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Background: With rapid urbanization, massive migration, and non-family–based eldercare involvement, Chinese concepts of eldercare responsibility and filial piety are shifting. We performed age-period-cohort (APC) analyses to assess the transition of old-age pension coverage, eldercare responsibility, and filial piety concepts and its urban-rural differences among Chinese adults using data from the China General Social Survey (2006–2017). Methods: Old-age pension coverage (yes/no) and primary eldercare responsibility (government/offspring/self/sharing) were investigated in 2010, 2012, 2013, 2015, and 2017. Filial piety was evaluated using customized questionnaires in 2006 and 2017. The APC effects were estimated using mixed effects and generalized additive models. Results: Among 66,182 eligible participants (mean age: 48.8 years, females: 51.7%) in the six waves, APC analyses indicated that old-age pension coverage increased with aging and over time. Across cohort groups, it grew as the cohort was younger in urban residents but decreased in rural residents. The concept of offspring-based (> 50%) and government/self/offspring-shared eldercare (> 30%) predominated. APC analyses revealed that the offspring-based concept declined with aging (OR = 0.81, 95% CI: 0.79–0.84), whereas the government-based (OR = 1.37, 95% CI: 1.33–1.41) and self-based (OR = 1.55, 95% CI: 1.47–1.63) concepts increased with aging. People born around the 1940s have a comparatively higher possibility to perceive that the primary eldercare responsibility should be undertaken by the government and elder parents. In contrast, people born in the younger cohort were more likely to perceive that adult children are responsible for their parents' primary eldercare. Filial piety score slightly increased with aging (β = 0.18, SD: 0.05) but decreased as the birth cohort was younger. In addition, rural participants were more likely to perceive offspring-based eldercare and maintain filial piety, and the related urban-rural difference was intensified by aging. Conclusions: The traditional concept that eldercare solely relies on offspring has changed to relying on multiple entities, including the government and self-reliance. Diluted filial piety in people born in the young cohort requires reinforcement. Moreover, future healthy aging policies need to focus more on urban-rural disparities to promote equity in social well-being. [ABSTRACT FROM AUTHOR]

This study aims to investigate influencing factors of quality of life (QoL) and depression among COVID-19 survivors during convalescence. A cross-sectional study was conducted in November 2020 in Wuhan, China. Information on social support, physical activity, QoL and depressive symptoms were assessed using self-administered questionnaires. Multivariate linear regression and multivariate logistic regression were used to assess the risk factors of subdomains of QoL (physical component score (PCS) and mental component score (MCS)) and depression, respectively. A total of 151 COVID-19 survivors (68 males) aged 53.21 (SD: 12.70) years participated in the study. Multivariate linear regression showed that age (β=−0.241), history of chronic disease (β=−0.4.774), physical activity (β = 2.47) and social support (β = 0.147) were significantly associated with PCS, while having a spouse (β = 9.571), monthly income (β = 0.043) and social support (β = 0.337) were significantly associated with MCS. Logistic regression suggested that participants aged 40–60 years (OR = 10.20, 95%CI: 1.41–73.82) or above 60 years (OR = 15.63, 95%CI: 1.87–131.00), with high school or above education (OR = 5.81, 95%CI: 1.24–27.20), with low/moderate physical activity (low, OR = 2.97, 95%CI: 1.14–7.77; moderate, OR = 3.42, 95%CI: 1.07–10.91) and low/medium social support (low, OR = 4.81, 95% CI: 2.02–11.43; medium, OR = 9.70, 95%CI: 1.17–80.10) were more likely to be depressed, while higher monthly income (≥3000 Yuan RMB/month) was associated with lower risk for depression (OR = 0.27, 95%CI: 0.09–0.82). These findings indicate COVID-19 survivors with older age, having chronic conditions, without a spouse, low monthly income, low level of physical activity and social support had significantly increased risks for poor QoL and depression, and more attention should be given to this population. [ABSTRACT FROM AUTHOR]

Background: In the literature, scarce data investigate the link between 25-hydroxyvitamin D (25[OH]D) and blood lipids in the osteoporosis (OP) population. 25(OH)D, as a calcium-regulating hormone, can inhibit the rise of parathyroid hormone, increase bone mineralization to prevent bone loss, enhance muscle strength, improve balance, and prevent falls in the elderly. This retrospective cross-sectional study aimed to investigate the association between serum 25(OH)D levels and lipid profiles in patients with osteoporosis, with the objective of providing insight for appropriate vitamin D supplementation in clinical settings to potentially reduce the incidence of cardiovascular disease, which is known to be a major health concern for individuals with osteoporosis. Methods: This is a retrospective cross-sectional study from the Affiliated Kunshan Hospital of Jiangsu University, including 2063 OP patients who received biochemical blood analysis of lipids during hospitalization from January 2015 to March 2022. The associations between serum lipids and 25(OH)D levels were examined by multiple linear regression. The dependent variables in the analysis were the concentrations of serum lipoprotein, total cholesterol (TC), triglycerides (TGs), apolipoprotein-A, lipoprotein A, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol (LDL-C). The independent variable was the concentration of blood serum 25(OH)D. At the same time, age, body mass index, sex, time and year of serum analysis, primary diagnosis, hypertension, diabetes, statins usage, beta-C-terminal telopeptide of type I collagen, procollagen type I N-terminal propeptide were covariates. Blood samples were collected in the early morning after the overnight fasting and were analyzed using an automated electrochemiluminescence immunoassay on the LABOSPECT 008AS platform (Hitachi Hi-Tech Co., Ltd., Tokyo, Japan). The generalized additive model was further applied for nonlinear associations. The inception result for smoothing the curve was evaluated by two-piecewise linear regression exemplary. Results: Our results proved that in the OP patients, the serum 25(OH)D levels were inversely connected with blood TGs concentration, whereas they were positively associated with the HDL, apolipoprotein-A, and lipoprotein A levels. In the meantime, this research also found a nonlinear relationship and threshold effect between serum 25(OH)D and TC, LDL-C. Furthermore, there were positive correlations between the blood serum 25(OH)D levels and the levels of TC and LDL-C when 25(OH)D concentrations ranged from 0 to 10.04 ng/mL. However, this relationship was not present when 25(OH)D levels were higher than 10.04 ng/mL. Conclusions: Our results demonstrated an independent relationship between blood lipids and vitamin D levels in osteoporosis patients. While we cannot establish a causal relationship between the two, our findings suggest that vitamin D may have beneficial effects on both bone health and blood lipid levels, providing a reference for improved protection against cardiovascular disease in this population. Further research, particularly interventional studies, is needed to confirm these associations and investigate their underlying mechanisms. [ABSTRACT FROM AUTHOR]

Backgrounds: Freezing of gait (FOG) and cognitive impairment are serious symptoms of Parkinson's disease (PD). Understanding the association between FOG and cognition may help formulate specific interventions for PD individuals. Objectives: We aimed to investigate the associations of cognitive impairment in different domains with FOG status using multiple neuropsychological tests. Methods: Two cohorts including 691 and 104 participants were recruited from Parkinson's progression markers initiative (PPMI) and central China, respectively. All participants underwent FOG assessment and neuropsychological tests, and 595 individuals from PPMI and 51 from central China were enrolled for longitudinal observation. Cross-sectional and longitudinal associations between cognition and FOG status were evaluated using multivariable-adjusted models. Results: Worse cognitive performances were observed in patients with FOG compared to those without FOG in both cohorts (β = − 0.020, p < 0.001) using multivariate-adjusted models. Moreover, patients with progressive FOG during follow-up manifested more serious cognitive declines (HR = 1.40, 95% CI = 1.07–1.80). The FOG was mainly associated with the decline of executive, attention, and orientation. Furthermore, FOG was associated with higher levels of cognition-related biomarkers including T-tau, P-tau, and NfL in cerebrospinal fluid (p < 0.050). Conclusions: FOG is a risk factor for cognitive decline in PD, which emphasizes the need for early detection and monitoring of cognitive changes and interventions on cognitive impairments in PD patients with FOG. [ABSTRACT FROM AUTHOR]

• Low handgrip strength was associated with an increased risk of stroke. • Metabolically healthy overweight/obesity and metabolic abnormal phenotype increased the risk of stroke compared to metabolically healthy non-overweight/obesity. • The combination of abnormal obesity phenotype and low handgrip strength could further increase stroke risk more than single factor. • Weight control and muscle strength enhancement may be effective strategy to lower the risk of stroke. The aim of this study was to investigate the combined effect of handgrip strength (HGS) and obesity phenotype on the risk of stroke in Chinese middle-aged and elderly people. The data was used from the China Health and Retirement Longitudinal Study (CHARLS). Middle-aged and older adults who participated in surveys between 2011 and 2018 were included in the study. They were divided into 4 different types of obesity phenotypes based on obesity and metabolic status: metabolically healthy non-overweight/obesity (MHNO), metabolically healthy overweight/obesity (MHO), metabolically abnormal non-overweight/obesity (MANO), and metabolically abnormal overweight/obesity (MAO). The HGS level was divided into low and high groups according to the median values. Cox proportional risk regression model was used to analyze the joint effect of HGS and obesity phenotype on the risk of stroke among participants. A total of 7904 participants aged 58.89±9.08 years were included in this study. After adjusting for potential confounders, high HGS&MHO (HR=1.86, 95 % CI=1.12–3.09), high HGS&MANO (HR=2.01, 95 %CI=1.42–2.86), high HGS&MAO (HR=2.01, 95 % CI=1.37–2.93), low HGS&MHNO (HR=1.57, 95 % CI=1.00–2.46), low HGS&MHO (HR=2.09, 95 % CI=1.29–3.38), low HGS&MANO (HR=2.02, 95 % CI=1.35–3.03), and low HGS&MAO (HR=2.48, 95 % CI=1.72–3.58) group had significantly higher risks of stroke than the high HGS&MHNO group. The coexistence of metabolically unhealthy and low HGS can synergistically increase the risk of stroke in Chinese middle-aged and elderly people. [ABSTRACT FROM AUTHOR]

Objective: Research on the link between inflammatory indicators and markers of bone metabolism is currently lacking, especially the interaction between Procollagen type 1 N-terminal propeptide (P1NP), the β-C-terminal telopeptide of type 1 collagen (β-CTX), and the fibrinogen-to-albumin ratio (FAR). This study intends to fill that knowledge gap by investigating the possible link between inflammatory indicators and bone metabolism., Methods: This observational study included 718 individuals diagnosed with osteoporotic fractures from Kunshan Hospital Affiliated to Jiangsu University between January 2017 and July 2022. After accounting for several confounders, the independent connection between FAR levels and β-CTX and P1NP was investigated via Generalized Estimating Equations (GEE). On top of that, we used a generalized additive model (GAM) to find any non-linear correlations, and a two-piecewise linear regression model to find the threshold effects in the smoothing curves that came out of it. To ensure the aforementioned result was stable, a subgroup analysis was carried out., Results: The results showed a positive linear correlation between FAR and β-CTX [β = 1.077, 95% confidence interval (CI): 0.24 to 1.92, P = 0.012]. The study's findings demonstrated that FAR and P1NP fit curves in an inverted U-shaped pattern, and an inflection point K = 0.0685 for FAR was detected. P1NP showed a positive correlation with FAR below the inflection point (β = 306.10, 95% CI: 47.37 to 564.83, P = 0.021), and a negative correlation with FAR beyond the inflection point (β = -117.57, 95% CI: -231.34 to -3.80, P = 0.043). The subgroup analysis revealed that women had a more significant association between FAR and β-CTX in women than in men., Conclusions: The results provide useful insights into the potential association between FAR and markers of bone metabolism. The study may provide a novel clinical implication by introducing FAR as a potential reference indicator for assessing bone health, offering a cost-effective and conveniently obtainable biomarker to monitor inflammation to improve bone metabolism in the treatment of osteoporosis., Competing Interests: Declarations. Ethics approval and consent to participate: The current study received ethical approval from the Institutional Review Board of Affiliated Kunshan Hospital of Jiangsu University (Approval No. 2020-03-046-K01) and was compliant with the Declaration of Helsinki. All participants included in the study provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

To examine the association of household fuel use with prehypertension regression among middle-aged and older people based on the China Health and Retirement Longitudinal Study (CHARLS), we included a total of 3501 participants with prehypertension at baseline, and they were followed up from 2011-2012 to 2015-2016 with information on blood pressure and household solid fuel use (heating and cooking fuels). Cox proportional hazards regression models were used to explore the hazard ratio (HR) and 95% confidence interval (CI) between fuel use and prehypertension regression. Additionally, we investigated the impact of switching fuels (2011-2013) on the regression to normotension during the 4-year follow-up. Linear regression was used to examine the effect of household fuel use on changes in blood pressure. Compared to solid fuel users, those who used clean fuel for heating at baseline had a positive effect on the regression of prehypertension (HR: 1.28, 95% CI: 1.08-1.53). Participants who used clean fuels for both heating and cooking had increased odds for the regression of prehypertension (HR: 1.32, 95% CI: 1.09-1.60). Compared to consistent solid fuel users, those who consistently used clean fuel for heating had a higher likelihood of transitioning from prehypertension to normotension (HR: 1.36, 95% CI: 1.06-1.73) and exhibited 2.45 mmHg lower systolic blood pressure. In conclusion, household clean fuel use for heating was positively associated with the regression of prehypertension to normotension. Furthermore, switching from solid fuel to clean fuel for heating could reduce the risk of prehypertension in Chinese middle-aged and older adults., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Objective: The aim of this study was to investigate the associations between residential greenness, air pollution (PM 2.5 , PM 10 , and NO 2 ), and the risk of visual impairment in Chinese middle-aged and elderly adults., Methods: The data were used from the China Health and Retirement Longitudinal Study (CHARLS), focusing on adults aged 45 years and older. Exposure to residential greenness was assessed using the Normalized Difference Vegetation Index (NDVI), while air pollution exposure (PM 2.5 , PM 10 , and NO 2 ) was estimated from the ChinaHighAirPollutants dataset. Visual impairment was self-reported and categorized as distance visual impairment (DVI) and near visual impairment (NVI). Cox proportional hazards models were applied to investigate the associations between residential greenness, air pollution, and visual impairment. Furthermore, we investigated the potential modification and mediation relationship between residential greenness, air pollution and visual impairment., Results: A total of 9,591 participants were included in this study. During a 7-year period, 2,650 cases of DVI and 3,130 cases of NVI were identified. In the single exposure model, a higher level of residential greenness was associated with a significantly reduced risk of both DVI and NVI. Specifically, for every 0.1 unit increase in NDVI, the hazard ratio (HR) was 0.68 (95%CI: 0.65,0.71) for DVI, and 0.67 (95%CI: 0.64,0.69) for NVI. Conversely, exposure to air pollution was positively associated with increased risks for both DVI and NVI. For each 10 µg/m 3 increase in PM 2.5 , the HR was 1.60 (95%CI: 1.56,1.65) for DVI and 1.64 (95%CI: 1.60,1.69) for NVI. Similarly, PM 10 and NO 2 exposure showed elevated risks with HR of 1.28 (95%CI: 1.27,1.30) and 1.73 (95%CI: 1.62,1.85) for DVI, and 1.30 (95%CI: 1.28,1.32) and 1.82 (95%CI: 1.72,1.94) for NVI, respectively. The multiple exposure model also showed significant association between residential greenness, air pollution and visual impairment risk. Additionally, the adverse effects of PM 2.5 , PM 10 , and NO 2 were attenuated in areas with the highest levels of residential greenness. Mediation analysis revealed that air pollution mediated a significant portion of the association between residential greenness and visual impairment., Conclusion: This study suggests that increased residential greenness may reduce the risk of visual impairment, partially by mitigating air pollution exposure. These findings highlight the environmental benefits to improve air quality and enhance green spaces, thereby promoting visual health in aging populations., Competing Interests: Declarations. Ethics approval and consent to participate: The data used in this study were approved by the Biomedical Ethics Review Committee of Peking University (Approval Number: IRB00001052-11015). Written informed consent was obtained from all participants. All methods in this study on humans described in the manuscript were performed in accordance with national law and the Helsinki Declaration of 1975. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The association between lumbar bone mineral density (BMD) and triglyceride (TG) levels has been extensively studied; however, the results remain controversial. Therefore, this research aimed to elucidate the association of TG levels with lumbar BMD in patients with osteoporotic fractures (OPFs) who have undergone surgery. This cross-sectional study analyzed 3,558 OPF patients (aged 50 years and above) who were admitted to the First People's Hospital of Kunshan and assessed their TG levels, lumbar BMD, and other variables. The outcome variable of this research was bone density, whereas the baseline glycerol trihydrate levels were considered as the exposure variable. An analysis adjustment was conducted for various covariates, including age, gender, body mass index (BMI), and other baseline laboratory and clinical results. Furthermore, the potential non-linear relationships were assessed via the smooth curve fitting, and threshold effect analyses. The mean age of 3,558 included OPF patients was 68.87 ± 10.55 years. In the fully adjusted multivariate regression analysis, a positive correlation was found between TG levels and lumbar BMD (β = 0.015, 95% CI: 0.001-0.028, p = 0.033). Furthermore, the threshold effect analysis revealed a curvilinear relationship between TG levels and lumbar BMD, with a turning point at 1.26 mmol/L. Moreover, on both sides of the turning point, different patterns were observed. On the left side, TG levels were positively correlated with lumbar BMD. However, despite higher TG levels, the differences in lumbar BMD on the right side of the turning point, were not statistically significant, indicating a lack of significant association (p = 0.712). In summary, this research indicated that in OPF patients, higher TG levels were significantly positively associated with lumbar BMD. Furthermore, there was a threshold value of 1.26 mmol/L, indicating that TG levels in OPF patients with concomitant hypertriglyceridemia should be maintained within the normal range, and reducing TG levels below 1.26 mmol/L requires continuous monitoring. This approach effectively controls TG levels without adversely impacting lumbar BMD., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval: We received ethical approval from the Affiliated Kunshan Hospital of Jiangsu University (approval No. 2021-06-015-K01), and was compliant with the Declaration of Helsinki. Consent to participate: Informed consent was obtained from all individual patients included in the study. Consent to publish: Patients signed informed consent regarding publishing their data., (© 2024. The Author(s).)

Background: To investigate the relationships of the dynamic changes in triglyceride glucose index-body mass index (TyG‑BMI) and cumulative TyG-BMI with the risk of hypertension among middle-aged and elderly Chinese., Methods: Data were used from the China Health and Retirement Longitudinal Study (CHARLS). Participants who participated in the baseline study (2011-2012) and in subsequent surveys (2015-2018) were included in this study. The primary exposures were changes in TyG-BMI and cumulative TyG-BMI from 2012 to 2015. Changes in TyG-BMI were categorized using k-means clustering methods, while cumulative TyG-BMI was categorized into quartiles. Cox proportional hazards regression models were performed to examine the association between changes in TyG-BMI and cumulative TyG-BMI with the incidence of hypertension. Linear regression analyzes were performed to examine the association between changes in TyG-BMI and cumulative TyG-BMI with cumulative systolic blood pressure (SBP) and cumulative diastolic blood pressure (DBP)., Results: Of a total of 2,561 participants aged 56.93 ± 8.08 years old at baseline, 253 individuals (9.9%) developed hypertension during the 7-year follow-up period. The hazard ratios (HR) and 95% confidence interval (CI) for hypertension were 1.50 (1.10-2.03) for class 2 (persistently medium class) and 2.35 (1.61-3.42) for class 3 (persistently high class), compared to class 1 (persistently low class). Additionally, class 2 showed increases of 7.70 mmHg (95% CI: 5.18-10.21) in cumulative SBP and 6.53 mmHg (95% CI: 4.68-8.38) in cumulative DBP, while class 3 exhibited increases of 14.10 mmHg (95% CI: 10.56-17.64) in cumulative SBP and 12.64 mmHg (95% CI: 10.03-15.25) in cumulative DBP, compared with class 1. Regarding cumulative TyG-BMI, the HR for hypertension were 1.75 (95% CI: 1.18-2.59) for quartile 3 and 2.15 (95% CI: 1.43-3.23) for quartile 4, compared with quartile 1. In quartile 2, cumulative SBP increased by 3.99 mmHg (95% CI: 0.88-7.11) and cumulative DBP by 2.74 mmHg (95% CI: 0.45-5.02). Quartile 3 showed increases of 8.32 mmHg (95% CI: 5.09-11.54) in cumulative SBP and 7.13 mmHg (95% CI: 4.76-9.49) in cumulative DBP. Quartile 4 exhibited the highest increases, with cumulative SBP rising by 13.15 mmHg (95% CI: 9.70-16.60) and cumulative DBP by 12.20 mmHg (95% CI: 9.67-14.74). Furthermore, a linear relationship was observed between cumulative TyG-BMI and the risk of hypertension., Conclusions: Changes in TyG-BMI and cumulative TyG-BMI were associated with an increased risk of hypertension, as well as higher cumulative SBP and DBP in Chinese middle-aged and elderly population., (© 2024. The Author(s).)

Evidence on the association between dietary nutrient-wide intake and cardiovascular disease (CVD) is inconclusive. Therefore, we systematically assessed the association between dietary intake of 29 nutrients and CVD risk using a nutrient-wide association study. Data were obtained from 7878 Chinese adults participating in the China Health and Nutrition Survey (CHNS) wave 2004-2015. We estimated the association of 29 nutrients with CVD risk. Significant findings were replicated in the National Health and Nutrition Examination Survey (NHANES). Four nutrients (selenium, vitamin A, carotenoids, and total protein) were significantly associated with CVD risk in the CHNS. The hazard ratio (HR) and 95% confidence interval (CI) for nutrient intake in the third tertile compared to the first tertile were 0.68 (0.51-0.90), 0.70 (0.54-0.91), 0.64 (0.50-0.83), and 0.54 (0.38-0.77), respectively. In the NHANES replication, selenium maintained a similar direction and strength of association, while the other nutrients were not replicated successfully. Our results provide support for a negative association between selenium intake and CVD risk, while the association of vitamin A, carotenoids and protein with CVD warrants further studies to confirm.

Introduction: Body weight perception (BWP) directly determines weight management behaviors. Although child neglect is a well-established risk factor for managing body weight, little is known about its association with the accuracy of BWP. This study aimed to assess the cross-sectional and longitudinal associations between child neglect and BWP accuracy in primary schoolchildren, and explore how these differ based on the sex of the child. Methods: The sample included 1,063 primary schoolchildren (557 boys and 506 girls, aged 8-10 years) from a two-wave observational study between 2018 and 2019 in Wuhan, China. Child neglect and BWP were investigated using self-administered questionnaires. The accuracy of BWP was defined by comparing the BWP and actual body weight, and it was categorized into three groups-consistent, underestimated, and overestimated. Multinomial logistic regression analysis was conducted with fitting child neglect as the independent variable and the accuracy of BWP as the dependent variable. Results: The prevalence of weight misperception was ~44% at baseline (underestimation 40%; overestimation 4%) in Chinese primary schoolchildren. In the cross-sectional analysis, children with a higher level of neglect were more likely to misperceive their body weight. Moreover, there was an apparent sex-related difference that boys who experienced a higher level of neglect significantly reported more underestimation, while girls reported more overestimation. There was no significant longitudinal association between child neglect and the change in BWP accuracy. Conclusions: This study revealed that a higher level of neglect was significantly associated with underestimated BWP in boys and overestimated BWP in girls. The mechanisms of sex-related difference and whether child neglect is involved in the change in BWP, merit further investigations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Yu, Liu, Liu, Zhang, Zheng and He.)