Background: Little is known about the interaction and joint associations of sex and modifiable risk factors with mortality, leaving critical gaps in understanding their contribution to population health outcomes. Methods: The Prospective Urban Rural Epidemiology (PURE)-China cohort study recruited participants aged 35 to 70 years from 115 urban and rural communities across 12 provinces in China during 2005-2009, and followed up until Aug 30, 2021. Metabolic, behavioural, and psychosocial risk factors were assessed using standardized measures and questionnaires, with all-cause mortality serving as the primary outcome. Results: Of 47,345 participants included in this analysis, 27,584 (58.3%) were women. After a median follow-up of 11.9 years (IQR 9.5-12.6), 1217 deaths were observed in women (age-standardised mortality 3.8 [95% CI 3.6-4.0] per 1000 person-years) and 1526 in men (6.1 [5.8-6.4] per 1000 person-years). Men exhibited higher prevalence of metabolic, behavioural, and psychosocial risk factors, although these differences diminished with age. Systolic blood pressure showed a stronger association with mortality in men (HR 1.25 [95% CI 1.19-1.31] per 20 mm Hg) than that among women (1.14 [1.08-1.20] per 20 mm Hg, P interaction <0.001), as was the case for hypertension. Conversely, women with low physical activity (<600 metabolic equivalents×minutes per week or <150 minutes per week of moderate intensity physical activity) (1.29 [1.10-1.51] vs. 1.00 [0.87-1.15], P interaction =0.003) and a PURE diet score ≤3 (1.18 [1.02-1.37] vs. 1.02 [0.90-1.15], P interaction =0.002) were associated with higher risks of mortality than that among men. Men with ≥7 risk factors had a significantly greater risk of mortality compared to women with 0-2 risk factors (3.40 [2.71-4.27]). Metabolic risk factors accounted for a higher excessive mortality in men (PAF 26.2% vs. 15.4% in women), whereas behavioural and psychosocial factors contributed more in women (35.1% vs. 24.5% in men). Conclusions: These findings underscore that metabolic risk factors, particularly systolic blood pressure, are key drivers of mortality in men, while behavioural and psychosocial factors, including physical inactivity and poor diet, are more influential in women. Targeted interventions addressing these sex-specific risk factors could significantly reduce mortality and enhance health equity in the Chinese population.

AIM:To explore the association of GLP-1 receptor agonists (GLP-1 RAs) with the risk of psychiatric disorders. METHODS:A systematic search was performed in PubMed, EMBASE, Cochrane Library and Web of Science (inception to June 13, 2025). Randomised clinical trials (RCTs) that compared the use of GLP-1 RAs with either placebo or other non-GLP-1 RAs treatments were included. Psychiatric disorders were collected based on reported treatment-emergent adverse events. Following PRISMA guidelines, two reviewers independently extracted data and evaluated the quality of each study using the Cochrane tool. Evidence quality was assessed using the GRADE framework. RESULTS:A total of 133 378 participants were included across 86 RCTs. No significant statistical difference was found in the incidence of psychiatric disorders between the GLP-1 RAs group and the control group (RR, 0.96; 95% CI, 0.85-1.08; I2 = 0%; ARD, -9 per 10 000 persons/year). GLP-1 RAs treatment was not associated with depression (RR, 0.88; 95% CI, 0.70-1.10), suicide (RR, 0.90; 95% CI, 0.59-1.38), anxiety (RR, 0.92; 95% CI, 0.72-1.19), sleep disorder (RR, 0.98; 95% CI, 0.70-1.37), bipolar disorder (RR, 1.19; 95% CI, 0.56-2.55), delirium (RR, 1.11; 95% CI, 0.74-1.66), addictive disorder (RR, 0.89; 95% CI, 0.45-1.77) or schizophrenia (RR, 1.45; 95% CI, 0.61-3.47). No statistically significant associations were observed for drug type, indication, dose, treatment duration, comparator type, baseline BMI, trial designation, age, inclusion of baseline psychiatric disorders or reporting category. Meta-regression analyses revealed no significant effect of changes in fasting blood glucose, haemoglobin A1c, weight or BMI on the risk of psychiatric disorders. CONCLUSION:GLP-1 RAs use was not associated with the risk of psychiatric disorders, including depression, suicide or anxiety. TRIAL REGISTRATION:PROSPERO Identifier: CRD42024546896.

[This corrects the article DOI: 10.3389/fendo.2025.1700349.].

Introduction:Clarifying heterogeneous diabetes distress (DD) trajectories and their predictors from a dynamic perspective is crucial. We aimed to develop a trajectory prediction model for dynamic DD. Methods:This prospective longitudinal study included 443 adults with type 2 diabetes mellitus who completed the demographics and diabetes characteristics questionnaire, scales measuring lifestyles and psychological factors (at baseline), and the Chinese version of the Diabetes Distress Scale (at baseline and at 3-, 6-, 9-, and 12-month follow-ups). After identifying the factors associated with DD, growth mixture modeling was used to determine latent longitudinal DD trajectory classes and develop a trajectory prediction model. Results:Five DD trajectories were identified: persistently low DD (65.01%), persistently moderate DD (25.28%), persistently high DD (3.61%), decreasing DD (3.16%), and increasing DD (2.94%). Using the persistently low DD group as the reference, people with no religious belief (B = -24.932, p < 0.001), longer diabetes duration (B = 0.042, p = 0.037), worse self-management behaviors (B = -0.032, p = 0.009), and lower self-efficacy (B = -0.287, p = 0.007) tended to have a persistently moderate DD trajectory. Insomnia severity (B = 0.232, p = 0.008) and type D personality (B = 2.783, p = 0.002) were significant positive predictors of persistently high DD trajectory. Those with higher HbA1c levels (B = 0.728, p = 0.003) and lower self-efficacy (B = -0.858, p = 0.044) were more likely to belong to the decreasing DD trajectory class. Self-management behaviors (B = -0.127, p = 0.012) were negatively associated with belonging to the increasing DD trajectory class. Conclusion:Demographics, diabetes characteristics, lifestyles, and psychosocial factors can predict dynamic heterogeneous trajectories of DD. The trajectory prediction model will enable healthcare professionals to anticipate DD trajectories and conduct targeted interventions [Trial registration: ChiCTR2100047071].

Body roundness index (BRI) is an innovative anthropometric indicator that reflects visceral adiposity and body composition. Although its association with mortality has been studied in both general and metabolic populations, its prognostic value in individuals with established atherosclerotic cardiovascular disease (ASCVD) remains unclear. This study aimed to investigate the association between BRI and all-cause and cardiovascular mortality in a nationally representative cohort of American adults diagnosed with ASCVD. Data were collected from 10 continuous cycles (1999-2018) of the National Health and Nutrition Examination Survey. In total, 2071 adults with self-reported ASCVD were included. The BRI was calculated from the waist circumference and height. Mortality outcomes were ascertained via linkage to the National Death Index in December 2019. Multivariate Cox proportional hazards regression models, restricted cubic splines, and subgroup analyses were used to assess associations. During a median follow-up of 6.9 years, 828 all-cause and 280 cardiovascular deaths occurred. A U-shaped nonlinear relationship was observed between the BRI and mortality (P-nonlinearity < .001). The inflection points were 5.54 for all-cause mortality and 6.09 for cardiovascular mortality. Below these points, the BRI was negatively correlated with mortality; above these points, each unit increase in the BRI significantly increased the risk of all-cause (hazard ratio = 1.114, 95% confidence interval: 1.113, 1.115) and cardiovascular mortality (hazard ratio = 1.101, 95% confidence interval: 1.099, 1.102). Subgroup analyses indicated that the associations were modified by gender, socioeconomic status, lifestyle behaviors, and comorbidities. In adults with ASCVD, the BRI is associated with both all-cause and cardiovascular mortality in a U-shaped manner, with the optimal risk observed within the range of approximately 5.5 to 6.0. BRI may serve as a valuable tool for risk stratification and personalized management in high-risk populations.

Artificial intelligence is increasingly integrated into nursing education, making AI literacy a key competency for students. Academic resilience is also essential for coping with learning challenges. However, the mechanisms linking AI literacy to academic resilience remain unclear, particularly the roles of self-efficacy and AI anxiety. This study examines these associations and tests the mediating effects of self-efficacy and AI anxiety. A cross-sectional study was conducted among 415 undergraduate nursing students from a university in northern China. AI literacy, academic resilience, self-efficacy and AI anxiety were assessed using validated scales. Statistical analyses included descriptive analysis, Pearson correlation and serial mediation testing using the PROCESS macro in SPSS with bootstrap sampling. (1) Academic resilience was significantly and positively correlated with AI literacy (r = 0.229, p < 0.01) and self-efficacy (r = 0.340, p < 0.01), and negatively correlated with AI anxiety (r = -0.426, p < 0.01). AI literacy was positively correlated with self-efficacy (r = 0.118, p < 0.05) and negatively correlated with AI anxiety (r = -0.143, p < 0.01). (2) AI literacy was positively associated with self-efficacy (β = 0.118, p = 0.017) and was negatively associated with AI anxiety (β = -0.143, p = 0.006). Self-efficacy positively was positively associated with academic resilience (β = 0.340, p < 0.001), while AI anxiety was negatively associated with academic resilience (β = -0.426, p < 0.001). (3) In the model of AI literacy → self-efficacy → AI anxiety → academic resilience, the total indirect effect was 0.055. The mediating effect of self-efficacy accounted for 36.4

BackgroundPregnant women exhibit a high prevalence of sleep disturbances; however, the relationships between sleep variability, sleep irregularity, and gestational metabolic syndrome (GMS) remain poorly understood. This study aimed to investigate prospective associations of sleep variability and irregularity with the odds of GMS and its individual components.MethodsFour sub-cohorts of pregnant women were established based on data from the Fujian Birth Cohort Study (FJBCS) collected from 2019 to 2021. Logistic regression models were adopted to assess the associations between sleep variability and irregularity during pregnancy and the occurrence of GMS and its components. Stratified analyses examined potential modification of effects by demographic factors. Restricted cubic spline (RCS) models were used to evaluate potential non-linear relationships.ResultsGreater sleep variability was significantly associated with increased odds of GMS (aOR 1.348; 95% CI: 1.136-1.559) and dyslipidemia (aOR 1.086; 95% CI: 1.019-1.159), although no significant associations were found for hyperglycemia or hypertension. Sleep irregularity exhibited no significant association with GMS or its components. Subgroup analyses revealed increased vulnerability in women of advanced maternal age compared to younger age groups (aOR: 1.536 vs. 1.279). Those with a history of two or more prior pregnancies and natural pregnancies were more susceptible. RCS modeling confirmed the absence of nonlinear associations.ConclusionsHigher sleep variability is prospectively associated with an increased odds of GMS and dyslipidemia, with potential modulation by maternal age, conception method, and gravidity. No significant association was found between sleep irregularity and GMS or its components.

Purpose:Glucose-dependent insulinotropic polypeptide (GIP) plays a crucial role in lipid metabolism. The effect of GIP on pancreatic lipid and whether it modulates risk of type 2 diabetes (T2D) associated with fatty pancreas remain unknown. The aim of this study was to investigate the interaction between genetically predicted GIP levels and fatty pancreas in the development of T2D. Methods:This is a large-scale cohort study using data from the UK Biobank. Participants of White ethnicity without diabetes at the imaging visit were included in the analysis. The loss-of-function GIPR variant E354Q was used for the prediction of fasting GIP levels, and a polygenic risk score (PRS) of postprandial GIP was used for the prediction of postprandial GIP levels. The presence of fatty pancreas disease (FPD) was determined with magnetic resonance imaging (MRI). Diagnosis of T2D was ascertained based on ICD10-CM diagnosis code E11. During a median follow-up of 51 months, 276 cases of incident T2D were identified. Results:A significant interaction between the carrying status of E354Q and FPD (p for interaction = 0.018) and between 2hGIP PRS and FPD (p for interaction = 0.015) in the development of T2D was found. FPD is associated with a greater increase of risk of T2D in individuals without E354Q [hazard ratio (HR) 2.44, 95% confidence interval (CI) 1.78-3.34] or with higher levels of genetically predicted postprandial GIP (HR 2.64, 95% CI 1.86-3.76). Conclusion:Our findings show that genetically predicted GIP modifies risk of T2D associated with FPD, suggesting that GIP may play a role in linking pancreatic fat accumulation to metabolic dysfunction. These findings are derived from genetically predicted rather than measured GIP.

This study aimed to investigate the availability, prices, and affordability of nationally negotiated antidiabetic medicines in China. This study collected monthly medicine usage data from 2018 to 2023 from the China Medical Economic Information Network (CMEI). The study focused on 12 nationally negotiated antidiabetic medicines included in the 2020 edition of the National Reimbursement Drug List for Basic Medical Insurance, Work-Related Injury Insurance, and Maternity Insurance. This study covered 804 public general hospitals in 31 provincial administrative regions in China, among which 537 (66.79

Although antihypertensive medication is central to hypertension management, substantial residual risks persist. This study evaluated the associations of healthy lifestyle behaviors with all-cause mortality and cardiovascular disease (CVD) among individuals with hypertension, and assessed whether favorable lifestyles provided additional benefits beyond antihypertensive medication. From the perspective of predictive, preventive, and personalized medicine (PPPM/3PM), we assumed that comprehensive lifestyle assessment could refine risk stratification and help identify priority targets. This study included 16,314 participants with hypertension from the Prospective Urban Rural Epidemiology (PURE)-China study. A healthy lifestyle score (0–6, higher scores indicating healthier behaviors) was constructed based on six lifestyle behaviors. Antihypertensive medication use was defined as regular intake at least once per week. Cox frailty models were used to estimate hazard ratios (HRs) and 95

BACKGROUND:The Lancet Commission redefined obesity by integrating body mass index (BMI) and anthropometric measures, but it remains unclear if they better identify risk for cardiovascular-kidney-metabolic (CKM) syndrome. We aim to compare the CKM risk and all-cause mortality predicted by these new criteria against traditional BMI-based criteria. METHODS:Using Cox models to investigate the associations between different obesity phenotypes, which were normal weight, Anthropometric excess adiposity & Traditionally-defined non-obesity, Traditionally-defined obesity & Non-anthropometric excess adiposity, and excess adiposity by both criteria, with Anthropometric excess adiposity by the anthropometric criteria alone, Traditionally-defined obesity by BMI alone, and CKM syndrome and mortality in the UK Biobank. We further compared whether the anthropometric diagnostic sub-categories were associated with different levels of risk. RESULTS:Among 352 740 participants (mean age 56.8 years; 56% female) with a median follow-up of 13.2 years, compared to normal weight, the "Anthropometric excess adiposity & Traditionally-defined non-obesity" (HR 1.55, 95% CI 1.52-1.59) and "Traditionally-defined obesity & Non-anthropometric excess adiposity" (HR 1.61, 95% CI 1.29-2.02) exhibited similarly elevated risks for CKM syndrome. Those meeting both criteria had the highest risk (HR 2.61, 95% CI 2.56-2.66) for CKM syndrome. Anthropometric excess adiposity had an increased CKM risk (HR 2.00, 95% CI 1.96-2.04), which was lower than that for Traditionally-defined obesity (HR 2.45, 95% CI 2.41-2.49). Among the anthropometric sub-categories, the three BMI-inclusive definitions yielded similar HRs for CKM risk, which were higher than those of Traditionally-defined obesity and the non-BMI sub-categories. CONCLUSION:By incorporating central adiposity, the anthropometric criteria improve CKM risk stratification by identifying high-risk individuals overlooked by traditional standards, especially those with adverse body composition despite lower BMI.

Background:Osteoporosis is a major global health issue, but current early screening tools lack accuracy, and the gold-standard diagnostic method, dual-energy X-ray absorptiometry (DXA), is not widely accessible. This limits large-scale early screening efforts, as evidenced by China's low screening rate of 3.7% among adults aged over 50. To address these limitations, we developed OsteoSC-M3, a new risk assessment model for women using a stacked ensemble machine learning algorithm, designed to offer a precise and accessible tool for early risk identification. Methods:A model was developed based on a cohort of 5745 females (aged 50-90 years) from Shanghai Sixth People's Hospital (2013-2023); sex was self-reported. Participants were randomly partitioned into a Training Set (70%, n = 4022) and an Internal Validation Set (30%, n = 1723). First, missing values in the Training Set were imputed using the missForest method, and key predictive variables were selected through VIF, LASSO, and multivariable logistic regression. Nine base models and an ensemble model with XGBoost as the meta-learner were then constructed using the Training Set. The model was further validated on the Internal Validation Set and two independent multicentre external cohorts (Shanghai 2024 cohort, n = 1839; Jiangsu 2025 cohort, n = 305). Additionally, its prognostic value was assessed through a prospective study, which enrolled 405 female participants with low bone mass (T-score between -1.0 and -2.5) from the Health Examination Centre of Shanghai Sixth People's Hospital, with a follow-up period exceeding five years, where outcomes were evaluated using Kaplan-Meier survival analysis and Cox regression. This study is registered with the Chinese Clinical Trial Registry (part of the WHO International Clinical Trials Registry Platform), number ChiCTR2500097213. Findings:Eleven key variables, including age, height, weight, and eight serum biomarkers, were identified. All nine base models performed well without overfitting. The OsteoSC-M3 model achieved excellent diagnostic performance with a Training Set AUC of 0.973 (95% CI 0.969-0.976). It maintained excellent performance in the Internal Validation Set (AUC 0.943, 95% CI 0.933-0.954) and two external cohorts (Cohort 1: AUC 0.958, 95% CI 0.949-0.966; Cohort 2: AUC 0.917, 95% CI 0.897-0.928), demonstrating strong generalisability. Calibration curves showed good agreement, and decision curve analysis confirmed clinical utility. Prospectively, the model agreed well with follow-up results (Kappa = 0.82) and identified high-risk individuals 29 ± 9.31 months earlier (HR = 7.63, P < 0.001). It significantly outperformed the Osteoporosis Self-Assessment Tool for Asians (OSTA) across all cohorts. The model is accessible via an online platform (http://47.101.190.127:3838/scyz/), providing a valuable tool for precision screening and early intervention in osteoporosis. Interpretation:The OsteoSC-M3 model integrates demographic features with eight simple laboratory parameters to enable early, non-invasive prediction of osteoporosis risk in women, providing a 29-month lead time before clinical diagnosis. Superior to OSTA in risk stratification, it effectively identifies high-risk individuals requiring DXA confirmation and demonstrates strong utility in resource-limited settings without DXA equipment. This innovative screening approach creates a critical window for early intervention that could significantly improve participants' quality of life while reducing the economic burden on healthcare systems. Future research should focus on validating the model in more diverse ethnic populations and assessing its long-term impact on clinical outcomes through large-scale prospective trials. Funding:This study was funded by the Shanghai Pudong New Area Health Commission Joint Research Project, the Hospital Contractual Research Project, the Pudong New Area Science and Technology Development Fund, the Clinical Research Programme of Shanghai Sixth People's Hospital, and the Hospital's Clinical Backbone Team Cultivation Programme.

AIM:This study explored the key influencing factors and turning points in the formation of professional identity among male undergraduate nursing students in China from a life course perspective. BACKGROUND:With the rising proportion of male nurses in China, understanding how male nursing students develop professional identity is vital to promoting gender diversity and improving retention. However, limited research in China has examined this process from a life course perspective, which can help inform targeted educational and institutional strategies. DESIGN:An exploratory qualitative study. METHODS:Semi-structured interviews were conducted with 16 male undergraduate nursing students across academic years at a university in China. Guided by a life course theory-informed interview schedule, interviews focused on experiences shaping professional identity across life stages. Data were coded and thematised using reflexive thematic analysis and reported in line with COREQ. RESULTS:Five main themes emerged: 1) Early life experiences shaping initial views of nursing; 2) Identity transformation through education and practice; 3) Negotiating gender stereotypes and societal expectations; 4) Peer support and gendered collaboration; and 5) Pragmatic career thinking and evolving aspirations. The identity formation process was dynamic, cross-phase and influenced by both social contexts and personal agency. CONCLUSION:Male nursing students' professional identity in China is shaped by early experiences and continuously reshaped through education and clinical practice. Breaking gender stereotypes, strengthening educational and institutional support, building peer networks and offering diverse career development opportunities can help enhance identity formation and career stability among male nursing students.

BACKGROUND:Life expectancy is increasing globally, but if people are to age healthily, they must do so with fewer limitations in their daily activities. However, information on either the frequency or risk factors for limitations to walking ability or other key activities across different regions of the world is limited. Our aim was to describe the incidence, trajectories, risk factors, and population-attributable fraction of new-onset walking limitations in 25 countries at all socioeconomic levels. METHODS:PURE is an ongoing, prospective cohort study. The current analysis included community-dwelling participants who lived in four high-income countries (HICs), 16 middle-income countries (MICs), and five low-income countries (LICs). Individuals aged 35-70 years at baseline who completed a baseline questionnaire about activity limitations between Jan 12, 2001, and May 6, 2019, were included in our analysis. The activity limitation screen included questions on self-reported difficulty with walking, grasping, bending, seeing close-up, seeing distance, and hearing. The primary outcome was incident walking limitation and our analytic sample comprised those with no walking limitation at baseline. We estimated the incidence rates, adjusted for age and sex, per 100 person-years in the overall PURE population, by country income level (and separately for China) and sex. We used multistate modelling to evaluate trajectories across the life course, analysed across continuous age, through three distinct sequential states: no limitation, walking limitation, and death. We used survival models to evaluate the associations of socioeconomic status, vascular and behavioural factors, community walkability, and incident adverse events, with incident walking limitations. We then calculated the population-attributable fraction of selected modifiable factors and compared the risk factors for walking limitation and mortality. FINDINGS:172 889 people from the PURE cohort answered questions on walking limitations at baseline, 150 221 of whom reported no walking limitation and were included in the multistate model. Of these 150 221 individuals, 122 538 had at least one follow-up assessment with walking limitations data (mean age at baseline 49·7 years [SD 9·5]; 71 424 [58·3%] female and 51 114 [41·7%] male). Mean follow-up was 14·5 years (SD 3·3). Incidence of a new walking limitation per 100 person-years was higher in LICs (3·34 [95% CI 3·27-3·41]), and lowest in China (0·58 [0·56-0·60]), compared with other MICs (1·80 [1·77-1·84]) and HICs (1·31 [1·27-1·37]). The incidence of walking limitation was higher in female participants (1·84 [1·81-1·87]) than in male participants (1·25 [1·22-1·28]). In multistate models, state transitions from no walking limitation to walking limitation and death occurred at a higher rate and earlier in LICs, where the age at which the probability of transitioning to a walking limitation was reached by an estimated one-third of people at 64 years compared with age 76 years in HICs. Female participants had a higher probability of incident walking limitation across the age spectrum compared with male participants. Many socioeconomic, vascular, and behavioural risk factors, community walkability, and incident adverse events, especially incident stroke, were associated with incident walking limitations. The population-level risk factors with the highest population-attributable fractions for walking limitation were low education (11·1% [95% CI 9·9-12·4]), obesity (5·2% [4·7-5·8]), hypertension (3·6% [2·2-5·0]), and low recreational physical activity (4·3% [2·3-6·3]), with obesity being the highest in HICs (12·9% [11·2-14·6]) and low education being the highest elsewhere. Potentially modifiable individual-level risk factors explained approximately 32·9% of the population's risk of walking limitations and approximately 47·4% of mortality, and four of the top five factors were shared for both outcomes (low education, low recreational activity, poor diet, and hypertension). INTERPRETATION:Individuals in LICs had an accelerated transition to walking limitation, which was approximately 12 years earlier than those in HICs. Walking limitation and mortality shared a common set of modifiable risk factors, accounting for almost one-third of the population-level risk of walking limitations and highlighting opportunities for integrated prevention strategies in mid-life that simultaneously target disability and premature mortality across socioeconomic settings. FUNDING:Funding sources are listed at the end of the Article.

BACKGROUND:Cardiovascular-kidney-metabolic (CKM) syndrome is closely associated with a wide range of adverse health outcomes, yet its relationship with sarcopenia remains poorly defined. This study aimed to investigate the association between CKM syndrome and incident sarcopenia and to further evaluate its impact on sarcopenia state transitions. METHODS:We analyzed UK Biobank data from 47,431 participants without sarcopenia at baseline and with complete CKM risk factor. Kaplan-Meier method and Cox proportional hazards models were applied to evaluate the association between CKM stages and the incidence of sarcopenia, with subgroup and sensitivity analyses conducted. Additionally, 49,905 participants with complete baseline sarcopenia assessments were included in a multi-state Markov model to estimate the impact of CKM stages on transition probabilities and intensities among non-sarcopenia, possible sarcopenia, confirmed sarcopenia, and death. RESULTS:Kaplan-Meier curves demonstrated a gradual increase in the cumulative incidence of sarcopenia with advancing CKM stages (P < 0.0001). In fully adjusted Cox regression models, CKM stage 4 was associated with higher risks of developing probable sarcopenia (HR, 1.22; 95% CI, 1.07-1.39) and confirmed sarcopenia (HR, 1.68; 95% CI, 1.02-2.77). No significant interactions were found in subgroup analyses, and sensitivity analyses supported the robustness of the findings. In the multi-state Markov model, compared with participants in CKM stage 0, those in CKM stages 2-3 and 4 had a lower hazard of recovery from possible sarcopenia to non-sarcopenia (HR 0.55; 95% CI 0.46-0.67 and HR 0.50; 95% CI 0.36-0.68, respectively). Additionally, higher CKM stages were associated with greater probabilities of progression to more severe sarcopenia states. CONCLUSIONS:In this longitudinal cohort study, more advanced CKM stages were associated with a higher risk of incident sarcopenia and with less favorable trajectories of sarcopenia state transitions. Early identification and management of CKM may help prevent the onset of sarcopenia and attenuate its progression to more severe states.

BACKGROUND:Prolonged sedentary time is associated with adverse outcomes, but evidence in low-exposure ranges remains limited. The health effects of reallocating time between sitting, physical activity, and sleep have not been comprehensively examined. METHODS:We analyzed 41,733 adults (mean age = 50.6 years) from the Prospective Urban Rural Epidemiology (PURE)-China cohort, recruited between 2005 and 2009 and followed for a median of 11.9 years. Sitting, physical activity, and sleep were assessed using validated questionnaires. The primary outcome was a composite of all-cause mortality and major cardiovascular events. Cox frailty and isotemporal substitution models were applied. RESULTS:Median sitting time was 3.0 h/day (interquartile range (IQR): 1.7-4.6). Sitting showed a J-shaped association with outcomes, with lowest risk around 4 h/day. Both low (<2 h/day) and high (≥6 h/day) sitting were associated with higher risk. Among participants sitting ≥4 h/day, replacing 30 min of sitting with physical activity was associated with a 3%-4% lower risk of the composite outcome, with stronger associations observed for all-cause mortality (6%-7%). In contrast, among those sitting <4 h/day, reallocating 30 min of physical activity or prolonged sleep to sitting was associated a 4%-6% lower risk of the composite outcome and a 4%-10% lower risk of all-cause mortality. CONCLUSION:Sitting time demonstrates context-dependent associations with health. The finding that moderate sitting was protective in highly active individuals reflects a potential "sitting paradox". Our study highlights the bidirectional effects of reallocating sitting, activity, and sleep, underscoring the need for more context-specific guidance.

The potential causal relationship between hip osteoarthritis (HOA) and pancreatic cancer (PC) is not well understood. To investigate this, our study utilized a two-sample Mendelian randomization (MR) method to examine a possible causal link between HOA and an increased risk of PC. Genome-wide association study summary data for both HOA and PC were sourced from the Integrative Epidemiology Unit OpenGWAS database (https://gwas.mrcieu.ac.uk/datasets/). The single-nucleotide polymorphisms associated with these conditions at a statistically significant level (P value <5 × 10-8) were identified as instrumental variables for subsequent analysis. We conducted bidirectional two-sample MR analyses employing inverse-variance weighting (IVW), weighted median, MR-Egger regression, and weighted mode methods. The robustness of the findings was assessed through sensitivity testing. The IVW analysis indicated that HOA elevated the risk of PC (odds ratio = 1.788; 95% confidence interval: 1.166-2.742; P = .008). Conversely, in the reverse MR analysis, the IVW analysis provided no evidence that PC increased the risk of HOA (odds ratio = 1.016; 95% confidence interval: 0.973-1.060; P = .475). In addition, the weighted mode, weighted median, and MR-Egger regression methods did not uncover a causal relationship. There was no heterogeneity or horizontal pleiotropy among the instrumental variables. The "leave-one-out" analysis revealed that no single-nucleotide polymorphism significantly influenced the overall results. Genetically predicted HOA is significantly associated with an increased risk of PC. However, we found no evidence that PC leads to an increased risk of HOA.

Background:Although vascular aging and insulin resistance (IR) are recognized contributors to cardiovascular disease (CVD) pathophysiology, their independent and joint associations with CVD outcomes have not been fully clarified in large population-based cohorts. Evidence regarding their complementary rather than mediating roles remains limited. Methods:We used data from the Prospective Urban Rural Epidemiology (PURE) China study, a large prospective cohort comprising 47 931 individuals from 12 provinces across China. Vascular aging was assessed using estimated pulse wave velocity and categorized into supernormal (SVA), healthy (HVA), and early vascular aging (EVA) based on cohort percentiles. IR was evaluated using the triglyceride-glucose (TyG) index. The primary outcome was major CVD events (myocardial infarction, stroke, and heart failure). Cox frailty models with center-level random effects were used to estimate adjusted hazard ratios (aHRs). Results:A total of 40 513 participants with complete information were included in the current study. Over a median follow-up of 11.9 years (interquartile ranges 9.5-12.5), 3615 major CVD events, 829 CVD deaths, and 2344 all-cause deaths occurred. Compared with HVA, EVA was associated with substantially higher risks of major CVD events [aHR = 2.17, 95% confidence interval (CI): 1.99-2.35], CVD mortality (aHR = 4.07, 95% CI: 3.47-4.76), and all-cause mortality (aHR = 2.93, 95% CI: 2.65-3.23), while SVA showed consistently lower risks. Furthermore, higher TyG index levels were independently associated with major CVD event risk in a dose-response manner. Exploratory analyses revealed no significant mediation by the TyG index or interaction between vascular aging and TyG levels. Joint analysis revealed that individuals with both EVA and high TyG had the greatest major CVD risk (aHR = 2.20, 95% CI: 1.75-2.77). Conclusions:EVA and IR were independently associated with higher CVD risk, highlighting the need for integrated vascular-metabolic risk assessment in clinical practice, although further validation is warranted.

Background: Although prolonged sedentary time is linked to adverse health outcomes, evidence regarding its dose–response relationship in the low-exposure ranges remains limited. Moreover, the effects of reallocating time between sedentary behavior, physical activity, and sleep on all-cause mortality and cardiovascular disease have not been comprehensively examined. To address these gaps, we evaluated bidirectional time reallocations among sedentary behavior, physical activity, and sleep in a Chinese cohort. Methods: We analyzed data from the PURE-China study, which recruited 47,931 participants aged 35 to 70 years from 115 communities across 12 provinces between 2005 and 2009 in China and followed up every three years Sitting time, physical activity, and sleep duration were assessed using validated questionnaires. The primary outcome was a composite of all-cause mortality and major cardiovascular events. Cox frailty models were used to examine the associations of sitting time with outcomes. Isotemporal substitution models were applied to estimate the bidirectional reallocations of time between sedentary behavior, physical activity, and sleep. Results: Among 41,733 participants with a median follow-up of 11.9 years, the mean age was 50.6 ± 9.7 years, and the median sitting time was 3.0 hours/day (IQR: 1.7–4.6). Sitting time showed a J-shaped association with the composite outcome, with the lowest risk observed at 2–4 h/day. Both low (<2 h/day) and high (≥6 h/day) levels of sitting were associated with increased risks of all-cause mortality and composite outcome. Among participants sitting ≥4 h/day, replacing 30 minutes of sitting with moderate-to-vigorous physical activity (MVPA) or work-related activity was associated with a 3–7% reduction in mortality risk. Conversely, among those sitting <4 h/day, reallocating time from physical activity or prolonged sleep to sitting time was associated with a 4%-10% reduction risk of mortality. Conclusions: Sedentary behavior shows context-dependent associations with health, where both low and high levels relate to higher risks. The “sitting paradox” observed in highly active individuals highlights the bidirectional effects of reallocating time between sitting, physical activity, and sleep. These findings underscore the need for more nuanced public health recommendations tailored to baseline activity and sedentary patterns.

​BackgroundMen remain markedly underrepresented in the global nursing workforce, and male nursing students frequently face gender stereotypes, limited clinical opportunities, and insufficient professional support during their training.Such gendered experiences may impede their professional socialization and contribute to increased role strain.Although previous studies have explored stress and role conflict among nursing students, comprehensive quantitative evidence on the current status and determinants of role strain specifically among male nursing students—especially in Western China—remains limited. Aim To assess the level of role strain among male nursing students and identify the factors associated with it. Methods A multicenter cross-sectional survey was conducted from September to November 2025 in six nursing colleges in Sichuan Province, China.A total of 291 valid responses were obtained using convenience sampling.Data were collected using a general information questionnaire, the Role Strain Scale for Male Nursing Students (RSS-MNS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Nurse Professional Identity Scale.Statistical analyses included t-tests, one-way ANOVA, Pearson correlation analysis, and stepwise multiple linear regression. Results Male nursing students demonstrated a moderate level of role strain (M=31.90±7.67), with patient-related role strain showing the highest scores among all dimensions.Role strain was negatively correlated with both social support (r= –0.196, P< 0.01) and professional identity (r= –0.353, P< 0.01).Regression analysis identified professional identity (β= –0.383), intention to enter clinical nursing (β= 0.145), and award experience during university (β= 0.117) as significant predictors of role strain, together explaining 14.6% of the variance.Students without award experience, those intending to enter clinical nursing, and those with lower academic performance reported higher levels of role strain. Conclusion Male nursing students experience significant gender-related role strain shaped by both individual characteristics and educational contexts.Enhancing professional identity, strengthening social support systems, and fostering gender-inclusive learning and clinical environments may help reduce role strain.This study offers updated empirical evidence to inform targeted educational strategies and policy development aimed at promoting gender diversity and enhancing the quality of nursing education.