Understanding the impact of psychosocial factors and pain management on cardiovascular disease (CVD) risk and life expectancy in patients with chronic kidney disease (CKD) is critical for developing targeted interventions. We aimed to assess the associations of social isolation, loneliness, and pain risk with incident CVD in patients with CKD and to evaluate the impact of these factors on the life expectancy of CKD patients.

This prospective cohort study comprised 34,381 CKD patients from the UK Biobank. Loneliness and social isolation were measured using two-item and three-item scales, respectively. The risk of pain spreading score (ROPS) was determined by summing responses to six items based on mood, trauma, sleep, neuroticism, and anthropometric measurement. The Cox proportional hazards regression model was used to evaluate CVD risk by estimating hazard ratios (HRs) and 95 % confidence intervals (CIs).

Higher levels of loneliness (HR2 vs. 0 = 1.32, 95 % CI = 1.22-1.44), social isolation (HR2+ vs. 0 = 1.11, 95 % CI = 1.04-1.19), and higher ROPS (HRhigh vs low risk = 1.34, 95 % CI = 1.28-1.40) were associated with a higher risk of CVD in CKD patients (P-trend<0.001 for all). Significant interactions between loneliness and ROPS were observed, suggesting a synergistic effect on CVD risk. Moreover, loneliness, social isolation, and elevated ROPS were significantly associated with reduced life expectancy among patients with CKD.

The study findings suggest that addressing social isolation and loneliness, along with effective pain management, is crucial for reducing the risk of CVD and improving life expectancy in patients with CKD.

Social disconnection, including loneliness and social isolation, is associated with increased morbidity and death. However, its impact on the incidence and prognosis of atrial fibrillation (AF) remains inconclusive.

The present prospective cohort study enrolled 418 656 participants without AF and cardiovascular disease from the UK Biobank. A loneliness scale was constructed with 2 domains (loneliness feeling, inability to confide) and social isolation scale was constructed with 3 domains (living alone, lack of social support, and lack of social activity). We used a multistate model to analyze the impacts of the 2 scales on the progression from baseline to incident AF and subsequent major adverse cardiovascular events and further to death. Over a median follow-up of 14.7 years, 25 539 participants developed incident AF, among whom 7283 developed incident major adverse cardiovascular events, and 5165 died. Social isolation and loneliness scales were associated with both a higher incidence and worse prognosis of AF, with hazard ratios per 1-point increase of 1.06 (95% CI, 1.04-1.09) for the loneliness scale and 1.03 (95% CI, 1.02-1.05) for the social isolation scale for incident AF, and 1.12 to 1.14 for the loneliness scale (all P<0.001) and 1.12 to 1.27 for the social isolation scale (all P<0.001) after AF development. Loneliness feeling and living alone may be important contributors.

Loneliness and social isolation were both associated with a higher incidence and a worse prognosis of AF but to different extents. These observations highlight the importance of integrating social connection into the prevention and management of AF.

Background: Hearing loss (HL) is one major cause of disability and can lead to social impairments. However, the relationship between loneliness and the risk of incident HL remains unclear. Our study aimed to investigate this association among adults in the UK. Methods: This cohort study was based on data from the UK Biobank study. Loneliness was assessed by asking participants if they often felt lonely. Incident HL was defined as a primary diagnosis, ascertained via linkage to electronic health records. Cox proportional hazard regression models were used to examine the association between loneliness and risk of incident HL. Results: Our analyses included 490,865 participants [mean (SD) age, 56.5 (8.1) years; 54.4% female], among whom 90,893 (18.5%) reported feeling lonely at baseline. Over a median follow-up period of 12.3 years (interquartile range, 11.3 to 13.1), 11,596 participants were diagnosed with incident HL. Compared to non-lonely participants, lonely individuals exhibited an increased risk of HL [hazard ratio (HR), 1.36; 95% confidence interval (CI), 1.30 to 1.43]. This association remained (HR, 1.24; 95% CI, 1.17 to 1.31) after adjusting for potential confounders, including age, sex, socioeconomic status, biological and lifestyle factors, social isolation, depression, chronic diseases, use of ototoxic drugs, and genetic risk of HL. The joint analysis showed that loneliness was significantly associated with an increased risk of incident HL across all levels of genetic risks for HL. Conclusions: Loneliness was associated with the risk of incident HL independent of other prominent risk factors. Social enhancement strategies aimed at alleviating loneliness may prove beneficial in HL prevention.

The relationship between depression and cardiovascular disease (CVD) in individuals with prediabetes, its relative importance compared with traditional risk factors and whether genetic risk modifies this association remain unclear.

To explore the potential interactive effects of controlling traditional risk factors and depression on CVD, and to assess how depression compares with traditional risk factors in terms of its relative contribution to CVD risk in individuals with prediabetes.

We analysed a prospective cohort of 42,020 individuals from the UK Biobank, all free of prevalent CVD. Depression was determined using multiple sources to accurately assess the exposure. The five traditional risk factors considered were sleep duration, smoking, blood pressure (BP), low-density lipoprotein (LDL) cholesterol and renal function. We used Cox proportional hazards regression models to examine the associations between depression, risk factor control and CVD events.

Over a median follow-up of 13.1 years, 5865 individuals developed CVD, including 4764 cases of coronary heart disease and 1415 strokes. Compared with controlling 4-5 risk factors, both depression and controlling 0-1 risk factor significantly increased the risk of CVD in individuals with prediabetes. The corresponding multivariable-adjusted hazard ratios (95% CI) for CVD were 1.18 (1.09-1.28) and 1.44 (1.29-1.60), respectively. Depression ranked second in predicting CVD among the selected risk factors. A synergistic effect between depression and risk factor control was observed for CVD, with a relative excess risk due to interaction of 0.16 (0.06-0.26). Furthermore, these associations were independent of the genetic susceptibility to CVD.

Among individuals with prediabetes, both depression and suboptimal control of traditional risk factors are associated with an increased risk of CVD, independent of genetic susceptibility.

Cardiometabolic risk factors have been associated with the risk of late-onset dementia. However, evidence regarding early-onset dementia was inconsistent, and the impact of clustered cardiometabolic risk factors was unclear. We aimed to investigate the associations of cardiometabolic profiles with incident early-onset and late-onset dementia.

Among 289 494 UK Biobank participants, cluster analysis was built on 12 common cardiometabolic markers. Analyses were performed on those aged <65 years at baseline (n = 249 870) for early-onset dementia and those ≥65 at the end of follow-up (n = 191 213) for late-onset dementia.

During a median follow-up of 14.1 years, 279 early-onset dementia cases and 3167 late-onset dementia cases were documented. Among the five clusters of cardiometabolic profiles identified (cluster 1 [obesity-dyslipidemia pattern], cluster 2 [high blood pressure pattern], cluster 3 [high liver enzymes pattern], cluster 4 [inflammation pattern] and cluster 5 [relatively healthy pattern]), cluster 3 was significantly associated with higher risks of both early-onset and late-onset dementia; however, the risk estimate for early-onset dementia (hazard ratio 2.58, 95% CI 1.61-4.14) was larger than that for late-onset dementia (1.36, 1.09-1.71). Cluster 4 was associated with a higher risk of late-onset dementia (hazard ratio 1.39, 95% CI 1.13-1.72). No significant interactions were observed between cardiometabolic clusters and apolipoprotein E ε4 genotype.

Cardiometabolic patterns characterised by relatively high liver enzyme levels or systemic inflammation were associated with increased risks of early-onset and late-onset dementia. Identification of high-risk subgroups according to distinct cardiometabolic patterns might help develop more precise strategies for dementia prevention regardless of apolipoprotein E (APOE) ε4 status.

Loneliness is prevalent in patients with chronic diseases and can threaten their health status, treatment process and quality of life. The stigma of loneliness stems from a derogatory and stigmatizing label that individuals possess towards loneliness with the possibility of being socially disadvantaged, which exacerbates the negative impact of loneliness on patients with chronic diseases and jeopardizes social support. However, few studies focused on this theme in patients with chronic diseases. This study aimed to assess the psychometric characteristics of the Chinese version of the Stigma of Loneliness Scale (SLS) among patients with chronic diseases, to provide a validated tool for related research.

The current study consisted of a two-phase questionnaire survey of 704 patients with chronic diseases. Sample 1 comprised 318 patients (Age:40.87 ± 18.55) with chronic diseases, and the data obtained were used for item analysis and exploratory factor analysis. Sample 2 included 386 patients (Age:40.65 ± 17.08) with chronic diseases, and the resulting data were of use for confirmatory factor analysis, criterion validity, incremental validity, and Cronbach's α coefficient test. Moreover, in Sample 2, the equivalence of SLS in male and female cohorts and in outpatient and inpatient groups was further examined.

In the exploratory factor analysis, two dimensions were extracted: Self-Stigma of Loneliness (SSL) and Public Stigma of Loneliness (PSL). The confirmatory factor analysis revealed that the first-order two-factor model demonstrated good fit indices (χ2/df = 2.754, RMSEA = 0.067, SRMR = 0.023, CFI = 0.988, IFI = 0.989, TLI = 0.983, PNFI = 0.677, PCFI = 0.681), and it was superior to both the one-factor model and the two-factor orthogonal model. The criterion validity test indicated that the SLS scores were significantly positively correlated with the scores of UCLA Loneliness Scale, Brief Illness Perception Questionnaire, Self-Concealment Scale, Social Interaction Anxiety Scale, Social Phobia Scale, Acceptance and Action Questionnaire-Second Edition, Kessler Psychological Distress Scale-6 scores. The Cronbach's α coefficient values for the SLS, SSL, and PSL were 0.961, 0.949, and 0.960, respectively. The results of the incremental validity tests indicated that stigma of loneliness and loneliness differ in psychological construct. In addition, the SLS showed measurement equivalence in populations of patients with chronic diseases of different genders, as well as ways of seeking medical care.

The Chinese version of the SLS showed favorable reliability and validity in patients with chronic disease populations, which can provide instrumental endorsement for recognition and intervention studies of stigma of loneliness.

Stroke is a leading cause of global morbidity and mortality, with risk factors like visceral adiposity and inflammation playing significant roles. This study introduces the Visceral Adiposity Inflammatory Index (VAII), combining the Visceral Adiposity Index (VAI) and high-sensitivity C-reactive protein (CRP), to better predict stroke risk. Analyzing data from 8415 participants in the China Health and Retirement Longitudinal Study over 9 years, the study found that higher VAII levels were strongly associated with increased stroke incidence, with a hazard ratio of 1.91 for the highest quartile. VAII outperformed VAI and CRP alone in predictive accuracy, enhancing traditional risk models as shown by improved Net Reclassification Index and Integrated Discrimination Improvement Index. Furthermore, blood pressure and the triglyceride-glucose index were identified as mediators in the VAII-stroke relationship. These findings underscore VAII as a promising tool for stroke risk assessment, suggesting that public health interventions targeting VAII reduction could help mitigate stroke risk.

With nearly three-quarters of global deaths attributed to lifestyle-associated diseases, effective lifestyle modifications are more urgent than ever. The American Heart Association's framework for cardiovascular health has evolved significantly, transitioning from 'Life's Simple 7' to 'Life's Essential 8' with the incorporation of sleep, and further to 'Life's Essential 9' by adding mental health as a key component. Despite these advancements, recent evidence reveals a persistently low prevalence of ideal cardiovascular and cerebrovascular health behaviors across populations. These findings highlight the critical gap in addressing modifiable lifestyle and psychosocial factors. To reduce the global disease burden, public health strategies must prioritize comprehensive interventions that encompass physical, neurological, and mental well-being.

Social isolation, loneliness, and fine particulate matter (PM2.5) exposure are significant social and environmental factors that frequently cooccur in vulnerable populations. The joint effects of these factors on the risk of cardiovascular disease (CVD), however, are not well supported by data. This study aimed to evaluate the independent and combined effects of social isolation, loneliness, and long-term PM2.5 exposure on CVD risk and to assess the interactions between social isolation or loneliness and PM2.5 exposure on CVD risk.

We used Cox proportional hazards models to estimate the independent and combined effects of loneliness, social isolation, and long-term PM2.5 exposure on CVD incidence. We also conducted interaction analyses to investigate whether the effects of social factors on CVD are modified by the level of PM2.5 exposure.

This study included 12,544 participants, with mean age of 58.7 ± 9.4 years. The median follow-up was 7 years, with 1761 CVD events occurred. Individuals with loneliness presented a 29% increased risk of CVD (hazard ratio [HR] = 1.290, 95% confidence intervals [CI]: 1.165-1.428). A 10 µg/m3 increase in PM2.5 exposure was associated with a 6% increase in CVD risk (HR = 1.060, 95% CI: 1.028-1.092). A significant additive interaction effect was observed between loneliness and PM2.5 on CVD (P for additive interaction = 0.042).

Among Chinese middle and older adults, loneliness and long-term PM2.5 exposure had combined effects on CVD risk. The public health consequences of high PM2.5 exposure are more pronounced among individuals who experience feelings of loneliness.

Loneliness and social isolation are serious yet underappreciated public health problems, with their genetic underpinnings remaining largely unknown. We aimed to explore the role of protein-coding variants in the manifestation of loneliness and social isolation.

We conducted the first exome-wide association analysis on loneliness and social isolation, utilizing 336,115 participants of white-British ancestry for loneliness and 346,115 for social isolation. Sensitivity analyses were performed to validate the genetic findings. We estimated the genetic burden heritability of loneliness and social isolation and provided biological insights into them.

We identified six novel risk genes (ANKRD12, RIPOR2, PTEN, ARL8B, NF1, and PIMREG) associated with loneliness and two (EDARADD and GIGYF1) with social isolation through analysis of rare coding variants. Brain-wide association analysis uncovered 47 associations between identified genes and brain structure phenotypes, many of which are critical for social processing and interaction. Phenome-wide association analysis established significant links between these genes and phenotypes across five categories, mostly blood biomarkers and cognitive measures.

The measurements of loneliness and social isolation in UK Biobank are brief for these multi-layer social factors, some relevant aspects may be missed.

Our study revealed 13 risk genes associated with loneliness and 6 with social isolation, with the majority being novel discoveries. These findings advance our understanding of the genetic basis of these two traits. The study provides a foundation for future studies aimed at exploring the functional mechanisms of these genes and their potential implications for public health interventions targeting loneliness and social isolation.

This study aims to examine the dose-response relationship between visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT), and sepsis and sepsis-related mortality. Additionally, we seek to determine whether VAT or ASAT offers better prognostic value for above outcomes compared to traditional measures such as waist circumference (WC) and body mass index (BMI), using data from the UK Biobank.

In this secondary analysis of the UK Biobank, 25,083 participants with available abdominal MRI data were included. Cox proportional hazards regression was used to examine the association between VAT and ASAT, both as tertiles and continuous variables, and the incidence of sepsis as well as sepsis-related mortality.

Over a median follow-up of 14.1 years (interquartile range: 13.4-14.9 years), 305 cases of incident sepsis (0.86 per 1000 person-years) and 90 sepsis-related deaths (0.25 per 1000 person-years) were identified. Both VAT and ASAT showed a linear relationship with sepsis risk, with hazard ratios (HR) of 1.29 (95% CI: 1.12-1.47) for VAT and 1.22 (95% CI: 1.07-1.40) for ASAT per standard deviation increase. After further adjusting for BMI or WC, the association with ASAT was eliminated, while VAT remained significant. Only VAT was positively associated with sepsis-related mortality, although this association was nullified after adjusting for BMI or WC. VAT was a more important predictor of sepsis risk than BMI or WC, and its inclusion improved the predictive model already adjusted for BMI or WC. In contrast, ASAT did not provide any additional predictive value for either sepsis risk or sepsis-related mortality compared to BMI and WC.

VAT is independently associated with sepsis risk and improves its prediction beyond traditional measures like BMI and WC. However, VAT does not enhance the prediction of sepsis-related mortality, with BMI and WC performing better in this context.

Emerging evidence suggests a role of psychological well-being in the development of cardiovascular disease (CVD), but supportive data remain limited. This study assessed the prospective associations between life satisfaction and incident CVD, as well as the relative importance of life satisfaction compared to traditional risk factors.

The study included 153,810 participants free of CVD at baseline, with measurements of life satisfaction on general happiness, personal health, family relationships, friendships, and financial situation, followed up until December 31, 2022. Cox proportional hazards models were used to estimate associations between life satisfaction and incident CVD. The relative importance of life satisfaction in predicting CVD was measured by explained R2 values.

During a median follow-up of 12.9 years, 14,370 incident CVD events occurred, including 10,070 CHD and 2,895 strokes. Individuals with low life satisfaction had an 80% higher risk of CVD compared to those with high life satisfaction (hazard ratio [95% confidence interval], 1.84 [1.63-2.07] for CVD, 1.83 [1.59-2.10] for CHD, and 1.74 [1.31-2.31] for stroke). Life satisfaction was ranked as the fourth-strongest CVD risk factor, following hypertension, race, and income. Low satisfaction with all individual aspects was significantly associated with higher risks of CVD and CHD (P < 0.05), while satisfaction with personal health showing the strongest association.

This study indicates that life satisfaction is robustly associated with incident CVD and may be considered one of the strongest predictors of CVD risk, alongside traditional risk factors. Our findings support the inclusion of life satisfaction in cardiovascular health metrics.

Social isolation and loneliness seriously impact the physical and mental quality of health and longevity. Social isolation and loneliness are important yet neglected social determinants for people of all ages. Cardiovascular diseases (CVD) are among the leading causes of death globally, and loneliness has been linked to worsening outcomes of CVD. This review aims to evaluate the impact of loneliness/social/self-isolation among adults living with any cardiovascular disease. A systematic search was done from inception to 23rd January 2025 on PubMed and Google Scholar, and 4,198 articles were synthesized; these articles were screened for duplication, and the duplicate articles were removed. A total of 3,606 articles underwent title and abstract screening, and 3,505 articles were removed following the predefined eligibility criteria. One hundred and one articles underwent full-text screening, and only 13 articles were included for qualitative analysis. We included adults aged 18 and above living alone/socially isolated with any cardiovascular disease. This systematic review analyzed 13 studies across eight countries, encompassing 63,978 participants, of whom 12,110 were identified as living alone or socially isolated, 7,264 male and 3,745 female participants; one study included only male participants, while two studies didn't mention the number of male and female participants. The findings provide compelling evidence that loneliness is associated with adverse cardiovascular disease (CVD) outcomes, including increased mortality, recurrent cardiovascular events, and higher hospitalization rates. Addressing loneliness and social isolation should be a priority in cardiovascular disease prevention and management. Integrating social interventions could significantly improve the prognosis of individuals living with CVD, ultimately reducing morbidity and mortality rates in this vulnerable population.

Previous study revealed that social isolation and loneliness are associated with incident type 2 diabetes mellitus (T2DM). However, the long-term effects of social isolation and loneliness on the population with T2DM have not been known. This study aims to evaluate the potential associations of social isolation and loneliness with all-cause and cause-specific mortality in individuals with T2DM.

The prospective cohort study included 26 549 UK adults diagnosed with T2DM at baseline. Social isolation and loneliness were evaluated through a self-reported questionnaire. Mortality data was obtained from the National Death Registration Centre.

During a median follow-up of 13.3 years (IQR: 12.5-14.2 years), 5467 (20.6%) participants died from all-cause, 1953 (7.4%) from cardiovascular disease (CVD) and 1569 (5.9%) from cancer. Social isolation could increase the risks of all-cause, CVD and cancer mortality (most vs least; adjusted HR (95% CI): 1.32 (1.22-1.42), 1.44 (1.26-1.65) and 1.19 (1.05-1.34), respectively). Similarly, loneliness significantly increased the risks of all-cause, and CVD mortality (yes vs no; adjusted HR (95% CI): 1.17 (1.07-1.28) and 1.26 (1.07-1.48)). In joint analyses, as the degree of social isolation intensified, there were concomitant rises in the risks of all-cause, and CVD mortality in the no-loneliness or loneliness subgroup (adjusted HR (95% CI): 1.4 (1.21-1.61) and 1.65 (1.29-2.11)).

This study found that social isolation was significantly associated with the increased risks of all-cause, CVD and cancer mortality among individuals with T2DM. Loneliness was also associated with all-cause mortality and CVD mortality, but not cancer mortality. These findings highlight the importance of social isolation and loneliness management in patients with T2DM.

Objective and subjective aging indicators reflect diverse biological and psychosocial processes, yet their combined association with premature mortality remains underexplored. This study aimed to investigate the association between a multidomain framework of aging indicators and premature mortality, addressing gaps in understanding cumulative effects. We included 369,741 UK Biobank participants initially free of cardiovascular disease (CVD) and cancer, followed until December 31, 2022. Four indicators, hearing loss, tooth loss, falls and subjective aging, were counted, and their joint associations with all-cause and cause-specific premature mortality were analyzed using the Cox proportional hazard models. During a median follow-up of 13.74 years, we documented 22,934 premature mortality. Participants with all indicators had an 81% (95%CI: 59-107%), 96% (47-160%), 55% (26-91%), and 114% (73-165%) higher risk of all-cause, CVD, cancer, and other-cause premature mortality, respectively, compared to those without indicators. The associations were particularly elevated among younger participants, those with unhealthy lifestyles, and those of lower socioeconomic status (P for interactions <0.05). Additive interaction with frailty contributed an additional 16.08% (7.91-24.25%) risk of premature mortality. Findings were replicated in the Health and Retirement Study, supporting the robustness of the multidomain aging framework. This study highlights the potential of integrating objective and subjective aging indicators to refine risk assessments and inform interventions targeting aging-related diseases.

The importance of integrating physical and psychosocial factors in assessing frailty -health outcomes has been increasingly acknowledged, while the related evidence is lacking. We sought to investigate the associations of joint physical-psychosocial frailty with risk of premature mortality and evaluate the relative importance of individual physical and psychosocial factors.

A total of 381,295 participants with no history of cancer or cardiovascular disease (CVD) were recruited from the UK Biobank cohort. The physical-psychosocial frailty was evaluated based on seven indicators including weight loss, exhaustion, physical activity, walking pace, grip strength, social isolation, and loneliness. The outcomes were premature mortality from all causes, cancer, CVD, and other causes. Cox proportional hazards models were used to assess the associations between the physical-psychosocial frailty and premature mortality.

During a median follow-up period of 12.7 years, we recorded 20,328 premature deaths. Each additional increment in the physical-psychosocial frailty index was associated with a 26% (HR 1.26, 95% CI 1.24-1.28), 10% (HR 1.10, 95% CI 1.08-1.12), 30% (HR 1.30, 95% CI 1.26-1.33), and 44% (HR 1.44, 95% CI 1.41-1.47) higher risk of all-cause, cancer, cardiovascular, and other-cause premature mortality, respectively. Compared with participants with the physical-psychosocial frailty index of 0, those with the index ≥ 4 had a 2.67 (95% CI 2.49-2.87)-fold higher risk of all-cause premature mortality. Slow walking pace and social isolation were the top two strongest predictors for all-cause premature mortality. In addition, we found that lower body mass index (BMI), age, smoking status, and dietary quality modified the associations of physical-psychosocial frailty with all-cause premature mortality (P-interaction < 0.05).

In this cohort study of UK Biobank participants, joint physical-psychosocial frailty is significantly associated with risks of all-cause and cause-specific premature mortality, highlighting the importance to jointly assess physical and psychosocial factors in determining aging-related health.

Previous studies have identified sarcopenia as a significant risk factor for cardiovascular disease (CVD). However, these studies primarily focused on sarcopenia status at baseline, without considering changes in sarcopenia status during follow-up. The aim of this study is to investigate the association between changes in sarcopenia status and the incidence of new-onset cardiovascular disease.

This study utilized prospective cohort data from the China Health and Retirement Longitudinal Study (CHARLS). Sarcopenia status was assessed using the 2019 Asian Working Group for Sarcopenia (AWGS) algorithm and categorized as non-sarcopenia, possible sarcopenia, or sarcopenia. Changes in sarcopenia status were evaluated based on assessments at baseline and at the second follow-up survey 2 years later. CVD was identified through self-reported physician diagnoses of heart disease, including angina, myocardial infarction, congestive heart failure, and other heart problems, or stroke. Cox proportional hazards models were employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounding factors.

Based on the inclusion and exclusion criteria, a total of 7499 CHARLS participants were included in the analysis, with 50.8% being female and an average age of 58.5 years. Compared to participants with stable non-sarcopenia status, those who progressed from non-sarcopenia to possible sarcopenia or sarcopenia exhibited a significantly increased risk of new-onset CVD (HR 1.30, 95% CI 1.06-1.59). Conversely, participants who recovered from sarcopenia to non-sarcopenia or possible sarcopenia had a significantly reduced risk of new-onset CVD compared to those with stable sarcopenia status (HR 0.61, 95% CI 0.37-0.99). Among participants with baseline possible sarcopenia, those who recovered to non-sarcopenia had a significantly lower risk of new-onset CVD compared to those with stable possible sarcopenia status (HR 0.67, 95% CI 0.52-0.86).

Changes in sarcopenia status are associated with varying risks of new-onset CVD. Progression in sarcopenia status increases the risk, while recovery from sarcopenia reduces the risk of developing cardiovascular disease.

We aimed to investigate the interrelationships among polygenic risk scores (PRS), healthy lifestyle factors (HLFs), and colorectal cancer (CRC) risk in individuals with prediabetes. To investigate whether adherence to HLFs influence CRC risk in those with elevated PRS within this specific population.

Data from 22,408 prediabetes participants without CRC at baseline were analyzed from the UK Biobank. HLFs were graded using healthy lifestyle scores (HLSs) and classified as favorable, intermediate, or unfavorable, while the PRS for CRC was categorized as high, medium, or low. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for CRC risk.

High PRS (HR: 2.36; 95% CI: 1.86-3.00) and medium PRS (HR: 1.42; 95% CI: 1.09-1.83) prediabetes were associated with increased CRC risk compared to those with low PRS. HLFs were linked to lower CRC risk in a dose-response manner, with never smoking (HR: 0.69; 95% CI: 0.57-0.84) and maintaining a healthy BMI (HR: 0.64; 95% CI: 0.49-0.82) associated with reduced CRC risk. Adherence to favorable HLFs may reduce the CRC risk in those with medium (HR: 0.51; 95% CI: 0.27-0.95) and high PRS (HR: 0.62; 95% CI: 0.39-0.99) over 15 years of follow-up. In participants with high PRS and unfavorable HLFs, the excess risk due to the additive interaction between PRS and HLFs was 1.41% (p < 0.01), especially for women (1.07%).

There is an additive interaction of PRS and HLFs on CRC risk in individuals with prediabetes. Adopting favorable HLFs should be integrated into the management of prediabetes individuals to reduce the risk of CRC.

To explore the association of cardiovascular-kidney-metabolic (CKM) health with the risk of depression and anxiety and to investigate the joint association of CKM health and social connection with depression and anxiety.

This prospective cohort study included 344 956 participants from the UK Biobank. CKM syndrome was identified as a medical condition with the presence of metabolic risk factors, cardiovascular disease, and chronic kidney disease, and was classified into five stages (stage 0-4) in this study. Loneliness and social isolation status were determined by self-reported questionnaires. Cox proportional hazards models were applied for analyses.

Compared with participants in stage 0, the HRs for depression were 1.17 (95% CI 1.10-1.25), 1.40 (95% CI 1.33-1.48), and 2.14 (95% CI 1.98-2.31) for participants in stage 1, 2-3, and 4, respectively. Similarly, participants in stage 2-3 (HR = 1.20, 95% CI 1.14-1.26) and stage 4 (HR = 1.63, 95% CI 1.51-1.75) had greater risks of incident anxiety. We found additive interactions between loneliness and CKM health on the risk of depression and anxiety. Participants simultaneously reported being lonely and in stage 4 had the greatest risk of depression (HR = 4.44, 95% CI 3.89-5.07) and anxiety (HR = 2.58, 95% CI 2.21-3.01) compared with those without loneliness and in stage 0. We also observed an additive interaction between social isolation and CKM health on the risk of depression.

Our findings suggest the importance of comprehensive interventions to improve CKM health and social connection to reduce the disease burden of depression and anxiety.

To investigate the extent to which joint risk factor control might attenuate the excess risk of chronic kidney disease (CKD) in participants with obesity.

We included a total of 97 538 participants who were obese at baseline and matched 97 538 normal weight control participants from the UK Biobank in the analysis. The degree of joint risk factor control was assessed based on six major CKD risk factors, including blood pressure, glycated haemoglobin, low-density lipoprotein cholesterol, albuminuria, smoking and physical activity. The Cox proportional hazards models were used to estimate associations between the degree of risk factor control and risk of CKD, following participants from their baseline assessment until the occurrence of CKD, death, or the end of the follow-up period.

Among participants with obesity, joint risk factor control showed an association with a stepwise reduction of incident CKD risk. Each additional risk factor control corresponded to an 11% (hazard ratio: 0.89; 95% confidence interval: 0.86-0.91) reduced risk of CKD among participants with obesity, with the optimal controlling of all six risk factors associated with a 49% (hazard ratio: 0.51; 95% confidence interval: 0.43-0.61) decrease in risk of CKD. Furthermore, in individuals with obesity who jointly controlled all six risk factors, the excess risk of CKD associated with obesity was effectively neutralized compared with normal weight control subjects. Notably, the protective correlations between the degree of joint risk factor control and the incidence of CKD were more pronounced in men compared with women, in individuals with a lower healthy food score versus a higher score, and among diabetes medication users as opposed to non-users (pinteraction = 0.017, 0.033 and 0.014, respectively).

The joint risk factor control is associated with an inverse association of CKD risk in an accumulative manner among individuals with obesity. Achieving ideal control over risk factors may effectively counterbalance the excessive risk of CKD typically associated with obesity.

Developed countries worldwide face the challenge of aging populations in which loneliness is problematic, leading to mental and physical health issues. Diabetes mellitus (DM) can cause decreased physical activity, reduced functioning, and depressive symptoms. However, how interactions between loneliness and DM influence health outcomes remains unclear. We aimed to determine the effects of loneliness and DM-related complications on the incidence of disability among older individuals.

We analyzed data from the Japanese National Center for Geriatrics and Gerontology Study of Geriatric Syndromes for community-dwelling adults aged ≥65 years without initial long-term care needs. Loneliness was assessed using the University of California Los Angeles Loneliness Scale, and DM status was determined based on medical history obtained through face-to-face interviews. Disability incidence was identified by monthly tracking of certifications under the Japanese long-term care insurance system. The combined effect of DM and loneliness on care needs was examined using Cox proportional hazard regression models.

Among 5,160 participants, 298 (5.8 %) developed incident disabilities within 24 months. Cox models adjusted for potential confounders revealed a significantly increased disability risk among persons with DM and loneliness. Having DM without loneliness and vice versa were not significant risk factors for disability incidence compared with having neither.

The combination of loneliness with DM was a risk factor for disability development among community-dwelling older adults. Loneliness and DM might be interrelated and associated with disability development, suggesting that support along with assessments of mental health and illness might help to avoid disability in this population.

Social disconnection has been associated with poor cardiometabolic health. This study sought to investigate the associations of social isolation and loneliness with diabetic microvascular complications (DMCs) among individuals with type 2 diabetes mellitus (T2DM) and compare these associations versus those related to traditional risk factors.

Prospective cohort study.

A total of 24,297 UK Biobank participants with T2DM and no DMCs at baseline.

Social isolation and loneliness were measured using self-reported questionnaires.

The incidence of DMCs defined as a composite of diabetic kidney disease, diabetic retinopathy, or diabetic neuropathy.

Multivariable cause-specific hazards regression. To compare the relative importance of social disconnection with other established factors, the R2 values of the Cox models were calculated.

During a median follow-up of 12.6 years, 5,530 patients were documented to experience DMCs (3,458 with diabetic kidney disease, 2,255 with diabetic retinopathy, and 1,146 with diabetic neuropathy). The highest level of social isolation was associated with an increased risk of any DMC component (most vs least: HR, 1.13; 95% CI, 1.05-1.22), especially diabetic kidney disease (HR, 1.14; 95% CI, 1.04-1.25) and neuropathy (HR, 1.31; 95% CI, 1.11-1.53). Any level of loneliness was associated with an increased risk of any DMC component (HR, 1.12; 95% CI, 1.02-1.23) and diabetic kidney disease (HR, 1.16; 95% CI, 1.03-1.30). Social isolation and loneliness exhibited associations with DMCs comparable to those of other conventional risk factors, including smoking, blood pressure, and physical activity.

Limited generalizability related to the composition of participants in the UK Biobank Study.

Social isolation and loneliness were independently associated with a higher risk of incident DMCs among individuals with T2DM, with comparable importance to other traditional risk factors. These findings underscore social isolation and loneliness as novel and potentially modifiable risk factors for DMCs.

Social isolation and loneliness are important social determinants that are associated with adverse cardiometabolic health. Individuals with diabetes are particularly vulnerable to social isolation and loneliness. However, the relationship of social isolation or loneliness with diabetic microvascular complications (DMCs) remains unclear. Our study used the UK Biobank study data to investigate the associations of social isolation and loneliness with the development of DMCs. We found that social isolation and loneliness were independently associated with a higher risk of incident DMCs. Remarkably, their association with DMCs was comparable to those of other lifestyle factors such as smoking, blood pressure, and physical activity. These findings collectively imply that social isolation and loneliness are 2 important potentially modifiable risk factors for DMCs among individuals with type 2 diabetes mellitus.

Loneliness-the subjective experience of social disconnection-is now widely regarded as a health risk factor. However, whether the associations between loneliness and multiple diseases are consistent with causal effects remains largely unexplored. Here we combined behavioural, genetic and hospitalization data from the UK Biobank to examine the associations of loneliness with a wide range of non-overlapping diseases. During a median 12.2-year follow-up, loneliness was associated with greater risks in 13 of 14 disease categories and 30 of 56 individual diseases considered. Of the 30 diseases significantly associated with loneliness, 26 had genetic data available for Mendelian randomization (MR) analyses. After Benjamini‒Hochberg correction and multiple sensitivity analyses within the MR framework, non-causal associations were identified between genetic liability to loneliness and 20 out of the 26 specific diseases, including cardiovascular diseases, type 2 diabetes mellitus, obesity, chronic liver diseases, chronic kidney disease, most neurological diseases and the other common diseases. Genetic liability to loneliness was only potentially causally associated with the remaining six diseases. Socioeconomic factors, health behaviours, baseline depressive symptoms and comorbidities largely explained the associations between loneliness and diseases. Overall, our study revealed a dissociation between observational and genetic evidence regarding the associations of loneliness with multiple diseases. These findings suggest that loneliness may serve as a potential surrogate marker rather than a causal risk factor for most diseases tested here.

The association of folate supplementation with congenital heart disease (CHD) prevention is controversial.

To examine the association of maternal serum folate levels at early to midpregnancy with CHD risk in offspring.

This case-control study recruited participants from one of China's largest cardiac referral centers between 2015 and 2018. CHD cases and non-CHD controls were matched according to maternal age at a ratio of 1:4. Data were analyzed from May to August 2023.

Maternal serum levels of folate, vitamin B12, and homocysteine were measured around the gestational age of 16 weeks.

The primary outcome was CHD, which was confirmed using echocardiography. The association between CHD risk in offspring with maternal folate levels was measured using adjusted odds ratios (aORs) with 95% CIs in conditional logistic regression analyses. Interactions between folate, vitamin B12, and homocysteine and CHD were estimated on a multiplicative scale.

A total of 129 CHD cases with ventricular septal defect as the most common phenotype and 516 matched controls were included. The mean (SD) maternal age at pregnancy was 31.6 (5.3) years. There was a U-shaped association between maternal serum folate levels at early to midpregnancy and CHD risk in offspring. Compared with the offspring in the second and third quartiles of maternal folate, those in the lowest (aOR, 3.09; 95% CI, 1.88-5.08) and highest quartiles (OR, 1.81; 95% CI, 1.07-3.06) had increased odds of CHD. The ORs were higher when applying the World Health Organization criteria to determine the normal range for serum folate levels. Interaction analyses suggested that the adverse associations between low and high maternal folate and CHD risk might be further magnified by vitamin B12 deficiency or elevated homocysteine.

In this case-control study of CHD, low maternal serum folate levels in early to midpregnancy were associated with an increased CHD risk in offspring, and excessively high folate levels were also associated with an elevated CHD risk. Further investigation is needed to make causal inferences for the observed associations and elucidate the underlying mechanisms.

To investigate the associations between ketone bodies (KB) and multiple adverse outcomes including cardiovascular disease (CVD), chronic kidney disease (CKD) and all-cause mortality according to diabetes status.

This prospective study included 222 824 participants free from CVD and CKD at baseline from the UK Biobank. Total KB including β-hydroxybutyrate, acetoacetate and acetone were measured by nuclear magnetic resonance. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between KB and adverse outcomes among participants with normoglycaemia, prediabetes and type 2 diabetes, respectively.

During a mean follow-up of 14.1 years, 24 088 incident CVD events (including 17 303 coronary heart disease events, 5172 stroke events and 5881 heart failure [HF] events), 8605 CKD events and 15 813 deaths, were documented. Higher total KB significantly increased the risk of HF among participants with normoglycaemia (HR, 1.32 [95% CI, 1.17-1.49], per 10-fold increase in total KB) and prediabetes (1.35 [1.04-1.76]), and increased the risk of CKD among those with normoglycaemia (1.20 [1.09-1.33]). Elevated KB levels were associated with an increased risk of all-cause mortality across the glycaemic spectrum (1.32 [1.23-1.42] for normoglycaemia, 1.45 [1.24-1.71] for prediabetes and 1.47 [1.11-1.94] for diabetes). Moreover, a significant additive interaction between KB and diabetes status was observed on the risk of death (P = .009), with 4.9% of deaths attributed to the interactive effects.

Our study underscored the variation in association patterns between KB and adverse outcomes according to diabetes status and suggested that KB could interact with diabetes status in an additive manner to increase the risk of mortality.

Identification of individuals with prediabetes who are at high risk of developing diabetes allows for precise interventions. We aimed to determine the role of nuclear magnetic resonance (NMR)-based metabolomic signature in predicting the progression from prediabetes to diabetes.

This prospective study included 13,489 participants with prediabetes who had metabolomic data from the UK Biobank. Circulating metabolites were quantified via NMR spectroscopy. Cox proportional hazard (CPH) models were performed to estimate the associations between metabolites and diabetes risk. Supporting vector machine, random forest, and extreme gradient boosting were used to select the optimal metabolite panel for prediction. CPH and random survival forest (RSF) models were utilized to validate the predictive ability of the metabolites.

During a median follow-up of 13.6 years, 2525 participants developed diabetes. After adjusting for covariates, 94 of 168 metabolites were associated with risk of progression to diabetes. A panel of nine metabolites, selected by all three machine-learning algorithms, was found to significantly improve diabetes risk prediction beyond conventional risk factors in the CPH model (area under the receiver-operating characteristic curve, 1 year: 0.823 for risk factors + metabolites vs 0.759 for risk factors, 5 years: 0.830 vs 0.798, 10 years: 0.801 vs 0.776, all p < 0.05). Similar results were observed from the RSF model. Categorization of participants according to the predicted value thresholds revealed distinct cumulative risk of diabetes.

Our study lends support for use of the metabolite markers to help determine individuals with prediabetes who are at high risk of progressing to diabetes and inform targeted and efficient interventions.

Shanghai Municipal Health Commission (2022XD017). Innovative Research Team of High-level Local Universities in Shanghai (SHSMU-ZDCX20212501). Shanghai Municipal Human Resources and Social Security Bureau (2020074). Clinical Research Plan of Shanghai Hospital Development Center (SHDC2020CR4006). Science and Technology Commission of Shanghai Municipality (22015810500).

It remains unknown how the patterns of change of social isolation and loneliness are associated with the onset of cardiovascular disease (CVD) and mortality. We aimed to investigate the longitudinal association of changes in social isolation and loneliness with incident CVD, all-cause mortality, CVD mortality and subsequent cardiac function.

This prospective cohort study included 18,258 participants aged 38-73 years who participated in visit 0 (2006-2010) and visit 1 (2012-2013) using UK Biobank (mean age 57.1, standard deviation [SD] 7.4; 48.7% males). Social isolation or loneliness was categorized into four patterns: never, transient, incident, and persistent. Incident CVD, all-cause and CVD mortality were ascertained through linkage data. Cardiac function was assessed by cardiovascular magnetic resonance imaging in a subsample (N = 5188; visit 2, since 2014).

Over a median follow-up of 8.3 (interquartile range [IQR] 8.1-8.6) years, compared with never social isolation, persistent social isolation was associated with the higher risk of incident CVD (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.03-1.33), all-cause (1.42, 1.12-1.81) and CVD (1.53, 1.05-2.23) mortality. Likewise, persistent loneliness was strongly associated with the greater risk of incident CVD (1.13, 1.00-1.27), all-cause (1.28, 1.02-1.61) and CVD mortality (1.52, 1.06-2.18).

Persistent social isolation and loneliness posed a substantially higher risk for incident CVD, all-cause and CVD mortality, and cardiac dysfunction than other patterns. Persistent social isolation and loneliness, along with an increasing cumulative score, are associated with lower cardiac function.

It is widely accepted that loneliness is associated with health problems, but less is known about the predictors of loneliness. In this study, we constructed a model to predict individual risk of loneliness during adulthood. Data were from the prospective population-based FinHealth cohort study with 3444 participants (mean age 55.5 years, 53.4% women) who responded to a 81-item self-administered questionnaire and reported not to be lonely at baseline in 2017. The outcome was self-reported loneliness at follow-up in 2020. Predictive models were constructed using bootstrap enhanced LASSO regression (bolasso). The C-index from the final model including 11 predictors from the best bolasso -models varied between 0.65 (95% CI 0.61 to 0.70) and 0.71 (95% CI 0.67 to 0.75) the pooled C -index being 0.68 (95% CI 0.61 to 0.75). Although survey-based individualised prediction models for loneliness achieved a reasonable C-index, their predictive value was limited. High detection rates were associated with high false positive rates, while lower false positive rates were associated with low detection rates. These findings suggest that incident loneliness during adulthood. may be difficult to predict with standard survey data.

Cardiovascular disease (CVD) is a major health concern for middle-aged and older adults, with lifestyle and metabolic risk factors well-studied. However, the role of psychosocial factors in CVD remains underexplored.

This study aims to delve into the connection between psychosocial factors and the occurrence of CVD.

We utilized data from the UK Biobank, a large-scale study covering adults aged 38 to 73 recruited from various centers across the UK between 2006 and 2010. We employed Cox proportional hazards models to analyze the relationship between social isolation, loneliness, and incident CVD. CVD diagnoses were confirmed through hospital records and death-register data. Additionally, we conducted mediation analyses to assess the impact of low-grade inflammation.

The study encompassed 427,942 participants free from CVD, 55.8% of whom are women. High levels of social isolation and loneliness were linked to a higher risk of CVD (HRs 1.11, 95% CI 1.06-1.16; HRs 1.17, 95% CI 1.11-1.23). Depression also emerged as a predictor of CVD onset (HRs 1.25, 95% CI 1.19-1.31), with each psychosocial factor independently contributing to increased CVD risk. Mediation analyses pinpointed inflammation as a crucial mediator, especially for loneliness (indirect effect proportion: 4.7%).

This study underscores the significance of psychosocial factors in relation to CVD. Integrating assessments for social isolation, loneliness, and depression into routine healthcare could potentially aid in CVD prevention among middle-aged and elderly individuals. This study underscores the significance of psychosocial factors in relation to CVD, emphasizing the association between social isolation or loneliness and the heightened risk of CVD.

Loneliness and social isolation have been found to be associated with various health-related outcomes. Our study aimed to evaluate the association of loneliness and social isolation with the risk of glaucoma.

A total of 373,330 participants from the UK Biobank without glaucoma at recruitment were included in this study. Self-reported questionnaires were used to define loneliness and social isolation. Incident glaucoma events were identified by hospital inpatient admissions and self-reported data. COX proportional hazards models adjusted for sociodemographic, lifestyle, and health-related factors were used to estimate hazard ratios (HRs) and 95% CIs.

During a median follow-up of 13.1 (interquartile range: 12.3-13.9) years, 6,489 participants developed glaucoma. After adjusting for confounding factors, loneliness (yes vs. no: adjusted HR: 1.16; 95% CI: 1.04-1.30; P = 0.009) and social isolation (yes vs. no: adjusted HR: 1.08; 95% CI: 1.01-1.16; P = 0.033) were associated with an increased risk of glaucoma.

In this population-based prospective cohort study, loneliness and social isolation were associated with a higher risk of glaucoma.

This review addresses key findings on loneliness from the social, neurobiological and clinical fields. From a translational perspective, results from studies in humans and animals are included, with a focus on social interaction, mental and physical illness and the role of oxytocin in loneliness. In terms of social interactions, lonely individuals tend to exhibit a range of abnormal behaviors based on dysfunctional social cognitions that make it difficult for them to form meaningful relationships. Neurobiologically, a link has been established between loneliness and the hypothalamic peptide hormone oxytocin. Since social interactions and especially social touch regulate oxytocin signaling, lonely individuals may have an oxytocin imbalance, which in turn affects their health and well-being. Clinically, loneliness is a predictor of physical and mental illness and leads to increased morbidity and mortality. There is evidence that psychopathology is both a cause and a consequence of loneliness. The final section of this review summarizes the findings from social, neurobiological and clinical perspectives to present a new model of the complex construct of loneliness.

The relationship of ozone (O3), particularly the long-term exposure, with impacting metabolic homeostasis in population was understudied and under-recognised. Here, we used data from ChinaHEART, a nationwide, population-based cohort study, combined with O3 and PM2.5 concentration data with high spatiotemporal resolution, to explore the independent association of exposure to O3 with the prevalence of insulin resistance (IR). Among the 271 540 participants included, the crude prevalence of IR was 39.1%, while the age and sex standardized prevalence stood at 33.0%. Higher IR prevalence was observed with each increase of 10.0 μg/m3 in long-term O3 exposure, yielding adjusted odds ratios (OR) of 1.084 (95% CI: 1.079-1.089) in the one-pollutant model and 1.073 (95% CI: 1.067-1.079) in the two-pollutant model. Notably, a significant additive interaction between O3 and PM2.5 on the prevalence of IR was observed (P for additive interaction < 0.001). Our main findings remained consistent and robust in the sensitivity analyses. Our study suggests long-term exposure to O3 was independently and positively associated with prevalence of IR. It emphasized the benefits of policy interventions to reduce O3 and PM2.5 exposure jointly, which could ultimately alleviate the health and economic burden related to DM.

Artificial sweeteners are widely popular worldwide as substitutes for sugar or caloric sweeteners, but there are still several important unknowns and controversies regarding their associations with cardiovascular disease (CVD). We aimed to extensively assess the association and subgroup variability between artificial sweeteners and CVD and CVD mortality in the UK Biobank cohort, and further investigate the modification effects of genetic susceptibility and the mediation role of type 2 diabetes mellitus (T2DM).

This study included 133,285 participants in the UK Biobank who were free of CVD and diabetes at recruitment. Artificial sweetener intake was obtained from repeated 24-hour diet recalls. Cox proportional hazard models were used to estimate HRs. Genetic predisposition was estimated using the polygenic risk score (PRS). Furthermore, time-dependent mediation was performed.

In our study, artificial sweetener intake (each teaspoon increase) was significantly associated with an increased risk of incident overall CVD (HR1.012, 95%CI: 1.008,1.017), coronary artery disease (CAD) (HR: 1.018, 95%CI: 1.001,1.035), peripheral arterial disease (PAD) (HR: 1.035, 95%CI: 1.010,1.061), and marginally significantly associated with heart failure (HF) risk (HR: 1.018, 95%CI: 0.999,1.038). In stratified analyses, non-whites were at greater risk of incident overall CVD from artificial sweetener. People with no obesity (BMI < 30 kg/m2) also tended to be at greater risk of incident CVD from artificial sweetener, although the obesity interaction is not significant. Meanwhile, the CVD risk associated with artificial sweeteners is independent of genetic susceptibility, and no significant interaction exists between genetic susceptibility and artificial sweeteners in terms of either additive or multiplicative effects. Furthermore, our study revealed that the relationship between artificial sweetener intake and overall CVD is significantly mediated, in large part, by prior T2DM (proportion of indirect effect: 70.0%). In specific CVD subtypes (CAD, PAD, and HF), the proportion of indirect effects ranges from 68.2 to 79.9%.

Our findings suggest significant or marginally significant associations between artificial sweeteners and CVD and its subtypes (CAD, PAD, and HF). The associations are independent of genetic predisposition and are mediated primarily by T2DM. Therefore, the large-scale application of artificial sweeteners should be prudent, and the responses of individuals with different characteristics to artificial sweeteners should be better characterized to guide consumers' artificial sweeteners consumption behavior.

Individuals with diabetes have a significantly higher risk of developing chronic kidney disease (CKD) and higher levels of social isolation and loneliness compared with those without diabetes. Recently, the American Heart Association highlighted the importance of considering social determinants of health (SDOH) in conjunction with traditional risk factors in patients with diabetes.

To investigate the associations of loneliness and social isolation with incident CKD risk in patients with diabetes in the UK Biobank.

A total of 18 972 patients with diabetes were included in this prospective study. Loneliness and Social Isolation Scales were created based on self-reported factors. An adjusted Cox proportional hazard model was used to investigate the associations of loneliness and social isolation with CKD risk among patients with diabetes. The relative importance in predicting CKD was also calculated alongside traditional risk factors.

During a median follow-up of 10.8 years, 1127 incident CKD cases were reported. A higher loneliness scale, but not social isolation, was significantly associated with a 25% higher risk of CKD, independent of traditional risk factors, among patients with diabetes. Among the individual loneliness factors, the sense of feeling lonely emerged as the primary contributing factor to the elevated risk of CKD. Compared with individuals not experiencing feelings of loneliness, those who felt lonely exhibited a 22% increased likelihood of developing CKD. In addition, feeling lonely demonstrated greater relative importance of predicting CKD compared with traditional risk factors such as body mass index, smoking, physical activity and diet.

This study indicates the significant relationship between loneliness and CKD risk among patients with diabetes, highlighting the need to address SDOH in preventing CKD in this population.

The nationwide study German Health Update (GEDA) 2021/2022-Diabetes was conducted to assess the current healthcare and health situation of adults with diabetes in Germany.

GEDA 2021/2022-Diabetes comprises a sample of adults with diagnosed diabetes from the general population. The analysis focuses on adults aged 45 years and over with type 2 diabetes (N = 1,448) and provides selected indicators on diabetes care as well as mental, social and general health.

87.5 % of participants aged 45 years and over with type 2 diabetes are treated with blood glucose-lowering medication. 36.5 % receive insulin alone or in combination with other antidiabetics; 0.7 % use an insulin pump. Almost 96 % had an HbA1c measurement in the last year and about two thirds each report annual foot and eye examinations, participation in a diabetes self-management education programme and self-monitoring of their feet and of blood glucose (12.0 % with continuous glucose monitoring). On average, the quality of diabetes care is perceived as moderate. 23.8 % rate their mental health as excellent/very good. More than a tenth each have anxiety or depressive symptoms and feelings of loneliness. Half rate their general health as very good/good.

There is a potential for improvement in the quality of diabetes care and the mental and physical health of adults with type 2 diabetes.