Liu Jianping, Song Yuanying, Luo Rong, Wang Sufang, Pan Pinglei, Han Lijian
Department of Neurology, Yancheng Third People's Hospital (The Sixth Affiliated Hospital of Nantong University, The Yancheng School of Clinical Medicine of Nanjing Medical University, The Affiliated Hospital of Jiangsu Vocational College of Medicine), Yancheng, Jiangsu, China.
Department of Central Laboratory, The Yancheng School of Clinical Medicine of Nanjing Medical University (Yancheng Third People's Hospital), Yancheng, Jiangsu, China.
Front Nutr. 2025 Jun 25;12:1613721. doi: 10.3389/fnut.2025.1613721. eCollection 2025.
Cardiovascular-kidney-metabolic (CKM) syndrome is a multistage disorder with significant global health and socioeconomic impact. Environmental factors are increasingly recognized as key risk factors in disease development. This study aims to assess the relationship between urinary heavy metals and CKM risk, as well as the mediating roles of triglyceride-glucose index (TyG), weight-adjusted waist index (WWI), and estimated glomerular filtration rate (eGFR).
This cross-sectional analysis uses data from the National Health and Nutrition Examination Survey (NHANES). CKM stages 0-2 are classified as non-advanced, and stages 3-4 as advanced. Multivariable logistic regression, restricted cubic splines (RCS), weighted quantile sum (WQS) regression, quantile-based g-computation (Qgcomp) regression, and Bayesian kernel machine regression (BKMR) were applied to explore associations between metal exposure and advanced CKM. Mediation analysis examined the roles of TyG, WWI, and eGFR in heavy metal-induced advanced CKM.
Among 5,221 participants, 4,340 were non-advanced and 881 had advanced CKM. Both individual and mixed heavy metal exposures were positively linked to advanced CKM risk. Cobalt (Co) was identified as a primary contributor. TyG, WWI, and eGFR partially mediate the relationship between heavy metal exposure and advanced CKM prevalence.
Heavy metal exposure is associated with increased CKM risk. TyG, WWI, and eGFR were found to partially mediate the association between heavy metal exposure and advanced CKM prevalence, suggesting potential pathways linking environmental exposures to CKM risk.
心血管-肾脏-代谢（CKM）综合征是一种具有重大全球健康和社会经济影响的多阶段疾病。环境因素日益被认为是疾病发展的关键风险因素。本研究旨在评估尿重金属与CKM风险之间的关系，以及甘油三酯-葡萄糖指数（TyG）、体重调整腰围指数（WWI）和估计肾小球滤过率（eGFR）的中介作用。
本横断面分析使用了美国国家健康与营养检查调查（NHANES）的数据。CKM 0-2期被归类为非晚期，3-4期为晚期。应用多变量逻辑回归、受限立方样条（RCS）、加权分位数和（WQS）回归、基于分位数的g计算（Qgcomp）回归和贝叶斯核机器回归（BKMR）来探讨金属暴露与晚期CKM之间的关联。中介分析考察了TyG、WWI和eGFR在重金属诱导的晚期CKM中的作用。
在5221名参与者中，4340名处于非晚期，881名患有晚期CKM。个体和混合重金属暴露均与晚期CKM风险呈正相关。钴（Co）被确定为主要贡献因素。TyG、WWI和eGFR部分介导了重金属暴露与晚期CKM患病率之间的关系。
重金属暴露与CKM风险增加有关。发现TyG、WWI和eGFR部分介导了重金属暴露与晚期CKM患病率之间的关联，提示了将环境暴露与CKM风险联系起来的潜在途径。
