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Exposure to environmental contaminants and the development of hypertension and diabetes represent crucial risk factors for chronic kidney disease (CKD). Toxicological studies have revealed that organophosphate esters (OPEs) impair kidney function. However, the joint effects of OPE exposure on kidney injury and the interactions of OPE exposure with hypertension or diabetes on kidney injury remain unclear. Our study aimed to investigate the individual and joint effects of OPE exposure on renal injury, as well as the potential interaction between OPE exposure and hypertension or diabetes on kidney injury. The study enrolled 1938 participants from Wuhan, China. To explore the relationship between OPE exposure and renal injury, we conducted multivariate linear and logistic regression analysis. The results indicated that each unit increase in 4-hydroxyphenyl diphenyl phosphate (4-HO-DPHP), bis(2-butoxyethyl) phosphate (BBOEP), and tris(2-chloroethyl) phosphate (TCEP) (1 μg/L-ln transformed) was associated with a decreased 0.57 mL/min/1.73 m 2 (95%CI: -1.05, -0.09), 0.85 mL/min/1.73 m 2 (95%CI: -1.52, -0.19) and 1.24 mL/min/1.73 m 2 (95%CI: -2.26, -0.23) of estimated glomerular filtration rate (eGFR), while each unit increase in 4-HO-DPHP and BBOEP (1 μg/L-ln transformed) was associated with 14% and 20% elevation of incident impaired renal function (IRF) risk. Notably the highest tertile of BCIPHIPP was positively associated with eGFR, although the p for trend ＞ 0.05. We employed Bayesian kernel machine regression (BKMR) and quartile-based g-computation (qgcomp) models to explore the joint effects of OPE mixtures on eGFR and IRF. Both the results of BKMR and qgcomp model consistently demonstrated negative associations between OPE mixtures and eGFR, and TCEP and 4-HO-DPHP were major contributors. Furthermore, we observed multiplicative interactions of diphenyl phosphate (DPHP), BBOEP, di-ocresyl phosphate (DoCP) & di-p-cresyl phosphate (DpCP), 1-hydroxy-2-propyl bis(1-chloro-2-propyl) phosphate (BCIPHIPP) and hypertension or diabetes on kidney injury (all P＜0.05). Those with diabetes or hypertension and higher OPE metabolite concentrations had increased risk of kidney function impairment compared to those who did not have diabetes or hypertension. These findings suggest that specific OPE exposure may elevate the risk of renal injury, particularly among hypertensive and diabetic populations., Competing Interests: Declaration of competing interest The authors declare no competing interests in this paper., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Objectives: Evidence on the association between long-term exposure to ambient air pollution and serum glycosylated hemoglobin A 1c (HbA 1c ) is limited and inconclusive. In addition, whether vitamin D can modify the association between air pollution exposure and glucose metabolism has not been previously investigated. We aimed to evaluate the effects of various air pollutants on serum HbA 1c levels in patients with hypertension and, further, to explore the modification effect of individual serum vitamin D levels., Methods: This study was derived from UK Biobank study, and 246 027 participants with hypertension were included in our analysis. Individual exposures to particulate matters (PMs) and nitrogen oxides were estimated using the land use regression model. The associations between air pollutants and HbA 1c were assessed using the multivariable linear regression model. Among the 222 845 participants with a measurement of serum vitamin D, we explored the associations in subgroups stratified by vitamin D levels., Results: Long-term air pollutant exposures were significantly associated with higher HbA 1c levels. After adjusting for potential confounders, 10-μg/m 3 (or 1-m -1 ) increases in concentrations of PM with diameters ≤2.5 µm (PM 2.5 ), PM with diameters ≤10 µm, PM with diameters from 2.5 µm to 10 µm, PM 2.5 absorbance, nitrogen oxides, and nitrogen dioxide were significantly associated with 0.59 (95% confidence interval, 0.28-0.89), 0.49 (0.33-0.65), 0.81 (0.48-1.14), 0.56 (0.44-0.69), 0.06 (0.04-0.09), and 0.16 (0.12-0.21) mmol/mol increase in serum HbA 1c levels, respectively. The associations were weakened but remained significant after additional adjustment of vitamin D. In addition, the associations of air pollutants with HbA 1c were more evident in participants with low serum vitamin D levels (all P values for interaction <0.001)., Conclusions: Long-term exposures to ambient air pollutants were associated with higher levels of HbA 1c in a dose-response fashion in a large UK cohort. Serum vitamin D status significantly modified these associations, and high serum vitamin D levels may attenuate the relationships between air pollution exposures and HbA 1c levels., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose of Review: To evaluate the status of elevated blood pressure in Chinese children and adolescents, and identify potential influence factors., Recent Findings: We searched PubMed, the Web of science, the WanFang, the VIP, and the CNKI to identify articles that were published from Jan 1, 1997, to May 30, 2019. We used random effects models to estimate the pooled prevalence of elevated blood pressure, and heterogeneity among the studies was assessed with Cochran's Q statistic. The potential source of heterogeneity was explored by meta-regression and subgroup comparisons using Q test based on ANOVA. Fifty-nine studies were included in the qualitative synthesis and the prevalence of elevated blood pressure ranged from 2.2 to 26.4%. The meta-analysis included 25 studies (341,281 participants), and the pooled prevalence of elevated blood pressure was 9.8% (95% CI 7.9, 11.9). The prevalence of elevated blood pressure in the obese children (34.1%, 95% CI 26.9, 41.7) and overweight children (15.5%, 95% CI 10.1, 21.7) was much higher than that in the normal or underweight children (5.0%, 95% CI 2.4, 8.4). Fluctuating trends in the prevalence of elevated blood pressure both in the total sample of Chinese children and adolescents and in each subgroup were observed from 2007 to 2014. Our study showed that prevalence of elevated blood pressure in children and adolescents in China was in the medium level in the world. Primary prevention for childhood hypertension should be implemented and focus on weight control and healthy lifestyle habits.

Objectives: Earlier age at natural menopause has been associated with cardiovascular disease in several studies, but evidence of its association with hypertension is lacking. We aimed to examine the relationship between age at natural menopause and hypertension among middle-aged and older Chinese women., Methods: A total of 13 406 postmenopausal women (mean age 63.5 years) were enrolled from the Dongfeng-Tongji cohort study in Hubei province, China. Age at natural menopause was self-reported and was categorized into three groups (≤45, 46-52, or ≥53 years). Logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension in relation to age at natural menopause., Results: Of the study participants, 6690 (49.9%) women were diagnosed as hypertension. The mean age at natural menopause was 49.3 ± 3.3 years. After adjustment for potential confounders, the ORs of hypertension for women who reached menopause at age 45 or less and 46-52 years were 1.27 (95% CI, 1.08, 1.50) and 1.14 (95% CI, 1.01, 1.29), respectively, compared with those who reached menopause at age at least 53 years. Each 1-year delay in menopause was associated with 2% decrease in prevalence of hypertension (OR, 0.98; 95% CI, 0.97, 0.99)., Conclusion: Our findings suggested that earlier age at natural menopause was related to prevalence of hypertension independent of potential confounders. Identification of women with earlier menopause offers a window of opportunity to improve women's health during the postmenopausal years.

Objectives: Famine exposure in early life has been reported to be associated with higher risk of hypertension prevalence in adults. The aim of the present study was to investigate the association of exposure to the Chinese famine during early life with the risk of hypertension prevalence in adults., Methods: There were 8742 participants born between 1952 and 1964 derived from the Dongfeng-Tongji cohort included in the present study. Participants were classified as nonexposed group, fetal exposed group, early-childhood exposed group, mid-childhood exposed group, and late-childhood exposed group, respectively. Logistic regression model was used to explore the association between famine exposure in early life and risk of hypertension prevalence in adults., Results: The prevalence of hypertension among individuals in nonexposed group, fetal exposed group, early-childhood exposed group, mid-childhood exposed group, and late-childhood exposed group were 34.0, 38.0, 43.9, 47.4, and 54.4%, respectively. Compared with nonexposed group, participants exposed to the famine in the fetal [1.24, 95% confidence interval (CI): 1.01-1.51], early childhood (1.44, 95% CI: 1.20-1.73), mid-childhood (1.67, 95% CI: 1.38-2.02), and late childhood (2.11, 95% CI: 1.75-2.55) had higher risk of hypertension prevalence in adults after adjustment for potential confounders (P for trend <0.0001). Adjustment for age did not materially change the results., Conclusion: Results in the present study indicated that exposure to the famine in early life increases the risk of hypertension prevalence in adulthood.

Evidence from epidemiological studies reported that height was inversely associated with cardiovascular diseases, but the association between height and hypertension was unclear. The purpose of this study was to explore the association between height and blood pressure or prevalence of hypertension in a middle-aged and older Chinese population. A total of 33,197 participants aged 37 to 94 years were recruited from the Dongfeng-Tongji cohort study in Hubei province, China. All participants completed baseline questionnaires, medical examinations and provided blood samples. Hypertension was define as a systolic blood pressure (SBP) over 140 mmHg or/and a diastolic blood pressure (DBP) over 90 mmHg, or current use of antihypertensive medication, or participants with self-reported physician diagnosis of hypertension. Multivariate linear and logistic regression models were used. The prevalence of hypertension was 69.1% for men and 58.0% for women. Pulse pressure (PP) and SBP, but not DBP decreased linearly with increasing height among men and women. Comparing the highest with the shortest quartile of height, the multivariate-adjusted odds ratios were 0.80 (95% confidence interval, 0.71, 0.91) for men and 0.83 (0.74, 0.92) for women. In conclusion, height was associated with reduced SBP, PP and prevalence of hypertension in a middle-aged and older Chinese population.

Background: In this study, we investigated the independent and combined effects of sleep duration and afternoon napping on the risk of incident diabetes among a cohort of middle-aged and older Chinese adults., Methods: Information of sleep and napping was obtained by questionnaires during face-to-face interviews. We categorized sleep duration into <7 h, 7∼<8 h (reference), 8∼<9 h, 9∼<10 h, and ≥ 10 h. Afternoon napping was divided into no napping (0 min) (reference), 1-30 min, 31-60 min, 61-90 min, and > 90 min. Cox proportional hazard regression models were used., Results: Compared with referential sleeping group, subjects sleeping ≥10 h had a 42% higher risk of developing diabetes. The HR was 1.28 for napping > 90 min when compared with no napping. These associations were more pronounced in individuals without hypertension. Combined effects of long sleep duration and afternoon napping were further identified. Individuals with both sleep duration ≥ 10 h and napping > 60 min had a 72% higher risk of incident diabetes than those with sleeping 7∼<8 h and napping 0 min (all above p < 0.05)., Conclusions: Both long sleep duration and afternoon napping were independently and jointly associated with higher risk of incident diabetes. Key messages Sleep duration was associated with diabetes, but whether it is a real cause of incident diabetes especially in Chinese still remains to be elucidated. The association of afternoon napping and diabetes was not consistent and definite, we clarified this association in a large prospective study. Long sleep duration and afternoon napping were independently and jointly associated with higher risk of incident diabetes.

Objective: Evidence from epidemiological studies suggested that shorter and longer duration of nocturnal sleeping may increase the risk of hypertension for older adults. Little is known about the duration of midday nap on the variability of blood pressure among older adults. In this study, we examined whether duration of habitual midday nap is associated with level of blood pressure or the risk of hypertension in a middle-aged and older Chinese population., Methods: A total of 27 009 participants (mean age 63.6 years) from Dongfeng-Tongji Cohort Study received baseline examination including physical examination and laboratory tests, and a face-to-face-interview including demographic information, disease history, and lifestyle. Participants were categorized into five groups according to nap duration, such as no napping, less than 30 min, 30∼60 min, 60∼90 min, and at least 90 min. A series of categorical logistic regression models was used to examine the odd ratios of nap duration with hypertension., Results: The level of SBP and DBP increased significantly with longer duration of habitual midday napping. Nappers with longer nap duration had considerably higher rate of hypertension. The longer duration of napping was related to higher blood pressure level and was associated with a higher risk of hypertension. After adjusting for possible confounders, the longer duration (>60 min) of napping was still associated with hypertension, Conclusion: : Our findings showed that the practice of longer afternoon nap is associated with a higher increased risk of hypertension, independent of several covariates. Further prospective researches are needed to examine the midday nap duration for development of hypertension.

Background: Shift work has been associated with adverse health effects by disturbing circadian rhythms. However,its potential long-term health effects and the persistent effects after leaving shifts have not been well established., Methods and Results: We studied 26,463 workers from Tongji-Dongfeng Cohort in China. All the participants are retired employees of Dongfeng Motor Company. Information on demographics, occupational history and medical history were gathered through questionnaires. After adjusting potential confounders in the logistic regression models, shift work was associated with poor sleeping quality, diabetes and hypertension independently. We observed significant effects of shift work on poor sleeping quality, diabetes and hypertension; the ORs (95%CI) are 1.18 (1.09-1.27), 1.10 (1.03-1.17) and 1.05 (1.01-1.09) respectively. In the further analysis, we found elevated ORs (95%CI) for participants with poor sleeping quality, the ORs (95%CI) are 1.34 (1.08-1.60), 1.13 (1.05-1.21), 1.05 (1.03-1.07) and 1.05 (1.01-1.09) for 1-4, 5-9, 10-19, ≥20 years of shift work respectively. However, with the extension of leaving shift work duration, the effects of shift work on sleep quality gradually reduced., Conclusions: Shift work may be an independent risk factor for sleeping quality, diabetes and hypertension even in retired workers. Applicable intervention strategies are needed for prevention of sleep loss, diabetes, and hypertension for shift workers.

Background: There is little information regarding the obesity epidemical situation and risk factors of childhood hypertension (HTN) in China. The present study aimed to determine the prevalence of HTN/prehypertension (PHTN), as well as the associated risk factors, among adolescents in Changsha city, China., Methods: A total of 88,974 adolescents from 49 middle schools in Changsha city between 12 and 17 years of age were examined during 2009. Body weight, height, and blood pressure (BP) were measured in all adolescents. HTN and PHTN were defined according to sex- and age-specific Chinese reference data. Overweight and obesity were also defined according to sex- and age-specific Chinese reference data., Results: It was determined that the prevalence of PHTN and HTN were 7.2 and 3.1%, respectively. Furthermore, 14.6% of male adolescents were overweight and 7.0% were obese, whereas 8.6% of female adolescents were overweight and 2.9% were obese. The risk ratio (RR) of HTN were significantly higher in overweight (RR: 2.8, 95% confidence interval (CI): 2.6-3.2) and obese (RR: 8.7, 95% CI: 8.1-9.5) adolescents adjusted for age, sex, and height., Conclusions: Chinese reference data were used to evaluate BP and body mass index (BMI) of children and adolescents. Higher prevalence of HTN was associated with higher BMI percentiles. Being overweight or obese markedly increased the risk of both HTN and PHTN among adolescents between 12 and 17 years of age in Changsha city, China.

Abstract The relation between nonalcoholic fatty liver disease (NAFLD) and hypertension is not fully understood. To examine the effect of the change in NAFLD status on the risk of incident hypertension, and vice versa, 6704 eligible hypertension-free subjects and 9328 NAFLD-free subjects from the Dongfeng-Tongji cohort study at baseline were enrolled in the study. Among the hypertension-free subjects, development and persistence of NAFLD were associated with an increased odds ratio (OR) for incident hypertension (OR: 1.49, 95% confidence interval [CI]: 1.26–1.76, P <.0001; OR: 1.50, 95% CI: 1.27–1.78, P <.0001). However, the resolution of NAFLD was not a risk factor for incident hypertension. Among the NAFLD-free subjects, the risk of new-emerging NAFLD was robust for hypertension status both in no-yes (OR: 1.45, CI: 1.23–1.71) and yes-yes (OR: 1.61, CI: 1.35–1.92). Moreover, stratified analysis by diabetes and overweight/obese for the risk of incident NAFLD showed that incident hypertension (no-yes) and persistent hypertension (yes-yes) were associated with risk of incident NAFLD in subjects without diabetes or overweight/obesity. In the overweight/obese participants, persistent hypertension (yes-yes) was a risk factor for incident NAFLD (OR: 1.29, 95% CI: 1.01–1.64, P =.0387). Conclusively, incidence and persistence of NAFLD are associated with increased risk of hypertension, and vice versa. Highlights • There are bidirectional associations between nonalcoholic fatty liver disease (NAFLD) and hypertension. • Hypertension is associated with increased risk of NAFLD. • Incident hypertension and persistent hypertension were associated with risk of incident NAFLD in subjects without diabetes or overweight/obesity. [ABSTRACT FROM AUTHOR]

Background: Whether cigarette smoking and moderate drinking are associated with non-alcoholic fatty liver disease (NAFLD)has not been fully described. This study investigated the separate and joint effects of smoking and moderate drinking on Chinese men with NAFLD. Methods: Across-sectional assay from DFTJ Cohort study was performed with a size of 9432 elderly Chinese men excluding excessive alcohol consumption (<210g/week). Fatty liver was diagnosed by standardized ultrasonographic inspection. The odds ratio (OR) of alcohol consumption and smoking for the prevalence of NAFLD were analyzed using multiple logistic regression with multiple adjustments. Results: The prevalence of NAFLD in current smokers (pack-year≥40) and drinkers (80~210g/week or drinking duration≥35years) was significantly higher than that in non-smokers and non-drinkers, respectively. The combination of current smoking (pack-year≥40) and drinking (80~210g/week) was associated with the highest risk of NAFLD (OR 1.85; 95% confidence interval [CI] 1.28–2.68;P<0.01). The similar combined effect was found in participants with pack-year≥40 and drinking duration≥35 years (OR 1.72; 95% CI 1.26–2.34;P<0.01). Moreover, an interaction was observed between current smoking and moderate drinking in NAFLD. Conclusions: In elderly Chinese men, cigarette smoking and moderate alcohol consumption exerts an evident joint effect and interaction on the prevalence of NAFLD, although both are significantly and independently associated with NAFLD prevalence. Such findings highlight particular significance of avoidance of cigarette and alcohol on NAFLD prevention. [ABSTRACT FROM AUTHOR]

Background: Studies regarding the effects of parity on metabolic syndrome in later life have produced conflicting results. The purpose of this study was to explore the association between parity and the risk of metabolic syndrome and its components in a population of Chinese women. Methods: A cross-sectional study was performed in a total of 13,358 women (mean age 61.5 years) with at least one live birth from the Dongfeng-Tongji cohort study. Each woman completed baseline questionnaires and received baseline examination, including a physical examination and laboratory tests. Participants were categorized into four groups according to parity (one, two, three, four or more live births). The metabolic syndrome was defined according to the International Diabetes Foundation criteria. Logistic regression was conducted to examine the association between parity and metabolic syndrome, with adjustment of potential confounders. Results: In this study sample, the prevalence of metabolic syndrome was 38.6% (5,156 of 13,358). After adjusting for demographic, lifestyle, and reproduction-related factors, women with two, three, or four or more live births had 1.18 times (95% confidence interval [CI], 1.05-1.32), 1.44 times (95% CI, 1.24-1.67), and 1.52 times (95% CI, 1.26-1.83), respectively, higher odds of having metabolic syndrome compared with those with one live birth. Furthermore, parity showed a positive association with waist circumference and a negative association with high-density lipoprotein cholesterol. Conclusions: Multiparity was associated with increasing risk of metabolic syndrome independent of main covariates in this population of Chinese women. The findings suggested that multiparity may be a risk factor for metabolic syndrome. [ABSTRACT FROM AUTHOR]