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To explore the association between ethnicity and cardiovascular disease (CVD) risk factors, including physical inactivity, obesity, hypertension, type 2 diabetes (T2D), lack of health insurance and low family income in a nationally representative sample of U.S. adults. Adults from the National Health and Nutrition Examination Survey (NHANES 2011-2020, n = 17,355) were classified as having CVD risk factors based on both self-reported and metabolic data. Ethnic differences in how these CVD risk factors relate to prevalent CVD and CVD mortality was examined in Whites, Blacks, Asians and Hispanics. Compared to Whites, significant disparities were noted in several CVD risk factors in ethnic minorities, such as lower PA, lower income, and more prevalent metabolic risk factors. Blacks and Hispanics commonly had higher prevalent CVD risk as compared to Whites even after adjusting for income and metabolic risk factors. Physical inactivity was most strongly associated with prevalent CVD and CVD mortality among Whites and Blacks. There were no ethnic differences in the inverse association between income and prevalent CVD risk, but Blacks with low income were associated with the greatest elevated CVD mortality. Hypertension and T2D were similarly related with prevalent CVD across ethnic groups, but Blacks and Hispanics with hypertension or T2D were at greater CVD mortality risk as compared to Whites. Our study identified that socioeconomic and metabolic risk factors may relate differently to CVD outcomes among ethnic minority groups in the United States. Addressing these ethnic disparities in health warrants further investigation.

OBJECTIVE: The clinical relevance of the metabolically normal but obese phenotype for mortality risk is unclear. This study examines the risk for all-cause mortality in metabolically normal and abnormal obese (MNOB and MAOB, respectively) individuals. RESEARCH DESIGN AND METHODS: The sample included 6,011 men and women from the Third National Health and Nutrition Examination Survey (NHANES III) with public-access mortality data linkage (follow-up = 8.7 ± 0.2 years; 292 deaths). Metabolically abnormal was defined as insulin resistance (IR) or two or more metabolic syndrome (MetSyn) criteria (excluding waist). RESULTS: A total of 30% of obese subjects had IR, and 38.4% had two or more MetSyn factors, whereas only 6.0% (or 1.6% of the whole population) were free from both IR and all MetSyn factors. By MetSyn factors or IR alone, MNOB subjects (hazard ratio [HR]MetSyn 2.80 [1.18-6.65]; HRIR 2.58 [1.00-6.65]) and MAOB subjects (HRMetSyn 2.74 [1.46-5.15]; HRIR 3.09 [1.55-6.15]) had similar elevations in mortality risk compared with metabolically normal, normal weight subjects. CONCLUSIONS: Although a rare phenotype, obesity, even in the absence of overt metabolic aberrations, is associated with increased all-cause mortality risk.

Attenuated heart rate recovery (HRR) immediately after exercise is an independent predictor of cardiovascular disease and mortality in adults. We examined the effects of aerobic exercise (AE), resistance exercise (RE), and combined AE and RE on HRR, and the relationship of HRR with body composition and metabolic risk factors in adolescents with overweight or obesity. We included 147 adolescents (BMI ≥ 85th percentile, 12-18 years) who participated in exercise intervention studies (3-6 months), and had a complete data set including VO2peak, body composition by dual-energy X-ray absorptiometry, and cardiometabolic risk factors before and after the interventions. HRR was calculated as the difference between peak HR during the maximal treadmill test and HR at 1-, 2-, 3-, 4-, and 5-min after the cessation of the test. After interventions, a faster HRR at 2-5 min was observed following AE (17.3-25.6% change, P < 0.0001), RE (7.1-10.9%, P < 0.05), and combined AE and RE (10.7-12.0%, P < 0.05) compared to pre-intervention. Compared to controls, AE (14.0-24.0%, P < 0.05) was the only exercise group to exhibit a significantly faster HRR at 1-, 2-, 3-, 4-, and 5-min after the exercise intervention. Collapsed across exercise groups, improvements in 2-, 3-, 4-, and 5-min HRR are independently associated (P < 0.05) with increases in VO2peak. Changes in HRR were not associated with the changes in % body fat or metabolic risk factors. AE training is more beneficial than RE or combined AE and RE training for improving HRR in adolescents with overweight or obesity.

Background This study aims to look at the prevalence and characteristics of postpartum depression symptomatology (PPDS) among Canadian women. Studies have found that in developed countries, 10-15% of new mothers were affected by major postpartum depression. Mothers who suffer from postpartum depression may endure difficulties regarding their ability to cope with life events, as well as negative clinical implications for maternal-infant attachment. Methods An analysis based on 6,421 Canadian women, who had a live birth between 2005 and 2006 and were part of the Maternity Experience Survey (MES), was performed. PPDS was measured based on the Edinburgh Postnatal Depression Scale. Various factors that assessed socio-economic status, demographic factors, and maternal characteristics were considered for the multinomial regression model. Results The national prevalence of minor/major and major PPDS was found to be 8.46% and 8.69% respectively. A mother's stress level during pregnancy, the availability of support after pregnancy, and a prior diagnosis of depression were the characteristics that had the strongest significant association with the development of PPDS. Conclusions A significant number of Canadian women experience symptoms of postpartum depression. Findings from this study may be useful to increase both the attainment of treatment and the rate at which it can be obtained among new mothers. Interventions should target those with the greatest risk of experiencing PPDS, specifically immigrant and adolescent mothers.

To examine changes in the use of diet, exercise, and pharmacological/diet product weight loss (WL) practices over time, and differences in these trends by sex and obesity status, data from the National Health and Examination Survey (NHANES Continuous 1999–2018) was used. The prevalence of diet, exercise and use of WL drugs and products over time were examined in men and women with and without obesity in a series of cross-sectional nationally representative samples (n = 43,020). Women and those with obesity were more likely to engage in WL practices over the past year, with an increased prevalence of WL efforts over time (38.4 to 43.2%). Amongst those who engaged in WL attempts, diet-related WL was most common (87–93%), followed by exercise-related WL (47–68%), whereas use of WL drugs and products was the least common (5–21%). There were modest differences in the prevalence of diet or exercise WL over time, with some differences by sex and obesity status. Most notable was the increase in the prevalence of exercise WL practices in women with obesity, with no differences among men or women without obesity. When examining specific types of diets, there were more clear differences in the adoption of diets over time, with the use of more traditional calorie/portion/fat restriction diets becoming less prevalent, and sugar/carbohydrate restriction becoming more prevalent over time (P<0.005). Changes over time in the use of diets were, were however, similar in men and women with and without obesity. Use of pharmacotherapy/diet products tended to decline in prevalence over time but was consistently highest in women with obesity. Thus, there are differences in the types of WL strategies individuals have employed over time, with variations in their popularity of use by sex and obesity status. However, the pattern of changes over time were quite similar in men and women with and without obesity.

Polycyclic aromatic hydrocarbons (PAH) are both man-made and naturally occurring environmental pollutants that may be related to cardiometabolic health risk. To determine whether PAH is associated with obesity in the adult population and to examine whether urinary concentrations of PAH metabolites are associated with differences in how obesity relates to 3 or more risk factors for the metabolic syndrome (3RFMetS), type 2 diabetes (T2D), hypertension, and dyslipidemia. A total of 4765 adult participants from the 2001-2008 National Health and Nutrition Examination Survey were examined. The association between 8 urinary hydroxylated PAH metabolites, obesity, and health were examined using weighted logistic regressions adjusting for age, sex, ethnicity, PIR, smoking status, and urinary creatinine. There was a positive dose-dependent association between obesity and 2-phenanthrene quintiles (P trend <0.0001). Contrarily, higher quintiles of 1-naphthalene were associated with lower risk of obesity (P trend = 0.0004). For a given BMI, those in the highest quintile of 2-naphthalene, 2-fluorene, 3-fluorene and 2-phenanthrene had a 66-80% greater likelihood of 3RFMetS (P≤0.05) compared to low levels. Higher quintiles of 1-naphthalene, 2-naphthalene, 2-phenanthrene and 1-pyrene were associated with a 78-124% greater likelihood of T2D (P≤0.05) compared to low levels while high 1-naphthalene, 2-naphthalene, 2-fluorene, 3-fluorene and 2-phenanthrene were associated with a 38-68% greater likelihood of dyslipidemia (P≤0.05) compared to lower levels. Finally, 2-naphthalene and 2-phenanthrene were positively associated with hypertension (P trend = 0.008 and P trend = 0.02 respectively). PAH is related to obesity and the expression of a number of obesity-related cardiometabolic health risk factors. Future research is needed to bring to light the mechanistic pathways related to these findings.

This study aimed to summarize the observational evidence from prospective cohort studies examining the associations of regular physical activity, sedentary behaviour, and sleep duration with incident dementia among community-dwelling adults aged 35 years and older. Systematic literature searches (1946 to August 2025) of CINAHL, EMBASE, MEDLINE, PSYCINFO, and SPORTDISCUS were performed. Eligible studies included community-dwelling adults aged 35 + years with at least one year of follow-up and valid measures of movement behaviours and dementia outcomes. Studies were excluded if they included participants with baseline dementia, lacked risk estimates for all-cause dementia. Grey literature was excluded. Random effects meta-analysis generated pooled risk ratio (RR) and 95% confidence intervals (CI). Primary exposures were defined using national thresholds for physical activity, sedentary time, and sleep duration. Subgroup analyses were performed by age and follow-up duration. Forty-nine studies with physical activity (n = 2,855,529), 17 studies on sleep duration (n = 1,344,170), and three studies on sedentary duration (n = 295,809) were included. Regular physical activity significantly reduced the risk of incident dementia (pooled RR = 0.75, 95% CI = 0.68 to 0.82), though heterogeneity was substantial and partially explained by subgroup analyses. Prolonged sedentary behaviour (8 + hours/day sitting) increased dementia risk (RR = 1.27, 95% CI = 1.17 to 1.39) with low heterogeneity. Moreover, both short (<7 hours; RR = 1.18, 95% CI = 1.09 to 1.28) and long (>8 hours; RR = 1.28, 95% CI = 1.15 to 1.43) sleep were linked to higher dementia risk compared with 7-8 hours. Heterogeneity was moderate to substantial. Regular physical activity, less sedentary time and appropriate nightly sleep (7-8 h) may be associated with reduced risk of dementia and are potentially modifiable factors in the prevention or delay of dementia. Future studies with middle-aged adults and longer-term follow-up including changes in movement behaviours over time are needed to better understand the relationship between physical activity, sedentary behaviour, and sleep for dementia risk. CRD42021272054.

The purpose of the study was to determine trends in the prevalence of individual health risk factors across time and to examine if their associations with mortality have changed over time. Data from the National Health and Nutrition Examination Surveys (NHANES III- 1988-1994 and NHANES 1999-2014; age ≥20 years) was used to examine differences in the odds ratio (OR) of 5-year mortality risk associated with various common health risk factors over the two survey periods using weighted logistic regression analysis adjusting for age, sex, obesity category and white ethnicity (n = 28,279). Over 97% of individuals had at least one of the 19 risk factors examined with no difference in the prevalence over time (P>0.34). The prevalence of lifestyle, social/mental and physical risk factors (2.2 to 19.1%) increased over time (P<0.0002), while the prevalence of having physiological risk factors decreased by ~6.5% (P<0.0001). Having any lifestyle or social/mental risk factor was significantly associated with a higher 5-year OR for mortality risk in 1999-2014, than 1988-94. In particular, having low education or use of mental health medication were not associated with mortality risk in 1988-94 (P>0.1), but were significantly associated with a higher 5-year OR for mortality in 1999-2014 (P<0.0001). Conversely, physiological risk factors were more weakly related with mortality risk in 1988-1994, than 1999-2014. Having any physical risk factor, and poor self-rated health were similarly related with 5-year mortality risk at both timepoints. Health risk factors have both increased and decreased in prevalence over time, along with changes in the association between many of the risk factors and mortality risk. Taken together, these changes complicate interpretation of temporal trends and warrant cautious interpretation of population health patterns based on surveillance data.

Background We examined the relationship between ratios of select biomarkers of kidney and liver function on all-cause and coronary heart disease (CHD) mortality, both in isolation, and in combination with metabolic syndrome (MetS), among adults (20 + years, n = 10,604). Methods Data was derived from the U.S. National Health and Nutrition Examination Survey (1999–2016) including public-use linked mortality follow-up files through December 31, 2015. Results Select biomarker ratios of kidney (UACR or albuminuria and BUN-CR) and liver (AST-ALT and GGT-ALP) function in isolation and in combination with MetS were associated with all-cause and CHD mortality. Compared to individuals with neither elevated biomarker ratios nor MetS (HR = 1.00, referent), increased risk of all-cause mortality was observed in the following groups: MetS with elevated UACR (HR, 95% CI = 2.57, 1.99–3.33), MetS with elevated AST-ALT (HR = 2.22, 1.61–3.07), elevated UACR without MetS (HR = 2.12, 1.65–2.72), and elevated AST-ALT without MetS (HR = 1.71, 1.35–2.18); no other biomarker ratios were associated with all-cause mortality. For cause-specific deaths, elevated risk of CHD mortality was associated with MetS with elevated UACR (HR = 1.67, 1.05–2.67), MetS with elevated AST-ALT (HR = 2.80, 1.62–4.86), and elevated BUN-CR without MetS (HR = 2.12, 1.12–4.04); no other biomarker ratios were associated with CHD mortality. Conclusion Future longitudinal studies are necessary to examine the utility of these biomarker ratios in risk stratification for chronic disease management.

The association between metabolic syndrome (MetS) and all-cause mortality is well established but it is unclear if there are differences in mortality risk among the 32 possible MetS combinations. Hence, the purpose of this study is to evaluate the associations between different MetS combinations and its individual components with all-cause mortality, and to examine differences in the association by age and sex. A merged sample of 82,717 adults from 7 U.S. cohorts was used. In our sample, MetS was present in 32% of men, 34% of women, 28% of younger adults (18-65 years) and 62% of older adults (>65 years) with 14,989 deaths over 14.6 ± 7.4 years of follow-up. Risk of all-cause mortality was higher in younger individuals with a greater number of MetS factors present, but in older adults having all 5 MetS factors was the only combination significantly associated with mortality. Regardless of age or sex, elevated blood pressure was the MetS factor most consistently present in MetS combinations that were significantly and most strongly associated with mortality. In fact, elevated blood pressure in the absence of other risk factors was significantly associated with mortality in men (HR, 95% CI = 1.56, 1.33-1.84), women (HR = 1.62, 1.44-1.81) and younger adults (HR = 1.61, 1.45-1.79). Conversely, waist circumference, glucose and triglycerides in isolation were not associated with mortality (p>0.05). In a large U.S. population, different combinations of MetS components vary substantially in their associations with all-cause mortality. Men, women and younger individuals with MetS combinations including elevated blood pressure had stronger associations with greater mortality risk, with minimal associations between MetS and mortality risk in older adults. Thus, we suggest that future algorithms may wish to consider differential weighting of these common metabolic risk factors, particularly in younger populations.