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Xu L, Li D, Song Z, Liu J, Zhou Y, Yang J, Wen P. The association between monocyte to high-density lipoprotein cholesterol ratio and chronic kidney disease in a Chinese adult population: a cross-sectional study. Ren Fail 2024; 46:2331614. [PMID: 38522954 PMCID: PMC10962299 DOI: 10.1080/0886022x.2024.2331614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Monocyte to high-density lipoprotein cholesterol ratio (MHR) was confirmed as a novel inflammatory marker and strongly associated with the risk of several diseases. This study aimed to investigate the relationship between MHR and chronic kidney disease (CKD) in a Chinese adult population. METHODS In this cross-sectional study, 232,775 community-dwelling adults in Binhai who completed health checkups in 2021 were enrolled. Participants were categorized based on the MHR quartiles. Clinical characteristics of participants across different groups were compared using one-way ANOVA, Kruskal-Wallis h-test, and Chi-squared test as appropriate. Univariate and multivariable logistic regression analyses were taken to assess the relationship between MHR and the presence of CKD, as well as its association with low estimated glomerular filtration rate (eGFR) and proteinuria. Subgroup analyses were further executed to confirm the reliability of this relationship. RESULTS A total of 21,014 (9.0%) individuals were diagnosed with CKD. Characteristic indicators including waist circumference, body mass index (BMI), blood pressure (BP), serum uric acid (SUA), triglyceride, and fasting blood glucose (FBG) showed a gradual increase with higher MHR quartiles, whereas parameters such as age, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and eGFR decreased (p < .001). In the multivariable logistic regression analysis, we observed independent associations between MHR (per 1 SD increase) and CKD, as well as low eGFR and proteinuria, with odds ratio (ORs) and 95% confidence intervals (95%CIs) of 1.206 (1.186-1.225), 1.289 (1.260-1.319), and 1.150 (1.129-1.171), respectively (p < .001). Similar conclusions were confirmed in subgroup analysis stratified by gender, age, BMI, central obesity, hypertension, and diabetes mellitus, after justification for confounding factors. CONCLUSION Elevated MHR level was independently associated with the presence of CKD, suggesting that it might serve as a useful clinical tool for risk stratification, offering valuable insights to inform preventive and therapeutic approaches for clinicians in their routine medical practice.
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Affiliation(s)
- Lingling Xu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dongling Li
- Department of Nephrology, People’s Hospital of Binhai County, Yancheng, Jiangsu, China
| | - Zongwei Song
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jin Liu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yang Zhou
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping Wen
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Wang LH, Tan DH, Zhong XS, Jia MQ, Ke X, Zhang YM, Cui T, Shi L. Review on toxicology and activity of tomato glycoalkaloids in immature tomatoes. Food Chem 2024; 447:138937. [PMID: 38492295 DOI: 10.1016/j.foodchem.2024.138937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/18/2024]
Abstract
Owing to the lack of selection and limited intelligence in mechanical picking, some immature tomatoes that contain alkaloids are thrown away. Tomatine alkaloids are steroidal alkaloids naturally present in Solanaceae plants, which are distributed in small amounts in immature tomato fruits and decrease as the fruits ripen. Tomato glycoalkaloids are harmful to human health. However, in small quantities, there is some evidence that these compounds might be beneficial, as other non-antioxidant bioactivities. This article considers recent research on the biological effects of tomato glycoalkaloids in immature tomatoes, providing reference value for the potential development of these compounds.
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Affiliation(s)
- Li-Hao Wang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - De-Hong Tan
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Xue-Song Zhong
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Mei-Qi Jia
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Xue Ke
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Yu-Mei Zhang
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Tong Cui
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China
| | - Lin Shi
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China.
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Yang S, Xu J. Elevated small dense low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio is associated with an increased risk of metabolic dysfunction associated fatty liver disease in Chinese patients with type 2 diabetes mellitus. J Diabetes Investig 2024; 15:634-642. [PMID: 38251808 PMCID: PMC11060163 DOI: 10.1111/jdi.14148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION It is demonstrated that elevated small dense low-density lipoprotein cholesterol (sdLDL-C), and reduced high-density lipoprotein cholesterol (HDL-C) is associated with Metabolic dysfunction-associated fatty liver disease (MAFLD). This study aims to explore the relationship between sdLDL-C to HDL-C ratio (SHR) and MAFLD in Chinese patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS A cross-sectional study was performed among 1904 patients with T2DM. Weighted multivariable logistic regression analysis was conducted to explore the relationship between the SHR and the risk of MAFLD. In addition, this study used a two-part linear regression model to identify threshold effects. Subgroup analysis, interaction tests and receiver operating characteristic (ROC) curve analysis were also carried out. RESULTS The overall MAFLD prevalence reached 48.1%. Multiple logistic regression analysis showed that SHR was positively correlated with the risk of MAFLD (OR = 2.37, 95% CI = 1.80-3.12). Subgroup analysis stratified by age, gender, hypertension and BMI showed that there was a consistent positive correlation. A non-linear relationship and saturation effect between SHR and MAFLD risk were identified, with an inverted L shaped curve and an inflection point at 1.02. The area under the curve (AUC) for SHR in the ROC analysis was significantly greater than sdLDL-C and HDL-C, with a sensitivity of 71.2% and a specificity of 62.1%. CONCLUSIONS Elevated levels of SHR is independently associated with an increased risk of MAFLD in patients with T2DM. SHR may be taken as practical indicators to assess the risk of MAFLD in T2DM patients.
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Affiliation(s)
- Shouxing Yang
- Department of GastroenterologyThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Jing Xu
- Department of EndocrinologyThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
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Huang H, Xie J, Hou L, Miao M, Xu L, Xu C. Estimated small dense low-density lipoprotein cholesterol and nonalcoholic fatty liver disease in nonobese populations. J Diabetes Investig 2024; 15:491-499. [PMID: 38108613 PMCID: PMC10981148 DOI: 10.1111/jdi.14133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
AIMS/INTRODUCTION To explore the association between estimated small dense low-density lipoprotein cholesterol (sdLDL-C) and the risk of incident nonalcoholic fatty liver disease (NAFLD) in nonobese populations. MATERIALS AND METHODS This study included participants who underwent health checkups in 2014 and were followed up until 2019. We carried out Cox proportional hazards regression analyses to evaluate the association of estimated sdLDL-C with NAFLD. Discordance analyses were carried out to estimate the relative NAFLD risk in estimated sdLDL-C versus low-density lipoprotein cholesterol (LDL-C) discordant/concordant groups. Estimated sdLDL-C was calculated by equations based on LDL-C and triglycerides. The diagnosis of NAFLD was based on the presence of abdominal ultrasonography after excluding other causes of chronic liver disease. RESULTS Over a mean follow-up period of 26,694 person-years, 844 incident NAFLD cases were recorded. Compared with the first quartile of estimated sdLDL-C, the fourth quartile was associated with a 2.933-fold increased risk of NAFLD (95% confidence interval 2.095-4.107). With the increase in estimated sdLDL-C, the risk of NAFLD gradually increased both in participants within the normal range of LDL-C (hazard ratio 2.854, 95% confidence interval 1.650-5.617) and beyond the normal range of LDL-C (hazard ratio 2.636, 95% confidence interval 1.263-5.502). In addition, the inconsistent high estimated sdLDL-C/low LDL-C group was associated with an increased risk of NAFLD, but not the low estimated sdLDL-C/high LDL-C group. CONCLUSIONS Estimated sdLDL-C was positively associated with the risk of incident NAFLD in a nonobese population, independent of LDL-C.
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Affiliation(s)
- Hangkai Huang
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jiarong Xie
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- Department of GastroenterologyZhejiang University Ningbo HospitalNingboChina
| | - Linxiao Hou
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Min Miao
- Department of Internal MedicineZhenhai Lianhua HospitalNingboChina
| | - Lei Xu
- Department of GastroenterologyZhejiang University Ningbo HospitalNingboChina
| | - Chengfu Xu
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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Wang G, Zhao Y, Li Z, Li D, Zhao F, Hao J, Yang C, Song J, Gu X, Huang R. Association between novel inflammatory markers and non-alcoholic fatty liver disease: a cross-sectional study. Eur J Gastroenterol Hepatol 2024; 36:203-209. [PMID: 38047735 PMCID: PMC10906204 DOI: 10.1097/meg.0000000000002686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE This study aimed to investigate the association between novel inflammatory markers (NIMs) and non-alcoholic fatty liver disease (NAFLD). METHODS A total of 6306 subjects were enrolled in this cross-sectional study. NIMs, including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C-reactive protein to albumin ratio (CAR), lymphocyte to monocyte ratio (LMR), systemic immune-inflammation index (SII) and prognostic nutritional index (PNI), were calculated. The prevalence of NAFLD and its association with NIMs were assessed by multivariable logistic regression analysis. Subgroup analysis were performed based on age, sex and BMI. RESULTS The prevalence of NAFLD was 52.5% in the study population. Compared with non-NAFLD subjects, NAFLD patients were older and more frequent in females. The prevalence of NAFLD progressively increased among the higher quartile groups of CAR, LMR, SII and PNI ( P -trend < 0.05), whereas it progressively decreased among the higher quartile group of NLR and PLR ( P -trend < 0.05). According to multivariable logistic regression analysis, the highest quartile (Q4) had a significantly higher risk of NAFLD compared with Q1 in LMR [odds ratio (OR): 1.43; 95% confidence interval (CI): 1.17-1.75; P -trend < 0.001] and PNI (OR: 1.92; 95% CI: 1.57-2.35; P -trend < 0.001). The subgroup analysis showed a stronger association of PNI with NAFLD. CONCLUSION The study highlights the association between NIMs and NAFLD, with LMR and PNI identified as potential non-invasive markers of inflammation in NAFLD. Specifically, PNI exhibited the strongest association and may serve as a valuable marker for assessing inflammation in NAFLD.
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Affiliation(s)
- Gang Wang
- Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Yu Zhao
- Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Zeya Li
- Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Dan Li
- Beijing Tongzhou Yongshun Community Health Service, Beijing, China
| | - Feng Zhao
- Beijing Tongzhou Yongshun Community Health Service, Beijing, China
| | - Jing Hao
- Beijing Tongzhou Yongshun Community Health Service, Beijing, China
| | - Chunlei Yang
- Beijing Tongzhou Yongshun Community Health Service, Beijing, China
| | - Jiashu Song
- Beijing Tongzhou Yongshun Community Health Service, Beijing, China
| | - Xianzhong Gu
- Beijing Tongzhou Yongshun Community Health Service, Beijing, China
| | - Rongchong Huang
- Department of Cardiology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
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Huang H, Wang J, Wu L, Ruan J, Hou L, Shen C, Xu C. Remnant cholesterol and severity of nonalcoholic fatty liver disease. Diabetol Metab Syndr 2023; 15:238. [PMID: 37986027 PMCID: PMC10662644 DOI: 10.1186/s13098-023-01220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Serum remnant cholesterol levels are being increasingly acknowledged as a causal risk factor for atherosclerotic disease, regardless of conventional lipid parameters. The positive association between remnant cholesterol and nonalcoholic fatty liver disease (NAFLD) has been revealed in previous studies. However, whether remnant cholesterol is associated with the severity of NAFLD remains unknown. This study aimed to explore the association between serum remnant cholesterol and the risk of NAFLD severity. METHODS This cross-sectional study included a total of 6,053 participants who attended health checkups. The severity of hepatic steatosis was evaluated by liver ultrasound transient elastography. Univariable and multivariable logistic regression analyses were performed to calculate the odds ratio (OR) and 95% confidence interval (95% CI) for the association between remnant cholesterol and the severity of hepatic steatosis. To explore whether the association between remnant cholesterol and NAFLD severity was independent of conventional lipid parameters, we further investigated this association in individuals with normal values of low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and triglycerides. RESULTS In total, 36.9% of individuals had mild steatosis, and 5.9% had moderate-to-severe steatosis. The serum level of remnant cholesterol in nonsteatosis, mild steatosis and moderate-to-severe steatosis gradually increased (0.71 ± 0.33, 0.97 ± 0.52 and 1.07 ± 0.63 mmol/L, respectively). In the multivariable mode, remnant cholesterol was positively associated with mild hepatic steatosis (OR: 1.730, 95% CI: 1.541 - 1.941, P < 0.001) and moderate-to-severe steatosis (OR: 2.342, 95% CI: 1.765 - 3.109, P < 0.001). These associations were not significantly altered in individuals with normal triglycerides, HDL-C and LDL-C (OR: 1.664, 95% CI: 1.448 - 1.911, P < 0.001; OR: 2.269, 95% CI: 1.619 - 3.180, P < 0.001, respectively). CONCLUSIONS Higher levels of serum remnant cholesterol were associated with more severe hepatic steatosis, regardless of conventional lipid parameters. Individuals with higher remnant cholesterol may need more attention in regular surveillance of NAFLD.
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Affiliation(s)
- Hangkai Huang
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Jinghua Wang
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Li Wu
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jiaqi Ruan
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Linxiao Hou
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Chao Shen
- Health Management Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Chengfu Xu
- Department of Gastroenterology, Zhejiang Provincial Clinical Research Center for Digestive Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China.
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Huang XJ, Yin M, Zhou BQ, Tan XY, Xia YQ, Qin CX. Impact renaming non-alcoholic fatty liver disease to metabolic associated fatty liver disease in prevalence, characteristics and risk factors. World J Hepatol 2023; 15:985-1000. [PMID: 37701916 PMCID: PMC10494565 DOI: 10.4254/wjh.v15.i8.985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/18/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Recently, a group of hepatologists proposed to rename non-alcoholic fatty liver disease (NAFLD) as metabolic associated fatty liver disease (MAFLD) with modified diagnostic criteria. It is important to note, however, that there are some differences between the diagnostic criteria used for NAFLD and MAFLD. Since the research on MAFLD is just beginning, however, evidence on its incidence and prevalence in the general population and in specific subpopulations remains limited. AIM To assess epidemiology of fatty liver in new definition and compare MAFLD with NAFLD. Exploring risk factors of MAFLD individuals. METHODS This was a retrospective, cross-sectional study. A total of 85242 adults were selected from the Chinese health management database in 2017-2022. The data of general information, laboratory indicators, lifestyle management and psychological status were obtained. MAFLD was diagnosed as ultrasound diagnosis of fatty liver and at least one between these three conditions: Overweight/obesity, type 2 diabetes mellitus (T2DM) or metabolic dysregulation. Metabolic factors were not considered in NAFLD diagnosis standard. The clinical characteristics of MAFLD and NAFLD were analysed using descriptive statistics. Continuous variables normally distributed were expressed as means ± SD. Categorical variables were expressed as frequencies and proportions. Binary logistic regression was used to determine risk factors of the MAFLD. RESULTS The prevalence of MAFLD and NAFLD was 40.5% and 31.0%, respectively. The MAFLD or NAFLD population is more likely to be older (M: 47.19 ± 10.82 vs 43.43 ± 11.96; N: 47.72 ± 11.17 vs 43.71 ± 11.66), male (M: 77.21% vs 44.43%; N: 67.90% vs 53.12%) and high body mass index (M: 26.79 ± 2.69 vs 22.44 ± 2.48; N: 26.29 ± 2.84 vs 23.29 ± 3.12) than the non-MAFLD or non-MAFLD population. In multivariate analysis, general information (e.g., ≥ 2 metabolic abnormalities OR = 3.38, (95%CI: 2.99-3.81), P < 0.001; diastolic blood pressure OR = 1.01, (95%CI: 1.00-1.01), P = 0.002), laboratory results [e.g.,total bilirubin (TBIL) OR = 0.98, (95%CI: 0.98-0.99), P < 0.001; serum uric acid(SUA) OR = 1.01, (95%CI: 1.01-1.01), P < 0.001], and lifestyle factors [e.g., drink beverage OR = 0.32, (95%CI: 0.17-0.63), P = 0.001] were influence factors for MAFLD. Our study results offer new insight into potential risk factors associated with fatty liver disease, including SUA, TBIL and creatinine, all of which are related to chronic renal disease (CKD). CONCLUSION MAFLD is more prevalent than NAFLD, with two-fifths of individuals meeting the diagnosis criteria. MAFLD and NAFLD populations have different clinical characteristics. CKD may be related with MAFLD.
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Affiliation(s)
- Xin-Juan Huang
- Xiangya Nursing of School, Central South University, Changsha 410013, Hunan Province, China
| | - Man Yin
- Xiangya Nursing of School, Central South University, Changsha 410013, Hunan Province, China
| | - Bing-Qian Zhou
- Xiangya Nursing of School, Central South University, Changsha 410013, Hunan Province, China
| | - Xin-Yun Tan
- Xiangya Nursing of School, Central South University, Changsha 410013, Hunan Province, China
| | - Yuan-Qin Xia
- School of Medicine, Jishou University, Jishou 416000, Hunan Province, China
| | - Chun-Xiang Qin
- Department of Health Examination Center, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China.
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Zhang X, Qin H, Tan X, Mo Y, Li Z, Huang G, Wei Z. Predictive value of monocyte to high-density lipoprotein cholesterol ratio and tumor markers in colorectal cancer and their relationship with clinicopathological characteristics. World J Surg Oncol 2023; 21:200. [PMID: 37420210 DOI: 10.1186/s12957-023-03079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/14/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE To evaluate the predictive value of monocyte (M) to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) and tumor markers in colorectal cancer (CRC) and their correlation with clinicopathological characteristics. METHODS Hematology test data and medical records of 202 CRC patients and 201 healthy subjects were collected retrospectively. The diagnostic efficacy of MHR was evaluated using receiver operating characteristic (ROC) curves and risk factors for CRC were analyzed by multivariate logistic regression. RESULTS CRC patients had significantly higher M, MHR, carcinoembryonic antigen (CEA), and carbohydrate antigen 199 (CA199) levels, but significantly lower HDL-C levels than healthy controls (all P < 0.05). Additionally, MHR was positively correlated with tumor differentiation in CRC patients (P = 0.049); CEA and CA199 levels in CRC patients increased with increased stage, lymph node metastasis and tumor size ≥ 5 cm (all P < 0.05). Furthermore, high levels of MHR, CA199 and CEA were independent risk factors for CRC. The area under ROC curve of MHR combined with CEA and CA199 was 0.882/0.869 for the diagnosis of CRC, respectively. CONCLUSION This is the first study to explore the predictive value of MHR in CRC, and its continuous increase is an independent risk factor for CRC. MHR is a promising predictor for CRC progression along with CA199 and CEA.
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Affiliation(s)
- Xuan Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Hongyan Qin
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiaodan Tan
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Yuncong Mo
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhenyong Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Guofeng Huang
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhixiao Wei
- Department of Nuclear Medicine, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
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Shen S, Huang H, Wang J, Tang Z, Shen C, Xu C. Positive Association Between the Chinese Visceral Adiposity Index and Nonalcoholic Fatty Liver Disease in Lean Adults. Dig Dis Sci 2023; 68:656-664. [PMID: 36512267 DOI: 10.1007/s10620-022-07787-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/05/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chinese visceral adiposity index (CVAI) is a novel indicator that precisely evaluates visceral obesity and has been shown to be significantly associated with nonalcoholic fatty liver disease (NAFLD) in the general population. However, the relationship between CVAI and NAFLD in lean adults remains unclear. AIMS This study aimed to explore the association of CVAI with NAFLD in a lean population and evaluate the diagnostic capability of CVAI for lean NAFLD. METHODS A cross-sectional study was conducted among 9,607 lean adults (body mass index < 24 kg/m2), who underwent their annual health examinations at the First Affiliated Hospital, Zhejiang University School of Medicine in 2021. NAFLD was determined by ultrasonography to the exclusion of other known etiologies. RESULTS The prevalence of NAFLD was 16.4% in this lean population. CVAI values were significantly higher in participants with NAFLD than those without NAFLD and the CVAI quartile was positively associated with the prevalence of NAFLD, which was 0.4%, 6.0%, 19.4%, and 39.8% among the participants with CVAI in quartile 1 to 4, respectively (P for trend < 0.001). Logistic regression analysis found that CVAI was positively associated with the risk of NAFLD (adjusted odds ratio: 1.025, 95% confidence interval: 1.021-1.028; P < 0.001). Furthermore, CVAI had a significantly higher area under curve value for detecting NAFLD than other visceral obesity indices. CONCLUSION Our study showed that CVAI was positively associated with the prevalence and risk of NAFLD in lean adults, and CVAI showed the highest diagnostic ability for lean NAFLD.
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Affiliation(s)
- Shuxia Shen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Hangkai Huang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Jinghua Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China
| | - Zexi Tang
- School of Science, Hong Kong University of Science and Technology, Hong Kong, China
| | - Chao Shen
- Health Management Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengfu Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
- Zhejiang Provincial Clinical Research Center for Digestive Diseases, Hangzhou, China.
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Xu Y, Liu X, Zhang Z. STV-Na attenuates lipopolysaccharide-induced lung injury in mice via the TLR4/NF-kB pathway. Immun Inflamm Dis 2023; 11:e770. [PMID: 36705406 PMCID: PMC9846117 DOI: 10.1002/iid3.770] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Acute lung injury (ALI) is a potentially fatal disorder that is largely caused by inflammation. Sodium isostevanol (STV-Na) is a terpenoid produced from stevioside, which possesses anti-inflammatory and antioxidative stress characteristics. nevertheless, it is still unclear how STV-Na affects ALI. Therefore, we investigated the possible STV-Na therapeutic impacts on lipopolysaccharide (LPS)-induced (ALI). METHODS We employed hematoxylin-eosin staining to observe the impact of STV-Na on lung histopathological alterations and used kits to detect the oxidative stress status of lung tissues, such as superoxide dismutase, malondialdehyde, and glutathione. The reactive oxygen species and myeloperoxidase expression in the tissues of lung was assessed by immunofluorescence and immunohistochemistry. Additionally, we detected the impact of STV-Na on inflammatory cell infiltration in lung tissue using Wright-Giemsa staining solution and immunohistochemistry, which was found to reduce inflammation in lung tissue by enzyme-linked immunosorbent assay. Finally, using WB, we examined the impact of STV-Na on the TLR4/NF-kB pathway. RESULTS We observed that STV-Na attenuated lung histopathological alterations in LPS-induced lung damage in mice, reduced infiltration of inflammatory cell and oxidative stress in the tissue of lung, and via the TLR4/NF-kB pathway, there is a reduction in the inflammatory responses in mouse lung tissue. CONCLUSIONS These outcomes indicate that the response of inflammatory cells to LPS-induced ALI in mice was attenuated by STV-Na.
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Affiliation(s)
- Yanhong Xu
- Department of RespiratoryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xiaoming Liu
- Department of Plastic Surgery, The First Affiliated Hospital of Xinjiang Medical UniversityXinjiang Medical UniversityXinjiangUrumqiChina
| | - Zhihui Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Xinjiang Medical UniversityXinjiang Medical UniversityXinjiangUrumqiChina
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Wang L, Zhang Y, Yu B, Zhao J, Zhang W, Fan H, Ren Z, Liang B. The monocyte-to-high-density lipoprotein ratio is associated with the occurrence of atrial fibrillation among NAFLD patients: A propensity-matched analysis. Front Endocrinol (Lausanne) 2023; 14:1127425. [PMID: 37056665 PMCID: PMC10086442 DOI: 10.3389/fendo.2023.1127425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Accumulating evidence suggests that patients with nonalcoholic fatty liver disease (NAFLD) have a significantly high risk of incident atrial fibrillation (AF). Systemic inflammation, metabolic disorders and oxidative stress could be the potential mechanisms by which NAFLD drives AF. Monocyte-to- high-density lipoprotein ratio (MHR) has emerged as a novel biomarker of inflammation and oxidative stress that has not been studied in AF with NAFLD patients. We aimed to investigate the relationship between MHR and the risk of AF among NAFLD patients. METHODS A retrospective analysis was performed for the clinical data of the patients with NAFLD in the Second Hospital of Shanxi Medical University from January 2019 to October 2022, among whom 204 patients with AF were enrolled as NAFLD+AF group and 613 patients without AF were enrolled as NAFLD control, and 152 patients were selected from each group based on propensity score matching (PSM) at a ratio of 1:1 to balance the covariates between groups. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Logistic regression analysis was performed to identify the independent predictor for occurrence of AF among NAFLD patients. Trend chi-square test to analyze the prevalence of AF among MHR tertiles, and then the correlation between MHR and the risk of AF confirmed by restricted cubic splines (RCS). The receiver operating characteristic (ROC) curve analysis was used to determine the optimum MHR cutoff value to predict AF. RESULTS Univariate analysis showed that AF patients had higher MHR than non-AF patients (P < 0.001). Meanwhile, compared with pure NAFLD patients, multivariate logistic regression analysis showed that MHR remained to be an independent risk factor for AF after adjusting for confounding risk factors (OR = 10.67, 95% CI 2.17-52.37, P = 0.004). TC、HDL-C were also independent risk factors for AF. Among them, TC and HDL-C are protective factors for AF. The trend chi-square test showed that the risk of AF increased with an increase in MHR (P < 0.05). However, the RCS showed a nonlinear and J-shaped relationship between MHR and the risk of AF (P for non-linearity = 0.023). The occurrence of AF increased with increasing MHR only when MHR > 0.44. The ROC curve showed that MHR combined with traditional risk factors can improve the ability to predict AF. CONCLUSION MHR is an independently associated with incident AF in patients with NAFLD and show a certain predictive value.
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Affiliation(s)
- Leigang Wang
- Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yao Zhang
- Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Bing Yu
- Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jianqi Zhao
- Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenjing Zhang
- Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongxuan Fan
- Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhaoyu Ren
- Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Bin Liang
- Department of Cardiovascular Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- *Correspondence: Bin Liang,
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Wang L, Dong J, Xu M, Li L, Yang N, Qian G. Association Between Monocyte to High-Density Lipoprotein Cholesterol Ratio and Risk of Non-alcoholic Fatty Liver Disease: A Cross-Sectional Study. Front Med (Lausanne) 2022; 9:898931. [PMID: 35665350 PMCID: PMC9161020 DOI: 10.3389/fmed.2022.898931] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is a global health problem affecting more than a quarter of the entire adult population. Both monocytes and high-density lipoprotein cholesterol (HDL-C) were found to participate in the progression of hepatic inflammation and oxidative stress. We speculated that the monocyte-to-HDL-C ratio (MHR) may be associated with the risk of NAFLD. Methods We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. NAFLD was identified using a controlled attenuation parameter (CAP) of ≥274 dB/m. Degree of liver fibrosis were assessed by liver stiffness measurement (LSM) and LSM values≥8.0, ≥ 9.7, and ≥13.7 kPa were defined as significant fibrosis (≥F2), advanced fibrosis (≥F3) and cirrhosis (F4), respectively. The association between MHR and the risk of NAFLD and liver fibrosis was estimated using weighted multivariable logistic regression. The non-linear relationship between MHR and the risk of NAFLD was further described using smooth curve fittings and threshold effect analysis. Results Of 4,319 participants, a total of 1,703 (39.4%) participants were diagnosed with NAFLD. After complete adjustment for potential confounders, MHR was positively associated with the risk of NAFLD (OR = 2.87, 95% CI: 1.95-4.22). The risk of NAFLD increased progressively as the MHR quarter increased (P for trend < 0.001). In subgroup analysis stratified by sex, a positive association existed in both sexes; Women displayed higher risk (men: OR = 2.12, 95% CI: 1.33-3.39; women: OR = 2.64, 95%CI: 1.40-4.97). MHR was positively associated with the risk of significant liver fibrosis (OR = 1.60, 95% CI: 1.08-2.37) and cirrhosis (OR = 1.83, 95% CI: 1.08-3.13), but not with advanced liver fibrosis (OR = 1.53, 95% CI: 0.98-2.39) after full adjustment for potential confounders. In the subgroup analysis by sex, the association between MHR and different degrees of liver fibrosis was significantly positive in women. When analyzing the relationship between MHR and NAFLD risk, a reverse U-shaped curve with an inflection point of 0.36 for MHR was found in women. Conclusion Higher MHR was associated with increased odds of NAFLD among Americans of both sexes. However, an association between MHR and liver fibrosis was found mainly among women.
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Affiliation(s)
- Liping Wang
- Department of Infectious Diseases, Ningbo First Hospital, Ningbo University, Ningbo, China
- Department of Hepatology, Non-alcoholic Fatty Liver Disease (NAFLD) Research Center, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Jinzhong Dong
- Department of Intensive Care Medicine, Ningbo First Hospital, Ningbo University, Ningbo, China
| | - Miao Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo University, Zhejiang, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo University, Zhejiang, China
| | - Naibin Yang
- Department of Infectious Diseases, Ningbo First Hospital, Ningbo University, Ningbo, China
- Department of Hepatology, Non-alcoholic Fatty Liver Disease (NAFLD) Research Center, Ningbo Hospital of Zhejiang University, Ningbo, China
| | - Guoqing Qian
- Department of Infectious Diseases, Ningbo First Hospital, Ningbo University, Ningbo, China
- Department of Hepatology, Non-alcoholic Fatty Liver Disease (NAFLD) Research Center, Ningbo Hospital of Zhejiang University, Ningbo, China
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Zhao Y, Xia J, He H, Liang S, Zhang H, Gan W. Diagnostic performance of novel inflammatory biomarkers based on ratios of laboratory indicators for nonalcoholic fatty liver disease. Front Endocrinol (Lausanne) 2022; 13:981196. [PMID: 36518239 PMCID: PMC9742359 DOI: 10.3389/fendo.2022.981196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION There is few effective biomarkers for diagnosing nonalcoholic fatty liver disease (NAFLD) in clinical practice. This study was aimed to investigate the predictive ability of novel inflammatory biomarkers, including the monocyte to high-density lipoprotein cholesterol ratio (MHR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR), for NAFLD. METHODS A total of 4465 outpatients diagnosed with NAFLD and 3683 healthy controls were enrolled between May 2016 and November 2021 from the West China Hospital of Sichuan University, and anthropometric and laboratory examination data were collected. The two-sample Mann-Whitney U test and binary logistic regression analysis were used to evaluate the correlations between four inflammatory biomarkers and NAFLD. The areas under the curves (AUCs) of receiver operating characteristic were used to evaluate their predictive ability for NAFLD. RESULTS The MHR, NLR and LMR were higher in patients with NAFLD than in healthy controls (P<0.001), whereas the PLR was remarkably lower (P<0.001). The OR values of the MHR, NLR, PLR, and LMR were 1.599 (1.543-1.658), 1.250 (1.186-1.317), 0.987(0.986-0.988) and 1.111(1.083-1.139), respectively(P<0.001). After adjusting for confounding factors, MHR was still the most relevant risk factor for NAFLD compared with other inflammatory markers (P<0.001). The AUCs of the MHR, NLR, PLR, and LMR were as follows: 0.663 (0.651-0.675), 0.524 (0.512-0.537), 0.329 (0.318-0.341), and 0.543 (0.530-0.555), respectively (P<0.001). Furthermore, the diagnostic model combining the MHR with alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglycerides, fasting blood glucose, creatinine, uric acid, and body mass index had the best AUC of 0.931 (0.925-0.936). CONCLUSIONS MHR was superior to NLR, PLR and LMR as an inflammatory biomarker in the prediction of NAFLD. When combined with relevant laboratory parameters, the MHR may improve the clinical noninvasive diagnosis of NAFLD.
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Affiliation(s)
- Yanhua Zhao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Junxiang Xia
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
- Department of Laboratory Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - He He
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shanshan Liang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - He Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Gan
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Wei Gan,
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Wang W, Chen ZY, Guo XL, Tu M. Monocyte to High-Density lipoprotein and Apolipoprotein A1 Ratios: Novel Indicators for Metabolic Syndrome in Chinese Newly Diagnosed Type 2 Diabetes. Front Endocrinol (Lausanne) 2022; 13:935776. [PMID: 35909551 PMCID: PMC9330493 DOI: 10.3389/fendo.2022.935776] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Increasing evidence highlighted that chronic inflammation involved in the development of metabolic syndrome (MetS) and Type 2 diabetes mellitus (T2DM). This prospective study was aimed to assess the association between MetS and novel pro-inflammatory indicators like monocyte-to-high-density lipoprotein and monocyte-to-apolipoprotein A1 ratios (MHR and MAR) in Chinese newly diagnosed T2DM. METHOD A total of 605 Chinese newly diagnosed T2DM with complete and available data were enrolled in this study. Demographic and anthropometric information were collected. Laboratory assessments were determined by standard methods. MetS was based on the Chinese Diabetes Society definition. Multiple binomial logistic regression model was used to estimate the independent variables of MHR and MAR for MetS. Receiver operating characteristic (ROC) curve was conducted to assess the optimal cutoff value of MHR and MAR in identifying MetS. RESULTS Overall, the prevalence of MetS was 60.2%. The correlation analysis showed that MHR and MAR were closely correlated with metabolic risk factors like body mass index, waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, uric acid, and insulin resistance. MHR and MAR were also significantly associated with higher odds of MetS after adjustment for other confounders, the odds ratios (ORs) (95%CI) were 1.50 (1.14-1.97) and 2.26(1.79-2.87) respectively. Furthermore, MHR and MAR were also seemed to have higher area under the curve (AUC) for MetS than ApoA1 and monocyte alone from the ROC curve analysis (P < 0.05). The AUCs of MHR and MAR identifying MetS were 0.804 (95% CI: 0.768-0.839) and 0.840 (95% CI: 0.806-0.873) respectively (P < 0.001). The optimal cutoff values of MHR and MAR were 3.57 × 108/mmol (sensitivity: 76.1%, specificity: 73.4%) and 3.95 × 108/g (sensitivity: 79.7%, specificity: 84.6%), respectively. CONCLUSIONS MHR and MAR were significantly associated with MetS. These two novel pro-inflammatory indicators may be useful markers for MetS in Chinese newly diagnosed T2DM.
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