Objective: To investigate the association of depressive symptoms with the incidence of cardiovascular disease (CVD), cancer, and chronic obstructive pulmonary disease (COPD). Methods: Baseline data were derived from the China Chronic Disease and Risk Factor Surveillance Survey conducted in Jiangsu Province in 2010. Depressive status of the study participants was evaluated by using Patient Health Questionnaire-9 (PHQ-9). A total of 7 709 study participants who completed the baseline survey were included in the follow-up, and additional data on the incidence of target diseases or deaths were collected from Jiangsu Provincial Cardiovascular and Cerebrovascular Disease Reporting System, Tumor Registry System, and Cause of Death Registry System, thus establishing a prospective cohort. The follow-up ended on December 31, 2021. In the follow-up, 220 study participants were lost to follow-up (2.85%, 220/7 709). In addition, 271 study participants with confirmed diagnoses of CVD, cancer or COPD at baseline survey were excluded. Finally, a total of 7 218 study participants were included in the final analysis. Cox proportional hazards regression model was used to analyze the association between depressive symptoms and the risk for CVD, cancer and COPD. Stratified analyses were further conducted according to baseline characteristics, including sex, age, marital status, educational level and smoking status. Results: During the follow-up period, a total of 692 cases of CVD, 362 cases of cancer, and 112 cases of COPD occurred. After adjusting for potential confounding factors, compared with the group with PHQ-9 score of 0, the HRs for CVD incidence were 1.44 (95%CI: 1.06-1.94) in the group with score of 5-9, and 2.00 (95%CI: 1.24-3.22) in the group with score of ≥10. For cancer incidence, the HR was 0.67 (95%CI: 0.51-0.89) in the group with PHQ-9 score of 1-4 compared with the group with the score of 0. As for COPD incidence, the HRs were 1.90 (95%CI: 1.25-2.89), 2.42 (95%CI: 1.26-4.66), and 3.52 (95%CI: 1.40-8.87) in the groups with PHQ-9 score of 1-, 5-, and ≥10, respectively. Compared with the study participants without depressive symptoms at baseline survey, those with depressive symptoms had 1.55-fold (HR=1.55, 95%CI: 1.20-2.00) increased risk for CVD and 2.16-fold (HR=2.16, 95%CI: 1.26-3.69) increased risk for COPD. In stratified analyses by baseline characteristics including sex, age, marital status, educational level, and smoking status, no significant interaction effects were found between depressive symptoms and the aforementioned baseline characteristics on the risk for CVD, cancer, and COPD (all interaction P>0.05). Conclusions: Depressive symptoms might be associated with increased risks for CVD and COPD. The prevention and management of depressive symptoms should be considered in the prevention and control of CVD and COPD.

Objective: To analyze the associations of exposure to single pollutants and their mixture with metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with significant liver fibrosis in adults in China. Methods: A total of 23 806 participants from the third resurvey of the China Kadoorie Biobank were included. An elastic-net logistic regression model was used to calculate the weighted environmental risk score (WERS). Logistic regression models were used to evaluate the associations of the exposures to single pollutant [fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀), nitrogen dioxide (NO₂), and warm-season ozone (O₃)], and their mixture (WERS) with the risk for MASLD and MASLD with significant liver fibrosis. Restricted cubic spline models were used to evaluate non-linear relationships. Logistic regression models were also used to estimate the population attributable fraction (PAF) for air pollutants and major risk factors. Results: The mean age of the study participants was (65.3±9.1) years. Among them, 13 428 had MASLD, including 2 457 with significant liver fibrosis. Exposure to PM_2.5, PM₁₀, NO₂, and warm-season O₃ was positively associated with MASLD risk, with ORs of 1.27 (95%CI: 1.05-1.53), 1.77 (95%CI: 1.36-2.31), 1.20 (95%CI: 1.08-1.33), and 1.53 (95%CI: 1.20-1.95) per 1-SD increase, respectively. PM_2.5 showed a non-linear association with MASLD risk (P for nonlinear=0.007). The association between PM_2.5 and MASLD was mild at low exposure levels but increased obviously at higher concentrations. PM₁₀ and warm-season O₃ exposures were positively associated with significant liver fibrosis in MASLD patients. Each 1-unit increase in WERS (representing simultaneous 1-SD increases in the four pollutants) was associated with a 40% higher risk for MASLD (95%CI: 18%-65%) and a 42% higher risk for significant liver fibrosis (95%CI: 1%-100%). Compared with people with low exposure to air pollutants, the PAFs for MASLD in those with higher exposures to PM_2.5, PM₁₀, and warm-season O₃ ranged from 25.4% to 66.4%. Conclusion: Exposures to PM_2.5, PM₁₀, NO₂, and warm-season O₃, as well as their mixture, were associated with increased risk for MASLD and MASLD with significant liver fibrosis in adults in China.

In a retrospective Nigerian cohort of 33 982 people with HIV-1 initiating or switching to tenofovir, lamivudine, and dolutegravir, virological suppression reached 80%-82% among participants with available viral load data and 63%-65% by intention-to-treat analysis. Suppression was higher among switchers, while age and gender predicted suppression.

The world food systems are facing the fundamental challenges that are being necessitated by climatic changes, increasing population count, protein demand and the escalating non-communicable diseases. Ecological nutrition approaches should therefore be concerned with ecological stability and functional health outcomes. The South Indian traditional medicine is Siddha medicine, an ancient system that provides a constitution-based dietary system that focuses on the three humours, i.e., Vatham, Pitham and Kabam, and the concept of food as medicine. In line with this, other proteins, such as plant-based, microbial and insect-derived proteins and cultivated proteins, have also become viable options to minimise the environmental impact of traditional livestock production and satisfy the human protein needs. This review explains how the bridging of Siddha nutrition philosophy and current alternative-protein innovation can be affected to suggest a unified and sustainable mix of food. It also critically reviews the Siddha dietary categories, methods of digestive improvement, fermentation and detoxification methods, and how they correlate to the bioavailability, digestibility, and activity of other proteins. The sustainability of the environment is determined in terms of Siddha ecological ethics and the life-cycle assessment of alternative protein systems. The issues of safety, allergenicity, cultural acceptance, and the regulatory viewpoints are also considered in favour of the support of translational applicability. Lastly, the review provides future research directions such as personalized nutrition based on constitutions, integrative clinical validation models, and the innovation strategies of functional foods. Applying the Siddha wisdom to the other protein science provides a culturally based, ecologically sustainable and functional-driven concept that can be used to achieve sustainable food transitions and enhance global health outcomes.

The achievement of guideline-recommended care targets for stroke survivors in China has remained inadequately understood.

This study aimed to assess the proportions of stroke survivors who achieved the 7 main risk factors according to the Chinese stroke prevention and control guidelines.

Using the data from the China national stroke screening survey in Guangdong Province, we assessed the control status of 7 modifiable risk factors in 3,305 stroke patients, including blood pressure, blood lipids, blood glucose, smoking, alcohol use, physical inactivity, and obesity. Estimates were compared by sex, age, income level, and education level. We also investigated the factors associated with the achievement of risk factor control targets.

The proportion of stroke patients who achieved joint control of all 3 metabolic risk factors (blood pressure, lipids, and glucose) was extremely low at 2.9% (95% CI: 2.4%-3.6%), and that of patients who achieved behavioral and lifestyle risk factors (smoking, alcohol use, physical inactivity, and obesity) was 21.1% (95% CI: 19.7%-22.5%). Only 0.4% (95% CI: 0.2%-0.7%) of all stroke patients achieved guideline-recommended targets for all 7 modifiable risk factors. Sex, education level, and income were potential influencing factors of risk factor control.

Stroke remains a significant public health challenge in China. The multifactorial control of risk factors among community-dwelling stroke patients in China remains suboptimal, with substantial gaps in achieving guideline-recommended targets, particularly for metabolic risk factors. Future efforts should strengthen secondary stroke prevention management and health education initiatives to mitigate the poor prognosis associated with inadequate control of risk factors.

Dietary folic acid (FA) intake may reduce homocysteine levels and alleviate oxidative stress, both of which are closely associated with the development and progression of diabetic retinopathy (DR). This study aims to investigate the association between dietary FA intake and DR among patients with diabetes aged ≥40 years in the United States.

Data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES) were used. The study population comprised 3 220 patients previously diagnosed with type 2 diabetes mellitus, after excluding patients with diabetes who had missing data on dietary FA intake or DR. Multivariable logistic regression was used to evaluate the association between dietary FA intake and the prevalence of DR, with subgroup analyses and interaction tests performed. Smooth curve fitting was used to explore the potential nonlinear relationship between dietary FA intake and DR.

After adjustment for potential confounders, higher dietary FA intake was significantly associated with a lower prevalence of DR (OR=0.394, 95% CI 0.193 to 0.804, P=0.011). Smooth curve fitting revealed a predominantly linear, inverse dose-response relationship between dietary FA intake and the odds of DR, with no significant non-linearity detected (P value for non-linearity=0.6535). Subgroup analyses demonstrated that the inverse association remained consistent across subgroups stratified by sex, age, body mass index (BMI), education level, smoking status, alcohol consumption, hypertension, and hypercholesterolemia (all P values for interaction >0.05).

Among adults with diabetes aged ≥40 years in the United States who were diagnosed clinically or based on biochemical testing, higher dietary FA intake is significantly associated with a lower prevalence of DR. Future prospective studies are needed to clarify the causal relationship and underlying mechanisms.

Objective: To investigate the influencing factors for cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM) and to develop a predictive model. Methods: A retrospective analysis was performed on clinical data of 831 patients with T2DM hospitalized in the Suqian Hospital Affiliated to Xuzhou Medical University from September 2024 to December 2025. Patients were divided into a training set (n=581) and a validation set (n=250) at a 7∶3 ratio using a random number table method. According to the presence of CAN, patients in the training set were further classified into the non-CAN group (n=307) and the CAN group (n=274). Compare the differences in various indicators between the two groups. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression models were used to analyze influencing factors for CAN in patients with T2DM, and a nomogram prediction model was constructed. The area under the receiver operating characteristic curve (AUC), calibration curve and decision curve analysis were adopted to evaluate the predictive performance, accuracy and clinical applicability of the model. Results: In the training set, patients in the CAN group presented higher age, diabetes duration, glycated hemoglobin (HbA_1c), neutrophil count, platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, systemic immune-inflammation index (SII), and systemic inflammatory response index compared with the non-CAN group. By contrast, height, body weight, total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, fasting C-peptide and fasting insulin were lower in the CAN group (all P<0.05). The proportions of diabetic nephropathy, diabetic retinopathy (DR), diabetic peripheral neuropathy, history of hypertension, history of cardiovascular disease, history of stroke, anti-platelet agent use and insulin use were higher in the CAN group than in the non-CAN group (all P<0.05). Seven variables were screened out via LASSO regression analysis, including DR, age, diabetes duration, HbA1c, NLR, PLR and SII. Multivariate logistic regression analysis revealed that DR (OR=2.29, 95%CI: 1.48-3.56), longer diabetes duration (OR=1.04, 95%CI: 1.01-1.08), advancing age (OR=1.06, 95%CI: 1.04-1.09), elevated HbA_1c (OR=1.23, 95%CI: 1.13-1.36), increased NLR (OR=2.23, 95%CI: 1.36-3.69) and elevated PLR (OR=1.01, 95%CI: 1.00-1.02) were influencing factors for CAN in patients with T2DM. The nomogram prediction model constructed with the above 6 variables yielded AUC values of 0.839 (95%CI: 0.807-0.871) and 0.787 (95%CI: 0.732-0.843) for predicting CAN among T2DM patients in the training set and validation set, respectively. The corresponding sensitivity was 81.4% and 71.3%, and the specificity was 71.7% and 73.3%. Calibration curves demonstrated good agreement between predicted and observed CAN outcomes in both the training and validation sets. The Hosmer-Lemeshow test showed satisfactory calibration for the training set (χ²=6.701, P=0.461) and validation set (χ²=12.139, P=0.096). The decision curve analysis demonstrated that the model exhibits favorable clinical applicability when the threshold probability of the training set ranges from 1% to 88%, and that of the validation set ranges from 3% to 80%. Conclusions: DR, longer diabetes duration, advanced age, elevated HbA_1c, increased NLR and elevated PLR are risk factors for CAN in patients with T2DM. The nomogram prediction model established based on these variables can intuitively and individually assess the risk of CAN in patients with T2DM.

Although type 2 diabetes mellitus (T2DM) patients have normal or even elevated bone mineral density, they still face increased risk for fracture, a phenomenon known as the "Diabetes-bone mineral density paradox". This paper summarizes current domestic and international evidences regarding changes in bone mineral density, fracture risk, and the potential underlying mechanisms in patients with T2DM. Existing studies indicate that bone mineral density changes in T2DM patients are heterogeneous. In contrast, evidence for an increased fracture risk is relatively consistent, especially for hip fractures. Potential mechanisms might involve enhanced bone formation associated with hyperinsulinemia, as well as the combined effects of advanced glycation end products accumulation, low bone turnover, microarchitectural deterioration, and impaired bone quality. The "diabetes-bone mineral density paradox" suggests that the assessment of diabetes-related bone fragility should not rely solely on bone mineral density, but also consider bone quality and bone microstructure parameters. Multidimensional prospective studies are needed in the future to further improve fracture risk assessment for patients with T2DM.

Cord blood 25-hydroxyvitamin D [25(OH)D] at birth reflects maternal vitamin D availability and maternal-fetal handling. We compared cord 25(OH)D across hypertensive disorders of pregnancy (HDP), severe anaemia, gestational diabetes mellitus (GDM), and healthy controls using ANCOVA to determine whether group differences persisted after accounting for maternal substrate availability.

This cross-sectional comparative study enrolled 400 primigravida women presenting in active labour at ≥34 weeks gestation: HDP (n = 75), severe anaemia (haemoglobin <7 g/dL; n = 75), GDM (n = 50), and uncomplicated controls (n = 200). The primary ANCOVA adjusted for maternal 25(OH)D and clinical group; a pre-specified sensitivity analysis additionally adjusted for gestational age and birthweight.

In the primary ANCOVA, HDP was associated with a cord blood deficit (B = -6.14, p < 0.001) and severe anaemia with a smaller deficit (B = -2.93, p < 0.001); GDM was not significantly different from controls. After additional adjustment for gestational age and birthweight, deficits remained significant for HDP (B = -4.85, p < 0.001) and anaemia (B = -1.95, p = 0.002). No HDP neonate met the pre-specified sufficiency threshold of ≥20 ng/mL (0/75, 0.0%; 95% CI 0.0-4.8%).

HDP remained associated with substantially lower cord 25(OH)D after adjustment for maternal levels, gestational age, and birthweight. This residual association is compatible with altered maternal-fetal vitamin D handling but, given cross-sectional sampling at delivery and absence of direct placental measurements, does not establish impaired placental transport. Severe anaemia showed a smaller residual deficit; GDM showed no significant deficit.

Periodontal disease is common among adults with diabetes, yet periodontal screening is rarely incorporated into routine outpatient diabetes care. The Oral Health Assessment Tool (OHAT) is a structured observational tool designed for non-dental healthcare professionals; however, its relationship with periodontal screening findings remains unclear.

To examine the association between OHAT findings and periodontal screening outcomes in adults attending diabetes outpatient clinics.

This cross-sectional study included adults with type 1 or type 2 diabetes at a tertiary hospital in Sydney, Australia. Periodontal screening was performed using the Periodontal Screening and Recording (PSR) system, and oral health was assessed using OHAT. Periodontal status was dichotomized as no/mild (PSR 0-2) versus moderate-to-severe (PSR ≥ 3). Logistic regression examined associations of OHAT domains and total OHAT burden with periodontal status. Covariate-adjusted models assessed robustness. Screening performance was evaluated using sensitivity, specificity, and predictive values.

Among 120 participants (mean age 61.5 years, 64.2% with type 2 diabetes), 71.4% demonstrated moderate-to-severe periodontal findings. Mean OHAT score was 4.99 (SD 2.02). Change/unhealthy ratings for tongue (OR 3.23, 95% CI 1.30-8.02), gums and oral tissues (OR 4.59, 95% CI 1.78-11.85), and increasing categories of decayed teeth (OR 2.06, 95% CI 1.05-4.05) were associated with moderate-to-severe findings. Higher total OHAT score (> 5 vs. ≤ 5) was strongly associated with moderate-to-severe periodontal findings (OR 7.00, 95% CI 2.25-21.76), with consistent results. This threshold showed high specificity (87.5%) and positive predictive value (90.9%), but moderate sensitivity (50.0%).

OHAT findings were associated with moderate-to-severe periodontal screening findings among adults with diabetes, supporting further evaluation of OHAT as a pragmatic screening and referral aid in settings where formal periodontal assessment is not routinely available. Its performance when administered by non-dental clinicians requires further investigation.