Publications by authors named "An Pan"

277 Publications

Do carbon emissions accelerate low-carbon innovation? Evidence from 285 Chinese prefecture-level cities.

Environ Sci Pollut Res Int 2021 May 7. Epub 2021 May 7.

Cornell Institute for Public Affairs, Cornell University, Ithaca, NY, 14850, USA.

Climate change caused by carbon emissions has a strong influence on the economy and human society. Though numerous previous studies have emphasized the importance of low-carbon innovation on curbing or mitigating carbon emissions, not much attention has been given to the reverse effect. We used a panel of 285 Chinese prefecture-level cities from 2005 to 2016 and Cooperative Patent Classification (CPC)-Y02 patents as low-carbon innovation indicators. The results show that the increasing carbon emissions accelerate cities' low-carbon innovation in China, and the predicted effect varies across low-carbon innovation types. As carbon emissions rise, more low-carbon innovation will occur in activities with higher carbon emissions. Besides, we explore environmental awareness as the mediation channel for carbon emissions to impact low-carbon innovation. With the help of media, government, and enterprises, the growing carbon emissions promote public environmental awareness and change consumers' behaviors, motivating companies to speed up low-carbon innovation.
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http://dx.doi.org/10.1007/s11356-021-14291-wDOI Listing
May 2021

Circulating fatty acids and risk of gestational diabetes mellitus: prospective analyses in China.

Eur J Endocrinol 2021 Apr 1. Epub 2021 Apr 1.

J Wu, The George Institute for Global Health, University of New South Wales, Sydney, Australia.

Objective We aimed to examine prospective associations between circulating fatty acids in early pregnancy and incident gestational diabetes mellitus (GDM) among Chinese pregnant women. Methods Analyses were based on two prospective nested case-control studies conducted in western China (336 GDM cases and 672 matched controls) and central China (305 cases and 305 matched controls). Fasting plasma fatty acids in early pregnancy (gestational age at enrollment: 10.4 weeks [standard deviation, 2.0]) and 13.2 weeks [1.0], respectively) were determined by gas chromatography-mass spectrometry, and GDM was diagnosed based on the International Association of Diabetes in Pregnancy Study Groups criteria during 24-28 weeks of gestation. Multiple metabolic biomarkers (HOMA-IR [homeostatic model assessment for insulin resistance], HbA1c, c-peptide, high-sensitivity C-reactive protein, adiponectin, leptin, and blood lipids) were additionally measured among 672 non-GDM controls at enrollment. Results Higher levels of saturated fatty acids (SFAs) 14:0 (pooled odds ratio, 1.41 for each 1-standard deviation increase; 95% confidence interval, 1.25, 1.59) and 16:0 (1.19; 1.05, 1.35) were associated with higher odds of GDM. Higher levels of n-6 polyunsaturated fatty acid (PUFA) 18:2n-6 was strongly associated with lower odds of GDM (0.69; 0.60, 0.80). In non-GDM pregnant women, higher SFAs 14:0 and 16:0 but lower n-6 PUFA 18:2n-6 were generally correlated with unfavorable metabolic profiles. Conclusions We documented adverse associations of 14:0 and 16:0 but a protective association of 18:2n-6 with GDM among Chinese pregnant women. Our findings highlight the distinct roles of specific fatty acids in the onset of GDM.
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http://dx.doi.org/10.1530/EJE-21-0118DOI Listing
April 2021

Identifying windows of susceptibility to essential elements for semen quality among 1428 healthy men screened as potential sperm donors.

Environ Int 2021 Apr 25;155:106586. Epub 2021 Apr 25.

Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Rd, Wuhan 430030, Hubei Province, China. Electronic address:

Background: Essential elements such as iron (Fe), cobalt (Co), copper (Cu), zinc (Zn), selenium (Se), rubidium (Rb), strontium (Sr), and molybdenum (Mo) are necessary for reproductive health. However, their associations with human semen quality remain inconclusive.

Objectives: To investigate the associations of urinary Fe, Co, Cu, Zn, Se, Rb, Sr, and Mo concentrations with semen quality in healthy men screened as potential sperm donors and identify critical windows of susceptibility.

Methods: 1428 healthy men provided 3766 urine and 6527 semen samples, which were measured for urinary essential element concentrations and sperm quality parameters, respectively. Linear mixed models and cubic spline curves were used to evaluate associations between urinary essential elements and semen quality. Multiple informant models were used to identify potential critical windows of susceptibility.

Results: Linear mixed models and cubic spline curves showed positive dose-response relationships between urinary Zn and sperm concentration and total count and between urinary Mo and total sperm count [all False Discovery Rate (FDR) adjusted p-value for trend < 0.05]. In the multiple-element linear mixed models, the men in the highest versus lowest quartiles of urinary Zn and Mo had a higher sperm concentration of 17.5% (95% CI: 2.8%, 34.2%; p-value for trend = 0.006) and total sperm count of 18.3% (95% CI: 1.4%, 38.0%; p-value for trend = 0.027), respectively. Urinary Zn was also positively associated with total sperm count in a dose-dependent manner (p-value for trend = 0.036), though the percentile difference in total sperm count between men in the highest and lowest quartile was not statistically significant (16.4%, 95% CI: -1.7%, 37.9%). These associations appeared to be stronger when urinary Zn and Mo were measured at 0-9 days before the date of semen examination (i.e., corresponding to epididymal storage).

Conclusions: Higher urinary Zn and Mo, particularly during the period of epididymal storage, were associated with greater sperm production.
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http://dx.doi.org/10.1016/j.envint.2021.106586DOI Listing
April 2021

Non-communicable diseases during the COVID-19 pandemic and beyond.

Engineering (Beijing) 2021 Apr 20. Epub 2021 Apr 20.

Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.

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http://dx.doi.org/10.1016/j.eng.2021.02.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056943PMC
April 2021

How environmental regulation affects China's rare earth export?

PLoS One 2021 22;16(4):e0250407. Epub 2021 Apr 22.

School of Finance & Economics, Jiangsu University, Zhenjiang, Jiangsu, China.

China's rare earth export trade has developed so rapidly since 1990s that China has gradually occupied a leading position in the international market. However, this fast development was proceeding at the cost of the rare earth energy consumption and environmental devastation. Now China begins to attach great importance to environmental protection, which attracts many researchers. This study aims to analyze the influence of environmental regulation on China's rare earth export trade. And the original study is amongst the few to examine the relationship between environmental regulation and China's rare earth export with the product-level data. Different from previous studies, this paper selects China's rare earth export data from 1995 to 2015 and introduces product heterogeneity based on the rare earth production process. Moreover, this study uses the entropy weight method to measure the intensity of environmental regulation. The core conclusions are as follows: (1) Environmental regulation significantly promotes rather than restrains China's rare earth export. (2) According to the rare earth production process, this paper divides rare earth products into 3 kinds, that is, rare earth raw materials, rare earth useful components and rare earth end-use applications. Then, it is found that rare earth useful component export in processing and smelting is positively affected by environmental regulation. Rare earth raw materials and end-use applications in China's export are hardly affected. (3) Technological innovation has a mediating effect on the impact mechanism of environmental regulation on China's rare earth export, which means that environmental regulation significantly promotes technological innovation of enterprises, and thereby the rare earth export is increased. The findings are helpful for policymakers to resolve the issue of environmental devastation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250407PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062019PMC
April 2021

Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies.

BMJ 2021 04 14;373:n604. Epub 2021 Apr 14.

Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China

Objective: To examine whether overall lifestyles mediate associations of socioeconomic status (SES) with mortality and incident cardiovascular disease (CVD) and the extent of interaction or joint relations of lifestyles and SES with health outcomes.

Design: Population based cohort study.

Setting: US National Health and Nutrition Examination Survey (US NHANES, 1988-94 and 1999-2014) and UK Biobank.

Participants: 44 462 US adults aged 20 years or older and 399 537 UK adults aged 37-73 years.

Exposures: SES was derived by latent class analysis using family income, occupation or employment status, education level, and health insurance (US NHANES only), and three levels (low, medium, and high) were defined according to item response probabilities. A healthy lifestyle score was constructed using information on never smoking, no heavy alcohol consumption (women ≤1 drink/day; men ≤2 drinks/day; one drink contains 14 g of ethanol in the US and 8 g in the UK), top third of physical activity, and higher dietary quality.

Main Outcome Measures: All cause mortality was the primary outcome in both studies, and CVD mortality and morbidity in UK Biobank, which were obtained through linkage to registries.

Results: US NHANES documented 8906 deaths over a mean follow-up of 11.2 years, and UK Biobank documented 22 309 deaths and 6903 incident CVD cases over a mean follow-up of 8.8-11.0 years. Among adults of low SES, age adjusted risk of death was 22.5 (95% confidence interval 21.7 to 23.3) and 7.4 (7.3 to 7.6) per 1000 person years in US NHANES and UK Biobank, respectively, and age adjusted risk of CVD was 2.5 (2.4 to 2.6) per 1000 person years in UK Biobank. The corresponding risks among adults of high SES were 11.4 (10.6 to 12.1), 3.3 (3.1 to 3.5), and 1.4 (1.3 to 1.5) per 1000 person years. Compared with adults of high SES, those of low SES had higher risks of all cause mortality (hazard ratio 2.13, 95% confidence interval 1.90 to 2.38 in US NHANES; 1.96, 1.87 to 2.06 in UK Biobank), CVD mortality (2.25, 2.00 to 2.53), and incident CVD (1.65, 1.52 to 1.79) in UK Biobank, and the proportions mediated by lifestyle were 12.3% (10.7% to 13.9%), 4.0% (3.5% to 4.4%), 3.0% (2.5% to 3.6%), and 3.7% (3.1% to 4.5%), respectively. No significant interaction was observed between lifestyle and SES in US NHANES, whereas associations between lifestyle and outcomes were stronger among those of low SES in UK Biobank. Compared with adults of high SES and three or four healthy lifestyle factors, those with low SES and no or one healthy lifestyle factor had higher risks of all cause mortality (3.53, 3.01 to 4.14 in US NHANES; 2.65, 2.39 to 2.94 in UK Biobank), CVD mortality (2.65, 2.09 to 3.38), and incident CVD (2.09, 1.78 to 2.46) in UK Biobank.

Conclusions: Unhealthy lifestyles mediated a small proportion of the socioeconomic inequity in health in both US and UK adults; therefore, healthy lifestyle promotion alone might not substantially reduce the socioeconomic inequity in health, and other measures tackling social determinants of health are warranted. Nevertheless, healthy lifestyles were associated with lower mortality and CVD risk in different SES subgroups, supporting an important role of healthy lifestyles in reducing disease burden.
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http://dx.doi.org/10.1136/bmj.n604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044922PMC
April 2021

Knowledge About COVID-19 Among Adults in China: Cross-sectional Online Survey.

J Med Internet Res 2021 04 29;23(4):e26940. Epub 2021 Apr 29.

Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.

Background: A detailed understanding of the public's knowledge and perceptions of COVID-19 could inform governments' public health actions in response to the pandemic.

Objective: The aim of this study was to determine the knowledge and perceptions of COVID-19 among adults in China and its variation among provinces and by sociodemographic characteristics.

Methods: Between May 8 and June 8, 2020, we conducted a cross-sectional online survey among adults in China who were registered with the private survey company KuRunData. We set a target sample size of 10,000 adults, aiming to sample 300-360 adults from each province in China. Participants were asked 25 questions that tested their knowledge about COVID-19, including measures to prevent infection, common symptoms, and recommended care-seeking behavior. We disaggregated responses by age; sex; education; province; household income; rural-urban residency; and whether or not a participant had a family member, friend, or acquaintance who they know to have been infected with SARS-CoV-2. All analyses used survey sampling weights.

Results: There were 5079 men and 4921 women who completed the questionnaire and were included in the analysis. Out of 25 knowledge questions, participants answered a mean and median of 21.4 (95% CI 21.3-21.4) and 22 (IQR 20-23) questions correctly, respectively. A total of 83.4% (95% CI 82.7%-84.1%) of participants answered four-fifths or more of the questions correctly. For at least one of four ineffective prevention measures (using a hand dryer, regular nasal irrigation, gargling mouthwash, and taking antibiotics), 68.9% (95% CI 68.0%-69.8%) of participants answered that it was an effective method to prevent a SARS-CoV-2 infection. Although knowledge overall was similar across provinces, the percent of participants who answered the question on recommended care-seeking behavior correctly varied from 47.0% (95% CI 41.4%-52.7%) in Tibet to 87.5% (95% CI 84.1%-91.0%) in Beijing. Within provinces, participants who were male, were middle-aged, were residing in urban areas, and had higher household income tended to answer a higher proportion of the knowledge questions correctly.

Conclusions: This online study of individuals across China suggests that the majority of the population has good knowledge of COVID-19. However, a substantial proportion still holds misconceptions or incorrect beliefs about prevention methods and recommended health care-seeking behaviors, especially in rural areas and some less wealthy provinces in Western China. This study can inform the development of tailored public health policies and promotion campaigns by identifying knowledge areas for which misconceptions are comparatively common and provinces that have relatively low knowledge.
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http://dx.doi.org/10.2196/26940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086781PMC
April 2021

Association between pyrethroid exposure and cardiovascular disease: A national population-based cross-sectional study in the US.

Environ Int 2021 Apr 9;153:106545. Epub 2021 Apr 9.

Department of Epidemiology and Biostatistics, Ministry of Education & Ministry of Environmental Protection Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address:

Objective: Pyrethroids-containing products are widely used as commercial and household insecticides. While animal studies and clinical case reports have shown acute cardiovascular outcomes of pyrethroids exposure, little has been known on the effect of chronic pyrethroid exposure on cardiovascular disease (CVD). We aimed to examine the associations between chronic pyrethroid exposure and CVD in the US adults.

Methods: Cross-sectional data from the National Health and Nutrition Examination Survey 1999-2002 and 2007-2012 were analyzed. The exposure to pyrethroids was determined as the urinary level of 3-phenoxybenzoic acid (3-PBA), and CVD was ascertained based on self-reported physician diagnoses. Multivariable logistic regression models were fitted to evaluate associations of pyrethroid exposure with CVD, coronary heart disease (CHD), and stroke.

Results: Included were 6,471 participants with a mean age of 44.77 years (standard error, 0.39) for final analyses. The weighted prevalence of CVD, CHD, and stroke was 6.85%, 4.57% and 2.27%, respectively. With adjustments for major confounders, participants in the highest tertile of urinary 3-PBA had higher odds of CVD (odds ratio, 1.58; 95% confidence interval: 1.12, 2.23) and CHD (OR, 1.75; 95% CI: 1.17, 2.61) compared to those in the lowest tertile. There were linear associations for CVD (P for trend = 0.04) and CHD (P for trend = 0.02). However, no significant association was noted for stroke (1.29; 0.78, 2.16) in the main analyses.

Conclusions: 3-PBA was adversely associated with CVD and CHD in the US adults. Our findings highlight potential cardiovascular risk of chronic exposure to pyrethroids, and should be validated in large prospective studies in different populations in future.
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http://dx.doi.org/10.1016/j.envint.2021.106545DOI Listing
April 2021

Three-dimensional heterogeneity analysis of climate aid's carbon reduction effect.

J Environ Manage 2021 Jul 7;289:112524. Epub 2021 Apr 7.

School of Economics, Wuhan University of Technology, Wuhan, Hubei, 430070, PR China.

Exploring the effectiveness of climate aid is crucial to distribute funds scientifically and maximize its impact. A body of related literature has estimated the impact of international climate aid on carbon emissions. However, these studies did not adequately consider the multi-dimensional heterogeneity of climate aid's carbon reduction effect. Based on national panel data of 77 recipients from 1980 to 2016, this study is the first to analyze the heterogeneous characteristics of climate aid's carbon reduction effect from three dimensions of emission level, aid level, and income level. Results show that, totally speaking, climate aid has a significant negative effect on carbon emissions in recipient countries. From the perspective of heterogeneity, climate aid has significant reduction effects for the recipient countries with middle-emission level. Meanwhile, climate aid also has significant negative effects on carbon emissions in recipient countries with high-aid level, i.e., only when the amount of aid reaches relatively high levels can climate aid play its role in reducing emissions. Furthermore, climate aid only conducts a significant reduction effect for middle-income recipients. This study recommends proposing a new collective quantified financial target, pursuing low-carbon economic development, optimizing the aid distribution, and enhancing capacity building to maximize the effectiveness of climate aid.
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http://dx.doi.org/10.1016/j.jenvman.2021.112524DOI Listing
July 2021

Dietary total antioxidant capacity and late-life cognitive impairment: the Singapore Chinese Health Study.

J Gerontol A Biol Sci Med Sci 2021 Apr 7. Epub 2021 Apr 7.

Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Background: With the dramatically rapid rate of aging worldwide, the maintenance of cognitive function in old age is a major public health priority. The association between total antioxidant capacity (TAC) of midlife diet and cognitive function in late-life is still unclear.

Methods: The study included 16 703 participants from a prospective cohort study in Singapore. Dietary intakes and selected supplementary use were assessed with a validated 165-item food frequency questionnaires at baseline (1993-1998). Two dietary TACs were calculated from the intake of antioxidant nutrients, the Comprehensive Dietary Antioxidant Index (CDAI) and the Vitamin C Equivalent Antioxidant Capacity (VCEAC). Cognitive function was assessed 20.2 years later using a Singapore-modified version of the Mini-Mental State Examination when subjects were 61-96 years old. Cognitive impairment was defined using education-specific cut-offs. Multivariable logistic regression models were utilized to estimate the associations between dietary TACs, component nutrients and cognitive impairment.

Results: A total of 2392 participants (14.3%) were defined to have cognitive impairment. Both CDAI and VCEAC scores were inversely associated with odds of cognitive impairment in a dose-dependent manner. The odds ratio (95% confidence interval; p-trend) comparing the highest with the lowest quartile was 0.84 (0.73, 0.96; p-trend = .003) for the CDAI and 0.75 (0.66, 0.86; p-trend < .001) for the VCEAC. Higher intakes of vitamin C, vitamin E, carotenoids, and flavonoids were all inversely associated with cognitive impairment.

Conclusions: Higher dietary total antioxidant capacity was associated with lower odds of cognitive impairment in later life in a Chinese population in Singapore.
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http://dx.doi.org/10.1093/gerona/glab100DOI Listing
April 2021

Association of Consumption of Sugar-Sweetened Beverages or Artificially Sweetened Beverages with Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies.

Adv Nutr 2021 03;12(2):374-383

Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) intakes have been reported to be associated with mortality; however, conclusions have been inconsistent. This review synthesized the evidence on the associations of SSB and ASB intakes with mortality from all causes, cardiovascular disease (CVD), and cancer among all populations (including general, diseased, or occupational populations, etc.). PubMed, EMBASE, Web of Science, Cochrane Library, ProQuest, ClinicalTrials.gov, and the International Clinical Trials Registry Platform were searched up to March 2020. Fifteen studies including 17 cohorts were included in meta-analyses. Each serving (12 fluid ounces or 355 mL) increase in daily SSB consumption was associated with higher risks of all-cause (HR: 1.08; 95% CI: 1.04, 1.12; 11 cohorts with 965,851 participants) and CVD (HR: 1.08; 95% CI: 1.04, 1.12; 13 cohorts with 898,005 participants) mortality. The associations of ASB intakes with all-cause and CVD mortality were J-shaped, and HRs (95% CI) across different doses (0, 1, 1.5, 2, and 2.5 servings/d) were 1.00, 1.01 (0.99, 1.03), 1.04 (1.02, 1.07), 1.08 (1.05, 1.11), and 1.13 (1.09, 1.18) for all-cause mortality and 1.00, 1.01 (0.96, 1.07), 1.07 (1.01, 1.13), 1.15 (1.08, 1.23), and 1.25 (1.14, 1.37) for CVD mortality. No significant association was found for cancer mortality. According to the NutriGrade scoring system, the quality of evidence on the associations of SSB intakes with all-cause and CVD mortality was high, and the quality of evidence on other associations was low to moderate. In summary, higher SSB and ASB intakes were associated with higher risks of all-cause mortality and CVD mortality. Given the limited evidence, future studies should further investigate the association between ASB intakes and cause-specific mortality.
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http://dx.doi.org/10.1093/advances/nmaa110DOI Listing
March 2021

Association of spontaneous abortion with all cause and cause specific premature mortality: prospective cohort study.

BMJ 2021 03 24;372:n530. Epub 2021 Mar 24.

Department of Nutrition, Harvard T H Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA

Objective: To investigate the association of spontaneous abortion with the risk of all cause and cause specific premature mortality (death before the age of 70).

Design: Prospective cohort study.

Setting: The Nurses' Health Study II (1993-2017), United States.

Participants: 101 681 ever gravid female nurses participating in the Nurses' Health Study II.

Main Outcomes Measures: Lifetime occurrence of spontaneous abortion in pregnancies lasting less than 6 months, determined by biennial questionnaires. Hazard ratios and 95% confidence intervals for all cause and cause specific premature death according to the occurrence of spontaneous abortion, estimated with time dependent Cox proportional hazards models.

Results: During 24 years of follow-up, 2936 premature deaths were recorded, including 1346 deaths from cancer and 269 from cardiovascular disease. Crude all cause mortality rates were comparable for women with and without a history of spontaneous abortion (1.24 per 1000 person years in both groups) but were higher for women experiencing three or more spontaneous abortions (1.47 per 1000 person years) and for women reporting their first spontaneous abortion before the age of 24 (1.69 per 1000 person years). The corresponding age adjusted hazard ratios for all cause premature death during follow-up were 1.02 (95% confidence interval 0.94 to 1.11), 1.39 (1.03 to 1.86), and 1.27 (1.11 to 1.46), respectively. After adjusting for confounding factors and updated dietary and lifestyle factors, the occurrence of spontaneous abortion was associated with a hazard ratio of 1.19 (95% confidence interval 1.08 to 1.30) for premature mortality during follow-up. The association was stronger for recurrent spontaneous abortions (hazard ratio 1.59, 95% confidence interval 1.17 to 2.15 for three or more spontaneous abortions; 1.23, 1.00 to 1.50 for two; and 1.16, 1.05 to 1.28 for one compared with none), and for spontaneous abortions occurring early in a woman's reproductive life (1.32, 1.14 to 1.53 for age ≤23; 1.16, 1.01 to 1.33 for ages 24-29; and 1.12, 0.98 to 1.28 for age ≥30 compared with none). When cause specific mortality was evaluated, the association of spontaneous abortion with premature death was strongest for deaths from cardiovascular disease (1.48, 1.09 to 1.99). Spontaneous abortion was not related to premature death from cancer (1.08, 0.94 to 1.24).

Conclusions: Spontaneous abortion was associated with an increased risk of premature mortality, particularly death from cardiovascular disease.
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http://dx.doi.org/10.1136/bmj.n530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988453PMC
March 2021

Past Shift Work and Incident Coronary Heart Disease in Retired Workers: A Prospective Cohort Study.

Am J Epidemiol 2021 Mar 17. Epub 2021 Mar 17.

Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Present shift work has been associated with coronary heart disease (CHD) among employed workers, but it remains unclear whether shift work in the past is still associated with CHD in retired workers. We recruited 21,802 retired workers in Shiyan, China in 2008-2010 and 2013, and followed them up for CHD events to December 31, 2018. Retired workers with longer duration of past shift work had higher CHD risks (hazard ratios for those with ≤5.0, 5.25 to 10.0, 10.5 to 20.0, and >20.0 years of past shift work were 1.05 (95% confidence interval: 0.94, 1.16), 1.08 (0.94, 1.25), 1.23 (1.07, 1.42), and 1.28 (1.08, 1.51)). The association was substantially higher among services or sales workers than among manufacturing or manual labor workers (hazard ratio for every 5-year increase in past shift work, 1.11 (95% confidence interval: 1.05, 1.16) versus 1.02 (0.98, 1.06)). Moreover, the risk was lower among those who were physically active than their inactive counterparts (P for interaction, 0.019). Longer duration of past shift work was associated with higher risk of incident CHD among retired workers, especially those from services or sales sectors. Physical exercise might be beneficial in reducing the excess risk.
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http://dx.doi.org/10.1093/aje/kwab074DOI Listing
March 2021

High-efficient coupler for thin-film lithium niobate waveguide devices.

Opt Express 2021 Feb;29(4):5397-5406

Lithium niobate (LN) devices have been widely used in optical communication and nonlinear optics due to its attractive optical properties. The emergence of the thin-film lithium niobate on insulator (LNOI) improves performances of LN-based devices greatly. However, a high-efficient fiber-chip optical coupler is still necessary for the LNOI-based devices for practical applications. In this paper, we demonstrate a highly efficient and polarization-independent edge coupler based on LNOI. The coupler, fabricated by a standard semiconductor process, shows a low fiber-chip coupling loss of 0.54 dB/0.59 dB per facet at 1550 nm for TE/TM light, respectively, when coupled with an ultra-high numerical aperture fiber (UHNAF) of which the mode field diameter is about 3.2 μm. The coupling loss is lower than 1dB/facet for both TE and TM light in the wavelength range of 1527 nm to 1630 nm. A relatively large tolerance for optical misalignment is also proved, due to the coupler's large mode spot size up to 3.2 μm. The coupler shows a promising stability in high optical power and temperature variation.
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http://dx.doi.org/10.1364/OE.416492DOI Listing
February 2021

Prospective Study on Plasma MicroRNA-4286 and Incident Acute Coronary Syndrome.

J Am Heart Assoc 2021 Mar 10;10(6):e018999. Epub 2021 Mar 10.

Department of Occupational and Environmental Health Key Laboratory of Environment and Health Ministry of Education and State Key Laboratory of Environmental Health (Incubating) School of Public Health Tongji Medical CollegeHuazhong University of Science and Technology Wuhan China.

Background Mounting evidence suggests that circulating microRNAs (miRNAs) are critical indicators of cardiovascular disease. However, prospective studies linking circulating miRNAs to incident acute coronary syndrome (ACS) are limited, and the underlying effect of associated miRNA on incident ACS remains unknown. Methods and Results Based on a 2-stage prospective nested case-control design within the Dongfeng-Tongji cohort, we profiled plasma miRNAs from 23 pairs of incident ACS cases and controls by microarray and validated the candidate miRNAs in 572 incident ACS case-control pairs using quantitative real-time polymerase chain reaction. We observed that plasma miR-4286 was associated with higher risk of ACS (adjusted odds ratio according to an interquartile range increase, 1.26 [95% CI, 1.07-1.48]). Further association analysis revealed that triglyceride was positively associated with plasma miR-4286, and an interquartile range increase in triglyceride was associated with an 11.04% (95% CI, 3.77%-18.83%) increase in plasma miR-4286. In addition, the Mendelian randomization analysis suggested a potential causal effect of triglyceride on plasma miR-4286 ( coefficients: 0.27 [95% CI, 0.01-0.53] and 0.27 [95% CI, 0.07-0.47] separately by inverse variance-weighted and Mendelian randomization-pleiotropy residual sum and outlier tests). Moreover, the causal mediation analysis indicated that plasma miR-4286 explained 5.5% (95% CI, 0.7%-17.0%) of the association of triglyceride with incident ACS. Conclusions Higher level of plasma miR-4286 was associated with an increased risk of ACS. The upregulated miR-4286 in plasma can be attributed to higher triglyceride level and may mediate the effect of triglyceride on incident ACS.
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http://dx.doi.org/10.1161/JAHA.120.018999DOI Listing
March 2021

One-Step Construction of a Hollow Au@Bimetal-Organic Framework Core-Shell Catalytic Nanoreactor for Selective Alcohol Oxidation Reaction.

ACS Appl Mater Interfaces 2021 Mar 3;13(10):12463-12471. Epub 2021 Mar 3.

National Synchrotron Radiation Laboratory and Department of Chemical Physics, University of Science and Technology of China, Hefei 230029, P. R. China.

Hollow core-shell catalytic nanoreactors have received tremendous attention due to their high mass transfer in catalysis applications. Herein, we present a novel type of well-arranged, hollow core-shell nanoreactors featured with a bimetallic porous Zn/Ni-MOF-2 shell and a tiny Au nanoparticle core. The well-designed hollow Au@Zn/Ni-MOF-2 nanoreactors were constructed through the strategy of a facile one step from a rare crystal-structure transformation without any additional template. These nanoreactors exhibit outstanding multifunctional catalysis for a broad range of alcohol oxidation under the green oxidant environment. Moreover, such hollow nanoreactors show excellent recyclability toward the selective alcohol oxidation. These findings might provide a promising platform for a general construct of various metal-organic framework-based hollow core-shell nanostructures and further highly augmented catalytic applications.
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http://dx.doi.org/10.1021/acsami.0c20445DOI Listing
March 2021

Association between combined lifestyle factors and healthy ageing in Chinese adults: the Singapore Chinese Health Study.

J Gerontol A Biol Sci Med Sci 2021 Feb 1. Epub 2021 Feb 1.

Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.

Background: To examine the relations of individual lifestyle factors and its composite score with healthy ageing among Chinese.

Methods: We included 14,159 participants aged 45-74 years at baseline from the Singapore Chinese Health Study, a population-based prospective cohort. A protective lifestyle score (0-5 scale) was calculated at baseline (1993-1998) and updated at the second follow-up visit (2006-2010) on the basis of optimal body mass index (18.5-22.9 kg/m2), healthy diet (upper 40% of the Alternative Healthy Eating Index score), being physically active (≥2 hours/week of moderate activity or ≥0.5 hours/week of strenuous activity), non-smoking (never smoking), and low-to-moderate alcohol drinking (>0 to ≤14 drinks/week for men and >0 to ≤7 drinks/week for women). Healthy ageing was assessed at the third follow-up visit (2014-2016), and was defined as absence of specific chronic diseases, absence of cognitive impairment and limitations in instrumental activities of daily living, good mental and overall self-perceived health, good physical functioning, and no function-limiting pain.

Results: About 20.0% (2,834) participants met the criteria of healthy ageing after a median follow-up of 20 years. Each one-point increase in the protective lifestyle score computed at baseline and second follow-up visits was associated with higher likelihood of healthy ageing by 25% (95% CI: 20%-30%) and 24% (18%-29%), respectively. The population-attributable risk percent of adherence to 4-5 protective lifestyle factors was 34.3% (95% CI: 25.3%-42.3%) at baseline and 31.3% (23.0%-38.7%) at second follow-up visits for healthy ageing. In addition, positive increase in lifestyle scores from baseline to second follow-up visits was also significantly associated with a higher likelihood of healthy ageing with an odds ratio of 1.18 (95% CI: 1.12-1.24) for each increment in protective lifestyle score.

Conclusions: Our findings confirmed that adopting healthy lifestyle factors, even after midlife, was associated with healthy ageing at old age.
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http://dx.doi.org/10.1093/gerona/glab033DOI Listing
February 2021

Coherent synthetic aperture imaging for visible remote sensing via reflective Fourier ptychography.

Opt Lett 2021 Jan;46(1):29-32

Synthetic aperture radar can measure the phase of a microwave with an antenna, which cannot be directly extended to visible light imaging due to phase lost. In this Letter, we report an active remote sensing with visible light via reflective Fourier ptychography, termed coherent synthetic aperture imaging (CSAI), achieving high resolution, a wide field-of-view (FOV), and phase recovery. A proof-of-concept experiment is reported with laser scanning and a collimator for the infinite object. Both smooth and rough objects are tested, and the spatial resolution increased from 15.6 to 3.48 µm with a factor of 4.5. The speckle noise can be suppressed obviously, which is important for coherent imaging. Meanwhile, the CSAI method can tackle the aberration induced from the optical system by one-step deconvolution and shows the potential to replace the adaptive optics for aberration removal of atmospheric turbulence.
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http://dx.doi.org/10.1364/OL.409258DOI Listing
January 2021

Associations of Menstrual Cycle Characteristics Across the Reproductive Life Span and Lifestyle Factors With Risk of Type 2 Diabetes.

JAMA Netw Open 2020 12 1;3(12):e2027928. Epub 2020 Dec 1.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Importance: Menstrual cycle dysfunction is associated with insulin resistance, a key feature early in the pathogenesis of type 2 diabetes. However, the evidence linking irregular and long menstrual cycles with type 2 diabetes is scarce and inconsistent.

Objectives: To evaluate the associations between menstrual cycle characteristics at different points throughout a woman's reproductive life span and risk of type 2 diabetes and the extent to which this association is modified by lifestyle factors.

Design, Setting, And Participants: This prospective cohort study included 75 546 premenopausal US female nurses participating in the Nurses' Health Study II from 1993 to June 30, 2017. Data analysis was performed from February 1 to December 30, 2019.

Exposures: Self-reported usual length and regularity of menstrual cycles at the age ranges of 14 to 17 years, 18 to 22 years, and 29 to 46 years.

Main Outcomes And Measures: Incident type 2 diabetes identified through self-report and confirmed by validated supplemental questionnaires.

Results: Among the 75 546 women in the study at baseline, the mean (SD) age was 37.9 (4.6) years (range, 29.0-46.0 years). A total of 5608 participants (7.4%) had documented new cases of type 2 diabetes during 1 639 485 person-years of follow-up. After adjustment for potential confounders, women reporting always having irregular menstrual cycles between the age ranges of 14 to 17 years, 18 to 22 years, and 29 to 46 years were, respectively, 32% (95% CI, 22%-44%), 41% (95% CI, 23%-62%), and 66% (95% CI, 49%-84%) more likely to develop type 2 diabetes than women reporting very regular cycles (within 3-4 days of expected period) in the same age range. Similarly, women reporting a usual cycle length of 40 days or more between the age ranges of 18 to 22 years and 29 to 46 years were, respectively, 37% (95% CI, 19%-57%) and 50% (95% CI, 36%-65%) more likely to develop type 2 diabetes during follow-up compared with women reporting a usual cycle length of 26 to 31 days in the same age ranges. These associations appeared to be stronger among women with overweight or obesity, a low-quality diet, and low levels of physical activity. The relative excess risk of type 2 diabetes due to the interaction between irregular and long menstrual cycles and the overall unhealthy lifestyle score was 0.73 (95% CI, 0.57-0.89) and 0.68 (95% CI, 0.54-0.83), respectively.

Conclusions And Relevance: In this cohort study of US female nurses participating in the Nurses' Health Study II, irregular and long menstrual cycles throughout life were associated with a greater risk of type 2 diabetes, particularly among women with overweight or obesity, a low-quality diet, and low levels of physical activity.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.27928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753904PMC
December 2020

Consumption of dietary nuts in midlife and risk of cognitive impairment in late-life: the Singapore Chinese Health Study.

Age Ageing 2020 Dec 18. Epub 2020 Dec 18.

Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore.

Background: evidence from prospective studies investigating the association between consumption of nuts in midlife and risk of cognitive impairment in late life is limited.

Methods: this study analysed data from 16,737 participants in a population-based cohort, the Singapore Chinese Health Study. Intake of nuts was assessed using a validated food-frequency questionnaire at baseline (1993-1998), when participants were 45-74 years old (mean age = 53.5 years). Cognitive function was tested using the Singapore modified Mini-Mental State Examination during the third follow-up visit (2014-2016), when participants were 61-96 years old (mean age = 73.2 years). Cognitive impairment was defined using education-specific cut-off points. Logistic regression models were used to estimate the odds ratio (OR) and the 95% confidence interval (CI) for the association between intake and risk of cognitive impairment.

Results: cognitive impairment was identified in 2,397 (14.3%) participants. Compared with those who consumed <1 serving/month of nuts, participants who consumed 1-3 servings/month, 1 serving/week and ≥2 servings/week had 12% (95% CI 2-20%), 19% (95% CI 4-31%) and 21% (2-36%) lower risk of cognitive impairment, respectively (P-trend = 0.01). Further adjustment for intake of unsaturated fatty acids attenuated the association to non-significance. Mediation analysis showed that the 50.8% of the association between nuts and risk of cognitive impairment was mediated by the intake of total unsaturated fatty acids (P < 0.001).

Conclusion: higher intake of nuts in midlife was related to a lower risk of cognitive impairment in late life, which was partly mediated by unsaturated fatty acids.
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http://dx.doi.org/10.1093/ageing/afaa267DOI Listing
December 2020

Prospective associations between change in sleep duration and cognitive impairment: Findings from the Singapore Chinese Health Study.

J Affect Disord 2021 02 8;281:125-130. Epub 2020 Dec 8.

Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. Electronic address:

Background: The relation of changes in sleep duration with risk of cognitive impairment are inconclusive. This study evaluated the prospective relationships of changes in sleep duration with risk of cognitive impairment in Singapore Chinese.

Methods: We used data from 16,948 Chinese men and women who were aged 45-74 years at baseline (1993-1998) during recruitment into the Singapore Chinese Health Study cohort. Daily sleep duration was assessed at baseline, follow-up 2 (2006 to 2010) and follow-up 3 interviews (2014-2016). Cognitive function was evaluated with a Singapore-Modified Mini-Mental State Examination at follow-up 3 interviews when participants were 61-96 years old. Multivariable logistic regression models were used to calculate odd ratios (ORs) and 95% confidence intervals (95% CIs) for cognitive impairment.

Results: Of the 16,948 participants, 14.4% were defined to have cognitive impairment. Compared with 7 h/day sleep at both baseline and follow-up 2, the OR (95% CI) for cognitive impairment was 1.50 (1.04-2.16) for those who maintained long sleep duration (≥9 h/day), 2.18 (1.37-3.45) for those who prolonged sleep from short duration (≤5 h/day) to long duration (≥9 h/day), and 1.55 (1.20-2.02) for those who prolonged sleep from recommended duration (7 h/day) to long duration. The highest risk was observed in those who shortened sleep from long to short duration (2.93, 1.35-6.34).

Limitations: Measures of sleep were self-reported.

Conclusions: Substantial changes in sleep duration over time were associated with higher risks of cognitive impairment. The findings underscore the importance of maintaining optimal sleep duration for the prevention of cognitive impairment.
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http://dx.doi.org/10.1016/j.jad.2020.12.007DOI Listing
February 2021

Association Between Dietary Patterns in Midlife and Healthy Ageing in Chinese Adults: The Singapore Chinese Health Study.

J Am Med Dir Assoc 2020 Nov 18. Epub 2020 Nov 18.

Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore. Electronic address:

Objective: To examine the associations between dietary patterns in midlife and likelihood of future healthy ageing in Chinese older adults.

Design: Prospective population-based study.

Setting And Participants: We included 14,159 participants aged 45-74 years who were free from cancer, cardiovascular disease, or diabetes at baseline (1993-1998) from the Singapore Chinese Health Study.

Methods: Dietary intakes in midlife were assessed by a validated food frequency questionnaire at baseline. Diet quality was scored according to the alternate Mediterranean diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) diet, the alternative Healthy Eating Index (AHEI)-2010, overall plant-based diet index (PDI), and healthful plant-based diet index (hPDI). Healthy ageing was assessed at the third follow-up visit (2014-2016), which occurred about 20 years after the baseline visit, and was defined as the absence of 10 chronic diseases, no impairment of cognitive function, no limitations in instrumental activities of daily living, no clinical depression at screening, good overall self-perceived health, good physical functioning, and no function-limiting pain among participants who had survival to at least 65 years of age. Multivariable-adjusted logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between each dietary pattern score and healthy ageing.

Results: About 20.0% of participants met the healthy ageing criteria. The OR (95% CI) for healthy ageing comparing the highest with the lowest quartile of diet quality scores was 1.52 (1.31-1.77) for aMED, 1.53 (1.35-1.73) for DASH, 1.39 (1.23-1.57) for AHEI-2010, 1.34 (1.18-1.53) for PDI, and 1.45 (1.27-1.65) for hPDI (all P-trend < .001). Each standard deviation increment in different diet quality scores was associated with 12% to 18% higher likelihood of healthy ageing.

Conclusions And Implications: In this Chinese population, adherence to various healthy dietary patterns at midlife is associated with higher likelihood of healthy ageing at later life.
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http://dx.doi.org/10.1016/j.jamda.2020.09.045DOI Listing
November 2020

Seventeen-Year Associations between Diet Quality Defined by the Health Star Rating and Mortality in Australians: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab).

Curr Dev Nutr 2020 Nov 14;4(11):nzaa157. Epub 2020 Oct 14.

The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.

Background: The Health Star Rating (HSR) is the government-endorsed front-of-pack labeling system in Australia and New Zealand.

Objectives: We aimed to examine prospective associations of a dietary index (DI) based on the HSR, as an indicator of overall diet quality, with all-cause and cardiovascular disease (CVD) mortality.

Methods: We utilized data from the national population-based Australian Diabetes, Obesity and Lifestyle Study. The HSR-DI at baseline (1999-2000) was constructed by ) calculation of the HSR points for individual foods in the baseline FFQ, and ) calculation of the HSR-DI for each participant based on pooled HSR points across foods, weighted by the proportion of energy contributed by each food. Vital status was ascertained by linkage to the Australian National Death Index. Associations of HSR-DI with mortality risk were assessed by Cox proportional hazards regression.

Results: Among 10,025 eligible participants [baseline age: 51.6 ± 14.3 y (mean ± standard deviation)] at entry, higher HSR-DI (healthier) was associated with higher consumption of healthy foods such as fruits, vegetables, and nuts, and lower consumption of discretionary foods such as processed meats and confectionery (-trend < 0.001 for each). During a median follow-up of 16.9 y, 1682 deaths occurred with 507 CVD deaths. In multivariable models adjusted for demographic characteristics, lifestyle factors, and medical conditions, higher HSR-DI was associated with lower risk of all-cause mortality, with a hazard ratio (95% confidence interval) of 0.80 (0.69, 0.94; -trend < 0.001) comparing the fifth with the first HSR-DI quintile. A corresponding inverse association was observed for CVD mortality (0.71; 0.54, 0.94; -trend = 0.008).

Conclusions: Better diet quality as defined by the HSR-DI was associated with lower risk of all-cause and CVD mortality among Australian adults. Our findings support the use of the HSR nutrient profiling algorithm as a valid tool for guiding consumer food choices.
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http://dx.doi.org/10.1093/cdn/nzaa157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7649117PMC
November 2020

Temporal variability of organophosphate flame retardant metabolites in spot, first morning, and 24-h urine samples among healthy adults.

Environ Res 2020 Oct 22:110373. Epub 2020 Oct 22.

Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address:

A single measurement of organophosphate flame retardant (OPFR) metabolites in a spot sample is often used in epidemiological studies to estimate individual exposures. Over seven consecutive days, we collected 661 spot samples, including 127 first morning voids (FMVs) and 123 simulated 24-h collections, from 20 healthy adults and analyzed for eight OPFR metabolites. Intraclass correlation coefficients (ICCs) were calculated to evaluate the variability of the analyzed metabolites. In spot samples group, serial measurements of OPFR metabolites showed poor reproducibility (0.0422 ≤ ICC ≤ 0.349), and the within-day variability was the main contributor of the total variability. The estimated ICCs based on different correction methods for urine dilution (i.e., specific gravity-adjusted, creatinine-adjusted, and creatinine as a covariate) were similar, but varied according to gender and body mass index. Uniformly low sensitivities (0.417-0.633) were observed when using a single FMV or spot sample to predict the 1-week highly (top 33.0%) exposed volunteers. Therefore, using a single urinary measurement to predict chronic exposure to OPFRs can lead to a high degree of classification errors. When multiple urine samples are collected, considering the sampling type, the time of collection, and demographic characteristics may provide a more complete approach to assess exposure to diverse OPFRs.
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http://dx.doi.org/10.1016/j.envres.2020.110373DOI Listing
October 2020

Association of Serum 25-Hydroxyvitamin D Concentrations With All-Cause and Cause-Specific Mortality Among Individuals With Diabetes.

Diabetes Care 2021 Feb 8;44(2):350-357. Epub 2020 Nov 8.

Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Objective: The evidence regarding vitamin D status and mortality among people with diabetes is scarce. This study aimed to examine the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with all-cause and cause-specific mortality among adults with diabetes.

Research Design And Methods: This study included 6,329 adults with diabetes from the Third National Health and Nutrition Examination Survey (NHANES III) and NHANES 2001-2014. Death outcomes were ascertained by linkage to National Death Index records through 31 December 2015. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% CIs for mortality from all causes, cardiovascular disease (CVD), and cancer.

Results: The weighted mean (95% CI) level of serum 25(OH)D was 57.7 (56.6, 58.8) nmol/L, and 46.6% had deficient vitamin D (<50 nmol/L [20 ng/mL]). Higher serum 25(OH)D levels were significantly associated with lower levels of glucose, insulin, HOMA of insulin resistance, HbA, blood lipids, and C-reactive protein at baseline (all < 0.05). During 55,126 person-years of follow-up, 2,056 deaths were documented, including 605 CVD deaths and 309 cancer deaths. After multivariate adjustment, higher serum 25(OH)D levels were significantly and linearly associated with lower all-cause and CVD mortality: there was a 31% reduced risk of all-cause mortality and a 38% reduced risk of CVD mortality per one-unit increment in natural log-transformed 25(OH)D (both < 0.001). Compared with participants with 25(OH)D <25 nmol/L, the multivariate-adjusted HRs and 95% CI for participants with 25(OH)D >75 nmol/L were 0.59 (0.43, 0.83) for all-cause mortality ( = 0.003), 0.50 (0.29, 0.86) for CVD mortality ( = 0.02), and 0.49 (0.23, 1.04) for cancer mortality ( = 0.12).

Conclusions: Higher serum 25(OH)D levels were significantly associated with lower all-cause and CVD mortality. These findings suggest that maintaining adequate vitamin D status may lower mortality risk in individuals with diabetes.
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http://dx.doi.org/10.2337/dc20-1485DOI Listing
February 2021

Menstrual cycle regularity and length across the reproductive lifespan and risk of premature mortality: prospective cohort study.

BMJ 2020 09 30;371:m3464. Epub 2020 Sep 30.

Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA

Objective: To evaluate whether irregular or long menstrual cycles throughout the life course are associated with all cause and cause specific premature mortality (age <70 years).

Design: Prospective cohort study.

Setting: Nurses' Health Study II (1993-2017).

Participants: 79 505 premenopausal women without a history of cardiovascular disease, cancer, or diabetes and who reported the usual length and regularity of their menstrual cycles at ages 14-17 years, 18-22 years, and 29-46 years.

Main Outcome Measures: Hazard ratios and 95% confidence intervals for all cause and cause specific premature mortality (death before age 70 years) were estimated from multivariable Cox proportional hazards models.

Results: During 24 years of follow-up, 1975 premature deaths were documented, including 894 from cancer and 172 from cardiovascular disease. Women who reported always having irregular menstrual cycles experienced higher mortality rates during follow-up than women who reported very regular cycles in the same age ranges. The crude mortality rate per 1000 person years of follow-up for women reporting very regular cycles and women reporting always irregular cycles were 1.05 and 1.23 for cycle characteristics at ages 14-17 years, 1.00 and 1.37 for cycle characteristics at ages 18-22 years, and 1.00 and 1.68 for cycle characteristics at ages 29-46 years. The corresponding multivariable adjusted hazard ratios for premature death during follow-up were 1.18 (95% confidence interval 1.02 to 1.37), 1.37 (1.09 to 1.73), and 1.39 (1.14 to 1.70), respectively. Similarly, women who reported that their usual cycle length was 40 days or more at ages 18-22 years and 29-46 years were more likely to die prematurely than women who reported a usual cycle length of 26-31 days in the same age ranges (1.34, 1.06 to 1.69; and 1.40, 1.17 to 1.68, respectively). These relations were strongest for deaths related to cardiovascular disease. The higher mortality associated with long and irregular menstrual cycles was slightly stronger among current smokers.

Conclusions: Irregular and long menstrual cycles in adolescence and adulthood are associated with a greater risk of premature mortality (age <70 years). This relation is slightly stronger among women who smoke.
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http://dx.doi.org/10.1136/bmj.m3464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526082PMC
September 2020

Association of sugar-sweetened beverage and artificially sweetened beverage intakes with mortality: an analysis of US National Health and Nutrition Examination Survey.

Eur J Nutr 2020 Sep 18. Epub 2020 Sep 18.

Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hongkong Rd, Wuhan, 430030, China.

Purpose: Current evidence on the associations between sugar-sweetened beverage (SSB) intakes and mortality is inconsistent, whereas the evidence on artificially sweetened beverages (ASBs) was sparse. We aimed to investigate the associations of SSB and ASB intakes with mortality in a nationally representative sample of US adults.

Methods: Participants from the National Health and Nutrition Examination Survey (NHANES, 1999-2014; n = 31,402) were linked to the US mortality registry by the end of 2015. SSB and ASB intakes were collected using 24-h dietary recalls. Cox proportional hazard regression models were used to assess the associations of intakes of SSBs, ASBs, and added sugar from SSBs with mortality with adjustment for demographic, lifestyle, comorbidity, and dietary factors.

Results: After a mean follow-up of 7.9 years, 3878 deaths were identified. The multivariate-adjusted hazard ratios (95% confidence intervals) associated with each additional serving/d of SSB were 1.05 (1.01-1.09) for all-cause mortality and 1.11 (1.03-1.21) for heart disease mortality. Hazard ratios (95% confidence intervals) comparing the extreme quintiles of added sugar intakes from SSBs were 1.22 (1.05-1.42) for all-cause mortality and 1.45 (1.06-1.97) for heart disease mortality. No significant relationship was found between SSB intakes and cancer mortality or between high ASB intakes and mortality. Substituting one serving/d of SSB by an equivalent amount of ASBs, unsweetened coffees and teas, and plain water was associated with a 4-7% lower risk of all-cause mortality.

Conclusion: Higher SSB intakes were associated with higher risks of all-cause mortality and heart disease mortality. High ASB intakes were not significantly associated with mortality. ASBs, unsweetened coffees and teas, and plain water might be optional alternatives for reducing SSB intakes.
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http://dx.doi.org/10.1007/s00394-020-02387-xDOI Listing
September 2020

Combined lifestyle factors, all-cause mortality and cardiovascular disease: a systematic review and meta-analysis of prospective cohort studies.

J Epidemiol Community Health 2021 Jan 5;75(1):92-99. Epub 2020 Sep 5.

Department of Epidemiology and Biostatistics, Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Introduction: Unhealthy lifestyles caused a huge disease burden. Adopting healthy lifestyles is the most cost-effective strategy for preventing non-communicable diseases. The aim was to perform a systematic review and meta-analysis to quantify the relationship of combined lifestyle factors (eg, cigarette smoking, alcohol consumption, physical activity, diet and overweight/obesity) with the risk of all-cause mortality, cardiovascular mortality and incident cardiovascular disease (CVD).

Methods: PubMed and EMBASE were searched from inception to April 2019. Cohort studies investigating the association between the combination of at least three lifestyle factors and all-cause mortality, cardiovascular mortality or incidence of CVD were filtered by consensus among reviewers. Pairs of reviewers independently extracted data and evaluated study quality. Random-effects models were used to pool HRs. Heterogeneity and publication bias were tested.

Results: In total, 142 studies were included. Compared with the participants with the least-healthy lifestyles, those with the healthiest lifestyles had lower risks of all-cause mortality (HR=0.45, 95% CI 0.41 to 0.48, 74 studies with 2 584 766 participants), cardiovascular mortality (HR=0.42, 95% CI 0.37 to 0.46, 41 studies with 1 743 530 participants), incident CVD (HR=0.38, 95% CI 0.29 to 0.51, 22 studies with 754 894 participants) and multiple subtypes of CVDs (HRs ranging from 0.29 to 0.45). The associations were largely significant and consistent among individuals from different continents, racial groups and socioeconomic backgrounds.

Conclusions: Given the great health benefits, comprehensively tackling multiple lifestyle risk factors should be the cornerstone for reducing the global disease burden.
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http://dx.doi.org/10.1136/jech-2020-214050DOI Listing
January 2021

Association between weight status, metabolic syndrome, and chronic kidney disease among middle-aged and elderly Chinese.

Nutr Metab Cardiovasc Dis 2020 10 1;30(11):2017-2026. Epub 2020 Jul 1.

Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430030, PR China. Electronic address:

Background And Aims: Obesity often initiates or coexists with certain metabolic abnormalities. This study sought to examine the independent and joint relations of weight and metabolic syndrome (MetS) with incident chronic kidney disease (CKD) among Chinese elderly people.

Methods And Results: A total of 15,229 participants (mean age: 62.8 years) from the Dongfeng-Tongji cohort with complete baseline questionnaire and medical examination data were followed from 2008 to 2010 to 2013. All participants were categorized into four phenotypes: metabolically healthy non-overweight/obesity (MHNO), metabolically healthy overweight/obesity (MHO), metabolically unhealthy non-overweight/obesity (MUNO), metabolically unhealthy overweight/obesity (MUO). Multivariable-adjusted logistic regression models were applied to estimate the odds ratios (ORs) and confidence intervals (CIs) of four phenotypes with the risk of incident CKD, which was defined as estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m. A total of 1151 CKD cases were identified during a mean of 4.6-year follow-up. After adjusting for potential confounders, both overweight/obesity and MetS were associated with higher risk of CKD, and the ORs (95% CI) were 1.32 (1.15-1.52) and 1.50 (1.31-1.73), respectively. The risk of CKD was progressively higher in MHO (1.31, 1.09-1.57), MUNO (1.54, 1.22-1.93), and MUO (2.05, 1.73-2.42) as compared with MHNO phenotype, without significant multiplicative interaction between overweight/obesity and MetS (P = 0.906). These associations were slightly stronger among those aged >60 years or with baseline diabetes.

Conclusion: Both overweight/obesity and MetS were associated with an increased risk of CKD. It is worth noting that MHO and MUNO also have an elevated risk. Maintaining both normal weight and healthy metabolic profile is recommended.
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http://dx.doi.org/10.1016/j.numecd.2020.06.025DOI Listing
October 2020

Effect of an Inactivated Vaccine Against SARS-CoV-2 on Safety and Immunogenicity Outcomes: Interim Analysis of 2 Randomized Clinical Trials.

JAMA 2020 09;324(10):951-960

National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co Ltd, Wuhan, Hubei, China.

Importance: A vaccine against coronavirus disease 2019 (COVID-19) is urgently needed.

Objective: To evaluate the safety and immunogenicity of an investigational inactivated whole-virus COVID-19 vaccine in China.

Interventions: In the phase 1 trial, 96 participants were assigned to 1 of the 3 dose groups (2.5, 5, and 10 μg/dose) and an aluminum hydroxide (alum) adjuvant-only group (n = 24 in each group), and received 3 intramuscular injections at days 0, 28, and 56. In the phase 2 trial, 224 adults were randomized to 5 μg/dose in 2 schedule groups (injections on days 0 and 14 [n = 84] vs alum only [n = 28], and days 0 and 21 [n = 84] vs alum only [n = 28]).

Design, Setting, And Participants: Interim analysis of ongoing randomized, double-blind, placebo-controlled, phase 1 and 2 clinical trials to assess an inactivated COVID-19 vaccine. The trials were conducted in Henan Province, China, among 96 (phase 1) and 224 (phase 2) healthy adults aged between 18 and 59 years. Study enrollment began on April 12, 2020. The interim analysis was conducted on June 16, 2020, and updated on July 27, 2020.

Main Outcomes And Measures: The primary safety outcome was the combined adverse reactions 7 days after each injection, and the primary immunogenicity outcome was neutralizing antibody response 14 days after the whole-course vaccination, which was measured by a 50% plaque reduction neutralization test against live severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Results: Among 320 patients who were randomized (mean age, 42.8 years; 200 women [62.5%]), all completed the trial up to 28 days after the whole-course vaccination. The 7-day adverse reactions occurred in 3 (12.5%), 5 (20.8%), 4 (16.7%), and 6 (25.0%) patients in the alum only, low-dose, medium-dose, and high-dose groups, respectively, in the phase 1 trial; and in 5 (6.0%) and 4 (14.3%) patients who received injections on days 0 and 14 for vaccine and alum only, and 16 (19.0%) and 5 (17.9%) patients who received injections on days 0 and 21 for vaccine and alum only, respectively, in the phase 2 trial. The most common adverse reaction was injection site pain, followed by fever, which were mild and self-limiting; no serious adverse reactions were noted. The geometric mean titers of neutralizing antibodies in the low-, medium-, and high-dose groups at day 14 after 3 injections were 316 (95% CI, 218-457), 206 (95% CI, 123-343), and 297 (95% CI, 208-424), respectively, in the phase 1 trial, and were 121 (95% CI, 95-154) and 247 (95% CI, 176-345) at day 14 after 2 injections in participants receiving vaccine on days 0 and 14 and on days 0 and 21, respectively, in the phase 2 trial. There were no detectable antibody responses in all alum-only groups.

Conclusions And Relevance: In this interim report of the phase 1 and phase 2 trials of an inactivated COVID-19 vaccine, patients had a low rate of adverse reactions and demonstrated immunogenicity; the study is ongoing. Efficacy and longer-term adverse event assessment will require phase 3 trials.

Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000031809.
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http://dx.doi.org/10.1001/jama.2020.15543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426884PMC
September 2020