weighted quantile sum (WQS) analyses demonstrated the overall effect of the OPE mixtures on MetS risk, with BBOEP identified as the primary contributor. Mediation analysis further revealed that the association between urinary BCIPHIPP and BBOEP and MetS risk was mediated by urinary 8-hydroxy-2-deoxyguanosine (8-OHdG), with mediation proportions of 23.27% and 8.70%, respectively. In addition, serum C-reactive protein (CRP) concentration mediated the association between BBOEP and MetS risk, and the proportion of mediation was 16.32%. Our results indicated that oxidative stress and inflammation might exert a substantial influence on the correlations between OPE exposure and the risk of MetS.

Exposure to organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) has been reported to be associated with renal impairment and chronic kidney disease (CKD). Nevertheless, the research results thus far have exhibited inconsistency, and the effect of lifestyle on their association is not clear. In this study, we assessed the correlation between serum OCPs/PCBs and CKD and renal function indicators including estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) among 1721 Chinese adults. In order to further investigate the potential impact of lifestyle, we conducted joint associations of lifestyle and OCPs/PCBs on CKD. We found a negative correlation between p,p′-DDE and eGFR, while logistic regression results showed a positive correlation between PCB-153 and CKD (OR, 1.92; 95

Toxicologic studies reported that organophosphate esters (OPEs) may disrupt lipid metabolism, thus affecting serum lipid levels. However, epidemiological evidence regarding the association between OPEs and the risk of hyperlipidemia (HPL) as well as serum lipid levels is scarce. In the present study, our aim was to investigate the impact of individual and mixed OPE exposure on HPL. A total of 1981 Chinese adults were involved based on a cross-sectional design. Overall, we found a positive association between bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) and the risk of HPL. Bis(1-chloro-2-propyl) phosphate (BCIPHIPP) showed a positive association with total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). BDCIPP, diphenyl phosphate (DPHP), di-ocresyl phosphate and di-p-cresyl phosphate (Docp Dpcp), and 4-hydroxyphenyl-diphenyl phosphate (4-OH-DPHP) exhibited a negative association with high-density lipoprotein cholesterol (HDL-C). In stratified analyses, BDCIPP and BCIPHIPP were significantly correlated with the increased risk of HPL in the age ≤ 45 group. Bis(2-butoxyethyl) phosphate (BBOEP) was in relationship with an elevated risk of HPL in the subgroup of BMI < 24 kg/m2. BDCIPP was also positively associated with HPL in men. Quantile-based g computation (qgcomp) and generalized weighted quantile sum regression (gWQS) models demonstrated a negative association between OPEs mixed exposure and HDL-c in the total population, as well as a positive effect of them on HPL in the subgroup of age ≤ 45 years, which is consistent with the individual analyses. Furthermore, joint effect analyses revealed that participants with detected BDCIPP urinary levels and unhealthy lifestyles had the highest risk of HPL. Our findings offer evidence supporting the correlation between exposure to OPE and the risk of HPL, necessitating further prospective studies for validation.

BACKGROUND:Previous research has investigated the hepatotoxicity of single metal exposure. However, there is limited evidence about metal mixture and their association with metabolic dysfunction-associated fatty liver disease (MAFLD), particularly in the Chinese population. OBJECTIVE:To investigate the individual and combine effects of 20 metals on MAFLD in a large population in China. METHODS:This study included 3651 participants from the Medical Physical Examination Center of Tongji Hospital, Wuhan, China. MAFLD was identified based on ultrasonic graphic evidence of hepatic steatosis and the presence of overweight/obese, diabetes mellitus, or metabolic dysregulation. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine urinary concentrations of 20 metals. Logistic regression was used to assess the relationship between individual metal and MAFLD, with results presented as odds ratios (ORs) and 95 % confidence intervals (CIs). Weighted quantile sum (WQS) regression was performed to evaluate the combine effect of metals. RESULTS:The prevalence of MAFLD among the participants was 32.1 % (1173/3651). In singe-metal analysis, high exposure to zinc (OR =1.42; 95 % CI = 1.27, 1.59) and selenium (OR = 1.23; 95 % CI = 1.10, 1.39) were positively associated with MAFLD. No significant association was found for other metals. WQS regression analysis showed that urinary metal mixture was positively associated with MAFLD (OR = 1.32, 95 % CI: 1.15, 1.51), with zinc (50.4 %) being the largest contributor, followed by barium (10.8 %). CONCLUSIONS:In conclusion, our finding suggested that exposure to the mixture of metals was positively correlated with MAFLD, with zinc being the major contributor.

Exposure to environmental contaminants and the development of hypertension and diabetes represent crucial risk factors for chronic kidney disease (CKD). Toxicological studies have revealed that organophosphate esters (OPEs) impair kidney function. However, the joint effects of OPE exposure on kidney injury and the interactions of OPE exposure with hypertension or diabetes on kidney injury remain unclear. Our study aimed to investigate the individual and joint effects of OPE exposure on renal injury, as well as the potential interaction between OPE exposure and hypertension or diabetes on kidney injury. The study enrolled 1938 participants from Wuhan, China. To explore the relationship between OPE exposure and renal injury, we conducted multivariate linear and logistic regression analysis. The results indicated that each unit increase in 4-hydroxyphenyl diphenyl phosphate (4-HO-DPHP), bis(2-butoxyethyl) phosphate (BBOEP), and tris(2-chloroethyl) phosphate (TCEP) (1 μg/L-ln transformed) was associated with a decreased 0.57 mL/min/1.73 m2 (95%CI: -1.05, -0.09), 0.85 mL/min/1.73 m2 (95%CI: -1.52, -0.19) and 1.24 mL/min/1.73 m2 (95%CI: -2.26, -0.23) of estimated glomerular filtration rate (eGFR), while each unit increase in 4-HO-DPHP and BBOEP (1 μg/L-ln transformed) was associated with 14% and 20% elevation of incident impaired renal function (IRF) risk. Notably the highest tertile of BCIPHIPP was positively associated with eGFR, although the p for trend ＞ 0.05. We employed Bayesian kernel machine regression (BKMR) and quartile-based g-computation (qgcomp) models to explore the joint effects of OPE mixtures on eGFR and IRF. Both the results of BKMR and qgcomp model consistently demonstrated negative associations between OPE mixtures and eGFR, and TCEP and 4-HO-DPHP were major contributors. Furthermore, we observed multiplicative interactions of diphenyl phosphate (DPHP), BBOEP, di-ocresyl phosphate (DoCP) & di-p-cresyl phosphate (DpCP), 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate (BCIPHIPP) and hypertension or diabetes on kidney injury (all P＜0.05). Those with diabetes or hypertension and higher OPE metabolite concentrations had increased risk of kidney function impairment compared to those who did not have diabetes or hypertension. These findings suggest that specific OPE exposure may elevate the risk of renal injury, particularly among hypertensive and diabetic populations.

The rapidly rising risk of cognitive decline is a serious challenge for the elderly. As the wide-distributed environmental chemicals, the effects of metals exposure on cognitive function have attracted much attention, but the results remain inclusive. This study aimed to investigate the roles of multiple metals co-exposure on cognition. We included a total of 6112 middle-aged and older participants, detected their plasma levels of 23 metals by using inductively coupled plasma mass spectrometry, and assessed their cognitive function by using the Mini- Mental State Examination (MMSE). The results showed that increased plasma levels of iron (Fe) and zinc (Zn) were positively associated with MMSE score, but the increased levels of nickel (Ni) and lead (Pb) were associated with decreased MMSE score (all FDR < 0.05). Subjects exposed to both high levels of Ni and Pb showed the lowest MMSE score [(3 (95% CI) =-0.310 (-0.519,-0.100)], suggesting that Ni and Pb had a synergistic toxic effect on cognitive function. In addition, the hazardous roles of Ni and Pb were mainly found among subjects with low plasma level of Zn, but were not significant among those with high-Zn level [Ni: (3 (95% CI) =-0.281 (-0.546,-0.015) vs.-0.146 (-0.351, 0.058); Pb: (3 (95% CI) =-0.410 (-0.651,-0.169) vs.-0.060 (-0.275, 0.155)], which suggested that Zn could attenuate the adverse effects of Pb and Ni on cognitive function. The cognitive function was gradually decreased among subjects with increased number of adverse exposures to the above four metals ( P (trend) < 0.001). In conclusion, our findings revealed the individual, interactive, and combined effects of Fe, Ni, Pb, and Zn on cognitive function, which may provide new perspectives on cognitive protection, but further prospective cohort studies and biological researches are needed to validate these findings.

Previous studies about metal exposures and bone mineral density (BMD) have mainly focused on individual metals. The objective of this study was to explore the association of single and multiple metal exposures with BMD among Chinese adults. We recruited 2922 participants from Tongji Hospital in Wuhan, China. The urinary concentrations of 21 metals were measured by the inductively coupled plasma mass spectrometer. BMD was measured using dual-energy X-ray absorptiometry. We applied linear regression and Bayesian kernel machine regression (BKMR) to examine the association of single and multiple metal exposure with BMD, respectively. The linear regression model showed that cadmium (Cd) and strontium (Sr) were associated with lower BMD (all P-trend < 0.05). Compared with the lowest quantiles, the β (95

Previous studies have suggested an adverse association between exposure to organophosphate esters (OPEs) and metabolic disorders. However, there is still limited evidence regarding the link between OPEs and metabolic dysfunction-associated fatty liver disease (MAFLD). Moreover, it remains uncertain whether the impact of OPEs on MAFLD is consistent across genders. This study aimed to investigate the associations of OPEs with MAFLD and to explore potential gender differences in these associations. We recruited 1863 participants from Wuhan, China, and measured the levels of fifteen urinary OPE metabolites. Logistic regression and weighted quantile sum (WQS) regression were utilized for single-pollutant and multi-pollutant analysis, respectively. Moreover, stratified and interaction analyses were performed to assess potential sex-specific associations. The results of single-pollutant analysis showed that participants in the highest tertile of BCIPHIPP (OR = 1.48, 95% CI = 1.11, 1.99) and BDCIPP (OR = 1.51; 95% CI = 1.12, 2.03) had a higher odds ratio of MAFLD compared to those in the lowest tertile. WQS regression revealed a detrimental effect of OPEs mixture on MAFLD (OR = 1.40, 95% CI = 1.19, 1.61), with BCIPHIPP (49.3%), and BDCIPP (29.5%) being the major contributors. Sex-specific analyses demonstrated that the positive association of OPEs with MAFLD was only observed in male participants. In conclusion, exposure to the mixture of OPEs was positively correlated with MAFLD and this adverse effect was more evident among men.

Epidemiological evidence regarding the associations of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) with lipid metabolism and its potential biological mechanisms remain largely unknown. We intended to explore the associations of OCPs and PCBs with dyslipidemia and blood lipid levels, and further evaluate the mediating role of total and differential white blood cell (WBC) counts. We measured the blood lipid levels, the concentration of OCPs/PCBs and WBC counts in serum among 2036 adults in Wuhan city, China. In the multiple-pollutant models, the results showed that β-hexachlorocyclohexane (HCH), p,p'-dichlorodiphenyldichloroethylene (DDE), and PCB-153 were positively correlated with increased odds of dyslipidemia. p,p'-DDE and PCB-153 were correlated with elevated triglyceride (TG) and lowered high-density lipoprotein cholesterol (HDL-c). A positive relationship was observed between p,p'-DDE and total cholesterol (TC) as well. Meanwhile, weighted quantile sum (WQS) regression analyses revealed that PCB and OCP mixtures were positively related to dyslipidemia risk and TG and negatively associated with HDL-c, to which p,p'-DDE was the major contributor. BMI, gender and age might modify the associations of OCPs and PCBs with dyslipidemia and TG. Furthermore, we found that WBC counts were significantly associated with dyslipidemia and blood lipid levels, and a positive correlation was also found between p,p'-DDE and lymphocyte count. Mediation analysis further indicated that lymphocyte count might mediate the associations of p,p'-DDE with dyslipidemia, TG, and TC. Accordingly, our results showed that OCPs and PCBs were related to abnormal lipid metabolism, which was partially mediated by WBC counts.

BACKGROUND:Ankle-brachial index (ABI) is a noninvasive diagnostic method for peripheral arterial disease (PAD) and a predictor of cardiovascular events. OBJECTIVE:The present study aimed to evaluate the association between individual or combined essential metals and ABI, as well as assess the collective impact of essential metals when coupled with healthy lifestyle on ABI. METHODS:A total of 2865 participants were recruited in Wuhan Tongji Hospital between August 2018 and March 2019. Concentrations of essential metals in urine were measured by inductively coupled plasma mass spectrometer. RESULTS:The results of general linear regression models demonstrated that after adjusting for confounding factors, there was a positive association between ABI increase and per unit increase of log 10-transformed, creatinine-corrected urinary Cr (β (95 % CI): 0.010 (0.004, 0.016), PFDR = 0.007), Fe (β (95 % CI): 0.010 (0.003, 0.017), PFDR = 0.018), and Co (β (95 % CI): 0.013 (0.005, 0.021), PFDR = 0.007). The WQS regression revealed a positive relationship between the mixture of essential metals and ABI (β (95 % CI): 0.006 (0.003, 0.010), P < 0.001), with Cr and Co contributing most to the relationship (weighted 45.48 % and 40.14 %, respectively). Compared to individuals with unfavorable lifestyle and the lowest quartile of Cr, Fe and Co, those with favorable lifestyle and the highest quartile of Cr, Fe and Co exhibited the most increase in ABI (β (95 % CI): 0.030 (0.017, 0.044) for Cr, β (95 % CI): 0.027 (0.013, 0.040) for Fe, and β (95 % CI): 0.030 (0.016, 0.044) for Co). CONCLUSION:In summary, our study indicates that adequate essential metal intake together with healthy lifestyle behaviors perform crucial roles in PAD protection.

目的:探讨成人体检人群体质量指数(BMI)与视网膜动脉硬化的相关性,为早发现、早干预微小血管病变提供新证据.方法:采用横断面研究方法,选取2019年1—12月在武汉同济医院健康管理中心进行过眼底照相的常规体检者,收集每个样本人口学信息、体格测量指标、血生化指标及既往疾病史等特征,并对视网膜血管进行分级,采用多因素Logistic分析方法探讨BMI与视网膜动脉硬化的关系.结果:本研究纳入研究对象8678人,其中男性5378人,女性3300人,年龄为(48.6±10.4)岁.视网膜动脉硬化患病率在对照组(BMI<24.0?kg/m2)、超重组(BMI?24.0～27.9?kg/m2)、肥胖组(BMI≥28.0?kg/m2)中分别为2.0％、3.7％、6.4％,整体呈上升趋势(趋势P<0.001).在调整了年龄、性别、高血压、糖尿病、血脂异常、高尿酸血症、谷丙转氨酶、谷草转氨酶、肾小球滤过率混杂因素后,BMI与视网膜动脉硬化患病风险成正相关关系,与对照组相比,超重组和肥胖组的OR值(95％CI)分别为1.13(0.83～1.55)、1.89(1.31～2.73),趋势P<0.001;BMI每增加1?kg/m2,视网膜动脉硬化患病风险OR值为1.09(1.05～1.14).结论:超重或肥胖与视网膜动脉硬化的发生密切相关,是视网膜动脉硬化的独立危险因素.

Recent research has reported positive associations of exposure to polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) with hyperuricemia. However, most of these studies have primarily focused on the individual effects of PCB/OCP exposure. We aimed to explore the associations of both individual and combined PCB/OCP exposure with hyperuricemia and examine whether such associations could be modified by lifestyle factors. The cross-sectional study recruited 2032 adults between March and May 2019 in Wuhan, China. Logistic regression and weighted quantile sum (WQS) regression were applied to explore the relationship of individual and combined PCB/OCP exposure with hyperuricemia, while considering the modified effects of lifestyle factors. Of the 2032 participants, 522 (25.7%) had hyperuricemia. Compared with the non-detected group, the detected groups of PCB153 and PCB180 exhibited a positive association with hyperuricemia, with OR (95% CIs) of 1.52 (1.22, 1.91) and 1.51 (1.20, 1.90), respectively. WQS regression showed that PCB/OCP mixture was positively associated with hyperuricemia (OR: 1.31, 95% CI: 1.08, 1.58). PCB153/PCB180 exposure, combined with an unhealthy lifestyle, has a significant additive effect on hyperuricemia. Overall, PCB/OCP mixture and individual PCB153/PCB180 exposure were positively associated with hyperuricemia. Adherence to a healthy lifestyle may modify the potential negative impact of PCBs/OCPs on hyperuricemia.

This study aimed to assess the relationships between exposure to individual organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and their mixture and arterial stiffness and explore whether adherence to an ideal cardiovascular health (CVH) could mitigate these associations. The cross-sectional study enrolled 1437 Chinese adults between March and May 2019 in Wuhan, China. OCPs and PCBs concentrations were measured using solid phase extraction coupled with gas chromatography–tandem mass spectrometry. Arterial stiffness was evaluated by brachial–ankle pulse wave velocity (baPWV). CVH was determined by three behavioral and four biological metrics and categorized as ideal, intermediate, and poor CVH. We applied generalized linear model and weighted quantile sum (WQS) regression to evaluate the associations of exposure to individual OCPs or PCBs and their mixture with baPWV, respectively. We found that participants with detectable levels of heptachlor epoxide, PCB-153, and PCB-180 had higher baPWV (β: 34.25, 95

Polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) are commonly detected in humans due to their persistence and bioaccumulation, and are suspected risk factors for metabolic syndrome (MetS). However, most studies have focused on individual rather than combined exposure. We explored the associations between indi-vidual and combined PCBs/OCPs exposure and MetS to better assess the health effects of PCBs and OCPs. This cross-sectional study included 1996 adults from Wuhan, China. A total of 338 participants fulfilled criteria for MetS. Eight PCBs and OCPs were detected in >50 % of the samples. Most of the hexachlorocyclohexanes (HCHs) in the serum were derived from the recent environmental input of lindane, while the high levels of dichlorodiphenyltrichloroethane (DDTs) were mainly due to historical use. Multivariate linear regression analyses revealed that beta-HCH, p,p '-dichlorodiphenyldichloroethylene (p,p '-DDE), PCB-52, PCB-153, and PCB-180 were positively correlated with in-creased odds of MetS. The profiles of the PCBs and OCPs associated with the different components of MetS were dis-tinct. Furthermore, quantile-based g computation (qgcomp) analyses showed that PCB and OCP mixtures were positively associated with the risk of MetS, and p,p'-DDE was the largest contributor to our model. These findings sug -gest that PCB and OCP concentrations, both individually and as mixtures, are associated with MetS risk. Prospective studies are needed to confirm these results.

Exposure to environmental pollutants and unhealthy lifestyles are key risk factors for metabolic dysfunction-associated fatty liver disease (MAFLD). While previous studies have suggested links between exposure to organochlorine pesticides (PCBs) and organochlorine pesticides (OCPs) and MAFLD, the results have been inconsistent. Furthermore, the combined effects of PCBs and OCPs on MAFLD and whether lifestyle factors can modify the associations remain unknown. Therefore, this study aimed to investigate the individual and joint effects of PCBs and OCPs on MAFLD and explore the potential modifying role of lifestyle. The study included 1923 participants from Wuhan, China. MAFLD was diagnosed based on ultrasonically diagnosed hepatic steatosis and the presence of overweight/obese, diabetes mellitus, or metabolic dysregulation. Healthy lifestyle score was determined by smoking, alcohol consumption, physical activity, and diet. Logistic regression and weighted quantile sum (WQS) were used to assess associations of individual and mixture of PCBs/OCPs with MAFLD. To explore the potential lifestyle modification, joint associations of PCBs/OCPs and lifestyle on MAFLD were conducted. Single-pollutant analysis showed positive associations of p,p'-DDE, β-HCH, PCB-153, and PCB-180 with MAFLD, with ORs (95% CIs) of 1.18 (1.05, 1.33), 1.57 (1.20, 2.05), 1.45 (1.14, 1.83), and 1.42 (1.12, 1.80), respectively. WQS regression demonstrated a harmful effect of PCBs/OCPs mixture on MAFLD (OR = 1.73, 95% CI = 1.24, 2.43), with β-HCH, p,p'-DDE, and PCB-180 being the major contributors. In the joint association analysis, participants with both high PCBs/OCPs exposure and unhealthy lifestyle have the highest odds of MAFLD. In conclusion, exposure to the mixture of PCBs and OCPs was positively correlated with MAFLD, and adopting a healthy lifestyle can mitigate the adverse impact.

Metallic elements are ubiquitous in the natural environment and always collaborate to affect human health. The relationship of handgrip strength, a marker of functional ability or disability, with metal co-exposure remains vague. In this study, we aimed to investigate the effect of metal co-exposure on sex-specific handgrip strength. A total of 3594 participants (2296 men and 1298 women) aged 21 to 79 years recruited from Tongji Hospital were included in the present study. Urinary concentrations of 21 metals were measured by inductively coupled plasma mass spectrometer (ICP-MS). We used linear regression, restricted cubic spline (RCS) model, and weighted quantile sum (WQS) regression to evaluate the association of single metal as well as metal mixture with handgrip strength. After adjusting for important confounding factors, the results of linear regression showed that vanadium (V), zinc (Zn), arsenic (As), rubidium (Rb), cadmium (Cd), thallium (Tl), and uranium (U) were adversely associated with handgrip strength in men. The results of RCS showed a non-linear association between selenium (Se), silver (Ag), and nickel (Ni) with handgrip strength in women. The results of WQS regression revealed that metal co-exposure was inversely related to handgrip strength for men (β = -0.65, 95