{"id":"https://openalex.org/W7171647656","doi":"https://doi.org/10.64898/2026.07.25.26358918","title":"Outcome definition and index validity in cross-national comparisons of diet-attributable metabolic burden","display_name":"Outcome definition and index validity in cross-national comparisons of diet-attributable metabolic burden","publication_year":2026,"publication_date":"2026-07-29","ids":{"openalex":"https://openalex.org/W7171647656","doi":"https://doi.org/10.64898/2026.07.25.26358918"},"language":"en","primary_location":{"id":"doi:10.64898/2026.07.25.26358918","doi":"https://doi.org/10.64898/2026.07.25.26358918","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.07.25.26358918","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/21/2026.07.25.26358918.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/21/2026.07.25.26358918.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5114168789","display_name":"Shangze Huang","orcid":"https://orcid.org/0009-0001-2126-8394","observed_orcids":["https://orcid.org/0009-0001-2126-8394","https://orcid.org/0009-0002-7399-984X"]},"institutions":[{"id":"https://openalex.org/I4210094789","display_name":"Ningbo City College of Vocational Technology","ror":"https://ror.org/00vkb8q56","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210094789"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Shangze Huang","raw_affiliation_strings":["Ningbo City College of Vocational Technology, No.9 Xuefu Road, Yinzhou, Ningbo 315100, Zhejiang, China"],"raw_orcid":"https://orcid.org/0009-0001-2126-8394","affiliations":[{"raw_affiliation_string":"Ningbo City College of Vocational Technology, No.9 Xuefu Road, Yinzhou, Ningbo 315100, Zhejiang, China","institution_ids":["https://openalex.org/I4210094789"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5143880131","display_name":"Xinyan Wang","orcid":"https://orcid.org/0009-0004-7668-096X","observed_orcids":["https://orcid.org/0009-0004-7668-096X"]},"institutions":[{"id":"https://openalex.org/I4210149708","display_name":"Zhejiang Fashion Institute of Technology","ror":"https://ror.org/05ajbr617","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210149708"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Xinyan Wang","raw_affiliation_strings":["Zhejiang Fashion Institute of Technology, 495 Fenghua Road, Jiangbei District, Ningbo 315211, Zhejiang, China"],"raw_orcid":"https://orcid.org/0009-0004-7668-096X","affiliations":[{"raw_affiliation_string":"Zhejiang Fashion Institute of Technology, 495 Fenghua Road, Jiangbei District, Ningbo 315211, Zhejiang, China","institution_ids":["https://openalex.org/I4210149708"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5114168789","https://openalex.org/A5143880131"],"corresponding_institution_ids":["https://openalex.org/I4210094789","https://openalex.org/I4210149708"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10866","display_name":"Nutritional Studies and Diet","score":0.9965999722480774,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10866","display_name":"Nutritional Studies and Diet","score":0.9965999722480774,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10387","display_name":"Fatty Acid Research and Health","score":0.000699999975040555,"subfield":{"id":"https://openalex.org/subfields/2916","display_name":"Nutrition and Dietetics"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11355","display_name":"Inflammatory Biomarkers in Disease Prognosis","score":0.00039999998989515007,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/dietary-inflammatory-potential","display_name":"dietary inflammatory potential","score":0.8209999799728394},{"id":"https://openalex.org/keywords/dietary-inflammatory-index","display_name":"Dietary Inflammatory Index","score":0.9869999885559082},{"id":"https://openalex.org/keywords/metabolic-syndrome","display_name":"metabolic syndrome","score":0.9919999837875366},{"id":"https://openalex.org/keywords/sex-differences","display_name":"sex differences","score":0.984000027179718},{"id":"https://openalex.org/keywords/sex-specific-association","display_name":"sex-specific association","score":0.6729999780654907},{"id":"https://openalex.org/keywords/c-reactive-protein","display_name":"C-reactive protein","score":0.7760000228881836},{"id":"https://openalex.org/keywords/mendelian-randomization","display_name":"Mendelian randomization","score":0.7820000052452087},{"id":"https://openalex.org/keywords/population-attributable-fraction","display_name":"population attributable fraction","score":0.9470000267028809},{"id":"https://openalex.org/keywords/cross-cultural-consistency","display_name":"cross-cultural consistency","score":0.6050000190734863},{"id":"https://openalex.org/keywords/anti-inflammatory-diet","display_name":"anti-inflammatory diet","score":0.7020000219345093},{"id":"https://openalex.org/keywords/diet-and-inflammation","display_name":"diet and inflammation","score":0.5120000243186951}],"concepts":[{"id":"https://openalex.org/C23131810","wikidata":"https://www.wikidata.org/wiki/Q818574","display_name":"Observational study","level":2,"score":0.784600019454956},{"id":"https://openalex.org/C2779901538","wikidata":"https://www.wikidata.org/wiki/Q6816584","display_name":"Mendelian randomization","level":5,"score":0.6872000098228455},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.5202999711036682},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.4575999975204468},{"id":"https://openalex.org/C151956035","wikidata":"https://www.wikidata.org/wiki/Q1132755","display_name":"Logistic regression","level":2,"score":0.45159998536109924},{"id":"https://openalex.org/C2780801425","wikidata":"https://www.wikidata.org/wiki/Q5164392","display_name":"Construct (python library)","level":2,"score":0.4284999966621399},{"id":"https://openalex.org/C2780578515","wikidata":"https://www.wikidata.org/wiki/Q657193","display_name":"Metabolic syndrome","level":3,"score":0.3898000121116638},{"id":"https://openalex.org/C156957248","wikidata":"https://www.wikidata.org/wiki/Q1862216","display_name":"Odds ratio","level":2,"score":0.3804999887943268},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.353300005197525},{"id":"https://openalex.org/C60644358","wikidata":"https://www.wikidata.org/wiki/Q128570","display_name":"Bioinformatics","level":1,"score":0.3337000012397766},{"id":"https://openalex.org/C77350462","wikidata":"https://www.wikidata.org/wiki/Q1125472","display_name":"Confounding","level":2,"score":0.3310999870300293},{"id":"https://openalex.org/C183905921","wikidata":"https://www.wikidata.org/wiki/Q1038757","display_name":"Multiple comparisons problem","level":2,"score":0.3262999951839447},{"id":"https://openalex.org/C186413461","wikidata":"https://www.wikidata.org/wiki/Q744727","display_name":"Genetic association","level":5,"score":0.31700000166893005},{"id":"https://openalex.org/C67636389","wikidata":"https://www.wikidata.org/wiki/Q784237","display_name":"Genetic predisposition","level":3,"score":0.3034000098705292},{"id":"https://openalex.org/C81941488","wikidata":"https://www.wikidata.org/wiki/Q853421","display_name":"Quantitative trait locus","level":3,"score":0.2994999885559082},{"id":"https://openalex.org/C34388435","wikidata":"https://www.wikidata.org/wiki/Q2267362","display_name":"Bounded function","level":2,"score":0.2937000095844269},{"id":"https://openalex.org/C142853389","wikidata":"https://www.wikidata.org/wiki/Q744778","display_name":"Association (psychology)","level":2,"score":0.29109999537467957},{"id":"https://openalex.org/C135763542","wikidata":"https://www.wikidata.org/wiki/Q106016","display_name":"Genotype","level":3,"score":0.28540000319480896},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.27320000529289246},{"id":"https://openalex.org/C2776914184","wikidata":"https://www.wikidata.org/wiki/Q101991","display_name":"Inflammation","level":2,"score":0.26759999990463257},{"id":"https://openalex.org/C168563851","wikidata":"https://www.wikidata.org/wiki/Q1436668","display_name":"Randomized controlled trial","level":2,"score":0.2637999951839447},{"id":"https://openalex.org/C95190672","wikidata":"https://www.wikidata.org/wiki/Q815382","display_name":"Meta-analysis","level":2,"score":0.25999999046325684},{"id":"https://openalex.org/C2780148112","wikidata":"https://www.wikidata.org/wiki/Q1432581","display_name":"Proxy (statistics)","level":2,"score":0.25589999556541443},{"id":"https://openalex.org/C49453240","wikidata":"https://www.wikidata.org/wiki/Q1592163","display_name":"Construct validity","level":3,"score":0.25380000472068787},{"id":"https://openalex.org/C143095724","wikidata":"https://www.wikidata.org/wiki/Q515895","display_name":"Odds","level":3,"score":0.25380000472068787},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.25110000371932983},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.250900000333786}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.07.25.26358918","doi":"https://doi.org/10.64898/2026.07.25.26358918","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.07.25.26358918","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/21/2026.07.25.26358918.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.07.25.26358918","doi":"https://doi.org/10.64898/2026.07.25.26358918","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.07.25.26358918","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/10/21/2026.07.25.26358918.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9940000176429749,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7171647656.pdf","grobid_xml":"https://content.openalex.org/works/W7171647656.grobid-xml"},"referenced_works_count":33,"referenced_works":["https://openalex.org/W1918432791","https://openalex.org/W2000054651","https://openalex.org/W2018135697","https://openalex.org/W2022288521","https://openalex.org/W2022318388","https://openalex.org/W2040028100","https://openalex.org/W2068151605","https://openalex.org/W2100224608","https://openalex.org/W2103714496","https://openalex.org/W2103783427","https://openalex.org/W2113699335","https://openalex.org/W2115098571","https://openalex.org/W2121076832","https://openalex.org/W2123609879","https://openalex.org/W2143104968","https://openalex.org/W2159203244","https://openalex.org/W2159678191","https://openalex.org/W2163369593","https://openalex.org/W2469755208","https://openalex.org/W2613603864","https://openalex.org/W2735301415","https://openalex.org/W2805983714","https://openalex.org/W2906887208","https://openalex.org/W2967554560","https://openalex.org/W2992832415","https://openalex.org/W3033597075","https://openalex.org/W3115077526","https://openalex.org/W4210956151","https://openalex.org/W4283821360","https://openalex.org/W4402993275","https://openalex.org/W4406088248","https://openalex.org/W4416124656","https://openalex.org/W7161798951"],"related_works":["https://openalex.org/W4403829565","https://openalex.org/W2793343555","https://openalex.org/W2886202838","https://openalex.org/W2804111835","https://openalex.org/W4302304978","https://openalex.org/W4401345895","https://openalex.org/W2521622043","https://openalex.org/W3045383373","https://openalex.org/W3091771717","https://openalex.org/W7162263864"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"In":[2],"three":[3],"national":[4,42],"surveys,":[5],"no":[6,167],"cross-national":[7,212],"ranking":[8],"of":[9,22,29,85,211,237],"diet-attributable":[10,215],"metabolic":[11,70],"burden":[12,217,232],"was":[13,130,170,176,190,218,222],"identified:":[14],"the":[15,20,23,27,30,45,65,86,104,123,154,187,194,201,206,209,220],"apparent":[16],"ordering":[17,221],"moved":[18],"with":[19,26,73,92,107],"definition":[21,226],"outcome":[24,155,225],"and":[25,52,68,103,165,197,227],"validity":[28,119,175,188],"dietary":[31],"index.":[32],"Both":[33],"were":[34,162],"tested.":[35],"Subjects/Methods":[36],"We":[37,80],"harmonised":[38],"individual-participant":[39],"data":[40,63],"from":[41,64],"surveys":[43],"in":[44,58,132,153,178,183,214],"USA":[46],"(NHANES":[47],"2017\u20132018),":[48],"Korea":[49,140],"(KNHANES":[50],"2015\u20132021)":[51],"Mexico":[53,143],"(ENSANUT":[54],"2018\u20132019);":[55],"56,365":[56],"adults":[57],"total,":[59],"recovered":[60],"Mexican":[61],"blood-pressure":[62],"raw":[66],"files,":[67],"defined":[69],"syndrome":[71],"(MetS)":[72],"a":[74,99],"common":[75,100],"five-component":[76],"ATP":[77],"III":[78],"rule.":[79],"estimated":[81],"survey-weighted":[82],"sex-specific":[83],"associations":[84],"energy-adjusted":[87],"Dietary":[88],"Inflammatory":[89],"Index":[90],"(E-DII)":[91],"MetS,":[93],"country-specific":[94],"population-attributable":[95],"fractions":[96],"(PAFs)":[97],"on":[98],"counterfactual":[101],"scale,":[102],"E-DII\u2019s":[105],"correlation":[106],"log":[108],"high-sensitivity":[109],"C-reactive":[110],"protein":[111],"(hsCRP).":[112],"A":[113],"quantitative":[114],"bias":[115],"analysis":[116],"examined":[117],"whether":[118],"differences":[120,213],"could":[121],"reverse":[122],"country":[124],"ordering.":[125],"Results":[126],"The":[127],"E-DII\u2013MetS":[128],"association":[129],"larger":[131],"women":[133,180,185],"(USA":[134],"OR":[135],"1.23,":[136],"95%":[137],"CI":[138],"0.98\u20131.55;":[139],"1.078,":[141],"1.028\u20131.132;":[142],"1.074,":[144],"0.992\u20131.163;":[145],"interaction":[146],"P=0.080)":[147],"but":[148],"disappeared":[149],"without":[150],"blood":[151],"pressure":[152],"(pooled":[156],"1.065,":[157],"0.982\u20131.155;":[158],"P=0.13).":[159],"Female":[160],"PAFs":[161],"15.0%,":[163],"7.6%":[164],"3.8%;":[166],"pairwise":[168],"difference":[169],"distinguishable":[171],"(all":[172],"P\u22650.23).":[173],"E-DII":[174],"0.137":[177],"US":[179],"versus":[181],"0.040":[182],"Korean":[184],"(P=2.0\u00d710\u22124);":[186],"ratio":[189],"0.29,":[191],"correction":[192],"reversed":[193],"observed":[195],"ordering,":[196],"its":[198],"interval":[199],"straddled":[200],"reversal":[202],"threshold.":[203],"Conclusions":[204],"Neither":[205],"direction":[207],"nor":[208],"magnitude":[210],"MetS":[216],"identified;":[219],"bounded":[223],"by":[224,228],"index":[229],"validity.":[230],"Cross-national":[231],"comparisons":[233],"require":[234],"local":[235],"validation":[236],"both.":[238]},"counts_by_year":[],"updated_date":"2026-11-03T10:50:19.383937","created_date":"2026-07-30T00:00:00"}