Objectives: This study aimed to investigate the relationship between the triglyceride–glucose (TyG) index, its combination with the body roundness index (BRI), and chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) based on a cross-sectional analysis conducted in Eastern China. Methods: The research originates from a cross-sectional study performed in Zhejiang Province, Eastern China, between March and November 2018. The TyG-BRI index was calculated based on triglyceride, fasting blood glucose, and the BRI. The correlation between the TyG-BRI index and the risk of CKD was assessed using a restricted cubic spline model. A multivariate logistic regression model was used to investigate the association between the TyG-BRI index and the risk of CKD. Receiver operating characteristic (ROC) analyses was used to evaluate the optimal cut-off and value of the TyG-BRI index for predicting CKD. Results: A total of 1756 T2DM participants were enrolled in this study. The TyG-BRI index was significantly higher in participants with CKD than in those without CKD. In the fully adjusted model, the odds ratios for CKD in the second, third, and fourth TyG-BRI quartiles were 0.93 (95% CI: 0.65–1.33), 1.33 (95% CI: 0.94–1.88), and 1.57 (95% CI: 1.10–2.25), respectively, compared to the first quartile. RCS analysis confirmed a linear dose–response relationship between the TyG-BRI index and CKD risk (all p for nonlinearity > 0.05). ROC curve analysis revealed that the TyG-BRI index had moderate predictive value for CKD, with an area under the curve of 0.626 (95% CI: 0.597–0.656, p < 0.001). The optimal cut-off value for the TyG-BRI index was 42.46, with a sensitivity of 68.2% and specificity of 52.2%. Conclusions: The TyG-BRI index was positively associated with the risk of CKD in a T2DM population, demonstrating a dose–response relationship and moderate predictive value. It may serve as a valuable tool for identifying high-risk individuals and informing targeted interventions to prevent or delay CKD progression in this population.

Objectives: The objective of this study was to examine the association between non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) and chronic kidney disease (CKD) in Chinese adults with type 2 diabetes mellitus (T2DM). Methods: This study originated from a survey carried out in Zhejiang Province, located in eastern China, between March and November 2018. To explore the relationship between NHHR and CKD, a multivariable logistic regression model was employed. The dose–response relationship was assessed using restricted cubic spline (RCS) analysis, while generalized additive models (GAMs) were applied to examine the associations between NHHR and urinary albumin-to-creatinine ratio (UACR) as well as estimated glomerular filtration rate (eGFR). Subgroup analyses were performed across various demographic and clinical categories to assess the consistency of the NHHR–CKD association. The optimal NHHR cutoff for CKD diagnosis, its predictive accuracy, and its comparison with its components and HbA1c were determined through receiver operating characteristic (ROC) curve analysis. Results: The study enrolled 1756 participants, including 485 individuals with CKD and 1271 without CKD. Multivariable logistic regression revealed a significant positive association between NHHR and CKD, with each standard deviation (SD) increase in NHHR linked to a 23% higher odds of CKD (OR = 1.23, 95% CI: 1.09–1.37) after adjusting for potential confounders. When comparing quartiles, the fully adjusted ORs for Q2, Q3, and Q4 were 1.29 (0.92–1.79), 1.31 (0.94–1.83), and 1.87 (1.34–2.60), respectively, relative to Q1 (p for trend < 0.01). RCS analysis confirmed a linear dose–response relationship between NHHR and CKD in both sexes (p for nonlinearity > 0.05). GAMs indicated a significant positive correlation between NHHR and UACR (ρ = 0.109, p < 0.001) but no significant association with eGFR (ρ = −0.016, p = 0.502). Subgroup analyses demonstrated consistent associations across most subgroups, except for the 18–44 years age group, the well-controlled glycemic group, and the non-alcohol drinking group (p > 0.05). ROC curve analysis identified an optimal NHHR cutoff of 3.48 for CKD prediction, with an area under the curve (AUC) of 0.606 (95% CI: 0.577–0.635). Notably, NHHR outperformed its individual components and HbA1c in predictive performance. Conclusions: This study revealed a linear link between higher NHHR levels and increased CKD prevalence in Chinese T2DM patients. NHHR may also serve as a potential complementary biomarker for early CKD detection, though further prospective studies are needed to confirm its predictive value and clinical utility in high-risk T2DM populations.

Background: Addressing high-salt diets in China through interventions can significantly reduce blood pressure (BP) and the associated health risks. Objective: This study aims to evaluate the effectiveness of a comprehensive salt reduction intervention implemented across counties in Zhejiang Province, focusing on system establishment, extensive publicity, and targeted population interventions. Methods: The Salt Reduction and Hypertension Prevention Project was initiated in Zhejiang Province. Cross-sectional surveys were conducted before the intervention and after. The research commenced in 2017 with a baseline survey involving 7512 participants from five counties. Four counties were randomly selected for the intervention, implementing a multifaceted salt reduction strategy, while one county served as a reference without any intervention. The primary outcomes measured were changes in BP and 24 h urinary sodium and potassium excretion. Results: Following the intervention, 24 h urinary potassium excretion experienced a significant increase, rising from 1441.3 (SD 681.9) to 1676.9 (SD 931.4) mg per day, p < 0.001. Utilizing a linear mixed-effects model, the adjusted net difference in urinary sodium changes was calculated to be 394.1 mg per day (95% CI, 133.2 to 655.0) (p = 0.003). There was a notable reduction in systolic blood pressure (SBP) from 131.2 (SD 19.2) to 129.8 mmHg (SD 18.0), and diastolic blood pressure (DBP) also decreased from 80.8 (SD 10.8) to 78.9 mmHg (SD 10.2), p < 0.001. The adjusted net differences for SBP and DBP between the intervention and reference groups were 1.3 (95%CI, 0.5 to 2.1) and 1.4 mmHg (95%CI, 0.9 to 2.0), respectively, p < 0.001. Conclusions: The findings indicate that a multi-sectoral approach, combined with extensive public awareness initiatives and precisely targeted interventions, can significantly increase urinary potassium excretion and reduce sodium and blood pressure.

Background/Objectives: Several studies have suggested a positive association between salt intake and obesity, yet longitudinal evidence is limited. We aimed to investigate the longitudinal association between salt intake and multiple adiposity indicators. Methods: We used longitudinal data from a cluster-randomized controlled trial conducted in Zhejiang Province, China, including 7372 adults with 12,800 observations. Twenty-four-hour salt intake was estimated using spot urine samples. Adiposity was assessed using body mass index (BMI), body roundness index (BRI), body fat mass, overweight and central obesity. Associations between salt intake and adiposity were evaluated using generalized linear mixed-effects models. Mediation analyses were conducted to quantify the proportion of associations mediated by body fat mass. Results: Mean baseline 24 h salt intake was 9.88 g/d. Compared with participants in the lowest quartile of salt intake (1 g/d) were associated with decreases in BMI [−0.21 kg/m² (−0.33, −0.09)], BRI [−0.04 (−0.09, 0.00)], and body fat mass [−0.14 kg (−0.36, 0.07)]. Associations were stronger among women and adults aged < 40 years (p-values < 0.05). Body fat mass mediated 56.93%–84.73% of the associations. Conclusions: This study indicates a dose–response association between salt intake and obesity risk, partly mediated by increased body fat mass. The findings suggest that dietary salt may influence cardiovascular risk through adiposity-related pathways.

Objectives: This study aimed to examine the cross-sectional associations between serum folate concentrations and four lipid abnormality subtypes among community-dwelling adults in Zhejiang Province, China. Methods: This population-based cross-sectional study included 3254 adults from Zhejiang Province, China. Serum folate concentrations were analyzed both as quartiles and per 1-standard deviation (SD) increments. Multivariable logistic regression models were used to evaluate the associations of serum folate with hypercholesterolemia, hypertriglyceridemia, high low-density lipoprotein cholesterol (LDL-C), and low high-density lipoprotein cholesterol (HDL-C). Restricted cubic spline (RCS) regression models were further applied to assess dose–response patterns. Additional RCS analyses using continuous lipid parameters were also performed. False discovery rate (FDR) correction, exploratory subgroup analyses, and sensitivity analyses were additionally conducted. Results: The prevalences of hypercholesterolemia, hypertriglyceridemia, high LDL-C, and low HDL-C were 7.87%, 17.12%, 4.30%, and 4.46%, respectively. In the fully adjusted model, each 1-SD increment in serum folate was associated with lower odds of hypertriglyceridemia (OR = 0.82, 95% CI: 0.73–0.92) and low HDL-C (OR = 0.63, 95% CI: 0.49–0.81). Compared with the lowest quartile, participants in the highest serum folate quartile had lower odds of hypertriglyceridemia (OR = 0.62, 95% CI: 0.46–0.82) and low HDL-C (OR = 0.38, 95% CI: 0.22–0.64), with significant trends across quartiles (both p for trend < 0.001). No significant associations were observed for hypercholesterolemia or high LDL-C. These findings remained significant after FDR correction. RCS analyses suggested an overall inverse association between serum folate and hypertriglyceridemia, with no evidence of nonlinearity (p for overall = 0.001; p for nonlinearity = 0.212), whereas the association with low HDL-C showed evidence of nonlinearity (p for overall < 0.001; p for nonlinearity = 0.009). Additional RCS analyses using continuous lipid parameters showed broadly consistent findings for TG and HDL-C. Exploratory subgroup and sensitivity analyses showed generally similar results. Conclusions: Higher serum folate concentrations were cross-sectionally associated with lower odds of hypertriglyceridemia and low HDL-C among community-dwelling adults in Zhejiang Province, China, whereas no significant associations were observed for hypercholesterolemia or high LDL-C. Further prospective cohort studies are warranted to verify these cross-sectional findings and to explore underlying mechanisms.

Objectives: We aimed to examine the association between bubble tea consumption and anxiety symptoms among adolescents in Eastern China and to explore the potential role of sleep disturbance in the observed association between bubble tea consumption and anxiety symptoms. Methods: This study utilized cross-sectional baseline data from the Zhejiang Childhood Behavior and Health Cohort. Bubble tea consumption frequency was categorized as 0, 1–2, and ≥3 days per week. Anxiety symptoms were assessed using the Generalized Anxiety Disorder—7 (GAD-7) scale, while sleep disturbance was measured through self-reported items. Associations between bubble tea consumption and anxiety symptoms were examined using multivariable logistic regression models, and dose–response relationships were evaluated with restricted cubic spline (RCS) models. Subgroup analyses stratified by age, sex, school type, residence, and body mass index (BMI) were conducted to assess the consistency of the associations. An exploratory mediation analysis with bootstrap confidence intervals was performed to evaluate the indirect association through sleep disturbance. Sensitivity analyses using a stricter definition of anxiety symptoms (GAD-7 ≥ 10) were conducted to assess robustness. Results: A total of 11,847 adolescents aged 12–18 years were included, of whom 32.03% met the GAD-7 threshold for any anxiety symptoms (GAD-7 ≥ 5, including mild symptoms). Compared with non-consumers, adolescents consuming bubble tea 1–2 days per week had higher odds of anxiety (OR = 1.12, 95% CI: 1.02–1.22), while those consuming bubble tea ≥3 days per week had substantially higher odds (OR = 1.53, 95% CI: 1.30–1.80). Each additional day of bubble tea consumption per week was associated with 10% higher odds of anxiety (OR = 1.10, 95% CI: 1.06–1.14). RCS analysis demonstrated a significant positive linear association between bubble tea consumption and anxiety (p for non-linearity > 0.05). Associations were consistent across age, sex, school type, residence, and BMI categories (all p for interaction > 0.05). Sensitivity analyses yielded similar results. Exploratory mediation analysis suggested that sleep disturbance may be statistically related to a portion of the observed association between bubble tea consumption and anxiety symptoms. Conclusions: Higher frequency of bubble tea consumption was associated with greater odds of anxiety symptoms among adolescents in a dose–response pattern. Sleep disturbance may statistically explain part of the association. These findings should be considered hypothesis-generating and require confirmation in prospective longitudinal studies.