Tongue age: a new dimension for disease risk assessment based on tongue-coating microbiome and image features

References

[1] Xu S, Liu Y, Zhu M, et al. Global burden of atherosclerotic cardiovascular disease attributed to lifestyle and metabolic risks. Sci China Life Sci 2025; 68(9): 2739-2754.

[2] Rutledge J, Oh H, Wyss—Coray T. Measuring biological age using omics data. Nat Rev Genet 2022; 23(12): 715-727.

[3] Li Y, Zhu M, Wang W, et al. Comparable tongue coating microbiota profiles from a simplified single—swab versus different sampling approaches: a pilot study. Clin Oral Investig 2025; 29(11): 543.

[4] Xie J, Jing C, Zhang Z, et al. Digital tongue image analyses for health assessment. Med Rev (2021) 2021; 1(2): 172-198.

[5] Ren Y, Chen M, Wang Z, et al. Oral microbiota in aging and diseases. Life Med 2024; 3(3): lnae024.

[6] Xu Q, Wang W, Li Y, et al. The oral—gut microbiota axis: a link in cardiometabolic diseases. NPJ Biofilms Microbiomes 2025; 11(1): 11.

[7] Liao C, Rolling T, Djukovic A, et al. Oral bacteria relative abundance in faeces increases due to gut microbiota depletion and is linked with patient outcomes. Nat Microbiol 2024; 9(6): 1555-1565.

[8] Xia Y, Wang Q, Feng X, et al. Tongue diagnosis based on hue—saturation value color space: controlled study of tongue appearance in patients treated with percutaneous coronary intervention for coronary heart disease. Intell Med 2023; 3(4): 252-257.

[9] Zhao M, Wang M, Fan L, et al. An explainable dual—modal diagnostic model for coronary artery disease: a feature—gated approach using tongue and facial image features. Front Artif Intell 2025; 8: 1662577.

[10] Qi Z, Tu LP, Chen JB, et al. The classification of tongue colors with standardized acquisition and ICC profile correction in traditional Chinese medicine. Biomed Res Int 2016; 2016: 3510807.

[11] Teoh JR, Dong J, Zuo X, et al. Advancing healthcare through multimodal data fusion: a comprehensive review of techniques and applications. PeerJ Comput Sci 2024; 10: e2298.

[12] Cumplido—Mayoral I, García—Prat M, Operto G, et al. Biological brain age prediction using machine learning on structural neuroimaging data: multi—cohort validation against biomarkers of Alzheimer’s disease and neurodegeneration stratified by sex. eLife 2023; 12: e81067.

[13] Jawinski P, Forstbach H, Kirsten H, et al. Genome—wide analysis of brain age identifies 59 associated loci and unveils relationships with mental and physical health. Nat Aging 2025; 5(10): 2086-2103.

[14] Hao M, Zhang H, Wu J, et al. Gompertz law—based biological age (GOLD BioAge): a simple and practical measurement of biological ageing to capture morbidity and mortality risks. Adv Sci (Weinh) 2025; 12(32): e01765.

[15] Poganik JR, Zhang B, Baht GS, et al. Biological age is increased by stress and restored upon recovery. Cell Metab 2023; 35(5): 807-820.e5.

[16] Wang T, Shi Z, Ren H, et al. Divergent age—associated and metabolism—associated gut microbiome signatures modulate cardiovascular disease risk. Nat Med 2024; 30(6): 1722-1731.

[17] Zhang Y, Wu J, Liu Y, et al. Cardiovascular 1.5—level prevention: a comprehensive screening and intervention for early cardiovascular organ damage. Sci Bull (Beijing) 2025; 70(9): 1380-1383.

[18] Zhou M, Li J, Lim J, et al. A machine learning model integrating tongue image features and myocardial injury markers predicts major adverse cardiovascular events in patients with coronary heart disease. Int J Gen Med 2025; 18: 3739-3765.

[19] Yunhu C, Moqing Y, Lihua F, et al. Mirror—like tongue is an important predictor of acute heart failure: a cohort study of acute heart failure in Chinese patients. J Tradit Chin Med 2023; 43(6): 1243-1251.

[20] Li Y, Liu Y, Cui J, et al. Oral—gut microbial transmission promotes diabetic coronary heart disease. Cardiovasc Diabetol 2024; 23(1): 123.

[21] Chen BY, Lin WZ, Li YL, et al. Roles of oral microbiota and oral—gut microbial transmission in hypertension. J Adv Res 2023; 43: 147-161.

[22] Li YL, Chen BY, Feng ZH, et al. Roles of oral and gut microbiota in acute myocardial infarction. J Adv Res 2025; 74: 319-332.

[23] Chen H, Ma Y, Li M, et al. Tongue—coating microbiome reflects cardiovascular health and determines outcome in blood pressure intervention. J Genet Genomics 2023; 50(10): 803-806.

[24] Tu S, Yin Y, Ma L, et al. Diagnosis of non—puerperal mastitis based on “whole tongue” features: non—invasive biomarker mining and diagnostic model construction. Front Cell Infect Microbiol 2025; 15: 1602883.