Outcomes, responses, and prognostic analyses of intrathecal combined treatment for leptomeningeal metastasis from lung adenocarcinoma.

BACKGROUND: Leptomeningeal metastasis (LM) is a severe lung cancer complication, with potentially fatal consequences. The use of intrathecal therapy (IT) combined with systemic therapy has shown promise as a treatment approach for LM. Thus, this study aimed to evaluate the features and responses to IT combined therapy and identify determinants affecting patients with leptomeningeal metastasis resulting from lung adenocarcinoma (LM-LA). METHODS: A retrospective analysis of medical records from our hospital database was performed, covering from April 2018 to August 2022, for 37 patients diagnosed with LM-LA and treated with IT combined therapy. Patients who received IT combined therapy for LM-LA were evaluated for demographic characteristics, treatment efficacy, survival, and variables that impacted them. RESULTS: The median overall survival (mOS) of 37 patients was 16.0 months, and the survival rates at 6 and 12 months were 75.7% and 35.1%, respectively. Among the 21 patients with LM-LA who received IT combined with tyrosine kinase inhibitors (TKIs), the mOS was 17.0 months, which was significantly longer than that of patients treated with IT combined with chemotherapy (7.0 months, P = 0.010) and the best supportive care (6.0 months, P = 0.001). However, no significant survival benefit was observed in patients treated with IT combined with TKIs when compared with those treated with IT combined with PD-1 (5.0 months, P = 0.249). Multivariate analysis indicated that the combination of TKIs was an independent favorable prognostic factor for patients with LM-LA. CONCLUSION: Combination treatment is regarded as an additional option for patients with LM-LA. Compared with other combination therapies in our study, IT combined with TKI therapy provided a better survival outcome for patients with LM-LA.

Adherence to Healthy Dietary Patterns and Glioma: A Matched Case-Control Study.

Recent studies have revealed a putative relationship between diet and glioma development and prognosis, but few studies have examined the association between overall diet and glioma risk. This study, conducted in China, employed a hospital-based case-control approach. The researchers utilized an a priori method based on dietary data to evaluate compliance scores for five healthy dietary patterns (the Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diet, the Paleolithic diet, and the Planetary Health Diet) in 1012 participants. At the same time, data-driven methods were used to explore the association between dietary patterns and glioma via principal component analysis (PCA). In the multivariate model, adhering to the Mediterranean diet (odds ratio (OR) = 0.29; 95% confidence interval (95% CI): 0.17-0.52), the DASH diet (OR = 0.09; 95% CI: 0.04-0.18), the MIND diet (OR = 0.25; 95% CI: 0.14-0.44), and the Paleolithic diet (OR = 0.13; 95% CI: 0.06-0.25) was associated with a reduced glioma risk. The results of PCA suggested that increasing the intake of plant-based foods and fish and limiting foods rich in carbohydrates, fats, and salts were associated with a reduced glioma risk. There was a substantial nonlinear dose-response association between glioma and the Mediterranean diet score. However, the DASH diet score, the MIND diet score, and the Paleolithic diet score exhibited linear dose-response relationships. Therefore, this study finds that dietary patterns may be an influencing factor for glioma risk.

Warburg effect-related risk scoring model to assess clinical significance and immunity characteristics of glioblastoma.

BACKGROUND: Glioblastoma (GBM), the most common primary malignant brain tumor, has a poor prognosis, with a median survival of only 14.6 months. The Warburg effect is an abnormal energy metabolism, which is the main cause of the acidic tumor microenvironment. This study explored the role of the Warburg effect in the prognosis and immune microenvironment of GBM. METHODS: A prognostic risk score model of Warburg effect-related genes (Warburg effect signature) was constructed using GBM cohort data from The Cancer Genome Atlas. Cox analysis was performed to identify independent prognostic factors. Next, the nomogram was built to predict the prognosis for GBM patients. Finally, the drug sensitivity analysis was utilized to find the drugs that specifically target Warburg effect-related genes. RESULTS: Age, radiotherapy, chemotherapy, and WRGs score were confirmed as independent prognostic factors for GBM by Cox analyses. The C-index (0.633 for the training set and 0.696 for the validation set) and area under curve (>0.7) indicated that the nomogram exhibited excellent performance. The calibration curve also indicates excellent consistency of the nomogram between predictions and actual observations. In addition, immune microenvironment analysis revealed that patients with high WRGs scores had high immunosuppressive scores, a high abundance of immunosuppressive cells, and a low response to immunotherapy. The Cell Counting Kit-8 assays showed that the drugs targeting Warburg effect-related genes could inhibit the GBM cells growth in vitro. CONCLUSION: Our research showed that the Warburg effect is connected with the prognosis and immune microenvironment of GBM. Therefore, targeting Warburg effect-related genes may provide novel therapeutic options.

Healthy and Unhealthy Plant-Based Diets and Glioma in the Chinese Population.

Plant-based diets have been suggested to help prevent various chronic diseases, including cancer. However, there are few reports on central nervous system tumors, and data on dose-response relationships are lacking. This individual-matched case-control study included 506 cases and 506 controls. The overall plant-based diet index (PDI), the healthy plant-based diet index (hPDI), and the unhealthy plant-based diet index (uPDI) were calculated using dietary information collected through a food frequency questionnaire, with higher scores indicating better adherence. We analyzed the relationship of plant-based diets with glioma. After adequate adjustment for confounders, PDI was associated with a reduced glioma risk (OR = 0.42, 95% CI: 0.24-0.72). Conversely, uPDI was associated with an elevated glioma risk (OR = 8.04, 95% CI: 4.15-15.60). However, hPDI was not significantly associated with glioma risk (OR = 0.83, 95% CI: 0.48-1.45). For subgroups, PDI was not significant in analyzing young age, BMI, or any pathological subtypes. The restricted cubic spline function showed a significant dose-response relationship between PDI (p-nonlinearity< 0.0001) and uPDI (p-nonlinearity= 0.0711) and glioma. Further analysis found that refined grains had the greatest effect on gliomas in the less healthy plant-based food group. Therefore, following a plant-based diet was linked to a lower risk of glioma, especially when consuming fewer unhealthy plant-based foods.

Efficacy and safety of new-generation Bruton tyrosine kinase inhibitors in chronic lymphocytic leukemia/small lymphocytic lymphoma: a systematic review and meta-analysis.

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a type of mature B lymphocyte clonal proliferative tumor with a specific immunophenotype. Bruton tyrosine kinase inhibitors (BTKi) have been approved for the treatment of CLL/SLL. However, the efficacy and safety of new-generation BTKi-based regimens have not been systematically studied. In this systematic review, we evaluated the efficacy and safety of new-generation BTKi-based regimens for the treatment of patients with CLL/SLL. A comprehensive search on PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. up to January 31, 2023, was conducted by us. Studies reporting data on CLL/SLL patients treated with new-generation BTKi were included. We assessed the overall response rate (ORR), complete response (CR) rate, and 24-month OS/PFS rates for efficacy analysis. For safety analysis, we evaluated the incidence of grade ≥ 3 adverse events (AEs). The meta-analysis included twenty studies. The pooled ORR for new-generation BTKi was 92% (95% CI, 89-95%, I2 = 80.68%, P = 0.00), while the pooled CR rate was 10% (95% CI, 6-14%, I2 = 88.11%, P = 0.00). Research has found that the new-generation BTKi-based therapy had higher efficacy under the following treatment conditions: < 65 years old, treatment-naive (TN)-CLL, and BTKi combination therapy. The ORR/CR rates and 24-month OS/PFS rates of BTKi combination therapy were higher than that of BTKi monotherapy. Compared to acalabrutinib monotherapy, zanubrutinib monotherapy demonstrated higher ORR/CR rates and 24-month OS/PFS rates. Common grade ≥ 3 AEs included cytopenia and hypertension. The new-generation BTKi-based therapy has good tolerance and provides incremental benefits for CLL/SLL patients. Despite the superior efficacy of BTKi combination therapy compared to monotherapy, its AEs rates are relatively high. Compared to acalabrutinib, Zanubrutinib may be the preferred monotherapy for CLL. However, randomized-controlled studies are still needed.

Chinese Dietary Indices and Glioma: New Insights of a Case-Control Study in the Chinese Population.

Identifying modifiable factors in primary prevention strategies is a typical goal of glioma epidemiology. Among many glioma risk factors, diet was always considered as one. Most of the relevant studies thus far were concentrated on the West. It was crucial to investigate the connection between the Chinese diet and gliomas given the stark variations between western and eastern diets. A food frequency questionnaire including 114 items was used to investigate the food intake of the study subjects. The Chinese Dietary Quality Index (CDQI), the Chinese Dietary Balance Index (CDBI), the Dietary Antioxidant Index (DAI), the Dietary Inflammation Index (DII), and the Chinese Healthy Eating Index (CHEI) were calculated based on the data provided by the food frequency questionnaire to evaluate dietary quality, dietary balance, dietary antioxidants, dietary inflammation and adherence to the Chinese dietary guidelines in 506 glioma patients and 506 controls, respectively. After adjusting covariates, CHEI (OR = 0.90, 95% CI: 0.88-0.93) and DAI (OR = 0.61, 95% CI: 0.54-0.70) were correlated to a reduced glioma risk, and CDBI-based undernutrition (OR = 1.08, 95% CI: 1.06-1.12) and overnutrition (OR = 1.14, 95% CI: 1.09-1.20) and DII (OR = 2.20, 95% CI: 1.81-2.68) were correlated to an elevated glioma risk. Moreover, restrictive cubic spline analysis showed that there were significant nonlinear dose-response relationships between CHEI, CDBI, DAI, DII, and glioma. Therefore, adhering to the Chinese dietary guidelines was connected with a lower glioma risk, and undernutrition and overnutrition in the Chinese diet were associated with an increased risk of glioma.

Magnetic amino-rich hyper-crosslinked polymers for fat-rich foodstuffs pretreatment in nontargeted analysis of chemical hazards.

Nontargeted analysis for chemical hazards is highly desirable in controlling food safety to ensure human health. As the dominating interference in fat-rich foodstuffs, lipids removal is a great challenge in sample pretreatment. Herein, diverse lipids from both animal and vegetable oils are effectively removed and 565 chemical hazards with various physicochemical properties are used for method validation. These benefits are from the designed magnetic amino-rich hyper-crosslinked core-shell polymeric composites (Fe3O4@poly(MAAM-co-EGDMA)) and the application of an auto extraction system. Among them, the amino groups are the key factors for lipid removal. Theoretical calculations, isothermal titration calorimetry (ITC), and functional monomer replacement demonstrated that the mechanisms to universally capture free fatty acids (FFAs) and triglycerides (TGs) are electrostatic interaction and supplemented by hydrogen bonding. Overall, this work highlights the great application potentials of polymeric adsorbents as sample pretreatment materials for nontargeted analysis in food safety.

Phytochemicals and Glioma: Results from Dietary Mixed Exposure.

The information about phytochemicals' potential to prevent cancer is encouraging, including for glioma. However, most studies on phytochemicals and glioma mainly focused on preclinical studies. Their epidemiological studies were not sufficient, and the evidence on the dose-response relationship is usually limited. Therefore, this investigation examined the association between dietary phytochemical intake and glioma in Chinese adults. This case-control study was carried out in a hospital in China. Based on the dietary information obtained from the food frequency questionnaire, the researchers estimated the phytochemical intake of 506 patients with glioma and 506 controls. Compared with participants in the lowest tertile, the highest intakes of carotene, flavonoids, soy isoflavones, anthocyanin, and resveratrol were associated with a reduced risk of glioma. The WQS and BKMR models suggested that anthocyanin and carotene have a greater influence on glioma. The significant nonlinear dose-response associations between dietary phytochemicals and glioma were suggested using the restricted cubic spline function. According to this study on phytochemicals and glioma, higher intakes of carotene, flavonoids, soy isoflavones, anthocyanins, and resveratrol are linked to a lower risk of glioma. So, we might not be able to ignore how phytochemicals affect gliomas.

Dietary B vitamins and glioma: A case-control study based on Chinese population.

Background: Dietary antioxidants have long been thought to be likely to prevent the development of gliomas. Previous studies have reported vitamin A, C, and E protective effects against gliomas. B vitamins, one of the main vitamins in the diet, are closely related to human health, but the association with gliomas has rarely been reported. Objective: This study aimed to evaluate the relationship between five B vitamins and glioma. Methods: In this Chinese population-based case-control study, 506 glioma cases and 506 matched (age and sex) controls were included. The dietary intake of study participants was assessed using a valid 111-item food frequency questionnaire. The intake of five B vitamins was calculated based on participants' dietary information from the food frequency questionnaire. The logistic regression model was used to examine the association between B vitamins and glioma, and the restriction cubic spline evaluated the dose-response relationship between the two. Results: After adjusting for confounding factors, thiamine (OR = 0.09, 95%CI: 0.05-0.20), riboflavin (OR = 0.12, 95%CI: 0.06-0.25), nicotinic acid (OR = 0.24, 95%CI: 0.12-0.47), folate (OR = 0.07, 95%CI: 0.03-0.15) and biotin (OR = 0.14, 95%CI: 0.07-0.30) in the highest tertile were associated with a significantly decreased risk of glioma compared with the lowest tertile. The results of thiamine and biotin in glioma with different pathological types and grades were different. The restricted cubic spline function showed significant dose-response relationships between the intake of five B vitamins and the risk of glioma. When B vitamins exceeded a specific intake, the risk of glioma did not change. Conclusion: Our study suggests that higher dietary intake of thiamine, riboflavin, nicotinic acid, and folate are associated with a decreased risk of glioma, but the results of biotin are not consistent among different populations. In the future, prospective studies should be conducted better to validate the effects of B vitamins on gliomas.

Association between dietary minerals and glioma: A case-control study based on Chinese population.

Background: As one of the essential nutrients for the human body, minerals participate in various physiological activities of the body and are closely related to many cancers. However, the population study on glioma is not sufficient. Objective: The purpose of this study was to evaluate the relationship between five dietary minerals and glioma. Methods: A total of 506 adult patients with glioma and 506 healthy controls were matched 1:1 according to age (±5 years) and sex. The food intake of the subjects in the past year was collected through the food frequency questionnaire, and the intakes of calcium, magnesium, iron, zinc, and copper in the diet were calculated. The logistic regression model was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for dietary minerals to gliomas. Results: After adjusting for confounders, higher intakes of calcium (OR = 0.65, 95% CI: 0.57-0.74), magnesium (OR = 0.18, 95% CI: 0.11-0.29), iron (OR = 0.04, 95% CI: 0.02-0.11), zinc (OR = 0.62, 95% CI: 0.54-0.73), and copper (OR = 0.22, 95% CI: 0.13-0.39) were associated with a significantly decreased risk of glioma. Similar results were observed in gliomas of different pathological types and pathological grades. The restriction cubic spline function suggested significant linear dose-response relationships between intakes of five minerals and the risk of glioma. When the dietary minerals exceeded a particular intake, the risk of glioma stabilized. Conclusion: Our study suggests that higher dietary intakes of calcium, magnesium, iron, zinc, and copper are associated with a decreased risk of glioma. However, the results of this study require further exploration of potential mechanisms in the future better to elucidate the effects of mineral intake on gliomas.

Signaling pathways in brain tumors and therapeutic interventions.

Brain tumors, although rare, contribute to distinct mortality and morbidity at all ages. Although there are few therapeutic options for brain tumors, enhanced biological understanding and unexampled innovations in targeted therapies and immunotherapies have considerably improved patients' prognoses. Nonetheless, the reduced response rates and unavoidable drug resistance of currently available treatment approaches have become a barrier to further improvement in brain tumor (glioma, meningioma, CNS germ cell tumors, and CNS lymphoma) treatment. Previous literature data revealed that several different signaling pathways are dysregulated in brain tumor. Importantly, a better understanding of targeting signaling pathways that influences malignant behavior of brain tumor cells might open the way for the development of novel targeted therapies. Thus, there is an urgent need for a more comprehensive understanding of the pathogenesis of these brain tumors, which might result in greater progress in therapeutic approaches. This paper began with a brief description of the epidemiology, incidence, risk factors, as well as survival of brain tumors. Next, the major signaling pathways underlying these brain tumors' pathogenesis and current progress in therapies, including clinical trials, targeted therapies, immunotherapies, and system therapies, have been systemically reviewed and discussed. Finally, future perspective and challenges of development of novel therapeutic strategies in brain tumor were emphasized.

Association between vitamins and risk of brain tumors: A systematic review and dose-response meta-analysis of observational studies.

Background: Brain tumor is one of the important causes of cancer mortality, and the prognosis is poor. Therefore, early prevention of brain tumors is the key to reducing mortality due to brain tumors. Objective: This review aims to quantitatively evaluate the association between vitamins and brain tumors by meta-analysis. Methods: We searched articles on PubMed, Cochrane Library, Web of Science, and Embase databases from inception to 19 December 2021. According to heterogeneity, the fixed-effects model or random-effects model was selected to obtain the relative risk of the merger. Based on the methods described by Greenland and Longnecker, we explored the dose-response relationship between vitamins and the risk of brain tumors. Subgroup analysis, sensitivity analysis, and publication bias were also used for the analysis. Results: The study reviewed 23 articles, including 1,347,426 controls and 6,449 brain tumor patients. This study included vitamin intake and circulating concentration. For intake, it mainly included vitamin A, vitamin B, vitamin C, vitamin E, ß-carotene, and folate. For circulating concentrations, it mainly included vitamin E and vitamin D in the serum (25-hydroxyvitamin D and α-tocopherol). For vitamin intake, compared with the lowest intakes, the highest intakes of vitamin C (RR = 0.81, 95%CI:0.66-0.99, I 2 = 54.7%, P for heterogeneity = 0.007), ß-carotene (RR = 0.78, 95%CI:0.66-0.93, I 2 = 0, P for heterogeneity = 0.460), and folate (RR = 0.66, 95%CI:0.55-0.80, I 2 = 0, P for heterogeneity = 0.661) significantly reduced the risk of brain tumors. For serum vitamins, compared with the lowest concentrations, the highest concentrations of serum α-tocopherol (RR = 0.61, 95%CI:0.44-0.86, I 2 = 0, P for heterogeneity = 0.656) significantly reduced the risk of brain tumors. The results of the dose-response relationship showed that increasing the intake of 100 µg folate per day reduced the risk of brain tumors by 7% (P -nonlinearity = 0.534, RR = 0.93, 95%CI:0.90-0.96). Conclusion: Our analysis suggests that the intake of vitamin C, ß-carotene, and folate can reduce the risk of brain tumors, while high serum α-tocopherol concentration also has a protective effect on brain tumors. Therefore, vitamins may provide new ideas for the prevention of brain tumors. Systematic Review Registration: PROSPERO, identifier CRD42022300683.

Association Between Dietary Nitrite intake and Glioma Risk: A Systematic Review and Dose-Response Meta-Analysis of Observational Studies.

Background: Nitrite and nitrate intake through food and water may be an important risk factor for many cancers, including glioma. However, the association of nitrite and nitrate with glioma is unclear. Objective: This review aimed to quantitatively assess the effects of nitrite and nitrate on glioma by meta-analysis. Methods: A literature search was conducted for available articles published in English using the databases of Embase, Web of Science, PubMed, Medline, and the Cochrane Library up to 24 March 2022. According to heterogeneity, the fixed-effects or random-effects model was selected to obtain the merger's relative risk (RR). Based on the methods described by Greenland and Longnecker, we explored the dose-response relationship between nitrite/nitrate and the risk of glioma. Subgroup analysis, sensitivity analysis, and publication bias tests were also used. Results: This study reviewed 17 articles, including 812,107 participants and 4,574 cases. For glioma in adults, compared with the lowest intakes, the highest intakes of nitrite significantly increased the risk of glioma (RR=1.26, 95% confidence interval (95%CI):1.09-1.47). For brain tumors in children, compared with the lowest intakes, the highest intakes of nitrate significantly increased the risk of brain tumors (RR=1.27, 95%CI:1.06-1.52). The results of subgroup and sensitivity analyses remained unchanged. In the dose-response relationship, per 1 mg/day increase in nitrite intake increased the risk of glioma by 14% (RR=1.14, 95%CI:1.01-1.27). Conclusions: Our analysis suggests that nitrite increases the risk of glioma in adults, while nitrate increases the risk of brain tumors in children. Therefore, the effects of nitrite and nitrate on glioma cannot be ignored. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022320295.

Dietary Factors and Risk of Glioma in Adults: A Systematic Review and Dose-Response Meta-Analysis of Observational Studies.

BACKGROUND: Gliomas are the most common primary intracranial tumors in adults. Inappropriate dietary habits are thought to be a risk factor for most human cancer, and glioma is no exception. However, the effect of dietary factors on glioma is not clear. OBJECTIVE: This review aims to quantitatively evaluate the association between various dietary intakes and glioma using a meta-analysis. METHODS: We searched articles on PubMed, the Cochrane Library, the Web of Science, and EMBASE from their inception until October 11, 2021. According to heterogeneity, the fixed-effects or random-effects model was selected to obtain the relative risk (RR) of merger. Based on the methods described by Greenland and Longnecker, we explored the dose-response relationship between dietary intakes and the risk of glioma. Subgroup analysis, sensitivity analysis, and publication bias were also used. RESULTS: This study reviewed 33 articles, including 3,606,015 controls and 8,831 patients with glioma. This study included 12 food groups. Compared with the lowest intakes, the highest intakes of tea (RR = 0.82, 95%CI:0.71-0.93), total vegetables (RR = 0.84, 95%CI: 0.70-1.00), green vegetables (RR = 0.80, 95%CI: 0.66-0.98), and orange vegetables (RR = 0.79, 95%CI: 0.66-0.96) significantly reduced the risk of glioma, while the highest intakes of grains (RR = 1.39, 95%CI: 1.16-1.66), processed meats (RR = 1.19, 95%CI: 1.00-1.42), and processed fish (RR = 1.37, 95%CI: 1.03-1.84) significantly increased the risk of glioma. The results of subgroup and sensitivity analyses remained unchanged. In the dose-response relationship, only tea was statistically significant. Taking an extra cup of tea every day reduced the risk of glioma by 4%. CONCLUSIONS: Our analysis suggests that the intakes of tea, total vegetables, green vegetables, and orange vegetables may reduce the risk of glioma, while the intakes of grains, processed meats, and processed fish may increase the risk of glioma. Therefore, the effect of dietary factors on glioma should not be ignored.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, CRD42022296658.

Case report: The treatment for olfactory neuroblastoma combined with leptomeningeal carcinomatosis via an ommaya reservoir.

Olfactory neuroblastoma is a rare neoplasm that usually presents in the upper nasal cavity. Although its prognosis is highly unfavorable, effective treatment options are still lacking. Moreover, there is no standard treatment for patients with olfactory neuroblastoma that progressed to leptomeningeal carcinomatosis. Here we report an uncommon case of a 59-year-old woman who was diagnosed with olfactory neuroblastoma and leptomeningeal carcinomatosis. For a direct delivery of the drugs to the tumor, and to avoid the impact of lumbar puncture on the patient's quality of life, the intravenous chemotherapy plus intrathecal administration of MTX via an Ommaya reservoir was chosen. The results were striking, with the disappearance of tumor cells in the cerebrospinal fluid and the relief of the patient's symptoms with PR. Our result indicates that chemotherapy via an Ommaya reservoir offers a new potential therapy for patients with meningeal metastases.

Multiple-element exposure and metabolic syndrome in Chinese adults: A case-control study based on the Beijing population health cohort.

BACKGROUND: Metabolic syndrome (MetS) patients have a considerably increased risk for noncommunicable diseases, which poses a serious burden on public health. The effects of different elements on MetS have received increasing attention in the field of noncommunicable diseases over the past decade. These elements can exert adverse or favourable effects on human health by synergistic or antagonistic actions. Nevertheless, few studies have explored the relationship between multiple-element exposure and MetS. METHOD: A total of 2095 MetS patients and 2039 controls free of major cardiovascular disease at baseline and follow-up visits were frequency matched for age (±5 years) and sex. The internal exposure levels of 15 elements in serum were investigated. Logistic regression models were employed to estimate odds ratios (ORs) of MetS for element concentrations categorized according to quartiles in the controls. RESULT: Magnesium (Mg), selenium (Se), barium (Ba) and mercury (Hg) were significantly associated with MetS in the multi-element exposure model. The ORs for the extreme quartiles of Mg, Se, Ba, and Hg were 0.29 (95% CI: 0.23-0.37, P-trend < 0.001), 0.52 (95% CI: 0.42-0.65, P-trend < 0.001), 1.86 (95% CI: 1.51-2.28, P-trend < 0.001), and 2.61 (95% CI: 2.11-3.22, P-trend < 0.001), respectively. Ba may be antagonistic to Mg and Se in the human body. CONCLUSIONS: Our study suggested that MetS was negatively associated with Mg and Se and positively associated with Ba and Hg. There were significant dose-response relationships between Mg, Se, Ba and Hg and the prevalence of MetS, suggesting that multiple elements may be involved in MetS.