{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:44:46Z","timestamp":1761896686371,"version":"build-2065373602"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Abnormal bowel health, including constipation and diarrhea, is common in the general population. The American Heart Association recently introduced Life\u2019s Essential 8 (LE8) as a framework for assessing cardiovascular health (CVH). Building on this, Life\u2019s Crucial 9 (LC9) was developed by adding psychological health as a ninth component, providing a more holistic measure of overall health. Our objective was to investigate whether LC9 is linked to bowel health. To our knowledge, this is the first study to examine the association between LC9 and bowel health outcomes using nationally representative data, with validation in an independent hospital-based cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional analysis included 12,817 adults from Nutrition Examination Survey (NHANES) 2005\u20132010, and validation was conducted in an external hospital-based cohort of 991 patients. The primary exposure was the LC9 score, and the primary outcomes were constipation and diarrhea. The primary analysis used weighted multivariable logistic regression to assess the associations of LC9 scores with bowel outcomes. Restricted cubic splines (RCS) were applied to evaluate potential non-linear relationships. Sensitivity and stratified analyses were performed to test the stability of the results. Internal validation was conducted within the U.S. NHANES cohort, and external validation was performed using a hospital-based cohort from our center to confirm robustness and generalizability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After adjusting for potential confounders, higher LC9 scores were significantly associated with a lower risk of both constipation [adjusted odds ratio (AOR)\u2009=\u20090.90,\n                      <jats:italic>p<\/jats:italic>\n                      =\u20090.001] and diarrhea (AOR\u2009=\u20090.82,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u20090.001). Compared to participants in the lowest tertile, those in the highest LC9 tertile showed a reduced risk of constipation (AOR\u2009=\u20090.70,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u20090.001) and diarrhea (AOR\u2009=\u20090.54,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u20090.001). RCS analysis demonstrated a linear dose\u2013response relationship between LC9 and bowel health outcomes. Stratified analyses confirmed consistent associations across most subgroups, with no significant interactions except for race in the LC9-diarrhea relationship. Sensitivity analyses using unweighted logistic models yielded similar results. Validation analyses confirmed consistent performance, with good discrimination, calibration, and net clinical benefit across cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A negative linear association was found between LC9 and both constipation and diarrhea in US adults. Future longitudinal cohort studies are needed to assess the association between LC9 and bowel health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1687499","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T06:25:14Z","timestamp":1761891914000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between Life\u2019s Crucial 9 and bowel health among US adults: a cross-sectional analysis of NHANES 2005\u20132010 with external validation"],"prefix":"10.3389","volume":"12","author":[{"given":"Xueman","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Lian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xintong","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.1016\/s0140-6736(20)32115-2","article-title":"Functional gastrointestinal disorders: advances in understanding and management","volume":"396","author":"Black","year":"2020","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.bpg.2010.12.010","article-title":"Epidemiology of constipation in children and adults: a systematic review","volume":"25","author":"Mugie","year":"2011","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1038\/ajg.2011.164","article-title":"Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis","volume":"106","author":"Suares","year":"2011","journal-title":"Am J Gastroenterol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1053\/j.gastro.2012.10.029","article-title":"American gastroenterological association medical position statement on constipation","volume":"144","author":"Bharucha","year":"2013","journal-title":"Gastroenterology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1111\/j.0269-2813.2004.01807.x","article-title":"Impact of functional gastrointestinal disorders on health-related quality of life: a population-based case-control study","volume":"19","author":"Halder","year":"2004","journal-title":"Aliment Pharmacol Ther"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1053\/j.gastro.2020.09.041","article-title":"Epidemiologic burden and treatment of chronic symptomatic functional bowel disorders in the United States: a nationwide analysis","volume":"160","author":"Ma","year":"2021","journal-title":"Gastroenterology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1038\/s41395-018-0256-8","article-title":"Burden of gastrointestinal symptoms in the United States: results of a nationally representative survey of over 71,000 Americans","volume":"113","author":"Almario","year":"2018","journal-title":"Am J Gastroenterol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"10943","DOI":"10.1038\/s41598-023-38068-y","article-title":"Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients","volume":"13","author":"Judkins","year":"2023","journal-title":"Sci Rep"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e14493","DOI":"10.1111\/nmo.14493","article-title":"Psychiatric comorbidities among adult patients with disorders of gut-brain interaction: prevalence and relationships to treatment outcomes","volume":"35","author":"Madva","year":"2023","journal-title":"Neurogastroenterol Motil"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1053\/j.gastro.2023.03.214","article-title":"American Gastroenterological Association-American College of Gastroenterology clinical practice guideline: pharmacological management of chronic idiopathic constipation","volume":"164","author":"Chang","year":"2023","journal-title":"Gastroenterology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1002\/ueg2.12259","article-title":"Functional bowel disorders with diarrhoea: clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility","volume":"10","author":"Savarino","year":"2022","journal-title":"United European Gastroenterol J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1038\/s41569-018-0108-7","article-title":"Dietary metabolism, the gut microbiome, and heart failure","volume":"16","author":"Tang","year":"2019","journal-title":"Nat Rev Cardiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2013","DOI":"10.3390\/microorganisms9102013","article-title":"Cardiovascular health and the intestinal microbial ecosystem: the impact of cardiovascular therapies on the gut microbiota","volume":"9","author":"Alhajri","year":"2021","journal-title":"Microorganisms"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"427","DOI":"10.3892\/etm.2024.12716","article-title":"Gut microbiota: implications in pathogenesis and therapy to cardiovascular disease (review)","volume":"28","author":"Lin","year":"2024","journal-title":"Exp Ther Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"G122","DOI":"10.1152\/ajpgi.00016.2025","article-title":"Gut-heart axis: cardiac remodeling and heart failure in the context of inflammatory bowel disease and dysbiosis","volume":"329","author":"Kochkarian","year":"2025","journal-title":"Am J Physiol Gastrointest Liver Physiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1016\/j.jacc.2021.12.017","article-title":"Inflammation, aging, and cardiovascular disease: JACC review topic of the week","volume":"79","author":"Liberale","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1963","DOI":"10.3748\/wjg.v30.i14.1963","article-title":"Bowel function and inflammation: is motility the other side of the coin?","volume":"30","author":"Panarese","year":"2024","journal-title":"World J Gastroenterol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"4264","DOI":"10.3390\/ijms26094264","article-title":"Gut microbiota and cardiovascular diseases: unraveling the role of dysbiosis and microbial metabolites","volume":"26","author":"Muttiah","year":"2025","journal-title":"Int J Mol Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e83084","DOI":"10.7759\/cureus.83084","article-title":"Gut microbiota dysbiosis and its role in the development of irritable bowel syndrome","volume":"17","author":"Saleem","year":"2025","journal-title":"Cureus"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/19490976.2021.1897212","article-title":"The role of short-chain fatty acids in the interplay between gut microbiota and diet in cardio-metabolic health","volume":"13","author":"Nogal","year":"2021","journal-title":"Gut Microbes"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.1161\/cir.0000000000001078","article-title":"Life\u2019s Essential 8: updating and enhancing the American Heart Association\u2019s construct of cardiovascular health: a presidential advisory from the American Heart Association","volume":"146","author":"Lloyd-Jones","year":"2022","journal-title":"Circulation"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1161\/circulationaha.123.066132","article-title":"Strengthening the pillars of cardiovascular health: psychological health is a crucial component","volume":"149","author":"Gaffey","year":"2024","journal-title":"Circulation"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2696","DOI":"10.1016\/j.cgh.2019.03.046","article-title":"Chronic diarrhea and constipation are more common in depressed individuals","volume":"17","author":"Ballou","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1080\/19490976.2016.1218585","article-title":"Irritable bowel syndrome, the microbiota and the gut-brain axis","volume":"7","author":"Raskov","year":"2016","journal-title":"Gut Microbes"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3945\/an.115.009258","article-title":"Update on NHANES dietary data: focus on collection, release, analytical considerations, and uses to inform public policy","volume":"7","author":"Ahluwalia","year":"2016","journal-title":"Adv Nutr"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.ynstr.2017.03.001","article-title":"Stress & the gut-brain axis: regulation by the microbiome","volume":"7","author":"Foster","year":"2017","journal-title":"Neurobiol Stress"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1016\/j.jand.2018.05.021","article-title":"Update of the Healthy Eating Index: HEI-2015","volume":"118","author":"Krebs-Smith","year":"2018","journal-title":"J Acad Nutr Diet"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"920","DOI":"10.3109\/00365529709011203","article-title":"Stool form scale as a useful guide to intestinal transit time","volume":"32","author":"Lewis","year":"1997","journal-title":"Scand J Gastroenterol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1473531","DOI":"10.3389\/fnut.2024.1473531","article-title":"Association between ideal cardiovascular health and bowel conditions among US adults","volume":"11","author":"Wang","year":"2024","journal-title":"Front Nutr"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"11819","DOI":"10.1038\/s41598-024-62715-7","article-title":"Exploring the association between cardiovascular health and bowel health","volume":"14","author":"Yu","year":"2024","journal-title":"Sci Rep"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e00801","DOI":"10.14309\/ctg.0000000000000801","article-title":"The associations between Life\u2019s Essential 8 and diarrhea and constipation: results from the 2005\u20132010 National Health and Nutrition Examination Survey","volume":"16","author":"Yang","year":"2025","journal-title":"Clin Transl Gastroenterol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"5013","DOI":"10.3390\/nu14235013","article-title":"Association between depression, anxiety symptoms and gut microbiota in Chinese elderly with functional constipation","volume":"14","author":"Liang","year":"2022","journal-title":"Nutrients"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1038\/s41579-024-01068-4","article-title":"The interplay between diet and the gut microbiome: implications for health and disease","volume":"22","author":"Ross","year":"2024","journal-title":"Nat Rev Microbiol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1016\/j.chom.2018.05.012","article-title":"The impact of dietary fiber on gut microbiota in host health and disease","volume":"23","author":"Makki","year":"2018","journal-title":"Cell Host Microbe"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"04197","DOI":"10.7189\/jogh.14.04197","article-title":"Physical activity and constipation: a systematic review of cohort studies","volume":"14","author":"Cui","year":"2024","journal-title":"J Glob Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"64","DOI":"10.5056\/jnm.2012.18.1.64","article-title":"Colon transit time according to physical activity level in adults","volume":"18","author":"Song","year":"2012","journal-title":"J Neurogastroenterol Motil"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1097\/MCO.0b013e32832e6776","article-title":"The impact of physical exercise on the gastrointestinal tract","volume":"12","author":"De Oliveira","year":"2009","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"2657","DOI":"10.3390\/nu16162657","article-title":"Effects of physical exercise on the microbiota in irritable bowel syndrome","volume":"16","author":"Li","year":"2024","journal-title":"Nutrients"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.1111\/apt.15774","article-title":"Review article: impact of cigarette smoking on intestinal inflammation-direct and indirect mechanisms","volume":"51","author":"Papoutsopoulou","year":"2020","journal-title":"Aliment Pharmacol Ther"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1017\/gmb.2024.3","article-title":"Impact of cigarette smoking on gut microbial dysbiosis: a structured literature review","volume":"5","author":"Imade","year":"2024","journal-title":"Gut Microbiome"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s00203-018-1506-2","article-title":"Smoking and the intestinal microbiome","volume":"200","author":"Savin","year":"2018","journal-title":"Arch Microbiol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"101691","DOI":"10.1016\/j.smrv.2022.101691","article-title":"The microbiota-gut-brain axis in sleep disorders","volume":"65","author":"Wang","year":"2022","journal-title":"Sleep Med Rev"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"9603","DOI":"10.3390\/ijms24119603","article-title":"Sleep deprivation and gut microbiota dysbiosis: current understandings and implications","volume":"24","author":"Sun","year":"2023","journal-title":"Int J Mol Sci"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"35405","DOI":"10.1038\/srep35405","article-title":"Chronic sleep disruption alters gut microbiota, induces systemic and adipose tissue inflammation and insulin resistance in mice","volume":"6","author":"Poroyko","year":"2016","journal-title":"Sci Rep"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"3254","DOI":"10.3390\/jcm13113254","article-title":"Gut microbiota dysbiosis and sleep disorders: culprit in cardiovascular diseases","volume":"13","author":"Pala","year":"2024","journal-title":"J Clin Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"3691","DOI":"10.2147\/dmso.S432344","article-title":"The characteristics, mechanisms and therapeutics: exploring the role of gut microbiota in obesity","volume":"16","author":"Zhuang","year":"2023","journal-title":"Diabetes Metab Syndr Obes"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"497","DOI":"10.4183\/aeb.2019.497","article-title":"Gastrointestinal motility disorders in obesity","volume":"15","author":"Miron","year":"2019","journal-title":"Acta Endocrinol"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"563","DOI":"10.4251\/wjgo.v8.i7.563","article-title":"Undernutrition, risk of malnutrition and obesity in gastroenterological patients: a multicenter study","volume":"8","author":"Rizzi","year":"2016","journal-title":"World J Gastrointest Oncol"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"80","DOI":"10.4239\/wjd.v3.i5.80","article-title":"Diabetes-related alterations in the enteric nervous system and its microenvironment","volume":"3","author":"Bagy\u00e1nszki","year":"2012","journal-title":"World J Diabetes"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2018\/3827301","article-title":"Diabetic enteropathy: from molecule to mechanism-based treatment","volume":"2018","author":"Meldgaard","year":"2018","journal-title":"J Diabetes Res"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.4254\/wjh.v13.i12.2052","article-title":"Gut dysbiosis and systemic inflammation promote cardiomyocyte abnormalities in an experimental model of steatohepatitis","volume":"13","author":"Longo","year":"2021","journal-title":"World J Hepatol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1333145","DOI":"10.3389\/fcimb.2024.1333145","article-title":"Structural and functional alteration of the gut microbiota in elderly patients with hyperlipidemia","volume":"14","author":"Xia","year":"2024","journal-title":"Front Cell Infect Microbiol"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1161\/circresaha.116.309006","article-title":"Hypertension-linked pathophysiological alterations in the gut","volume":"120","author":"Santisteban","year":"2017","journal-title":"Circ Res"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"543698","DOI":"10.3389\/fmed.2020.543698","article-title":"Risk factors for intestinal barrier impairment in patients with essential hypertension","volume":"7","author":"Li","year":"2020","journal-title":"Front Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1687499\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T06:25:18Z","timestamp":1761891918000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1687499\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":54,"alternative-id":["10.3389\/fmed.2025.1687499"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1687499","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]},"article-number":"1687499"}}