Serum antioxidant status and mortality from influenza and pneumonia in US adults

Objective: We examined the association between serum antioxidant status and mortality from influenza and pneumonia in US adults. Design: Serum concentrations of antioxidants included vitamin C, vitamin A, vitamin E, sum of α- and β-carotene, β-cryptoxanthin, lutein+zeaxanthin, and lycopene. We computed total antioxidant capacity (TAC) as a measure of composite antioxidant status in serum. Survey-weighted Cox proportional hazard models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) comparing quartiles of each antioxidant and TAC. Setting: Data from the US National Health and Nutrition Examination Survey (NHANES)-III. Participants: A total of 7428 NHANES-III participants ≥45 years of age. Results: With a weighted-median follow-up of 16.8 years, 154 participants died from influenza/pneumonia. After adjustment for covariates, serum vitamin C, the sum of α- and β-carotene, and TAC were non-linearly associated with influenza/pneumonia mortality, with the statistically significant smallest HRs at the third quartile vs the first quartile [HRs=0.38 (95% CI: 0.19–0.77), 0.29 (0.16–0.51), and 0.30 (0.15–0.59), respectively]. HRs comparing the fourth vs the first quartiles were weaker and non-significant: 0.57 (95% CI: 0.27–1.17), 0.70 (0.41–1.19), and 0.65 (0.31–1.35), respectively. Serum lycopene had a monotonic association with influenza/pneumonia mortality [HR=0.43 (95% CI: 0.23–0.83) comparing the fourth vs the first quartile, P-for-trend=0.01]. Conclusions: The present study suggests that antioxidant intake as reflected by serum concentrations may reduce mortality risk from influenza or pneumonia in the US general population. These findings warrant further confirmation in other populations with different settings (e.g., a shorter-term association with influenza infection).

Prevalence and correlates of Kaposi’s sarcoma-associated herpesvirus and herpes simplex virus type 2 infections among adults: evidence from the NHANES III data

Background Kaposi’s sarcoma-associated herpes virus (KSHV) prevalence and risk factors exhibit considerable variations across populations in different geographic regions. Determinants and the transmission routes of KSHV infection are uncertain. We seek to identify the possible risk factors and the transmission routes of KSHV infection in non-endemic areas. Methods We collected annual cases and seroprevalence of KSHV and herpes simplex virus type 2 (HSV-2) from the NHANES III sampled individuals from the US general population (1988–1994). We included 13,179 and 10,720 individuals with available remaining serum samples of KSHV and HSV-2. Logistic regression was employed to explore potential risk factors for the seropositivity. Results The seroprevalence was 2.05% for KSHV infection and 31.03% for HSV2 infection among this population. All risk factors of sexual behaviors included were strongly associated with HSV-2 positive, however, only MSM had an approximately fivefold increased risk of KSHV infection (OR = 4.71; 95%CI 1.61 11.30). Mexican Americans (2.51%) and older (chi-squaretrend = − 6.71, P < 0.001) individuals had a higher risk of KSHV infection. After adjustment, individuals with higher level of education and economic status had lower KSHV infection. Conclusions In non-endemic areas, KSHV transmission may be related to sexual activity in men, especially in male homosexuals. Higher education level and economic status are protective factors for KSHV infection.

Association Between Diabetes Mellitus and All-Cause and Cardiovascular Mortality Among Individuals With Ultrasound-Defined Non-Alcoholic Fatty Liver Disease

ObjectiveThe influence of diabetes on mortality among patients with non-alcoholic fatty liver disease (NAFLD) in the general population has not been extensively studied. This study aimed to determine the relationship between diabetes and all-cause and cardiovascular mortality in patients with hepatic ultrasound-confirmed NAFLD using data from the Third National Health and Nutrition Examination Survey (NHANES III), 1988–1994.MethodsData from 4,037 adult individuals with NAFLD from the NHANES III and mortality outcomes linked to National Death Index records through December 31, 2015, were included. Cox proportional hazards models were used to calculate the hazard ratio (HR) and corresponding 95% CI for mortality from all causes and cardiovascular disease after adjusting for multiple variables.ResultsAmong 4,037 subjects with NAFLD (55.9% female), 483 had diabetes at baseline. During a median follow-up of 22.1 years, 1,517 (11.5%) died, including 332 (8.22%) from cardiovascular causes. Diabetes was associated with increased all-cause (HR 3.02 [95% CI 2.67–3.41]) and cardiovascular (HR 3.36 [95% CI 2.61–4.32]) mortality in an unadjusted multivariable Cox regression model. The association remained statistically significant after adjusting for a range of potential confounders (HR 2.20 [95% CI 1.90–2.55] for all-cause mortality and HR 2.47 [95% CI 1.81–3.37] for cardiovascular mortality). An additional stratified analysis did not reveal significantly altered results.ConclusionDiabetes was associated with all-cause and cardiovascular mortality in patients with NAFLD. This link could be further characterized in future studies assessing the degree of glycemic control and its relationship with mortality in patients with diabetes and NAFLD.

Association Between Diet-Related Inflammation and COPD: Findings From NHANES III

Background and Aims: Little is known about diet-related inflammation in chronic obstructive pulmonary disease (COPD). In this study, we aimed to explore the association between COPD and dietary inflammatory index (DII) scores in adults over 40 years old.Methods: Data were obtained from the 2013 to 2018 National Health and Nutrition Examination Survey (NHANES). In the present study, 9,929 participants were included and analyzed. The DII score was calculated and divided into tertiles. Logistic regression analysis was performed to determine the odds ratios of DII tertiles.Results: Participants were categorized into COPD (565, 5.69%) and non-COPD groups (9,364, 94.31%) according to interview information. COPD individuals had higher DII scores than non-COPD individuals (0.429 ± 1.809 vs. −0.191 ± 1.791, p &lt; 0.001). The highest DII score tertile included 46.55% of COPD individuals was associated with lower family incomes and education and a higher smoking rate (p &lt; 0.01). The odds ratios (95% CIs) of COPD according to logistic regression were 0.709 (0.512–0.982) for T1 and 0.645 (0.475–0.877) for T2 of the DII score (p = 0.011).Conclusion: Higher DII scores were positively correlated with COPD in participants over 40 years old. These results further support that diet can be used as an intervention strategy for COPD management.

Reproduction of the Results of Onyike et al. (2003)

Onyike et al. (2003) analyzed data from a large-scale US-American data set, the Third National Health and Nutrition Examination Survey (NHANES-III), and reported an association between obesity and major depression, especially among people with severe obesity. Here, we report the results of a detailed replication of Onyike et al.’s analyses. While we were able to reproduce the majority of these authors’ descriptive statistics, this took a substantial amount of time and effort, and we found several minor errors in the univariate descriptive statistics reported in their Tables 1 and 2. We were able to reproduce most of Onyike et al.’s bivariate findings regarding the relationship between obesity and depression (Tables 3 and 4), albeit with some small discrepancies (e.g., with respect to the magnitudes of standard errors). On the other hand, we were unable to reproduce Table 5, containing Onyike et al.’s findings with respect to the relationship between obesity and depression when controlling for plausible confounding variables—arguably the paper’s most important results—because some of the included predictor variables appear to be either unavailable, or not coded in the way reported by Onyike et al., in the public NHANES-III data sets. We discuss the implications of our findings for the transparency of reporting and the reproducibility of published results.

Machine Learning to Predict 10-year Cardiovascular Mortality from the Electrocardiogram: Analysis of the Third National Health and Nutrition Examination Survey (NHANES III)

Background: The value of the electrocardiogram (ECG) for predicting long-term cardiovascular outcomes is not well defined. Machine learning methods are well suited for analysis of highly correlated data such as that from the ECG. Methods: Using demographic, clinical, and 12-lead ECG data from the Third National Health and Nutrition Examination Survey (NHANES III), machine learning models were trained to predict 10-year cardiovascular mortality in ambulatory U.S. adults. Predictive performance of each model was assessed using area under receiver operating characteristic curve (AUROC), area under precision-recall curve (AUPRC), sensitivity, and specificity. These were compared to the 2013 American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE). Results: 7,067 study participants (mean age: 59.2 +/- 13.4 years, female: 52.5%, white: 73.9%, black: 23.3%) were included. At 10 years of follow up, 338 (4.8%) had died from cardiac causes. Compared to the PCE (AUROC: 0.668, AUPRC: 0.125, sensitivity: 0.492, specificity: 0.859), machine learning models only required demographic and ECG data to achieve comparable performance: logistic regression (AUROC: 0.754, AUPRC: 0.141, sensitivity: 0.747, specificity: 0.759), neural network (AUROC: 0.764, AUPRC: 0.149, sensitivity: 0.722, specificity: 0.787), and ensemble model (AUROC: 0.695, AUPRC: 0.166, sensitivity: 0.468, specificity: 0.912). Additional clinical data did not improve the predictive performance of machine learning models. In variable importance analysis, important ECG features clustered in inferior and lateral leads. Conclusions: Machine learning can be applied to demographic and ECG data to predict 10-year cardiovascular mortality in ambulatory adults, with potentially important implications for primary prevention.

Prevalence and Correlates of Kaposi`S Sarcoma-Associated Herpesvirus and Herpes Simplex Virus Type 2 Infections Among Adults: Evidence from the NHANES III Data

Background Kaposi’s sarcoma-associated herpes virus (KSHV) prevalence and risk factors exhibit considerable variations across populations in different geographic regions. Determinants and the transmission routes of KSHV infection are uncertain. We seek to identify the possible risk factors and the transmission routes of KSHV infection in non-endemic areas.Methods We collected annual cases and seroprevalence of KSHV and herpes simplex virus type 2 (HSV-2) from the NHANES III sampled individuals from the US general population (1988-1994). We included 13179 and 10720 individuals with available remaining serum samples of KSHV and HSV-2. Logistic regression were employed to explore potential risk factors for the seropositivity.Results The seroprevalence was 2.05% for KSHV infection and 31.03% for HSV2 infection among this population. All risk factors of sexual behaviors included were strongly associated with HSV-2 positive, however, only MSM had an approximately fivefold increased risk of KSHV infection (OR=4.71; 95%CI 1.61 11.30). Mexican Americans (2.51%) and older (chi-sqauretrend=-6.71, P<0.001) individuals had a higher risk of KSHV infection. After adjustment, individuals with higher level of education and economic status had lower KSHV infection.Conclusions In non-endemic areas, KSHV transmission may be related to sexual activity in men, especially in male homosexuals. Higher education level and economic status are protective factors for KSHV infection.