Association between exposure to a mixture of organochlorine pesticides and hyperuricemia in U.S. adults: A comparison of four statistical models.

The association between the exposure of organochlorine pesticides (OCPs) and serum uric acid (UA) levels remained uncertain. In this study, to investigate the combined effects of OCP mixtures on hyperuricemia, we analyzed serum OCPs and UA levels in adults from the National Health and Nutrition Examination Survey (2005-2016). Four statistical models including weighted logistic regression, weighted quantile sum (WQS), quantile g-computation (QGC), and bayesian kernel machine regression (BKMR) were used to assess the relationship between mixed chemical exposures and hyperuricemia. Subgroup analyses were conducted to explore potential modifiers. Among 6,529 participants, the prevalence of hyperuricemia was 21.15%. Logistic regression revealed a significant association between both hexachlorobenzene (HCB) and trans-nonachlor and hyperuricemia in the fifth quintile (OR: 1.54, 95% CI: 1.08-2.19; OR: 1.58, 95% CI: 1.05-2.39, respectively), utilizing the first quintile as a reference. WQS and QGC analyses showed significant overall effects of OCPs on hyperuricemia, with an OR of 1.25 (95% CI: 1.09-1.44) and 1.20 (95% CI: 1.06-1.37), respectively. BKMR indicated a positive trend between mixed OCPs and hyperuricemia, with HCB having the largest weight in all three mixture analyses. Subgroup analyses revealed that females, individuals aged 50 years and above, and those with a low income were more vulnerable to mixed OCP exposure. These results highlight the urgent need to protect vulnerable populations from OCPs and to properly evaluate the health effects of multiple exposures on hyperuricemia using mutual validation approaches.

A naturally isolated symbiotic bacterium suppresses flavivirus transmission by Aedes mosquitoes.

The commensal microbiota of the mosquito gut plays a complex role in determining the vector competence for arboviruses. In this study, we identified a bacterium from the gut of field Aedes albopictus mosquitoes named Rosenbergiella sp. YN46 (Rosenbergiella_YN46) that rendered mosquitoes refractory to infection with dengue and Zika viruses. Inoculation of 1.6 × 103 colony forming units (CFUs) of Rosenbergiella_YN46 into A. albopictus mosquitoes effectively prevents viral infection. Mechanistically, this bacterium secretes glucose dehydrogenase (RyGDH), which acidifies the gut lumen of fed mosquitoes, causing irreversible conformational changes in the flavivirus envelope protein that prevent viral entry into cells. In semifield conditions, Rosenbergiella_YN46 exhibits effective transstadial transmission in field mosquitoes, which blocks transmission of dengue virus by newly emerged adult mosquitoes. The prevalence of Rosenbergiella_YN46 is greater in mosquitoes from low-dengue areas (52.9 to ~91.7%) than in those from dengue-endemic regions (0 to ~6.7%). Rosenbergiella_YN46 may offer an effective and safe lead for flavivirus biocontrol.

A mosquito salivary protein-driven influx of myeloid cells facilitates flavivirus transmission.

Mosquitoes transmit many disease-relevant flaviviruses. Efficient viral transmission to mammalian hosts requires mosquito salivary factors. However, the specific salivary components facilitating viral transmission and their mechanisms of action remain largely unknown. Here, we show that a female mosquito salivary gland-specific protein, here named A. aegypti Neutrophil Recruitment Protein (AaNRP), facilitates the transmission of Zika and dengue viruses. AaNRP promotes a rapid influx of neutrophils, followed by virus-susceptible myeloid cells toward mosquito bite sites, which facilitates establishment of local infection and systemic dissemination. Mechanistically, AaNRP engages TLR1 and TLR4 of skin-resident macrophages and activates MyD88-dependent NF-κB signaling to induce the expression of neutrophil chemoattractants. Inhibition of MyD88-NF-κB signaling with the dietary phytochemical resveratrol reduces AaNRP-mediated enhancement of flavivirus transmission by mosquitoes. These findings exemplify how salivary components can aid viral transmission, and suggest a potential prophylactic target.

Advances in research on arboviral acquisition from hosts to mosquitoes.

Arboviral acquisition is a critical step in virus transmission. In this review, we present an overview of the interactions between viruses and host blood-derived factors, highlighting the diverse ways in which they interact. Moreover, the review outlines the impact of host blood on gut barriers during viral acquisition, emphasizing the crucial role of this physiological process in virus dissemination. Additionally, the review investigates the responses of symbioses to invading arboviruses, providing insights into the dynamic reactions of these vital relationships to the presence of arboviruses.

The burden of chronic kidney disease associated with dietary exposure to cadmium in China, 2020.

Cadmium (Cd) exposure increases the risk of chronic kidney disease (CKD). But the contribution of dietary Cd intake, the primary exposure route of Cd in humans, to the CKD burden remains to be evaluated in China. Concentrations of Cd in foods and population glomerular filtration rate (GFR) were retrieved from studies published between January 2000 and February 2023 in China. Daily food consumption in adults aged ≥35 years old was obtained from two nationwide Chinese surveys. Dietary Cd intake and its contribution rate among total Cd exposure from diet, inhalation, smoking and water were evaluated. Urinary Cd (UCd) was estimated using the toxicokinetic (TK) model based on dietary Cd intake. The effect of Cd on kidney function has been quantified with the previously published dose-response relationship between UCd and GFR. The incidence and disability-adjusted life years (DALYs) of CKD attributable to dietary Cd intake were derived considering the contribution rate of dietary Cd intake at the national and provincial levels. The national average dietary Cd intake was 0.6891 µg/kg bw/day, contributing 63.69% of total Cd exposure. The Cd exposure through foods resulted in 2.34 (95% uncertainty interval, UI: 1.54-3.40) stage 4 CKD and 0.37 (95% UI: 0.20-0.59) stage 5 CKD cases per 100,000 persons/year in mainland China, 2020. The corresponding DALYs loss associated with stage 4 and stage 5 CKD due to dietary Cd intake were 5.14 (95% UI: 3.24-7.67) and 4.78 (95% UI: 2.32-8.30) per 100,000 persons/year, together accounting for 2% of total DALYs of CKD. Greater dietary Cd intake and corresponding burden of late-stage CKD were observed in Southern areas than in Northern areas. Diet remains the primary exposure to Cd in Chinese adults. Efforts to reduce dietary Cd exposure would positively impact public health, especially in Southern provinces with high Cd exposure.

Dietary Exposure to Glutamates of 2- to 5-Year-Old Toddlers in China Using the Duplicate Diet Method.

A duplicate diet collection method was used to estimate dietary exposure to glutamates in children aged 2-5 years in selected provinces of China. Daily duplicate diet samples were collected from 86 healthy toddlers over three consecutive days. Glutamates were analyzed using ultra-high-pressure liquid chromatography-MS/MS (UHPLC-MS/MS). Results showed that the highest glutamates content was found in mixed meals, at 5.12 mg/kg, followed by powdered formula (3.89 mg/kg), and milk and dairy products (2.29 mg/kg). The total mean daily dietary exposure for subjects was 0.20 mg/kg BW, and P95 daily dietary exposure was 0.44 mg/kg BW, both below the acceptable daily intake (ADI) (120 mg/kg BW) recommended by the Joint (FAO/WHO) Expert Committee on Food Additives (JECFA) and the ADI (30 mg/kg BW) set by the European Food Safety Authority (EFSA). Hence it can be considered that glutamates exposure would cause low risk in this group.

Insulin-like growth factor 2 hypermethylation in peripheral blood leukocytes and colorectal cancer risk and prognosis: a propensity score analysis.

Background: To comprehensively assess and validate the associations between insulin-like growth factor 2 (IGF2) gene methylation in peripheral blood leukocytes (PBLs) and colorectal cancer (CRC) risk and prognosis. Methods: The association between IGF2 methylation in PBLs and CRC risk was initially evaluated in a case-control study and then validated in a nested case-control study and a twins' case-control study, respectively. Meanwhile, an initial CRC patient cohort was used to assess the effect of IGF2 methylation on CRC prognosis and then the finding was validated in the EPIC-Italy CRC cohort and TCGA datasets. A propensity score (PS) analysis was performed to control for confounders, and extensive sensitivity analyses were performed to assess the robustness of our findings. Results: PBL IGF2 hypermethylation was associated with an increased risk of CRC in the initial study (ORPS-adjusted, 2.57, 95% CI: 1.65 to 4.03, P<0.0001), and this association was validated using two independent external datasets (ORPS-adjusted, 2.21, 95% CI: 1.28 to 3.81, P=0.0042 and ORPS-adjusted, 10.65, 95% CI: 1.26 to 89.71, P=0.0295, respectively). CRC patients with IGF2 hypermethylation in PBLs had significantly improved overall survival compared to those patients with IGF2 hypomethylation (HRPS-adjusted, 0.47, 95% CI: 0.29 to 0.76, P=0.0019). The prognostic signature was also observed in the EPIC-Italy CRC cohort, although the HR did not reach statistical significance (HRPS-adjusted, 0.69, 95% CI: 0.37 to 1.27, P=0.2359). Conclusions: IGF2 hypermethylation may serve as a potential blood-based predictive biomarker for the identification of individuals at high risk of developing CRC and for CRC prognosis.

The burden of mild intellectual disability attributed to prenatal exposure to methylmercury in China, 2017.

Methylmercury (MeHg) is a neurodevelopmental toxicant that is widespread in the environment and food. Considering the presence of multiple sources of MeHg exposure in the environment, the burden attributable to different exposure sources needs to be determined. This study aimed to estimate the burden of mild intellectual disability (MID) caused by in-utero exposure to MeHg and identify the attributable burden related to MeHg exposure from different sources in China. We applied the hair mercury concentrations from studies to evaluate the burden of MID associated with maternal MeHg exposure and quantify it by disability-adjusted life years (DALYs). The DALYs attributable to MeHg exposure sources were calculated by combining the total DALYs and the contribution rates of various sources of MeHg exposure. The maternal MeHg exposure resulted in 6504 MID cases and a loss of 63,354 DALYs in China in 2017. The contribution rates of aquatic products and rice were 52.2% and 27.1%, respectively, leading to health losses of 28,115 and 18,011 DALYs. The burden of MeHg-induced MID associated with aquatic products was high in coastal areas. Several sites such as Zhejiang, Hunan, and Guangxi had high DALYs caused by rice MeHg exposure. Regions with high DALYs of MID related to MeHg exposure require more attention. Local governments should establish targeted measures to reduce MeHg exposure, thus preventing health loss.

Quantitative microbiological risk assessment of nontyphoidal Salmonella in ground pork in households in Chengdu, China.

Foodborne disease caused by nontyphoidal Salmonella (NTS) is one of the most important food safety issues worldwide. The objectives of this study were to carry out microbial monitoring on the prevalence of NTS in commercial ground pork, investigate consumption patterns, and conduct a quantitative microbiological risk assessment (QMRA) that considers cross-contamination to determine the risk caused by consuming ground pork and ready-to-eat food contaminated during food handling in the kitchen in Chengdu, China. The food pathway of ground pork was simplified and assumed to be several units according to the actual situation and our survey data, which were collected from our research or references and substituted into the QMRA model for simulation. The results showed that the prevalence of NTS in ground pork purchased in Chengdu was 69.64% (95% confidence interval [CI], 60.2-78.0), with a mean contamination level of -0.164 log CFU/g. After general cooking, NTS in ground pork could be eliminated (contamination level of zero). The estimated probability of causing salmonellosis per day was 9.43E-06 (95% CI: 8.82E-06-1.00E-05), while the estimated salmonellosis cases per million people per year were 3442 (95% CI: 3218-3666). According to the sensitivity analysis, the occurrence of cross-contamination was the most important factor affecting the probability of salmonellosis. To reduce the risk of salmonellosis caused by NTS through ground pork consumption, reasonable hygiene prevention and control measures should be adopted during food preparation to reduce cross-contamination. This study provides valuable information for household cooking and food safety management in China.

Dietary Exposure Assessment of Rare Earth Elements in the Chinese Population.

Rare earth elements (REEs) are widely found in foods. A high intake of REEs may have associations with adverse effects on human health. This study aimed to investigate the concentrations of REEs in foods in China and to assess the risk of dietary REEs exposure in the Chinese population. The mean concentrations of the total REEs in 27,457 food samples from 11 food categories ranged from 0.04 to 1.41 mg/kg. The daily mean dietary exposure of the total REEs was 1.62 µg/kg BW in the general Chinese population and ranged from 1.61 to 2.80 µg/kg BW in different sex-age groups. The high consumer exposure (95th percentile, P95) was 4.83 µg/kg BW, 9.38% of the temporary ADI (tADI) of REEs (51.5 µg/kg BW). None of the P95 exposure exceeded the tADI in all of the sub-groups. Lanthanum, cerium, and yttrium accounted for approximately 63% of the total exposure of the 16 REEs. The hazard index of 16 REEs was far below 1. Therefore, the health risk of dietary REEs exposure in the general Chinese population was low. No cumulative risk was found for the 16 REEs in China. The results indicate there was no need to stipulate the limits of REEs in foods.

[Exposure assessment of deoxynivalenol in wheat and its products among residents in different regions of China].

OBJECTIVE: To assess the exposure and health risks of deoxynivalenol(DON) ingested by wheat and its products by residents in China's northern and southern regions. METHODS: We collected DON content data in wheat and its products from various provinces and cities in China by searching the literature. The food consumption data came from the food consumption survey of Chinese residents in 2015. The point assessment method and the probability assessment method were used to evaluate the exposure of residents of various age groups in the southern and northern regions through wheat and its products. Then the acute reference dose(ARfD) 8 µg/(kg·BW) and provisional maximum tolerated daily intake(PMTDI) 1 µg/(kg·BW·d) of DON were used as a reference value to assess the acute and chronic health risks of DON exposure in each population. RESULTS: The mean content of DON in wheat and its products in the south was 578.51 µg/kg, and in the north was 214.98 µg/kg, both of which were lower than the limit value(1000 µg/kg). The result of point assessment showed that 99% of residents do not have acute poisoning risk when ingesting DON through wheat and its products. In the south, the DON exposure in all age groups was higher than PMTDI at the 90 th percentile consumption level of wheat and its products. In the north, the DON exposure in all age groups was higher than PMTDI at the 75 th percentile consumption level. The result of the probability assessment showed that in the south, the proportion of people with DON exposure exceeding PMTDI in the age groups ≤6 years old, 7-12 years old, 13-17 years old, and ≥18 years old was 13.57%, 10.75%, 9.68% and 9.48%, respectively. In the north, the proportion was 22.05%, 21.67%, 17.69% and 14.41%, respectively. The exposure of DON to wheat and its products and the proportion of people exceeding PMTDI in the northern area was significantly higher than that in the southern area(P<0.001). The exposure to DON and the proportion of people exceeding PMTDI of the low-age group(≤6 years old) was higher than that of the high-age group(P<0.001). CONCLUSION: Exposure to DON from wheat and its products among the high consumers in China was considerably high, with a certain chronic health risk, especially the low-age residents in northern areas, which should be paid attention to.

Burden of Coronary Heart Disease and Cancer from Dietary Exposure to Inorganic Arsenic in Adults in China, 2016.

Background and Objectives: Inorganic arsenic (iAs) can cause a wide range of health problems, including coronary heart disease (CHD) and lung, bladder, and skin cancer. Although dietary iAs intake is the primary source of iAs, the burden of CHD and cancers from dietary iAs exposure in Chinese adults has not been well known. Methods: To estimate the iAs exposure level in Chinese adults' diet, we systematically collected food-specific iAs concentrations in China from Chinese and English literature databases during 2000-2020. Food consumption was extracted from two nationwide food and nutrition surveys in China. The population attributable fraction was calculated based on the dose-response relationship between iAs and CHD risk. Combining the 2016 Chinese tumor registry data, we calculated the annual incidence of cancer from dietary iAs exposure to measure the disability-adjusted life year (DALY) in 2016. Findings: The total amount of daily foodborne iAs intake was 0.55 µg/kg bw/day among Chinese adults. The DALY of foodborne iAs-associated CHD was 3,017,510, which accounted for 10.18% of total CHD DALY in Chinese adults in 2016. Moreover, the carcinogenic DALY for lung cancer, bladder cancer, and skin cancer of Chinese residents in 2016 related to dietary iAs was 314.24, 9.89, and 167.32 thousand, accounting for 2.05%, 1.70%, and 35.5% of the total cancer burden, respectively. Conclusions: Our findings suggested that dietary iAs exposure causes a substantial disease burden in Chinese adults. More efforts for foodborne iAs control are critical to reducing the disease burden of CHD and cancer in China and other countries with similar dietary patterns.

Cancer risk and disease burden of dietary acrylamide exposure in China, 2016.

BACKGROUND: Acrylamide is widely found in food as a side-product of high-temperature heating of starch-rich food. It has attracted much attention because of its neurotoxicity and carcinogenicity. However, the cancer risk and disease burden of dietary acrylamide exposure have not been quantified in China. OBJECTIVE: To estimate the cancer risk and the disease burden attributable to dietary acrylamide exposure and quantify its health hazards. METHOD: We first performed an exposure assessment of acrylamide in food, based on which the incremental excess lifetime cancer risk (ELCR) was calculated for cancer risk assessment. The DisMod Ⅱ software and the DALY calculator in R were used to calculate the disease burden due to dietary acrylamide exposure. RESULTS: Average dietary acrylamide exposure in males was 0.1531 µg·kg-1·d-1 and that in females was 0.1554 µg·kg-1·d-1, resulting in an ELCR of 7.81 × 10-5 for males and 7.92 × 10-5 for females in China. The dietary acrylamide exposure resulted in about 23,688.09 DALYs of cancers among the Chinese population in 2016, including 1331.93 DALYs of breast cancer, 243.32 DALYs of endometrial cancer, 248.91 DALYs of ovarian cancer, and 176.28 DALYs of kidney cancer, respectively. CONCLUSION: The health hazards of dietary acrylamide exposure deserve attention. The burden of disease assessment could quantify the health hazards of food contaminants for prioritizing policies.

Risk assessment of rare earth elements in fruits and vegetables from mining areas in China.

Assessment of contaminated food through the dietary intake is essential for human health. To investigate the health risk of rare earth element (REE) exposure to fruits and vegetables in mining areas in China, we collected 288 fruit samples and 942 vegetable samples from four representative mining points (Bayan Obo in Inner Mongolia, Weishan in Shandong, Maoming in Guangdong, Longnan in Jiangxi) and their control areas. The content of REEs was determined by inductively coupled plasma-mass spectrometry (ICP-MS). The total REEs in fruits from mining and control areas were 12.90 µg kg-1 and 11.89 µg kg-1, and in vegetables were 92.90 µg kg-1 and 62.38 µg kg-1, and the difference was statistically significant in vegetables (P = 0.048). The drupes had more REE concentration in fruits (68.41 µg kg-1, 16.90 µg kg-1 in mining and control areas, respectively) (P < 0.01), and the leafy vegetables had more REE concentration in vegetables (245.81 µg kg-1, 123.51 µg kg-1 in mining and control areas, respectively) (P < 0.01). With the enrichment of light rare earth elements (LREE), the REE distribution patterns coincided in mining and control areas and different types of fruits and vegetables. The health risk assessment indicated that the estimated daily intakes (0.02-0.06 µg kg-1 day-1, 0.53-1.22 µg kg-1 day-1 for fruits and vegetables, respectively) were lower than the allowable daily intake value (60.4 µg kg-1 day-1). In mining areas, REEs obtained from fruits and vegetables were insufficient to cause health damage to human beings. However, sustained exposure to low REEs, especially for children, still needs attention.

The burden of coronary heart disease and stroke attributable to dietary cadmium exposure in Chinese adults, 2017.

Cadmium (Cd) is a metal with a long biological half-life that could cause health issues, such as coronary heart disease (CHD), stroke, and other cardiovascular diseases (CVD). Recent studies showed an ascending trend in the dietary Cd intake in the Chinese population. The contribution of dietary Cd intake to CHD and stroke burden, on the other hand, remains to be established. To calculate the disease burden for CHD and stroke attributable to dietary Cd, we estimated dietary Cd intake by associating the Cd concentration in food with consumption frequency. The toxicokinetic (TK) model and dietary Cd consumption were used to simulate urinary cadmium (U-Cd) concentrations. The population attributable fraction (PAF) can be derived for the computation of the attributable disease burden expressed as Disability-Adjusted Life Years (DALYs) in provinces, genders, and age groups by combining the relative risk (RR) with the population distribution of U-Cd. The mean of dietary Cd consumption and the geometric mean of U-Cd in the Chinese adult population are 0.684 µg/kg bw/day and 0.88 µg/g creatinine. The CHD burden attributable to dietary Cd was 3.26 million DALYs, with a 9.69% proportion of the total CHD burden. The DALYs for stroke attributable to Cd in food was approximately 3.64 million, accounting for 8.22% of the overall stroke burden. Furthermore, the attributable disease burden of CHD and stroke are higher in the south, women, and middle-aged and older adults. Our study suggested that foodborne Cd exposure contributes a considerable proportion of the CHD and stroke burden. More attention is needed to control Cd in food in order to reduce the burden of CHD and stroke in the Chinese population.

[Preliminary quantitative risk assessment of the effect of Salmonella on human health in retail fresh pork].

OBJECTIVE: A quantitative microbiological risk assessment was conducted for Salmonella spp. in fresh pork from retail stores to consumers in China in order to provide evidence for adopting effective risk management measures. METHODS: The national food safety and risk monitoring data was used to estimate the initial contamination level of Salmonella in the retail fresh pork. The growth model and the cross-contamination model of Salmonella were referenced from the ComBase data base and scientific literature, respectively. Then the human health risk was predicted by the consumption of Salmonella-contaminated fresh pork and the Beta-Poisson dose-response model. RESULTS: The number of Salmonellosis per year among 1 million residents due to fresh pork was estimated to be 4748.The sensitivity analysis showed that the risk of Salmonellosis was mainly and positively correlated with the preparation rate of ready to eat food, the consumption quantity of pork, the initial contamination level of Salmonella in fresh pork, and the proportion of improper cleaning of knives and chopping boards. When the contamination level of Salmonella in fresh pork is controlled below 1 CFU/g, the average probability of illness will be reduced by 59.39%; the average probability of illness will be reduced by 58.97% by increasing the ratio of complete cleaning of chopping boards or the separation ratio of chopping boards for raw and ready-to-eat food to 90%. CONCLUSION: The risk could be effectively reduced by controlling the concentration of Salmonella contamination in retail pork or improving hygiene practices.

Estimating the national burden of mild intellectual disability in children exposed to dietary lead in China.

The effects of lead as a dietary pollutant remain a global public health concern that needs urgent resolution. Children are highly susceptible to the adverse outcomes of lead pollution, as even low levels of lead may cause irreversible damage to intellectual development. Since several sources of lead exposure are present in the environment, it is necessary to identify the attributable burden of lead-related diseases arising from different exposure sources. In the present study, we used epidemiological data from studies around the nation to estimate the burden of mild intellectual disability (MID) attributed to lead exposure sources by using disability-adjusted life years (DALYs). To this end, a dose-response approach was used and a model comprising three components was established: exposure, dose-response, and DALYs module. In Chinese children aged 0-6 years, blood lead levels (BLLs) of 5.34 ± 3.09 µg/dL resulted in a MID incidence rate of 12.84 cases per 1000 children, with an estimated burden of disease (BoD) of 42.23 DALYs per 1000 children. Owing to dietary lead exposure, 36.64 healthy life years per 1000 children were lost, which was notably higher than the outcomes associated with exposure from other sources. This was consistent with the result that dietary exposure was the main contributor to children's lead exposure, accounting for 86.76%. According to the regional distribution based on the existing literature, the areas in China with higher BLLs were Heilongjiang, Shanxi, and Jiangxi. Our findings provided the information for lead risk management decisions and policies making.

Multiple gene-specific DNA methylation in blood leukocytes and colorectal cancer risk: a case-control study in China.

The relationship between gene-specific DNA methylation in peripheral blood leukocytes and colorectal cancer (CRC) susceptibility is unclear. In this case-control study, the methylation status of a panel of 10 CRC-related genes in 428 CRC cases and 428 cancer-free controls were detected with methylation-sensitive high-resolution melting analysis. We calculated a weighted methylation risk score (MRS) that comprehensively combined the methylation status of the panel of 10 genes and found that the MRS_10 was significantly associated with CRC risk. Compared with MRS-Low group, MRS-High group and MRS-Medium group exhibited a 6.51-fold (95% CI, 3.77-11.27) and 3.85-fold (95% CI, 2.72-5.45) increased risk of CRC, respectively. Moreover, the CRC risk increased with increasing MRS_10 (Ptrend < 0.0001). Stratified analyses demonstrated that the significant association retained in both men and women, younger and older, and normal weight or underweight and overweight or obese subjects. The area under the receiver operating characteristic curves for the MRS_10 model was 69.04% (95% CI, 65.57-72.66%) and the combined EF and MRS_10 model yielded an AUC of 79.12% (95% CI, 76.22-82.15%). Together, the panel of 10 gene-specific DNA methylation in leukocytes was strongly associated with the risk of CRC and might be a useful marker of susceptibility for CRC.