Explore the vast range of titles available.

Abstract Introduction: Obesity is a public health crisis in the USA. This study aimed to estimate the prevalence of obesity and severe obesity in US children and adolescents and identify novel targetable risk factors associated with childhood obesity. Methods: From the US National Health and Nutrition Examination Survey from 1999 to 2018, 35,907 children aged 2–19 with body mass index (BMI) data were included. Obesity and severe obesity were defined as BMI ≥95th percentile and ≥120% of 95th percentile of US Centers for Disease Control and Prevention growth charts, respectively. Trends in the prevalence of obesity and subgroup analyses according to socioeconomic factors and language used in the interview were analyzed. Results: The prevalence of obesity and severe obesity increased from 14.7 [95% confidence interval: 12.9–17.0]% to 19.2 [17.2–21.0]% and 3.9 [2.9–5.0]% to 6.1 [4.8–8.0]% in 1999–2018, respectively (p = 0.001 and p = 0.014, respectively). In 2017–2018, the prevalence of obesity among children from Spanish-speaking households was 24.4 [22.4–27.0]%, higher than children from English-speaking households (p = 0.027). Conclusion: The prevalence of childhood obesity kept increasing in 1999–2018. The problem is worse in children from Spanish-speaking households. Novel and targeted public health intervention strategies are urgently warranted to effectively halt the rising epidemic of childhood obesity.

Abstract Context Previous studies suggested a potential link of maternal thyroid dysfunction with adverse neurocognitive outcomes and impaired development of internal organs in offspring. Objective To review the association between maternal thyroid dysfunction and the risk of adverse outcomes in offspring. Data Sources PubMed, EMBASE, and Cochrane Library. Study Selections Eligible studies reported the association between maternal thyroid hormone function and the risk of adverse outcomes in their children. Data Extraction Reviewers extracted data on study characteristics and results independently. Data Synthesis Estimates were pooled and reported as odds ratio (OR) with 95% confidence interval (CI). I2 tests were applied to assess the heterogeneity across studies. Results We identified 29 eligible articles and found an association between maternal hyperthyroidism and attention deficit hyperactivity disorder (ADHD) (OR: 1.18, 95% CI: 1.04-1.34, I2 = 0%) and epilepsy (OR: 1.19, 95% CI: 1.08-1.31, I2 = 0%) in offspring; as well as an association of maternal hypothyroidism with increased risk of ADHD (OR: 1.14, 95% CI: 1.03-1.26, I2 = 25%), autism spectrum disorder (OR: 1.41, 95% CI: 1.05-1.90, I2 = 63%), and epilepsy (OR: 1.21, 95% CI: 1.06-1.39, I2 = 0%) in offspring. Conclusion Routine measurement and timely treatment on thyroid function should be considered for pregnant women.

ABSTRACT Background Walking speed is a reliable marker of sarcopenia and a strong predictor of mortality, but its relationship with cancer incidence remains largely unexplored. We aimed to investigate the association between walking speed and the risk of any cancer and five common cancers, including lung, breast, colorectum, prostate, and stomach, and to explore potential mediation by biomarkers of inflammation, and lipid and glucose metabolism. Methods The primary analysis was conducted in 431 598 participants from the UK Biobank (mean age 56.3 [SD 8.1] years at baseline), and the generalizability of findings was further tested in 1311 participants from the Hong Kong Osteoporosis Study (HKOS; mean age 57.8 [SD 11.9] years). Walking speed was self‐reported in the UK Biobank and measured using a timed 6‐m walk test in the HKOS. Incident cancer cases were identified from electronic health records. We used Cox models, adjusted for age, sex, height, body mass index, socioeconomic, lifestyle factors, family history of cancer, and grip strength, to estimate the association between walking speed and cancer incidence. Single and multiple mediator models were performed in the UK Biobank to examine the mediating effects of C‐reactive protein (CRP), white blood cell (WBC) count, total cholesterol, low‐density lipoprotein (LDL) cholesterol, and glucose levels. Results Over a median follow‐up of 10.9 and 6.9 years, 11.7% and 5.0% of the UK Biobank and HKOS participants were diagnosed with cancer, respectively. In the UK Biobank, those reported a brisk vs. slow walking pace had a 13% lower risk of any cancer (95% CI 0.84–0.90). Similarly, HKOS participants with a faster walking speed (≥ 1.0 vs. < 1.0 m/s) had a 45% reduced risk of any cancer (95% CI 0.31–0.98). In the UK Biobank, brisk walking pace was associated with a significantly decreased risk of lung cancer (hazard ratio [HR] 0.47, 95% CI 0.42–0.53) and a slightly increased risk of prostate cancer (HR 1.11, 95% CI 1.02–1.21). CRP, WBC count, total cholesterol, and LDL cholesterol significantly mediated the association between brisk walking pace and any cancer, with proportions of mediation being 6.4% (95% CI 4.4–8.7%), 11.4% (8.4–17.1%), 9.3% (7.1–12.9%), and 8.3% (6.1–11.9%), respectively. The combined mediated proportion of all five potential mediators was 25.9% (19.5–37.2%). Conclusion Faster walking speed, whether self‐reported or measured, is associated with a reduced risk of cancer development. This association appears to be partially mediated by lower inflammation and improved lipid profiles.

Extended intervals between the first and second doses of mRNA Covid-19 vaccines may reduce the risk of myocarditis in children and adolescents. However, vaccine effectiveness after this extension remains unclear. To examine this potential variable effectiveness, we conducted a population-based nested case-control study of children and adolescents aged 5–17 years who had received two doses of BNT162b2 in Hong Kong. From January 1 to August 15, 2022, 5396 Covid-19 cases and 202 Covid-19 related hospitalizations were identified and matched with 21,577 and 808 controls, respectively. For vaccine recipients with extended intervals [≥28 days, adjusted odds ratio 0.718, 95% Confidence Interval: 0.619, 0.833] there was a 29.2%-reduced risk of Covid-19 infection compared to those with regular intervals (21–27 days). If the threshold was set at eight weeks, the risk reduction was estimated at 43.5% (aOR 0.565, 95% CI: 0.456, 0.700). In conclusion, longer dosing intervals for children and adolescents should be considered. Extending the interval between doses of mRNA Covid-19 vaccines has been linked with a reduced risk of myocarditis in children and adolescents, but impacts on vaccine effectiveness are not known. Here, the authors perform a nested case-control study using data from Hong Kong and find evidence of reduced risk of infection following a longer dosing interval.

INTRODUCTION Emerging evidence suggests neuroprotective effects of bisphosphonates. We aim to investigate whether nitrogen‐containing bisphosphonates (NBPs) could reduce the risk of Alzheimer's disease and related dementia (ADRD). METHODS We identified patients aged 60+ with osteoporosis or fragility fracture in 2005–2020 from a healthcare database in Hong Kong. Patients receiving NBPs were 1:1 matched with untreated patients and those receiving other anti‐osteoporosis medications (“non‐NBPs”) by time‐dependent propensity score. Follow‐up was conducted until December 31, 2021. Cause‐specific hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazard model. RESULTS Among 121,492 patients (NBP = 15,654, non‐NBP = 6331), we matched 10,833 pairs for NBPs‐vs‐untreated and 3080 pairs for NBPs‐vs‐non‐NBPs. NBP use was associated with a lower risk of ADRD compared to untreated (HR = 0.84, 95% CI = 0.78–0.90) and non‐NBP (HR = 0.76, 95% CI = 0.66–0.89). DISCUSSION NBP use was associated with a lower risk of dementia, suggesting further studies are warranted on its potential to improve cognitive function. Highlights Nitrogen‐containing bisphosphonates (NBPs) are associated with a reduced risk of Alzheimer's disease and related dementia. NBPs resulted in an absolute risk reduction of 0.007, 0.018, and 0.021 at 1, 3, and 5 years, respectively. The number needed to treat (NNT) with NBPs at 1, 3, and 5 years were 133, 56, and 48. There is potential for repurposing NBPs as a therapeutic agent for Alzheimer's disease.

Cardiovascular events are the leading cause of death among hip fracture patients. This study aims to identify subphenotypes of hip fracture patients and investigate their association with incident cardiovascular events, all-cause mortality, and health service utilisation in Hong Kong and the United Kingdom populations. By the latent class analysis, we show three distinct clusters in the Hong Kong cohort ( n  = 78,417): Cluster 1 has cerebrovascular and hypertensive diseases, hyperlipidemia, and diabetes; Cluster 2 has congestive heart failure; Cluster 3 consists of relatively healthy patients. Compared to Cluster 3, higher risks of major adverse cardiovascular events are observed in Cluster 1 (hazard ratio 1.97, 95% CI 1.83 to 2.12) and Cluster 2 (hazard ratio 4.06, 95% CI 3.78 to 4.35). Clusters 1 and 2 are also associated with a higher risk of mortality, more unplanned accident and emergency visits and longer hospital stays. Self-controlled case series analysis shows a significantly elevated risk of major adverse cardiovascular events within 60 days post-hip fracture. Similar associations are observed in the United Kingdom cohort ( n  = 27,948). Pre-existing heart failure is identified as a unique subphenotype associated with poor prognosis after hip fractures. Cardiovascular events (CVEs) are the leading cause of death among hip fracture patients. Here, the authors show the findings on subphenotyping the heterogeneous spectrum of hip fracture patients in both Hong Kong and the United Kingdom older adult populations and temporal associations with CVEs across all subphenotypes.

The small non-coding microRNAs (miRNAs) are post-transcription regulators that modulate diverse cellular process in bone cells. Because optimal miRNA targeting is essential for their function, single-nucleotide polymorphisms (SNPs) within or proximal to the loci of miRNA (miR-SNPs) or mRNA (PolymiRTS) could potentially disrupt the miRNA-mRNA interaction, leading to changes in bone metabolism and osteoporosis. Recent human studies of skeletal traits using miRNA profiling, genomewide association studies, and functional studies started to decipher the complex miRNA regulatory network. These studies have indicated that miRNAs may be a promising bone marker. This review focuses on human miRNA studies on bone traits and discusses how genetic variants affect bone metabolic pathways. Major ex vivo investigations using human samples supported with animal and in vitro models have shed light on the mechanistic role of miRNAs. Furthermore, studying the miRNAs' signatures in secondary osteoporosis and osteoporotic medications such as teriparatide (TPTD) and denosumab (DMab) have provided valuable insight into clinical management of the disease. © 2018 The Authors. Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

Background The influence of maternal levothyroxine treatment during pregnancy remains unclear. This study aimed to evaluate the associations of maternal levothyroxine treatment during pregnancy with the birth and neurodevelopmental outcomes in offspring. Methods This population-based cohort study was conducted among pregnant women using the Hong Kong Clinical Data Analysis and Reporting System. Mother-child pairs in Hong Kong from 2001 to 2015 were included and children were followed up till 2020. We defined the exposure group as mothers who were exposed to levothyroxine during pregnancy. Preterm birth and small for gestational age (SGA) were included as birth outcomes. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) were included as neurodevelopmental outcomes. Odds ratios (OR) or hazard ratios (HRs) with a 95% confidence interval (CI) were evaluated to assess the association of gestational levothyroxine use with offspring birth and neurodevelopmental outcomes respectively, using propensity score fine-stratification weighting and a Cox proportional hazards regression model. Results Among 422,156 mother-child pairs, 2125 children were born from mothers exposed to levothyroxine during pregnancy. A significantly increased risk of preterm birth was observed in children with maternal levothyroxine exposure during pregnancy, when compared to mothers who had no history of thyroid-related diagnoses or prescriptions (weighted OR [wOR]: 1.22, 95% CI: 1.07, 1.39). Similarly, an increased risk of preterm birth was found among children of gestational levothyroxine users, when compared to children of mothers who had used levothyroxine before but stopped during pregnancy (wOR: 2.16, 95% CI: 1.09, 4.25). Sensitivity analysis, by excluding mothers exposed to psychotropic or antiepileptic medications before or during pregnancy, also indicated a similar increased risk of preterm birth regarding the gestational use of levothyroxine (wOR: 1.26, 95% CI: 1.10, 1.45). No significant association was observed for the risk of SGA, ADHD, and ASD. Conclusions There is no evidence that gestational use of levothyroxine is associated with SGA, ADHD, or ASD in offspring. Gestational levothyroxine treatment is associated with a higher risk of preterm birth. Such risk might be confounded by the underlying maternal thyroid disease itself, however, we cannot completely exclude the possible effect of gestational L-T4 treatment on offspring preterm birth. Our findings provided support to the current guidelines on the cautious use of levothyroxine treatment during pregnancy.

To investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) and risk of incident diabetes in Hong Kong Chinese, after accounting for the effect of multiple bone- and mineral-related markers. We conducted a retrospective study on the Hong Kong Osteoporosis Study cohort. Incident diabetes was ascertained using electronic medical records. Serum 25(OH)D was measured at baseline and its association with incident diabetes was evaluated using multivariable Cox proportional-hazard regression. Individuals (n 4342) aged 20 years or above (1395 men, 2947 women; mean age 54·3 (sd 16·5) years) from the Hong Kong Osteoporosis Study, who were free of diabetes at baseline, were included. During 40 124·7 person-years of follow-up (a median of 9·2 years), 443 participants developed diabetes. Mean 25(OH)D was 63·34 (sd 13·07) nmol/l. Age-, sex- and BMI-adjusted Cox proportional-hazard regression showed no significant difference in the risk of incident diabetes between the lowest and the highest quintiles of 25(OH)D. In the analysis of the interaction effect between 25(OH)D and serum Ca, the interaction term did not affect the risk of incident diabetes significantly (P = 0·694). Similarly, there was no significant interaction of different subgroups (age, sex, BMI, femoral-neck T-score, serum Ca levels) with serum 25(OH)D. The present study finds that serum vitamin D level is not associated with the risk of incident diabetes in Hong Kong Chinese and this relationship is not modified by serum Ca level.

Purpose Phytosterols reduce intestinal cholesterol absorption and help to lower LDL-cholesterol. Many Chinese adults are lactose-intolerant and cannot tolerate bovine milk enriched with phytosterol. Soya-milk is a common beverage in Asia and it has beneficial effects on general health. We therefore conducted a randomized double-blind controlled trial to assess the effectiveness of a phytosterols-enriched soya drink in lowering serum LDL-cholesterol level (primary outcome) and other cardiovascular parameters (secondary outcomes). Methods One hundred and fifty-nine normocholesterolaemic participants (85 men and 74 women; aged 19–79) were randomized to daily intake of one serving of phytosterols-enriched soya drink ( N  = 82), equivalent to 2 g of phytosterol per day, or a matched soya drink without phytosterols ( N  = 77) for 3 weeks. Adverse events, withdrawal and compliance were documented. Results Among the treatment group ( N  = 82), phytosterols-enriched soya drink significantly decreased LDL-cholesterol by 5.96% (SE 1.48, 95% CI − 8.91%, − 3.00%) with a median of 6.74% compared with baseline, resulting in a significant reduction of 4.70% (95% CI − 8.89%, − 0.51%; p  = 0.028) with a median of 5.20% compared with placebo ( N  = 77). In contrast, there were no significant changes in other lipid parameters, blood glucose, blood pressure, body weight or waist circumference. Remarkably, 95% of the participants randomized to the fortified drink reported no adverse events at all. Conclusions Daily consumption of a phytosterols-enriched soya drink may be a simple and cost-neutral means of lowering LDL-cholesterol in individuals in China, with massive population and rising incidence of coronary heart disease (ClinicalTrials.gov identifier: NCT02881658; date of registration: 14 Aug 2016).