Adiposity change and mortality in middle-aged to older Chinese: an 8-year follow-up of the Guangzhou Biobank Cohort Study

ObjectiveTo examine the associations of change in body mass index (BMI) and waist circumference (WC) over an average of 4 years with subsequent mortality risk in middle-aged to older Chinese.DesignProspective cohort study based on the Guangzhou Biobank Cohort Study.SettingCommunity-based sample.Participants17 773 participants (12 956 women and 4817 men) aged 50+ years.Primary and secondary outcome measuresPrimary outcome measure was all-cause mortality. Secondary outcome measures were cardiovascular disease (CVD) and cancer mortality. Causes of death were obtained via record linkage, and coded according to the International Classification of Diseases (tenth revision).Results1424 deaths (53.4% women) occurred in the 17 773 participants (mean age 61.2, SD 6.8 years) during an average follow-up of 7.8 (SD=1.5) years, and 97.7% of participants did not have an intention of weight loss . Compared with participants with stable BMI, participants with BMI loss (>5%), but not gain, had a higher risk of all-cause mortality (HR=1.49, 95% CI 1.31 to 1.71), which was greatest in those who were underweight (HR=2.45, 95% CI 1.31 to 4.59). Similar patterns were found for WC. In contrast, for participants with a BMI of ≥27.5 kg/m2, BMI gain, versus stable BMI, was associated with 89% higher risk of all-cause mortality (HR=1.89, 95% CI 1.25 to 2.88), 72% higher risk of CVD mortality (HR=1.72, 95% CI 0.80 to 3.72) and 2.27-fold risk of cancer mortality (HR=2.27, 95% CI 1.26 to 4.10).ConclusionIn older people, unintentional BMI/WC loss, especially in those who were underweight was associated with higher mortality risk. However, BMI gain in those with obesity showed excess risks of all-cause and cancer mortality, but not CVD mortality. Frequent monitoring of changes in body size can be used as an early warning for timely clinical investigations and interventions and is important to inform appropriate health management in older Chinese.

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The Japanese food score and risk of all-cause, CVD and cancer mortality: the Japan Collaborative Cohort Study

British Journal Of Nutrition ◽

10.1017/s000711451800154x ◽

2018 ◽

Vol 120 (4) ◽

pp. 464-471 ◽

Cited By ~ 16

Author(s):

Emiko Okada ◽

Koshi Nakamura ◽

Shigekazu Ukawa ◽

Kenji Wakai ◽

Chigusa Date ◽

...

Keyword(s):

Cohort Study ◽

Cancer Mortality ◽

Food Groups ◽

Hazard Ratios ◽

All Cause Mortality ◽

Japanese Diet ◽

Cvd Mortality

AbstractFew studies have reported the association between the Japanese diet as food score and mortality. This study aimed to investigate adherence to the Japanese food score associated with all-cause, CVD and cancer mortality. A total of 58 767 (23 162 men and 34 232 women) Japanese participants aged 40–79 years, who enrolled in the Japan Collaborative Cohort Study between 1988 and 1990, were included. The Japanese food score was derived from the components of seven food groups (beans and bean products, fresh fishes, vegetables, Japanese pickles, fungi, seaweeds and fruits) based on the FFQ. The total score ranged from 0 to 7, and participants were divided into five categories based on scores (0–2, 3, 4, 5 and 6–7). Hazard ratios (HR) and 95 % CI for all-cause, CVD and cancer mortality based on sex were estimated using Cox proportional models. During the follow-up period until 2009, 11 692 participants with all-cause, 3408 with CVD and 4247 with cancer died. The multivariable HR in the 6–7 and 0–2 Japanese food score groups were 0·93 (95 % CI 0·86, 1·01) in men and 0·82 (95 % CI 0·75, 0·90) in women for all-cause mortality and 0·89 (95 % CI 0·76, 1·04) in men and 0·66 (95 % CI 0·56, 0·77) in women for CVD mortality. Our findings suggest that adherence to the Japanese food score consisting of food combinations characterised by a Japanese diet may help in preventing all-cause and CVD mortality, especially in women.

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Dietary supplement use and mortality in a cohort of Swedish men

British Journal Of Nutrition ◽

10.1017/s0007114507812049 ◽

2008 ◽

Vol 99 (3) ◽

pp. 626-631 ◽

Cited By ~ 23

Author(s):

Maria Messerer ◽

Niclas Håkansson ◽

Alicja Wolk ◽

Agneta Åkesson

Keyword(s):

Dietary Supplements ◽

Dietary Supplement ◽

Cancer Mortality ◽

Inverse Association ◽

Supplement Use ◽

All Cause Mortality ◽

Dietary Supplement Use ◽

Risk Of Cancer ◽

Cvd Mortality

The use of dietary supplements has increased substantially in most industrialized countries. The aim of this study was to prospectively examine the association between use of dietary supplements and all-cause mortality, cancer mortality and CVD mortality in men. We used the population-based prospective cohort of 38 994 men from central Sweden, 45–79 years of age, with no cancer or CVD at baseline and who completed a self-administered FFQ including questions on dietary supplement use and life-style factors in 1997. During average 7.7 years of follow-up, 3403 deaths were ascertained; among them, 771 due to cancer and 930 due to CVD (during 5.9 years of follow-up). In multivariate adjusted models including all men there was no association observed between use of any dietary supplement or of multivitamins, vitamin C, vitamin E or fish oil specifically and all-cause mortality, cancer or CVD mortality. Among current smokers, regular use of any supplement was associated with statistically significant increased risk of cancer mortality: relative risk (RR) 1·46 (95 % CI 1·06, 1·99). Among men reporting an inadequate diet at baseline (assessed by Recommended Food Score), there was a statistically significant inverse association between use of any dietary supplement and CVD mortality (RR 0·72; 95 % CI 0·57, 0·91), no associations were observed among men with adequate diets. In conclusion, we cannot exclude that the use of dietary supplements is harmful for smokers. On the other hand, among men with an insufficient diet, the use of supplements might be beneficial in reducing CVD mortality.

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End-stage knee osteoarthritis with and without sarcopenia and the effect of knee arthroplasty – a prospective cohort study

10.21203/rs.3.rs-33924/v4 ◽

2020 ◽

Author(s):

Kevin Ki-Wai Ho ◽

Lawrence Chun-Man Lau ◽

Wai Wang Chau ◽

Queena Poon ◽

Kwong-Yin Chung ◽

...

Keyword(s):

Cohort Study ◽

Muscle Strength ◽

Outcome Measures ◽

Prospective Cohort Study ◽

Knee Arthroplasty ◽

Prospective Cohort ◽

Functional Improvement ◽

Secondary Outcome ◽

End Stage

Abstract Background: Sarcopenia often accompanies osteoarthritis (OA), which is managed by total knee arthroplasty (TKA) in the late stage. Recent studies have suggested a higher risk of post-operative complications after TKA in sarcopenic OA subjects, but whether TKA can benefit them similar to non-sarcopenic subjects remains unexplored. This study aimed to examine the dynamic, mutual impact of sarcopenia and TKA in a one-year post-operative period.Methods: This prospective cohort study was conducted between 2015 to 2018 at our hospital. Patients with end-stage OA of the knee waiting for TKA were recruited into the study. Primary outcome measures were change in muscle strength, mass and function. Secondary outcome measures were quality of life (QOL) measurements for pain, psychological and physical health.Results: Fifty-eight patients were recruited, of which 79.3% were female and 32.8% already had sarcopenia at baseline. The average age of sarcopenic subjects and non-sarcopenic subjects was comparable (67.89±7.07 vs. 67.92±6.85; p=0.99), but sarcopenic subjects had a lower body mass index (BMI) (25.64±2.64 vs. 28.57±4.04; p=0.01). There was a statistically significant improvement in walking speed (10.24±5.35 vs. 7.69±2.68, p<0.01) and muscle strength in both sarcopenic and non-sarcopenic patients after TKA. This was accompanied by an improvement trend in muscle mass in all subjects. There was no change in handgrip power before and after TKA and subsequent follow-up (19.31±5.92 vs. 18.98±6.37 vs. 19.36±7.66; p=0.97). QOL measured before, after and at follow-up with WOMAC (total: 42.27±15.98 vs. 20.65±15.24 vs. 16.65±18.13) and SF12v2 (PCS: 33.06±8.55 vs. 38.96±8.01 vs. 40.67±7.93) revealed progressive significant improvement (both comparisons p≤0.01). Further analysis with the IPAQ also found increased engagement of high-intensity activities.Conclusions: This study showed that sarcopenia among patients with end-stage OA of the knee is not uncommon, but both sarcopenic and non-sarcopenic OA patients achieved significant clinical and functional improvement after TKA. Further studies with a larger sample size and different ethnicities could help ascertain a beneficial role of TKA in sarcopenic OA subjects.

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Abstract 11597: Voluntary and Occupational Physical Activity Have Different Effects on Mortality

Circulation ◽

10.1161/circ.132.suppl_3.11597 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Martin Bahls ◽

Sebastian Baumeister ◽

Henry Völzke ◽

Sven Gläser ◽

Michael Leitzmann ◽

...

Keyword(s):

Physical Activity ◽

Oxygen Consumption ◽

Cancer Mortality ◽

Leisure Time ◽

Large Population ◽

Cardiopulmonary Exercise Testing ◽

All Cause Mortality ◽

Reduced Risk ◽

Cvd Mortality

Introduction: Animal studies suggest oppositional effects for voluntary and involuntary physical activity (PA). To assess this in humans, we used distinct domains of PA (sports, leisure time, work) as well as physical fitness and associated these variables with all-cause, cardiovascular (CVD) and cancer mortality in a large population-based cohort. Methods: Data of 2,925 participants from the Study of Health in Pomerania (SHIP-1) were used [median age: 48 (interquartile range (IQR): 35, 62) years (y), 52% [[female symbol]]]. All-cause and cause-specific mortality was determined after a median follow-up of 7.0 y (IQR: 5.6 - 6.2). A Sports index (SI), Leisure Time index (LTI) and Work index (WI) were assessed using a modified Baecke questionnaire. Maximal oxygen consumption (VO2peak), oxygen consumption at the anaerobic threshold (VO2@AT), and maximal work load (Wmax) were measured on a bicycle ergometer during symptom-limited cardiopulmonary exercise testing (CPET). Cox models were adjusted for sex, age, smoking, alcohol consumption, years of schooling, income, and body mass index. Results: A total of 156 subjects died due to all-cause, 53 due to CVD and 50 due to cancer after follow-up. After adjustment, SI [hazard ratio (HR) per SD: 0.27; 95%-confidence interval (CI): 0.13; 0.55] and LTI (HR per SD: 0.34; 95%-CI: 0.15; 0.77) were associated with a reduced risk of all-cause mortality. WI was not associated with all-cause mortality. SI was associated with reduced risk of CVD mortality (HR: 0.26; 95%-CI: 0.07; 0.96). All CPET measures were significantly related to reduced risk of all-cause and cancer mortality (VO2peak - all-cause HR per SD: 0.007; 95%-CI: 0.001; 0.057 and cancer HR per SD: 0.011; 95%-CI: 0.005; 0.210; VO2@AT - all-cause HR per SD: 0.047; 95%-CI: 0.001; 0.028 and cancer HR per SD: 0.052; 95%-CI: 0.004; 0.073; Wmax - all-cause HR per SD: 0.012; 95%-CI: 0.002; 0.074 and cancer HR per SD: 0.01; 95%-CI: 0.0007; 0.166). Conclusion: Voluntary PA was associated with a reduced risk for all-cause and CVD mortality, while occupational PA was not. Exercise capacity was inversely related to all-cause and cancer mortality. Our results indicate that the benefits of PA may be limited to voluntary PA. Thus, questionnaires need to differentiate between voluntary and occupational PA.

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Physical heaviness of work and sitting at work as predictors of mortality: a 26-year follow-up of the Helsinki Birth Cohort Study

BMJ Open ◽

10.1136/bmjopen-2018-026280 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026280 ◽

Cited By ~ 4

Author(s):

Tuija M Mikkola ◽

Mikaela B von Bonsdorff ◽

Minna K Salonen ◽

Hannu Kautiainen ◽

Leena Ala-Mursula ◽

...

Keyword(s):

Cohort Study ◽

Birth Cohort ◽

Cardiovascular Mortality ◽

National Level ◽

Secondary Outcome ◽

Birth Cohort Study ◽

Specific Level ◽

Risk Of Death ◽

All Cause Mortality

ObjectivesTo examine the relationships of late-career physical heaviness of work and sitting at work with mortality. A national-level job exposure matrix was used to determine the occupation-specific level of physical heaviness and sitting.DesignProspective cohort study between years 1990 and 2015.SettingCommunity.Participants5210 men and 4725 women from the Helsinki Birth Cohort Study with an occupational code at baseline (ages 45–57 years).Primary and secondary outcome measuresTotal, cardiovascular (International Classification of Diseases 10th Revision I00–I99), cancer (C00–C97) and external (S00–Y84) mortality.ResultsThe exposures, physical heaviness and sitting had a non-linear, inverse relationship. During the 26-year follow-up, 1536 men and 759 women died. Among men, physical heaviness of work was positively associated and sitting at work was negatively associated with all-cause, cardiovascular and external cause mortality but they were not associated with cancer mortality. The HRs for men in the highest quartile of physical heaviness of work compared with men in the lowest quartile were 1.54 (1.31–1.80) for all-cause mortality, 1.70 (1.30–2.23) for cardiovascular mortality and 3.18 (1.75–5.78) for external cause mortality (adjusted for age and years of education). Compared with the lowest quartile, the HRs for the highest quartile of sitting at work among men were 0.71 (0.61–0.82) for all-cause mortality, 0.59 (0.45–0.77) for cardiovascular mortality and 0.38 (0.22–0.66) for external cause mortality. In women, neither physical heaviness of work nor sitting at work was associated with mortality.ConclusionsMen in physically heavy work at their late-work career are at higher risk of death than men in physically light work.

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Association between Urinary Cadmium-to-Zinc Intake Ratio and Adult Mortality in a Follow-Up Study of NHANES 1988–1994 and 1999–2004

Nutrients ◽

10.3390/nu12010056 ◽

2019 ◽

Vol 12 (1) ◽

pp. 56

Author(s):

Kijoon Kim ◽

Melissa M. Melough ◽

Junichi R. Sakaki ◽

Kyungho Ha ◽

Dalia Marmash ◽

...

Keyword(s):

Cancer Mortality ◽

Adult Mortality ◽

Urinary Cadmium ◽

Toxic Heavy Metal ◽

Zinc Intake ◽

Follow Up Study ◽

All Cause Mortality ◽

Cvd Mortality ◽

Intake Ratio

Cadmium (Cd) is a toxic heavy metal associated with increased mortality, but the effect of zinc (Zn) intake on the association between Cd and mortality is unknown. The objective of this study was to examine the association of urinary Cd to Zn intake ratio (Cd/Zn ratio) and mortality risk. In total, 15642 US adults in NHANES 1988–1994 and 1999–2004 were followed until 2011 (15-year mean follow-up). Of the 5367 total deaths, 1194 were attributed to cancer and 1677 were attributed to CVD. After adjustment for potential confounders, positive associations were observed between urinary Cd and all-cause mortality (HR for highest vs. lowest quartile: 1.38; 95% CI: 1.14–1.68) and cancer mortality (HR: 1.54; CI: 1.05–2.27). Urinary Cd was positively associated with cancer mortality among the lowest Zn consumers, and the association diminished among the highest Zn consumers. Positive relationships were observed between the Cd/Zn ratio and all-cause mortality (HR: 1.54; CI: 1.23–1.93), cancer mortality (HR: 1.65; CI: 1.11–2.47) and CVD mortality (HR: 1.49; CI: 1.18–1.88). In conclusion, these findings indicate that Zn intake may modify the association between Cd and mortality. Furthermore, the Cd/Zn ratio, which was positively associated with mortality from all causes, cancer, and CVD, may be an important predictor of mortality.

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End-stage knee osteoarthritis with and without sarcopenia and the effect of knee arthroplasty – a prospective cohort study

10.21203/rs.3.rs-33924/v3 ◽

2020 ◽

Author(s):

Kevin Ki-Wai Ho ◽

Lawrence Chun-Man Lau ◽

Wai Wang Chau ◽

Queena Poon ◽

Kwong-Yin Chung ◽

...

Keyword(s):

Cohort Study ◽

Muscle Strength ◽

Outcome Measures ◽

Prospective Cohort Study ◽

Knee Arthroplasty ◽

Prospective Cohort ◽

Functional Improvement ◽

Secondary Outcome ◽

End Stage

Abstract Background:Sarcopenia often accompanies osteoarthritis (OA), which is managed by total knee arthroplasty (TKA) in the late stage. Recent studies have suggested a higher risk of post-operative complications after TKA in sarcopenic OA subjects, but whether TKA can benefit them similar to non-sarcopenic subjects remains unexplored. This study aimed to examine the dynamic, mutual impact of sarcopenia and TKA in a one-year post-operative period.Methods: This prospective cohort study was conducted between 2015 to 2018 at our hospital. Patients with end-stage OA of the knee waiting for TKA were recruited into the study. Primary outcome measures were change in muscle strength, mass and function. Secondary outcome measures were quality of life (QOL) measurements for pain, psychological and physical health.Results: Fifty-eight patients were recruited, of which 79.3% were female and 32.8% already had sarcopenia at baseline. The average age of sarcopenic subjects and non-sarcopenic subjects was comparable (67.89±7.07 vs. 67.92±6.85; p=0.99), but sarcopenic subjects had a lower body mass index (BMI) (25.64±2.64 vs. 28.57±4.04; p=0.01). There was a statistically significant improvement in walking speed (10.24±5.35 vs. 7.69±2.68, p<0.01) and muscle strength in both sarcopenic and non-sarcopenic patients after TKA. This was accompanied by an improvement trend in muscle mass in all subjects. There was no change in handgrip power before and after TKA and subsequent follow-up (19.31±5.92 vs. 18.98±6.37 vs. 19.36±7.66; p=0.97). QOL measured before, after and at follow-up with WOMAC (total: 42.27±15.98 vs. 20.65±15.24 vs. 16.65±18.13) and SF12v2 (PCS: 33.06±8.55 vs. 38.96±8.01 vs. 40.67±7.93) revealed progressive significant improvement (both comparisons p≤0.01). Further analysis with the IPAQ also found increased engagement of high-intensity activities.Conclusions: This study showed that sarcopenia among patients with end-stage OA of the knee is not uncommon, but both sarcopenic and non-sarcopenic OA patients achieved significant clinical and functional improvement after TKA. Further studies with an larger sample size and different ethnicities could help ascertain a beneficial role of TKA in sarcopenic OA subjects.

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Relationship between Serum Uric Acid and Mortality Risk in Hemodialysis Patients: A Multicenter Prospective Cohort Study

American Journal of Nephrology ◽

10.1159/000509258 ◽

2020 ◽

Vol 51 (10) ◽

pp. 823-832

Author(s):

Yaya Yang ◽

Xianhui Qin ◽

Yumin Li ◽

Shenglin Yang ◽

Junzhi Chen ◽

...

Keyword(s):

Uric Acid ◽

Cohort Study ◽

Serum Uric Acid ◽

Prospective Cohort Study ◽

Mortality Risk ◽

Prospective Cohort ◽

All Cause Mortality ◽

Multicenter Prospective Cohort Study ◽

Multicenter Prospective Cohort ◽

Cvd Mortality

Background: Several studies have reported that low serum uric acid (SUA) levels are related to increased risk of mortality in maintenance hemodialysis (MHD) patients. However, the possible detrimental effects of high SUA on the mortality risk have not been well examined. Moreover, the possible effect modifiers for the SUA-mortality association have not been fully investigated. To address the aforementioned gap, we aimed to explore the nonlinear relationship between SUA levels and all-cause and cardiovascular disease (CVD) mortality risk, and to examine any possible effect modifiers in MHD patients. Methods: We conducted a multicenter, prospective cohort study among 1,018 MHD patients from 8 hemodialysis centers. The primary outcome was all-cause mortality, and the secondary outcomes were CVD mortality and non-CVD mortality. Results: The mean value for SUA in the total population was 8.5 ± 1.9 mg/dL. The lowest and highest quintiles of SUA were <7.0 and >10.1 mg/dL, respectively. Over a median follow-up of 45.6 months, 343 deaths were recorded, of which 202 (58.9%) were due to CVD. When SUA was assessed as quintiles, a significantly higher risk of all-cause mortality was found in patients in quintile 1 (<7.0 mg/dL; hazard ratio [HR], 1.33; 95% confidence interval [CI]: 1.02–1.73) or quintile 5 (≥10.1 mg/dL; HR, 1.47; 95% CI: 1.09–2.00), compared to those in quintiles 2–4 (7–10.1 mg/dL). Moreover, the U-shaped SUA-mortality association was mainly found in those with lower C-reactive protein levels (<3 compared with ≥3 mg/L; p for interaction = 0.018). Similar trends were found for CVD mortality and non-CVD mortality. Conclusion: There was a U-shaped relationship between SUA levels and the risk of all-cause mortality, CVD mortality, and non-CVD mortality in MHD patients.

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P645Low levels of low density lipoprotein cholesterol and cardiovascular, cancer and all-cause mortality outcomes

European Heart Journal ◽

10.1093/eurheartj/ehz747.0252 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Sung ◽

J Y Lee ◽

S J Lee

Keyword(s):

Cancer Mortality ◽

Validation Cohort ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

All Cause Mortality ◽

Low Levels ◽

Cvd Mortality

Abstract Aims The effect of low concentrations of low density lipoprotein-cholesterol (LDL-C) on cardiovascular disease (CVD) cancer and all-cause mortality is still controversial. In a large, young, well characterized, relatively healthy occupational cohort (Kangbuk Samsung health study, KSHS), we tested associations between low levels of LDL-C concentration, and CVD, cancer and all- cause mortality. To validate these associations, we analyzed data from another cohort (Korean genome and epidemiology study, KoGES). Methods and results 347,971 subjects in KSHS (mean age 39.6 years, 57.4% men) were studied over a mean follow up of 5.64±3.27 years. All subjects treated with any lipid lowering therapy were excluded. After excluding the data from subjects who died during the first 3 years of follow up, five groups were defined according to baseline LDL-C concentration (<70, 70–99, 100–129, 130–159, ≥160 mg/dL). Hazard ratios (HR and 95% CIs) for all-cause mortality, CVD and cancer mortality were estimated using Cox proportional hazards models. In the KoGES validation cohort, 182,943 subjects (mean age 53.1 years, 34.6% men) were studied over a mean follow up of 8.57±2.59 years with same methods. 2,028 deaths (897 from cancer and 282 from CVD) occurred during follow-up in KSHS. The lowest LDL-C group (LDL<70 mg/dL) had a higher risk of all-cause mortality (HR 1.95, 1.55–2.47), CVD mortality (HR 2.02, 1.11–3.64) and cancer mortality (HR 2.06, 1.46–2.90) compared to the reference group (LDL 120–139 mg/dL). This association was more prominent in men than in women. In the validation cohort, 2,338 deaths (1,823 from cancer and 199 from CVD) occurred during follow-up. The lowest LDL-C group (LDL<70 mg/dL) had a higher risk of all-cause mortality (HR 1.81, 1.44–2.28). Men in the lowest LDL-C group had a higher risk of CVD mortality (HR 3.15, 1.21–8.21) and cancer mortality (1.34, 0.99–1.82) in the KoGES cohort. Conclusions Low levels of LDL-C concentration are strongly and independently associated with increased risk of cancer, CVD and all-cause mortality especially in men.

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Association between serum advanced oxidation protein products and mortality risk in maintenance hemodialysis patients

Journal of Translational Medicine ◽

10.1186/s12967-021-02960-w ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Chun Zhou ◽

Yuanyuan Zhang ◽

Jianghua Chen ◽

Changlin Mei ◽

Fei Xiong ◽

...

Keyword(s):

Mortality Risk ◽

Collaborative Study ◽

Elevated Serum ◽

Advanced Oxidation ◽

Secondary Outcome ◽

Maintenance Hemodialysis ◽

Advanced Oxidation Protein Products ◽

All Cause Mortality ◽

Relationship Of ◽

Cvd Mortality

Abstract Background The association between serum advanced oxidation protein products (AOPP) and mortality risk remains equivocal. We aimed to assess the correlation of serum AOPP levels with the risk of all-cause mortality in hemodialysis (HD) patients. Methods A total of 1394 maintenance HD patients with complete data on AOPP and related parameters were included from China Collaborative Study on Dialysis (CCSD), a multi-center, prospective cohort study. The primary outcome was all-cause mortality, the secondary outcome was cardiovascular disease (CVD) mortality. Results During a median follow-up duration of 5.2 years (IQR, 2.1–5.4), all-cause mortality occurred in 492 (31.4%) participants. Overall, there was a reversed L-shaped association between serum AOPP and all-cause mortality in HD patients (P for nonlinearity = 0.04), with an inflection point at 87 µmol/L. Accordingly, there was no significant association between serum AOPP and all-cause mortality (per SD increment; HR, 0.94; 95%CI, 0.84, 1.05) in participants with AOPP < 87 µmol/L. However, there was a positive relationship of serum AOPP and all-cause mortality (per SD increment; HR, 1.24; 95%CI, 1.08, 1.42) in those with AOPP ≥ 87 µmol/L. Moreover, a similar trend was found for CVD mortality. Conclusions Elevated serum AOPP levels were associated with higher risk of all-cause mortality in Chinese maintenance HD patients.

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