Sub-region based radiomics analysis for prediction of isocitrate dehydrogenase and telomerase reverse transcriptase promoter mutations in diffuse gliomas

AIM

To enhance the prediction of mutation status of isocitrate dehydrogenase (IDH) and telomerase reverse transcriptase (TERT) promoter, which are crucial for glioma prognostication and therapeutic decision-making, via sub-regional radiomics analysis based on multiparametric magnetic resonance imaging (MRI).

MATERIALS AND METHODS

A retrospective study was conducted on 401 participants with adult-type diffuse gliomas. Employing the K-means algorithm, tumours were clustered into two to four subregions. Sub-regional radiomics features were extracted and selected using the Mann-Whitney U-test, Pearson correlation analysis, and least absolute shrinkage and selection operator, forming the basis for predictive models. The performance of model combinations of different sub-regional features and classifiers (including logistic regression, support vector machines, K-nearest neighbour, light gradient boosting machine, and multilayer perceptron) was evaluated using an external test set.

RESULTS

The models demonstrated high predictive performance, with area under the receiver operating characteristic curve (AUC) values ranging from 0.918 to 0.994 in the training set for IDH mutation prediction and from 0.758 to 0.939 for TERT promoter mutation prediction. In the external test sets, the two-cluster radiomics features and the logistic regression model yielded the highest prediction for IDH mutation, resulting in an AUC of 0.905. Additionally, the most effective predictive performance with an AUC of 0.803 was achieved using the four-cluster radiomics features and the support vector machine model, specifically for TERT promoter mutation prediction.

CONCLUSION

The present study underscores the potential of sub-regional radiomics analysis in predicting IDH and TERT promoter mutations in glioma patients. These models have the capacity to refine preoperative glioma diagnosis and contribute to personalised therapeutic interventions for patients.

[Dosimetric analysis of different optimization algorithms for three-dimensional brachytherapy for gynecologic tumors]

OBJECTIVE

To investigate the dosimetric difference between manual and inverse optimization in 3-dimensional (3D) brachytherapy for gynecologic tumors.

METHODS

This retrospective study was conducted among a total of 110 patients with gynecologic tumors undergoing intracavitary combined with interstitial brachytherapy or interstitial brachytherapy. Based on the original images, the brachytherapy plans were optimized for each patient using Gro, IPSA1, IPSA2 (with increased volumetric dose limits on the basis of IPSA1) and HIPO algorithms. The dose-volume histogram (DVH) parameters of the clinical target volume (CTV) including V200, V150, V100, D90, D98 and CI, and the dosimetric parameters D2cc, D1cc, and D0.1cc for the bladder, rectum, and sigmoid colon were compared among the 4 plans.

RESULTS

Among the 4 plans, Gro optimization took the longest time, followed by HIPO, IPSA2 and IPSA1 optimization. The mean D90, D98, and V100 of HIPO plans were significantly higher than those of Gro and IPSA plans, and D90 and V100 of IPSA1, IPSA2 and HIPO plans were higher than those of Gro plans (P < 0.05), but the CI of the 4 plans were similar (P > 0.05). For the organs at risk (OARs), the HIPO plan had the lowest D2cc of the bladder and rectum; the bladder absorbed dose of Gro plans were significantly greater than those of IPSA1 and HIPO (P < 0.05). The D2cc and D1cc of the rectum in IPSA1, IPSA2 and HIPO plans were better than Gro (P < 0.05). The D2cc and D1cc of the sigmoid colon did not differ significantly among the 4 plans.

CONCLUSION

Among the 4 algorithms, the HIPO algorithm can better improve dose coverage of the target and lower the radiation dose of the OARs, and is thus recommended for the initial plan optimization. Clinically, the combination of manual optimization can achieve more individualized dose distribution of the plan.

Diet Mediate the Impact of Host Habitat on Gut Microbiome and Influence Clinical Indexes by Modulating Gut Microbes and Serum Metabolites

The impact of external factors on the human gut microbiota and how gut microbes contribute to human health is an intriguing question. Here, the gut microbiome of 3,224 individuals (496 with serum metabolome) with 109 variables is studied. Multiple analyses reveal that geographic factors explain the greatest variance of the gut microbiome and the similarity of individuals' gut microbiome is negatively correlated with their geographic distance. Main food components are the most important factors that mediate the impact of host habitats on the gut microbiome. Diet and gut microbes collaboratively contribute to the variation of serum metabolites, and correlate to the increase or decrease of certain clinical indexes. Specifically, systolic blood pressure is lowered by vegetable oil through increasing the abundance of Blautia and reducing the serum level of 1-palmitoyl-2-palmitoleoyl-GPC (16:0/16:1), but it is reduced by fruit intake through increasing the serum level of Blautia improved threonate. Besides, aging-related clinical indexes are also closely correlated with the variation of gut microbes and serum metabolites. In this study, the linkages of geographic locations, diet, the gut microbiome, serum metabolites, and physiological indexes in a Chinese population are characterized. It is proved again that gut microbes and their metabolites are important media for external factors to affect human health.

[Relationship between the percentage of energy intake from macronutrients and obesity among adult residents in 15 provinces of China in 1991-2018]

OBJECTIVE

To explore the relationship between the percentage of energy intake from macronutrients and obesity in Chinese adult residents, and analyze the cut-off values of macronutrients for predicting obesity.

METHODS

Data was collected in China Health and Nutrition Survey(CHNS)in 1991-2018. Adults who participated in at least two waves of the surveys and were not obese at baseline were selected as the study subjects. Obesity was defined as body mass index(BMI)≥28.0 kg/m~2. Generalized estimating equation was used to analyze the relationship between the percentage of energy intake from macronutrients and BMI and obesity, and receiver operating characteristic curve(ROC) was used to analyze the cut-off values of percentage of energy intake from macronutrients to predict obesity.

RESULTS

The percentage of energy intake from protein and fat of adult residents in 15 provinces(autonomous regions and municipalities) in China showed an increasing trend(P<0.01), and the percentage of energy intake from carbohydrate showed a decreasing trend(P<0.01) between 1991 and 2018. After adjusting for covariates, the group of percentage of energy intake from fat in 20%～30%(β=0.05, 95%CI 0.01-0.08)and ≥30%(β=0.15, 95%CI 0.11-0.18)were positively correlated with BMI compared with the group of percentage of energy intake from fat <20%, and the risk of obesity in 20%-30% and ≥ 30% was increased by 17%(OR=1.17, 95%CI 1.04-1.31)and 6%(OR=1.06, 95%CI 1.24-1.56), respectively. Compared with the group of the percentage of energy intake from carbohydrate < 50%, the group of 50% to 65%(β=-0.08, 95% CI-0.11--0.05) and ≥ 65%(β=-0.17, 95%CI-0.20--0.13) was negatively correlated with BMI, and the percentage of energy intake from carbohydrate ≥ 65% reduced the risk of obesity(OR=0.71, 95%CI 0.63-0.80).

CONCLUSION

Carbohydrate intake was inversely correlated with the risk of obesity, and fat intake was positively correlated with the risk of obesity. Moderate intake of carbohydrates and reduced fat intake can prevent obesity.

[Designing effective front-of-package warning labels for prepackaged food in China:based on Delphi method]

OBJECTIVE

To design front-of-package warning labels for prepackaged food adapted to the Chinese context.

METHODS

Delphi method was used to evaluate the first graft of indicatorsof the front-of-package warning labels. The front-of-package warning labels suitable for China's national conditions was selected according to the direct scoring method.

RESULTS

4 sets of front-of-package warning labels for prepackaged food were selected after two rounds of Delphi expert method.

CONCLUSION

The final draft of the front-of-package warning labels for prepackaged food is in line with expectations.

[Evaluation of the front-of-package warning labels of prepackaged food in China based on focus group discussion]

OBJECTIVE

To understand the public's perceptions and preferences on the designed front-of-package warning labels of prepackaged food, and to evaluate and identify the effective warning label.

METHODS

A total of 116 participants were recruited from six provinces(autonomous regions/municipalities) in China. Focus group discussions were conducted with four types of warning labels on prepackaged food. And the score of attitude on different warning labels were compared.

RESULTS

There was no difference in the total score of the four warning labels. Total score of black shield label was higher in citizen participants and college education level participants than in their respective counterparts(P<0.05). Parents or primary caregiver of children under 16 years old gave higher scores to each labels than their respective counterparts(P<0.05). The black shield label was most likely to attract the attention of the respondents, most likely to influence the decision on eating and drinking, and most likely to have an unhealthy warning effect. The yellow hexagonal label was least likely to attract the attention of the respondents, least likely to affect the decision to eat and drink food, and least likely to have an unhealthy warning effect.

CONCLUSION

Black shield warning label is the most effective.

The Mediation and Moderation Effect Association among Physical Activity, Body-Fat Percentage, Blood Pressure, and Serum Lipids among Chinese Adults: Findings from the China Health and Nutrition Surveys in 2015

Physical activity (PA) is of benefit and particularly important for cardiovascular disease risk factors as being sedentary becomes a lifestyle habit. Research into Chinese complex association among physical activity, body-fat percentage (BF%), blood pressure, and serum lipids is limited. The present study is based on an observational study among adults (>18 years old) residing in fifteen provinces in China. Data of 10,148 adult participants in the 2015 China Health and Nutrition Survey (CHNS) were analyzed. The simple mediation effect models with covariates were utilized to assess the association among PA and blood pressure or serum lipids, and BF% was played as a mediator. The serial multiple-mediator models with covariates were constructed to the further analysis of the relationship between PA and blood pressure, and BF% was the mediator 1 and blood lipids were the mediator 2. Based on the above hypothesis, the moderated mediation models with covariates were used to analyze the association among PA, BF%, and blood pressure; in addition, BF% was used as the mediator and blood lipids played as the moderator. In the simple mediation models, the model with a dependent variable was high-density lipoprotein cholesterol (HDL-C) or low-density lipoprotein cholesterol (LDL-C); BF% was played as the partly mediation effect and the proportion of contribution was 0.23 and 0.25, respectively. In the serial multiple-mediator models, blood lipids, as the second mediator, played the mediation effect; however, the effect was smaller than the BF%. In the moderated mediation model, blood lipids had the moderation effect as the moderator variable. HDL-C played a moderating role in the latter pathway of the "PA→BF%→SBP/DBP" mediation model, and LDL-C/TC played a moderating role in the direct effect of the "PA→BF%→DBP". In conclusion, BF% played a mediating role in the relationship between PA and blood pressure. HDL-C, LDL-C, and TC were more likely to act as moderating variables in the mediation model "PA→BF%→SBP/DBP". PA could directly and indirectly benefit to control the CVD risk factors simultaneously.

[Relationship between physical activity and muscle mass loss among people aged 60 and above in 15 provinces of China in 2015]

OBJECTIVE

To analyze the relationship between physical activity and muscle mass loss among Chinese elderly aged 60 years and above in 15 provinces.

METHODS

Data was collected from 2015 China Nutritional Transition Cohort Study. Information on demographic characteristics and physical activity was investigated by questionnaire. Dietary intake was estimated from three consecutive 24-h recalls for each individual. Appendicular skeletal muscle mass(ASM) was assessed using the bioelectrical impedance analysis(BIA). Skeletal muscle mass(SMI) loss was diagnosed according Asian working group of sarcopenia(AWGS) 2019 recommendation(male: SMI <7.0 kg/m~2, female: <5.7 kg/m~2). A total of 4565 participants aged 60 years and above from 15 provinces in China with complete information were included in the final analysis. Different domains(occupational, domestic, travel and leisure), light physical activity(<3.0 METs), moderate physical activity(3.0-5.9 METs) and vigorous physical activity(≥6.0 METs) of physical activity among elderly adults were evaluated. Logistic multilevel model was used to analyze the relationship between low muscle mass and different intensity of physical activity duration.

RESULTS

Among all participants aged 60 years and above in 15 provinces of China in 2015, women's participation rate in domestic physical activity was 91.7%, which was higher than men's rate of 62.3%. However, men's participation rate in occupational, travel and leisure physical activity were higher than those of women. The participation rate, duration of light physical activity and moderate physical activity were higher in women than in men(light physical activity: female duration 11.0 h/week vs. male duration 3.5 h/week; female participation rate 89.9% vs. male participation rate 62.8%; moderate physical activity: female duration 7.0 h/week vs. male duration 4.7 h/week; female participation rate 90.6% vs. male participation rate 75.2%). The median vigorous physical activity was 0 h/week in both male and female group. The prevalence of muscle mass loss was 13.9% among subjects. The median weekly light physical activity and moderate physical activity in muscle mass loss group were 5.8 h and 4.7 h, which were lower than in non-muscle mass loss group(9.3 h and 6.0 h). The OR of muscle mass lass was 0.71(95%CI 0.42-0.98, P<0.05) for the male with 3.5-6.9 hours of moderate physical activity per week, compared to moderate physical activity less than 3.5 h/week. And OR of the female was 0.67(95%CI 0.47-0.95, P<0.05).

CONCLUSION

The vast majority of physical activity in China among the elderly is domestic and light physical activity. Light physical activity and moderate physical activity duration increments in female and moderate physical activity duration increments in male were associated with decreased risk of muscle mass loss.

[Development and validation of the nutrient-rich food index for China]

OBJECTIVE

To select the nutrient-rich food(NRF) index applicable to the food characteristics of Chinese residents through population-based dietary quality validation.

METHODS

Sixteen NRF indices were constructed based on the Chinese Food Composition Table and the Chinese Food Labelling Nutrient Reference Values, using 100 g as the base amount of food for calculation. The NRF indices were validated by the China Prime Diet Quality Score(CPDQS), a dietary quality assessment index, using food intake data collected from 14 068 adult residents in 15 provinces in 2018 under the China Health and Nutrition Survey. The CPDQS was used as the dependent variable and the dietary NRF index score was used as the independent variable. The multiple linear regression models were performed after adjusting the covariates and the NRF index with the largest coefficient of determination R~2 was used as the most appropriate index.

RESULTS

Regression analysis showed that the R~2 of NRF8.2 index was the largest, which was 0.16. Dried legumes, fungi and algae, nuts, vegetables, eggs and aquatic products scored higher on the NRF8.2 index. The high scoring subgroups had higher average daily intakes of cereals and potatoes, vegetables, fruits, soybeans and nuts, dairy, eggs and aquatic products, as well as lower consumption of livestock and poultry meat, beverages, salt and cooking oil, compared to the low scoring subgroup on the Dietary NRF8.2 Index. In terms of nutrient intake, the medium and high NRF8.2 subgroups had relatively high intakes of energy, protein, vitamins and minerals and relatively low intakes of fat and sodium.

CONCLUSION

The NRF8.2 index explains the maximum variation in CPDQS and is a relatively suitable NRF index for the Chinese population.

Multiple Trajectories of Body Mass Index and Waist Circumference and Their Associations with Hypertension and Blood Pressure in Chinese Adults from 1991 to 2018: A Prospective Study

Body mass index (BMI) and waist circumference (WC) have been suggested to be involved in the etiology of hypertension. The present study aimed to determine multiple trajectories of BMI and WC, then examined their associations with the risks of hypertension and high blood pressure in Chinese adults. The study used China Health and Nutrition Survey data from 1991 to 2018. The sample included 9651 adults aged 18 years or older. We used group-based multi-trajectory modeling to identify trajectories. We estimated the relationships between the trajectories and the risks of hypertension with a Cox proportional hazards regression model and the trajectories' relationships with blood pressure levels with a generalized linear model. We identified four trajectories for each gender: low stable BMI, low increasing WC (group 1); medium increasing BMI, medium increasing WC (group 2); increasing BMI to overweight, increasing WC to central obesity (group 3), increasing BMI to obesity, increasing central obesity WC (group 4). Group 1 was the reference group. Among males in groups 2, 3, and 4, the adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) of hypertension were 1.30 (1.15-1.48), 1.86 (1.58-2.18), and 2.60 (2.02-3.34), respectively. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of males in group 4 increased by 11.90 mm of mercury (mmHg) and 7.75 mmHg, respectively. Among females in groups 2, 3, and 4, the HR and 95% CI of hypertension were 1.35 (1.18-1.54), 1.92 (1.62-2.26), and 2.37 (1.85-3.03), respectively. The SBP and DBP of females in group 4 increased by 8.84 mmHg and 5.79 mmHg, respectively. These data indicated that increases in BMI and WC were associated with unfavorable hypertension risks. Attention to both BMI and WC trajectories has the potential to prevent hypertension.

Spatial Distribution and Temporal Trends of Dietary Niacin Intake in Chinese Residents ≥ 5 Years of Age between 1991 and 2018

Limited knowledge exists on trends in niacin consumption and the prevalence of inadequate intakes in China. Understanding trends and the spatial distribution of the prevalence of inadequate niacin intake is crucial to identifying high-risk areas and sub-populations. The dietary intakes of niacin between 1991 and 2018 were analyzed using the China Health and Nutrition Survey (CHNS) data. The estimated average requirement cut point was applied to estimate inadequacy. The geographic information system's ordinary kriging method was used to estimate the spatial distribution of the prevalence of inadequate niacin intakes. However, between 1991 and 2018, the prevalence of inadequate niacin intake increased from 13.00% to 28.40% in females and from 17.75% to 29.46% in males. Additionally, the geographically significant clusters of high and low prevalence were identified and remained stable over almost three decades. The high prevalence of insufficient niacin intake was more pronounced in Henan and Shandong over 27 years. Further, effective and tailored nutrition interventions are required to address inadequate niacin intake in China.

Consumers' Perceptions of the Design of Front-of-Package Warning Labels-A Qualitative Study in China

The warning label is identified as a simple front-of-package labeling format that assists consumers in making healthier food choices at the point of purchase. The color and/or shape of the design elements of the packaging labels can influence the understanding and purchase intention outcomes. This study aimed to explore the perceptions of consumers regarding differently designed warning labels (WLs) to identify a possibly suitable warning label design in the Chinese context. Using a qualitative approach, we collected data through 12 focus group discussions consisting of 116 participants residing in 6 provinces. Participants were selected by purposive sampling. Data were coded following inductive thematic analysis and summarized into three themes: (1) perceived preference for the appearance of the WLs, (2) perceived benefits of the WLs, and (3) suggestions for promoting the WLs. Participants preferred the black shield label showing a high content of the nutrients of concern (e.g., sodium, added sugar, and saturated fat) in both Chinese and English. Consumers generally agreed that the WLs were easy to understand and offered a simple method for choosing healthier foods. They anticipated that WLs could encourage the food industry to reformulate their products. Our study results will support the design and facilitate the use of WLs in China.

Association of Dietary Protein Intake with Muscle Mass in Elderly Chinese: A Cross-Sectional Study

Most data regarding the association between dietary protein intake and muscle mass come from developed Western countries. This cross-sectional study investigates the association between the amount and distribution of dietary protein intake and muscle mass in elderly Chinese adults. This analysis includes 4826 participants aged 60 years and above from the dataset of the China Health and Nutrition Survey (CHNS) 2018. Protein intake data were assessed using 3-day, 24 h dietary recalls. Appendicular skeletal muscle mass (ASM) was obtained using the bioelectrical impedance analysis (BIA). Two-thirds of dietary protein intake comes from plant sources in the elderly Chinese population. The median total dietary protein intake was 60.5 g/d in low muscle mass participants for males and 52.5 g/d for females, which was lower than for their respective counterparts. Compared to the lowest quartile of protein intake, the highest total protein intake group had increased muscle mass by 0.96 kg among men and by 0.48 kg among women (p < 0.0001), and the highest vegetable protein intake group had increased muscle mass by 0.76 kg among men and by 0.35 kg among women (p < 0.0001). The amount of dietary protein intake with each meal was less than 20 g. High total protein intake and high plant-based protein intake were positively associated with higher muscle mass. A U-shape was observed between total dietary protein intake and low muscle mass risk in elderly Chinese adults. It should be encouraged to increase total daily protein intake to maintain muscle health.

Associations of dietary diversity with the gut microbiome, fecal metabolites, and host metabolism: results from 2 prospective Chinese cohorts

BACKGROUND

Dietary diversity is essential for human health. The gut ecosystem provides a potential link between dietary diversity, host metabolism, and health, yet this mechanism is poorly understood.

OBJECTIVES

Here, we aimed to investigate the relation between dietary diversity and the gut environment as well as host metabolism from a multiomics perspective.

METHODS

Two independent longitudinal Chinese cohorts (a discovery and a validation cohort) were included in the present study. Dietary diversity was evaluated with FFQs. In the discovery cohort (n = 1916), we performed shotgun metagenomic and 16S ribosomal ribonucleic acid (rRNA) sequencing to profile the gut microbiome. We used targeted metabolomics to quantify fecal and serum metabolites. The associations between dietary diversity and the microbial composition were replicated in the validation cohort (n = 1320).

RESULTS

Dietary diversity was positively associated with α diversity of the gut microbiota. We identified dietary diversity-related gut environment features, including the microbial structure (β diversity), 68 microbial genera, 18 microbial species, 8 functional pathways, and 13 fecal metabolites. We further found 332 associations of dietary diversity and related gut environment features with circulating metabolites. Both the dietary diversity and diversity-related features were inversely correlated with 4 circulating secondary bile acids. Moreover, 16 mediation associations were observed among dietary diversity, diversity-related features, and the 4 secondary bile acids.

CONCLUSIONS

These results suggest that high dietary diversity is associated with the gut microbial environment. The identified key microbes and metabolites may serve as hypotheses to test for preventing metabolic diseases.

Waist Circumference of the Elderly over 65 Years Old in China Increased Gradually from 1993 to 2015: A Cohort Study

Objective

This study aimed to analyze the temporal trends and characteristics associated with waist circumference (WC) among elderly Chinese people.

Methods

We used data from 3,096 adults ≥ 65 years who participated in the China Health and Nutrition Survey (CHNS), an ongoing cohort study, between 1993 and 2015. We used longitudinal quantile regression models to explore the temporal trends and characteristics associated with WC.

Results

WC increased gradually among the elderly Chinese population during the survey. The WC curves shifted to the right with wider distributions and lower peaks in men and women. All WC percentile curves shifted upward with similar growth rates in the 25th, 50th, and 75th percentiles. The WC means increased from 78 cm to 86 cm during the 22 years of our study. WC significantly increased with age and body mass index and decreased with physical activity (PA). These associations were stronger in the higher percentiles than in the lower percentiles.

Conclusions

WC is rising among Chinese adults ≥ 65 years. Factors affecting WC in elderly people may have different effects on different percentiles of the WC distribution, and PA was the most important protective factor in the higher percentiles of the WC distribution. Thus, different interventional strategies are needed.

[Multilevel study on the effects of dietary nutrients on body mass index of Chinese children and adolescents aged 7-17]

OBJECTIVE

Analyze the relationship between dietary nutrients and body mass index of children and adolescents aged 7-17 in China.

METHODS

The data comes from the "China Health and Nutrition Survey", and 5562 children and adolescents aged 7-17 who participated in at least one round(2000, 2006, 2011 and 2015) of the survey and had complete dietary and physical measurement survey data were selected as the research objects. A three-level(community-individual-observation level) linear random intercept mixed effect model of body mass index was constructed to analyze the influence of dietary nutrient intake of children and adolescents of different genders in urban and rural areas on their body mass index(BMI).24 hours for 3 consecutive days and family weight accounting were used to evaluate the dietary nutrient intake.

RESULTS

BMI of urban children and adolescents is higher than that of rural children and adolescents. The BMI of children and adolescents aged 12-17 is higher than that of children and adolescents aged 7-11. BMI of boys was higher than that of girls, but the difference was statistically significant only in 2011 and 2015. After controlling for confounding factors such as individual level(survey year, age, physical activity and family per capita income) and community level(community urbanization index), the three-level model showed that the BMI of rural boys increased with the increase of cholesterol intake(P&lt;0.01). BMI of urban girls increased with the increase of vitamin B_1 intake(P&lt;0.05) and iron intake(P&lt;0.01). BMI of rural girls increased with the increase of vitamin E intake(P&lt;0.001) and sodium intake(P&lt;0.05).

CONCLUSION

There are some differences in dietary nutrients that affect the BMI level of 7-17 years old children and adolescents between urban and rural areas.

Association of gut microbiota with glycaemic traits and incident type 2 diabetes, and modulation by habitual diet: a population-based longitudinal cohort study in Chinese adults

AIMS/HYPOTHESIS

The gut microbiome is mainly shaped by diet, and varies across geographical regions. Little is known about the longitudinal association of gut microbiota with glycaemic control. We aimed to identify gut microbiota prospectively associated with glycaemic traits and type 2 diabetes in a geographically diverse population, and examined the cross-sectional association of dietary or lifestyle factors with the identified gut microbiota.

METHODS

The China Health and Nutrition Survey is a population-based longitudinal cohort covering 15 provinces/megacities across China. Of the participants in that study, 2772 diabetes-free participants with a gut microbiota profile based on 16S rRNA analysis were included in the present study (age 50.8 ± 12.7 years, mean ± SD). Using a multivariable-adjusted linear mixed-effects model, we examined the prospective association of gut microbiota with glycaemic traits (fasting glucose, fasting insulin, HbA_1c and HOMA-IR). We constructed a healthy microbiome index (HMI), and used Poisson regression to examine the relationship between the HMI and incident type 2 diabetes. We evaluated the association of dietary or lifestyle factors with the glycaemic trait-related gut microbiota using a multivariable-adjusted linear regression model.

RESULTS

After follow-up for 3 years, 123 incident type 2 diabetes cases were identified. We identified 25 gut microbial genera positively or inversely associated with glycaemic traits. The newly created HMI (per SD unit) was inversely associated with incident type 2 diabetes (risk ratio 0.69, 95% CI 0.58, 0.84). Furthermore, we found that several microbial genera that were favourable for the glycaemic trait were consistently associated with healthy dietary habits (higher consumption of vegetable, fruit, fish and nuts).

CONCLUSIONS/INTERPRETATION

Our results revealed multiple gut microbiota prospectively associated with glycaemic traits and type 2 diabetes in a geographically diverse population, and highlighted the potential of gut microbiota-based diagnosis or therapy for type 2 diabetes.

DATA AVAILABILITY

The code for data analysis associated with the current study is available at https://github.com/wenutrition/Microbiota-T2D-CHNS.

[Fat intake from pre-packaged foods among Chinese residents of 16 provinces in 2018]

OBJECTIVE

To investigate the impact of prepackaged food consumption on fat intake in 16 provinces of China in 2018.

METHODS

Data used in present study was derived from the eleventh round of China Health and Nutrition Survey(CHNS), 17312 residents aged 6 and over were selected and their consumed information of pre-packaged food was collected. The consumption of pre-packaged food and fat intake from pre-packaged food in urban and rural areas, different age groups, different regions and different genders were calculated and compared.

RESULTS

The median intake of fat from pre-packaged food among subjects and consumers were 33.6 g/d and 34.7 g/d, respectively.73.5% of the intake of fat from pre-packaged food comes from vegetable oil.

CONCLUSION

Vegetable oil was the main source of fat from pre-packaged food for Chinese residents.

[Trends of overweight and obesity among children and adolescents aged 7-17 in 16 provinces of China from 2000 to 2018]

OBJECTIVE

To analyze the distribution characteristics and trends of overweight and obesity in children and adolescents aged 7-17 years in 16 provinces of China.

METHODS

Data were collected from China health and nutrition survey in 2000, 2006, 2011, 2015 and 2018, 8398 children and adolescents aged 7-17 with complete data were selected as the research objects. Overweight and obesity were classified by body mass index(BMI) reference norm for screening overweight and obesity in Chinese children and adolescents. The distribution and trend of overweight and obesity among children and adolescents aged 7-17 in 16 provinces of China were analyzed by using Cochran-Armitage trend test and two-level random intercept model.

RESULTS

The prevalence of overweight and obesity in children and adolescents aged 7-17 in China showed an upward trend from 2000 to 2018(P&lt;0.05). The prevalence of overweight increased from 5.42% in 2000 to 12.92% in 2018, and the prevalence of obesity increased from 2.45% in 2000 to 12.36% in 2018. The result of multilevel model analysis showed that gender and urban and rural areas had significant effects on centralized BMI(P&lt;0.05), the BMI increase value of boys was greater than that of girls(β=0.2824), the BMI increase value of children and adolescents in rural areas was greater than that in urban areas(β=0.5902).

CONCLUSION

The prevalence of overweight and obesity among children and adolescents aged 7-17 in 16 provinces of China are increasing.

Pregnancy outcome after in-vitro fertilization/intracytoplasmic sperm injection in women with congenital uterus didelphys

OBJECTIVE

To investigate the pregnancy and obstetric outcomes of patients with congenital uterus didelphys who achieved clinical pregnancy after in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

METHODS

This was a retrospective matched-cohort study of 83 infertile patients with uterus didelphys who underwent IVF/ICSI and achieved clinical pregnancy from January 2005 to December 2018 at our center. For each patient in the study group, three control patients with normal uterine morphology who underwent IVF/ICSI in 2018 were selected randomly. Patients in the two groups were matched for number of gestational sacs, maternal age, infertility type, cause of infertility, fertilization method, endometrial thickness 1 day before embryo transfer and number of embryos transferred. The classification of congenital uterine anomalies was based on the American Fertility Society system (1988). The pregnancy and obstetric outcomes of the didelphic and control groups were compared separately for singleton and twin pregnancies, and for all pregnancies combined.

RESULTS

In singleton pregnancies, women with uterus didelphys had increased risk of preterm birth (odds ratio (OR), 4.68; rate difference (RD), 0.14; P < 0.001), Cesarean section (OR, 2.80; RD, 0.17; P = 0.016) and birth weight < 2500 g (OR, 4.06; RD, 0.10; P = 0.017) compared to women with normal uterine morphology. In twin pregnancies, the presence of uterus didelphys was associated with increased risk of preterm delivery (OR, 4.79; RD, 0.37; P = 0.006), perinatal mortality (OR, 3.16; RD, 0.19; P = 0.043) and birth weight < 2500 g (OR, 9.57; RD, 0.35; P = 0.001).

CONCLUSIONS

The presence of uterus didelphys was associated with significantly increased risk of some adverse pregnancy outcomes compared to pregnancies with normal uterine morphology in women who underwent IVF/ICSI. A twin pregnancy in women with uterus didelphys was associated with worse perinatal outcome. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

[Snacking behaviors of Chinese female adults aged 18 to 49 years old in 2004-2015]

OBJECTIVE

To describe shift in snacking behavior among Chinese female adults aged 18 to 49 years old in 2004-2015, and to analyze the contribution of snacks to energy and nutrients among them.

METHODS

The present study used data from "China Health and Nutrition Health" where a multistage stratified cluster design was employed to select a stratified probability sample. A total of 12 523 female participants aged 18-49 years old who participated in surveys conducted in 2004-2015 with completed data of demographic characteristics and dietary measurementswere selectedas subjects. There were 2376, 2149, 2142, 2844 and 3012 subjects in waves of 2004, 2006, 2009, 2011, and 2015, respectively. Multivariate Logistic regression model was used to analyze the relationship between socioeconomic factors and snack consumption. Generalized linear model was used to analyze the energy and nutrient intake of snack consumers and non-snack consumers, as well as the contribution of snacks to energy and nutrients.

RESULTS

The consumption rate of snacking for women aged 18 to 49 years old had an increasing trend over time(P&lt;0.05), and the rate was 14.24% in 2015, 3.5 times as high as that in 2004. Participants aged 18 to 29 years old whose snake consumption rates were relatively higher compared to those of other aged groups in general waves; also, female adults from the higher education group, the higher yearly income group, and the higher urbanicity index group, and those with the history of smoking or the alcohol use tended to consumed snacks. The change of the influential factors in relation to the consumption of the participant&apos;s snack was observed, and age, income level, education level, living area, and the behavior of smoking and drinking were all important factors of snacking. The daily energy and nutrient intake of female snack consumers aged 18 to 49 years old was higher than that of non-snack consumers. The contribution rate of snacks to energy and nutrients varies significantly between survey years; and the contribution of snacks to energy and main nutrients was more than 20% in 2011.

CONCLUSION

Snacks have become an important part of the diet of Chinese women aged 18 to 49 years old. Future health promotion programs should be targeted on nutrition education and intervention to guide a reasonable diet structure.

Stressed females, rather than males, tend to eat away from home

OBJECTIVES

The aim of this study is to examine the association between perceived stress and multifarious eating away from home among Chinese adults in different genders.

METHODS

We examined cross-sectional data from the China Health and Nutrition Survey conducted in 2018 among Chinese adults aged 18-59 years. A self-reported questionnaire involving the perceived stress scale with 10 items (PSS-10), and the food frequency questionnaire about eating away from home were used. Adjusted two-level zero-inflated Poisson regression models were used to explore the association.

RESULTS

There were 3161 males and 3599 females in the study. The median PSS-10 score was 16.0 and the frequencies of eating 1) breakfast, 2) lunch or supper, and 3) three main meals away from home were 12, 10, and 49 times per year, respectively. In males, PSS-10 score was not associated with eating away from home. In females, PSS-10 score was significantly positively associated with eating 1) lunch or supper, 2) three main meals, 3) Chinese food away from home, and 4) eating at stalls/restaurants (β₁ = 0.016, P₁ = 0.006; β₂ = 0.014, P₂ = 0.002; β₃ = 0.015, P₃ = 0.013; β₄ = 0.014, P₄ = 0.015 respectively). But there was not association between PSS-10 score and the frequency of eating breakfast away from home in females (β = 0.006, P = 0.325).

CONCLUSIONS

Stressed females tend to eat away from home, but the effects are very small.

[Secular trends in food intakes among the elderly aged 60 and older in nine provinces in China from 1991 to 2015]

OBJECTIVE

To analysis the status and trend of food intake of elderly aged 60 and older years old in nine provinces of China.

METHODS

The data of China Health and Nutrition Survey from 1991 to 2015 were used, which elderly ≥60 years old were selected as the subjects. The dietary survey used compared. The 3-consecutive day-24-hour dietary recall was used to collect information on food intake, the condiment intake was collected by weighting and bookkeeping method.

RESULTS

The intakes of cereals and tubers and vegetables among the elderly were 363.3 g/d and 249.1 g/d, respectively in 2015, decreased by 65.4 g/d and 17.6 g/d as compared with those in 1991. The intakes of meat, egg, and edible oil were 56.7 g/d, 19.2 g/d and 27.5 g/d respectively and increased by 7.5 g/d, 19.2 g/d and 2.5 g/d as compared to those with 1991. The intakes of eggs, soybeans and nuts were higher among the elderly people having high income or living in urban areas. In 2015, the proportion of elderly in nine provinces of China whose intake of vegetables, fruits, soybeans, milk and dairy products was lower than the recommended amount was relatively high. The proportion of meat higher than the recommended value is higher than that of aquatic products and eggs. Oil, salt and other limited flavoring intake of less than and above the limit was nearly 50 percent of the population.

CONCLUSION

There are three problems in the diet of the elderly in nine provinces in China: the structure of diet is not rational; low intake of the food rich in high quality protein and low fat such as aquatic products, eggs, dairy products and so on; the problem of excessive oil and salt in food.

Trajectories of energy intake distribution and subsequent risk of hyperglycemia among Chinese adults: findings from the China Health and Nutrition Survey (1997-2018)

AIMS

Few studies have examined the secular trend of the energy intake distribution, and its effect on future risk of hyperglycemia. This study aims to describe trajectories of energy intake distribution over 12 years and relate them to subsequent risk of hyperglycemia over 9 years of follow-up.

METHODS

Our study used ten waves of data from the CHNS survey, a population-based longitudinal survey in China, ongoing since 1989. We examined a cohort of adult participants who were free from diabetes but had at least three waves of dietary data from 1997 to 2009. We assessed energy intake using three consecutive 24 h recalls. We used these data to identify trajectory groups of energy intake distribution by multi-trajectory model based on energy intake proportions of breakfast, lunch, and dinner. We followed up participants for hyperglycemia, diabetes, and impaired fasting glucose for 9 years from 2009 to 2018. Outcomes were ascertained with fasting glucose, serum HbA1c, and self-report of diabetes and/or glucose-lowering medication. We estimated relative risk (RR) for hyperglycemia, diabetes, and impaired fasting glucose by identified trajectory groups using multilevel mixed-effects modified Poisson regression with robust (sandwich) estimation of variance. Gender difference was additionally examined.

RESULTS

A total of 4417 participants were included. Four trajectory groups were identified, characterized and labeled by "Energy evenly distributed with steady trend group" (Group 1), "Dinner and lunch energy dominant with relatively steady trend group" (Group 2), "Dinner energy dominant with increasing trend and breakfast energy with declining trend group" (Group 3), and "breakfast and dinner energy dominant with increasing trend group" (Group 4). During 48,091 person-years, 1053 cases of incident hyperglycemia occurred, 537 cases of incident diabetes occurred, and 516 cases of impaired fasting glucose occurred. Compared with Group 1, Group 3 was associated with higher subsequent risk of incident hyperglycemia in 9 years of follow-up (RR = 1.28, 95% CI = 1.02, 1.61). No association was found for incident diabetes and impaired fasting glucose. Among males, Group 3 was associated with higher risk of incident hyperglycemia in 9 years of follow-up (RR = 1.44, 95% CI = 1.07, 1.94). No relationship was found in females.

CONCLUSIONS

Energy intake distribution characterized by over 40% of energy intake from dinner with a rising trend over years was associated with higher long-term risk of hyperglycemia in Chinese adults.

Fate and transport in environmental quality

Changes in pollutant concentrations in environmental media occur both from pollutant transport in water or air and from local processes, such as adsorption, degradation, precipitation, straining, and so on. The terms "fate and transport" and "transport and fate" reflect the coupling of moving with the carrier media and biogeochemical processes describing local transformations or interactions. The Journal of Environmental Quality (JEQ) was one of the first to publish papers on fate and transport (F&T). This paper is a minireview written to commemorate the 50th anniversary of JEQ and show how the research interests, methodology, and public attention have been reflected in fate and transport publications in JEQ during the last 40 years. We report the statistics showing how the representation of different pollutant groups in papers changed with time. Major focus areas have included the effect of solution composition on F&T and concurrent F&T, the role of organic matter, and the relative role of different F&T pathways. The role of temporal and spatial heterogeneity has been studied at different scales. The value of long-term F&T studies and developments in modeling as the F&T research approach was amply demonstrated. Fate and transport studies have been an essential part of conservation measure evaluation and comparison and ecological risk assessment. For 50 years, JEQ has delivered new insights, methods, and applications related to F&T science. The importance of its service to society is recognized, and we look forward to new generations of F&T researchers presenting their contributions in JEQ.

Dietary Protein Intake Dynamics in Elderly Chinese from 1991 to 2018

Unique rapid urbanization-related changes in China may affect the dietary protein intake of the aging population. We aimed to evaluate trends in dietary protein intake and major food sources of protein and estimate conformity to the dietary reference intakes (DRIs) in the elderly Chinese population. A sample of 10,854 elderly adults aged 60 years or older, drawn from 10 waves of the China Health and Nutrition Survey (CHNS) between 1991 and 2018, was included. Protein intake data were obtained on the basis of 3-day, 24 h dietary recalls. The dietary protein intake among elderly Chinese individuals declined from 63.3 g/day to 57.8 g/day over the 28-year period, with a −0.032 ± 0.0001 g/day change per year (p < 0.05). There was a significant increase in the proportion of subjects with a protein intake level below the estimated averaged requirement (EAR) and a reduction in the proportion of subjects consuming protein above the recommended nutrient intake (RNI) across all population subgroups. Cereals ranked as the major sources of dietary protein, although their contribution to dietary protein gradually decreased as time went on. The contribution from meat steadily rose from 18.2% in 1991 to 28.7% in 2018. The proportion of energy gained from fat increased notably, reaching 34.2% in 2018. The elderly Chinese population experienced a significant reduction in dietary protein intake. Although the transformation of dietary patterns had positive effects on improving protein quality due to increases in animal source food, some elderly Chinese individuals currently face the risk of inadequate dietary protein intake.

Trajectories of Energy Intake Distribution and Risk of Dyslipidemia: Findings from the China Health and Nutrition Survey (1991-2018)

Few studies have examined the secular trend of energy intake distribution. This study aims to describe trajectories of energy intake distribution and determine their association with dyslipidemia risk. Data of 2843 adult participants from the China Health and Nutrition Survey (CHNS) were analyzed. Trajectory groups of energy intake distribution were identified by multi-trajectory model over 27 years. Multilevel mixed-effects modified Poisson regression with robust estimation of variance was used to calculate risk ratio for incident dyslipidemia in a 9-year follow-up. Four trajectory groups were identified: "Energy evenly distributed group" (Group 1), "Lunch and dinner energy dominant group" (Group 2), "Dinner energy dominant group" (Group 3), "breakfast and dinner energy dominant group" (Group 4). Compared with Group 1, Group 3 was associated with higher risk of dyslipidemia (RR = 1.48, 95% CI = 1.26, 1.75), hypercholesterolemia (RR = 1.96, 95% CI = 1.37, 2.81) and high low-density lipoproteins cholesterols (LDL-C) (RR = 2.41, 95% CI = 1.82, 3.20). A U-shape was observed between cumulative average proportion of dinner energy and dyslipidemia risk (p for non-linear = 0.01), with stronger relationship at 40% and above. Energy intake distribution characterized by higher proportion of dinner energy, especially over 40% was associated with higher dyslipidemia risk in Chinese adults.

P–357 The risk factors for early pregnancy loss based on a logistic model following 13,977 infertile patients after in vitro fertilization

Study question

What are the risk factors for early pregnancy loss (EPL) after in vitro fertilization-embryo transfer (IVF-ET)?

Summary answer

The maternal age, gestational sac diameter, embryonic length, yolk sac diameter, heart rate of day 27–29 and endometrium thickness on transfer day were risk factors. What is known already: The first routine ultrasound scan is commonly arranged on day 27–29 after IVF-ET in most reproductive centers in China to determine the location and viability of the embryo. Individual maternal factors, such as a high maternal age (MA) and abnormal ultrasound parameters such as embryonic bradycardia and excessively large or small yolk sac diameter (YSD) have been shown to be associated with pregnancy failures. However, few studies focused on the risk factors of the IVF population, and little is known about the clinical meaning of ultrasound indicators of 27–29 days after transplantation.

Study design, size, duration

This was a retrospective study in a single reproductive centre. The infertile patients included in this study underwent IVF treatment between June 2016 to December 2017. Participants/materials, setting, methods: During this period, 13,977 women were identified with a singleton pregnancy by TVS at day 27–29 after IVF-ET. The gestational sac diameter (GSD), embryonic length (EL), embryonic heart rate (EHR) and YSD and the presence of intrauterine hematoma (IUH) were measured. The clinical characteristics were also collected. The first trimester pregnancy outcome of these women was noted at 12 weeks of gestation. A backward Wald logistic regression model was established to screen the risk factors.

Main results and the role of chance

1,926 cases of spontaneous miscarriage ≤12 weeks of gestation, which were assigned as EPL and 12,051 women with an ongoing pregnancy for &gt;12 weeks of gestation.

When compared with the ongoing pregnancy group, the MA, infertility duration and transfer cycle were significantly higher, and the day–14 human chorionic gonadotrophin and the endometrium (EM) thickness on transfer day were significantly lower in the EPL group (p &lt; 0.001). Based on the TVS measurements, the GSD (18.5±3.6 vs. 13.2±4.8 mm), EL (3.5±0.9 vs. 1.2±1.6 mm), YSD (3.6±0.4 vs. 2.6±1.5 mm) and EHR (114.5±12.2 vs. 42.4±53.5 bpm) were significantly greater in the ongoing pregnancy group than those in the EPL group (p &lt; 0.001). The incidence of IUH (16.0% vs. 18.8%, P = 0.002) was also markedly higher in the EPL group

MA, GSD, EL, YSD, EHR and EM on transfer day finally entered the logistic model after stepwise screening. The probability of EPL was: exp(z)/(1 + exp(z)), where z = 2.432 + (0.092 × MA) - (0.074 × EM) - (0.114 ×GSD) - (0.245 × EL) - (0.034 × HR) - (0.159 × YSD).

Limitations, reasons for caution

Data on smoking and clinical symptoms such as vaginal bleeding or abdominal pain were not included in the final analysis which might be possible risk factors. These predictors were derived from an IVF population, the situation may not be the same in the general population.

Wider implications of the findings: The risk factors for EPL after IVF-ET are clearly identified in this study. The logistic model which incorporates readily available data that are routinely collected in clinical practice could be used for calculating the risk of EPL and effectively guide subsequent medical plans.

Trial registration number

None

P–405 The diagnosis and management of heterotopic intramural pregnancy after in vitro fertilization-embryo transfer: six-case series

Study question

What are the ultrasonic characteristics of heterotopic intramural pregnancy (HIMP)? How to manage and what about the clinical outcomes of HIMP?

Summary answer

Expectant management may be a considerable choice for an non-viable intramural pregnancy (IMP). Most intrauteine pregnancies (IUPs) of HIMPs seems to have good outcomes.

What is known already

Heterotopic pregnancy (HP) post in vitro fertilization is very rare in infertility women, with a prevalence of 0.04%. HIMP is one of the rarest types of HP, where one gestational sac (GS) is embedded within the endometrial cavity and the other one GS is implanted in the myometriun. HIMP was firstly and only described by Jiangtao Lyu et al. in 2018. So far, little is known about its natural history and ultrasonic imaging characteristics. And there is no consensus regarding the ultrasound diagnosis and clinical management for HIMP due to few evidence-based medicine records.

Study design, size, duration

A retrospective observational study was conducted of 6 infertile women who obtained a HIMP through in vitro fertilization-embryo transfer (IVF-ET) between January 2009 and December 2019 at our reproductive centre.

Participants/materials, setting, methods

Six infertile women conceived a HIMP via IVF-ET were retrospectively retrieved between January 2009 and December 2019 at the Reproductive and Genetic Hospital of CITIC-Xiangya (Changsha City, China). The ultrasound diagnosis, clinical management and pregnancy outcome of these cases were analysed. The ultrasound findings, therapeutic methods and clinical outcomes were obtained from the hospital’s electronic medical records. This study was approved by the local ethics committee. Main results and the role of chance: Six women with HIMPs were retrospectively analysed. Among them, 5 cases were revealed by ultrasound scans; however, one case was misdiagnosed. The diagnostic accuracy was 83.3%.

Five cases of HIMP were diagnosed at initial scan. The diagnostic time ranged from 22 to 38 days after ET (5 + 6 - 7 + 6 weeks). Among them, an intramural GS was observed in all 5 cases; embryonic cardiac activity (ECA) was detected in one case by the followed-up scans; there was a yolk sac only in one case; an empty GS was noted in 3 cases. An IUP was revealed in all 6 cases, and ECA was observed in 5 cases at the initial diagnosis or later. A GS with a yolk sac only was showed in one case.

Among the 5 diagnostic women, one case with a live IMP was treated with laparoscopy at 8 + 1 weeks, 4 cases were managed expectantly. Of them, the IUPs of 4 cases delivered live infants and one case managed expectantly experienced miscarriage. In one case, IMP was misdiagnosed as interstitial pregnancy at day–28 scan. Exploratory laparoscopy and foetal reduction were performed at 8 + 2 weeks. Laparoscopy confirmed an IMP and the retained IUP delivered a live infant.

Limitations, reasons for caution

The case numbers are too few to draw any objective conclusions, because of the extreme rarity of HIMP. Thus, a further multi-centre larger prospective study will help to confidently illustrate the clinical significance, and effective and appropriate management method for women with a HIMP.

Wider implications of the findings: Our study showed that HIMP may not be as rare as previously reported. Increased awareness of this condition, better comprehension of the diagnostic criteria and improved resolution of ultrasound equipment may result in more frequent and accurate detection of HIMP, which will be helpful for early management to preserve IUP.

Trial registration number

Not applicable.

[Choices of emergency treatment and surgical method for ruptured abdominal aortic aneurysms]

Objective: To investigate the emergency management process of ruptured abdominal aortic aneurysm (RAAA), and analyze the perioperative mortality factors of different surgical methods. Methods: The emergency data and hospitalization data of 91 patients with ruptured abdominal aortic aneurysm in Xiangya Hospital of Central South University from June 2010 to June 2019 were retrospectively analyzed.Twelve of the patients died preoperatively due to excessive blood loss, and the remaining 79 patients were hospitalized for open surgery (OSR) or endovascular repair (EVAR).The differences in age, time to hospital arrival, emergency preparation time, first creatinine value, emergency infusion volume, preoperative drop in blood pressure, preoperative use of vasoactive drugs and iliac artery involvement were compared between preoperative death group (n=12) and preoperative survival group (n=79), OSR group (n=50) and EVAR group (n=29), postoperative death group (n=23) and postoperative survival group (n=56). Results: Seventy-nine patients received open surgery or endovascular repair, and 23 died after operation. Age, time to hospital arrival, first creatinine value and emergency infusion volume were (77±11) years, (18±5)h, (469±150) μmol/L, (4 140±1 743) ml in the preoperative death group and (70±10) years, (12±8) h, (228±174) μmol/L, (1 358±1 211) ml in the preoperative survival group, respectively, and the differences were statistically significant (all P<0.05). There were no significant differences in preoperative data, intraoperative treatment and postoperative perioperative mortality between the open surgery group and the endovascular repair group (all P>0.05). The intraoperative blood loss, operation time and aortic occlusion rate in the endovascular repair group were 100 (50, 175) ml, (3.2±0.9) h, 13.8%, respectively, which were better than that in the open surgery group 1700 (600, 3425) ml, (5.2±1.1) h, 100%. The differences were statistically significant (all P<0.05). Age, emergency preparation time, first creatinine value, emergency infusion volume, blood pressure decline rate and vasoactive drug utilization rate in the death group were (77±8) years, (4.1±1.7) h, (456±172) μmol/L, (2 024±1 687) ml, 100%, 100%, respectively, and (68±10) years, (2.7±2.2) h, (135±26) μmol/L, (1 085±825) ml, 21.4%, 12.5% in the survival group, respectively. The differences were statistically significant (all P<0.05). Conclusions: Age, emergency preparation time, first creatinine value, emergency infusion volume, decreased blood pressure and use of vasoactive drugs are all associated with perioperative death in patients with ruptured abdominal aortic aneurysm. EVAR surgery is a better choice if conditions exist.

Field Ecology and Food Suitability of Tarsonemus spp. (Acari: Tarsonemidae)

Tarsonemus bakeri Ewing (Acari: Tarsonemidae) is a species of mite commonly associated with citrus in many countries including the United States. A short report in 1942 suggested this species is phytophagous, but it has not been reported as a pest in citrus or any other crop since then. A single survey of 78 orchards in three growing regions in California demonstrated that Tarsonemus spp. mites were only associated with leaf samples that had visible sooty mold. A seasonal population study in one citrus orchard showed that all life stages of Tarsonemus spp. were present year-round on leaves and fruit, with the population on fruit reaching a peak in December (59.7 ± 15.2 mites per fruit). Results from a food suitability study showed that the population declined sharply on both plastic and leaf substrate when the mites were not provided a supplementary food source. When supplementary food was provided in the form of Alternaria, honeydew, molasses, or combinations of these, mites survived and multiplied throughout the 29-d study, irrespective of the substrate. Tarsonemus bakeri were found on excised, decaying leaves collected from an orchard. These studies verify that Tarsonemus spp. are associated only with sooty mold in citrus orchards. T. bakeri populations cannot sustain themselves on leaf tissue alone, indicating that they are nondamaging to citrus and therefore need not be considered a phytosanitary concern by importing countries.

[Agreement analysis and result calibration by ordinary least product regression between bioelectrical impedance analysis and dual energy X-ray absorptiometry]

OBJECTIVE

To analyze agreement of body fat percentage measured by bioelectrical impedance analysis(BIA) and dual energy X-ray absorptiometry(DXA) in Chinese adults, and to calibrate BIA measurement by ordinary least product regression(OLP).

METHODS

Volunteers aged 18-65 were recruited to measure total body fat percentage and trunk fat percentage by BIA(Tanita BC-601 F) and DXA(Hologic Discovery QDR), respectively. Agreement between the two methods was compared by OLP. Bootstrap method was used to do the internal validation of the calibration equation. The calibration effect was verified by the agreement analysis of the calibrated BIA result and the DXA result.

RESULTS

Before calibration, all 95%CIs of the intercepts of the OLP regression lines did not include 0, and all 95%CIs of the slopes of the OLP regression lines did not include 1. 00. After calibration, all 95% CIs of the intercepts of the OLP regression lines included 0, and all 95% CIs of the slopes included 1. 00.

CONCLUSION

There are fixed bias and proportion bias between BIA and DXA in measuring total body fat percentage and trunk fat percentage in Chinese men and women. Calibration should be considered when body fat percentage is measured by BIA.

[Relationship between physical activity and cognition function among people aged 55 and above in 4 provinces of China]

OBJECTIVE

To analyze the relationship between different intensity of physical activity(PA) duration and cognitive function.

METHODS

The 2018 Community-based Cohort Study on Nervous System Diseases used multi-stage stratified cluster randomization sampling method to select study participants. A total of 5571 participants aged 55 years and above from four provinces in China with complete information on demographic characteristics and PA and cognitive function were included in the final analysis. Basic information and PA data were collected by questionnaire. The Montreal cognitive assessment(MoCA) score method was adopted to evaluate the cognitive function. Light physical activity(LPA) duration and moderate-to-vigorous physical activity(MVPA) duration were calculated. Multivariate Logistic regression and Multiple linear regressions were used to analyze the relationship between different intensity of PA duration and the risk of mild cognitive impairment(MCI) and MoCA total score.

RESULTS

The median(P25, P75) of LPA and MVPA were 7. 0(0. 0, 16. 3) and 7. 3(0. 0, 14. 0) hours per week in the non-MCI group among 5571 participants aged 55 years and above in four provinces of China in 2018. In the MCI group, the median duration were 9. 3(0. 0, 17. 5) and 7. 0(0. 0, 11. 7) hours per week. The Logistic analysis showed that the OR of MCI was 0. 63(95%CI 0. 49-0. 82, P&lt;0. 05) for the elderly with 3. 6-7. 0 hours of MVPA per week, compared to the elderly without MVPA. The OR of MCI was 1. 26(95%CI 0. 94-1. 67, P&gt;0. 05) for the elderly with 3. 6-7. 0 hours of LPA per week compared to the elderly without LPA. Multiple linear regression analysis showed that compared to the elderly without MVPA, the total MoCA score increased with LPA duration increased as the duration was less than 10. 5 hours per week. The MoCA score decreased with LPA duration increased as duration was between 10. 5 and 21. 0 hours per week.

CONCLUSION

MVPA duration increment was associated with decreased prevalence of MCI and increased cognitive function in the elderly in four provinces of China. LPA duration should be maintained at an appropriate level in order to reduce the incidence of MCI and increased cognitive function in the elderly.

Xiangshao granules can relieve emotional symptoms in menopausal women: a randomized controlled trial

OBJECTIVE

This study aimed to investigate the safety and efficacy of Xiangshao granules for treating emotional disorders in perimenopausal and postmenopausal women.

METHODS

The current investigation was a double-blind, randomized, placebo-controlled, multicenter trial that included 300 perimenopausal and postmenopausal Chinese women aged 40-60 years. Participants received either a placebo (n = 150) or Xiangshao granules (n = 150) for 8 weeks. Outcome measures included Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) scores, which were assessed at baseline, 4 weeks, and 8 weeks. The primary efficacy variables were changes in HAMD and HAMA scores after 8 weeks.

RESULTS

After 8 weeks, the mean HAMD scores decreased from 15.0 to 7.9 in the Xiangshao group and from 16.3 to 10.0 in the placebo group, and the respective mean reductions in HAMA scores were from 16.0 to 8.5 and from 17.1 to 10.9. Clinical improvements in symptoms of both depression and anxiety after 8 weeks differed significantly in the two groups (p < 0.05). The cure rate was significantly higher in the Xiangshao group. There were no significant differences in the rates of adverse events in the two groups.

CONCLUSIONS

Xiangshao granules can relieve symptoms of depression and anxiety significantly and safely.

[Dietary intake of thiamine, riboflavin and niacin among adults aged 65 and above in 15 provinces(autonomous regions and municipalities) in China in 2015]

OBJECTIVE

To assess the intake of thiamine, riboflavin and niacin and estimate the association between the adequacy of intake of those three B-vitamins and risk factors among older Chinese adults.

METHODS

A total of 3222 adults aged 65 and above with completed dietary data were derived from the 2015 survey of China Nutritional Transition Cohort Study 2015. The total subjects. Dietary data was recorded by three consecutive days with 24-hour recalls. The intake of those three B-vitamins were assessed by comparing with Chinese dietary thiamine, riboflavin and niacin reference intakes. The food sources of three vitamins were analyzed. Multivariate Logistic regression was used to estimate adjusted odds ratios for factors associated with the inadequacy of intake of those three vitamins.

RESULTS

The median daily intake of thiamine, riboflavin and niacin was 0. 8, 0. 7 and 12. 8 mg in males, and 0. 7, 0. 6 and 10. 9 mg in females, respectively. Adults aged 80 and above and living in the southern regions were more likely to have inadequate thiamine intake than adults aged 65-79 and living in northern regions, respectively. Adults had inadequate intake of riboflavin were more likely to be living in a village and adults with lower education levels than adults living in a city and adults with higher education levels. In males, adults had inadequate intake of niacin were more likely to be 80 years and above, with lower education levels, living in the northern regions, living in a village and with the lowest income. In females, adults had inadequate intake of niacin were more likely to be with lower education, living in northern regions and living in a village.

CONCLUSION

About 80% adults were at the risk of the inadequate intake of thiamine and riboflavin in China. Age, education, income, regions and areas of residence were associated with the intake of thiamine, riboflavin and niacin.

Correction to: Psychometric properties of the perceived stress scale in a community sample of Chinese

An amendment to this paper has been published and can be accessed via the original article.

The association between physical activity and body fat percentage with adjustment for body mass index among middle-aged adults: China health and nutrition survey in 2015

BACKGROUND

The inverse association between physical activity and body fat percentage (%) varies among different populations. We aim to examine whether the significant association between them was uniform across the subpopulations after taking into account body mass index (BMI).

METHODS

Our study relied on data from China Health and Nutrition Surveys in 2015, including 5763 participants aged 40-64 years from 15 regions. Physical activity was calculated as metabolic equivalent task hours per day (MET·h/d). Body fat% was measured by bioelectrical impedance analysis. Body mass index < 24 kg/m2 was defined as normal weight and BMI ≥ 24 kg/m2 was overweight/obese. The effects of physical activity on body fat% were estimated using the Kruskal-Wallis test among sex, age, BMI groups, education, income, region and urbanization. Quantile regression analyses were utilized to describe the relationship between physical activity and body fat% distribution.

RESULTS

Older adults, overweight/obese, higher education, higher income, residents of central China and those living in areas of higher urbanization had the lower physical activity. Participants who engaged in the highest level of physical activity had 2.0 and 1.5% lower body fat% than the lowest level of physical activity group (23.4, 34.8%) for men and women, respectively. There were 10.4 and 8.8% of normal weight males and females called normal weight obese. Overall, 1 h extra 4.5 MET•h/d was significantly associated with 0.079 and 0.110% less total body fat% at the 75th and 90th percentiles in normal weight males, with 0.071% less at the 25th percentiles in overweight/obese males, with 0.046-0.098% less at the 25th to 90th percentiles in normal weight females, and with 0.035-0.037% less from the 50th to 90th percentiles in overweight/obese females. The inverse association between physical activity and total body fat% was stronger in normal weight obese participants than other subgroups.

CONCLUSIONS

In middle-aged Chinese adults, the inverse association between physical activity and body fat% was only in particular subpopulations rather than the entire population. We should pay much attention to normal weight obese and give a suitable physical activity guideline taking into account people with different body fat%.

[Changes in the awareness of nutritional knowledge in Chinese adults during 2004-2015]

OBJECTIVE

To analyze the changes in the awareness of nutritional knowledge in Chinese adults during 2004-2015.

METHODS

The present study used data from "China Health and Nutrition Health" and selected those participated in surveys conducted in 2004-2015, with completed data of demographic characteristics and nutritional knowledge measurement and aged 18 years and above as subjects. We analyzed the awareness rates of Chinese Dietary Guidelines and various nutritional knowledges in adults from different provinces and adults of 9 provinces by characteristics, and evaluated the changes during 2004-2015.

RESULTS

There were 9615, 9702, 9999, 12 990 and 15 958 subjects in waves of 2004, 2006, 2009, 2011 and 2015, respectively. Awareness of dietary guidelines in adults from 9 provinces significantly increased during 2004-2015(P&lt;0. 0001), and the rate was 21. 1% in 2015, 2. 9 times as high as that in 2004. The awareness rates of all seven correct nutritional knowledges also displayed an increased trend during survey periods(P&lt;0. 0001), and there was a considerable rise in 2006. Awareness on staple foods was lower in each wave, especially in 2004(0. 9%). The changes in the awareness of all five wrong nutritional knowledges were inconsistent during 2004-2015, in which the awareness on sugar, high fat foods and physical activity showed a decreased trend(P&lt;0. 0001), and the awareness rate of physical activity was lower. Overall awareness of nutritional knowledges in adults tended to increase during 2004-2015(P&lt;0. 0001), however, that in each wave was very low, and just 4. 0% in 2015. Awareness of dietary guidelines in adults from 3 municipalities in 2015 was higher than that in 2011(P&lt;0. 0001), but the differences were opposite for most of nutritional knowledges. Moreover, awareness of dietary guidelines of 3 municipalities(Beijing, Shanghai and Chongqing)in 2011 and 2015 was higher than corresponding rate in 9 provinces or newly recruited 3 provinces. There were similar changes in the awareness of dietary guidelines and nutritional knowledges in adults from 9 provinces by age, gender, education level, residence area and location during 2004-2015 to that in total population, and there were differences in the awareness of nutritional knowledge by demographic characteristics in some survey waves.

CONCLUSION

The awareness of dietary guidelines and overall awareness of nutritional knowledges were lower in Chinese adults, especially for the items on staple foods, meat and physical activity.

[Level of body fat percentage among adults aged 18-65 years old in 15 provinces (autonomous regions and municipalities) of China in 2015 and its relationship with body mass index]

OBJECTIVE

To describe the regional and population-related differences in body fat percentage(BF%) and fat quality among 18-65 years old adults in 15 provinces(autonomous regions and municipalities) of China in 2015, and analyze the relationship between body fat percentage and body mass index(BMI).

METHODS

A total of 10 561 adults aged 18-65 years old who have complete physical measurements and relevant demographic economic data from the 2015 China Nutritional Transition Cohort Study were included. Body fat percentage and weight were measured using the bioelectrical impedance analysis. Body fat percentage and fat quality of different genders were described among different age groups, education levels, incomes, regions, urban and rural areas. And the obesity prevalence defined by body fat percentage(recommended by WHO) was described.

RESULTS

In 2015, the body fat percentage and fat quality of adult women aged 18-65 in 15 provinces(autonomous regions and municipalities)were 33. 6% and 19. 5 kg, respectively, and adult males were 23. 0% and 15. 7 kg. Body fat percentage and fat quality were higher in the North than in the South(P&lt;0. 0001). There were statistical differences in body fat percentage and fat quality among men of different ages, educational levels, incomes, regions and urban and rural populations(P&lt;0. 0001). There were differences in body fat percentage and fat quality among women of different ages, educational levels, regions(P&lt;0. 0001), and no differences in incomes and urban and rural areas. According to the body fat percentage(recommended by WHO), the prevalence of obesity of women was 42. 0% increasing by age, and the prevalence of obesity of women aged 60-65 was as high as 52. 4%. The prevalence of obesity of men was 37. 1%, which increased with age, but decreased in the 60-65 age group. The prevalence of obesity of males and females in northern regions was 41. 9% and 45. 6%, respectively, which was significantly higher than in the southern regions(34. 3% and 39. 9%). BMI was closely related to BF%, but in overweight people, more than 50% of people defined by body fat percentages reached obesity.

CONCLUSION

In 2015, there were significant regional and population differences in body fat percentage and fat quality among adults of different genders in 15 provinces(autonomous regions and municipalities), and the prevalence of obesity in the North was significantly higher than that in the South.

[Longitudinal multilevel analysis of correlative factors of abdominal obesity among Chinese reproductive women]

OBJECTIVE

To longitudinally analyze the associations between physical activity, sedentary time and dietary intake levels with waist circumference and abdominal obesity among Chinese reproductive women.

METHODS

In the five rounds of "China health and nutrition survey" in 2004, 2006, 2009, 2011 and 2015, 2951 women aged 15-49 years old who participated in at least two rounds of surveys were selected as research objects. Physical activity and sedentary time data were collected by questionnaire survey, and food consumption data were collected by 24-hour retrospective method for 3 consecutive days. Analysis of variance was used to analyze the time difference of continuous variables. Chi-square test was used to analyze the differences in time distribution of classified variables. Linear multilevel model was used to analyze the relationships between waist circumference and different levels of physical activity, sedentary time and dietary intake. Logistic multilevel model was used to analyze the risk of abdominal obesity with different levels of physical activity, sedentary time and dietary intake.

RESULTS

By incorporating physical activity, sedentary time and dietary intake levels into the multilevel model respectively, compared with the low level of leisure-time physical activity, the waist circumference of the medium level group increased by 0. 47 cm(P=0. 025); compared with low level of TV time, waist circumference of the medium and high level increased by 0. 49 cm(P=0. 033) and 0. 58 cm(P=0. 013), respectively, and the relative risk of abdominal obesity was 1. 13(P=0. 049) and 1. 17(P=0. 010), respectively; compared with the group with insufficient intake of dark vegetables, the waist circumference of the group with adequate intake decreased by 0. 82 cm(P&lt;0. 001), and the relative risk of abdominal obesity was 0. 87(P=0. 028); compared with the group with low level of pastry intake, the waist circumference of the high level group increased by 1. 16 cm(P&lt;0. 001) and the relative risk of abdominal obesity was 1. 33(P&lt;0. 001). By incorporating physical activity, sedentary time and dietary intake levels into the multilevel model simultaneously, there were still statistically significant differences between TV time and dietary intake levels with waist circumference and abdominal obesity and the statistical value did not change much. Compared with low level of TV time, the waist circumference of the medium and high level groups increased by 0. 54 cm(P=0. 028) and 0. 58 cm(P=0. 025), respectively, and the relative risk of abdominal obesity was 1. 15(P=0. 034) and 1. 18(P=0. 011), respectively. Compared with the group with insufficient intake of dark vegetables, the waist circumference of the group with adequate intake decreased by 0. 80 cm(P&lt;0. 001), and the relative risk of abdominal obesity was 0. 87(P=0. 027). Compared with the group with low level of pastry intake, the waist circumference of the high level increased by 1. 13 cm(P&lt;0. 001) and the relative risk of abdominal obesity was 1. 32(P&lt;0. 001). There was no statistical significance in physical activity level with waist circumference and abdominal obesity.

CONCLUSION

Television time and dietary factors(insufficient intake of dark color vegetables and high consumption of pastry) are independent risk factors for abdominal obesity among Chinese reproductive women. Besides strengthening physical activity, the prevention of abdominal obesity in reproductive women should also strengthen the intervention measures to reduce TV time and promote appropriate dietary behaviors(increasing dark color vegetable intake and reducing pastry intake).

Curative effects of vancomycin and cefotaxime combined with gamma globulin respectively in neonatal septicemia and their influences on PCT, CRP and hs-CRP

OBJECTIVE

To explore the curative effects of vancomycin and cefotaxime combined with gamma globulin respectively in neonatal septicemia and their influences on PCT, CRP, and hs-CRP, so as to provide references for clinical treatment.

PATIENTS AND METHODS

181 patients with neonatal septicemia admitted to Huangshi Maternity and Child Health Hospital from April 2012 to August 2014 were selected as the study subjects. Patients treated with vancomycin combined with gamma globulin were selected as group A (96 cases) and those treated with cefotaxime combined with gamma globulin were selected as group B (85 cases). The improvement time of clinical symptoms (milk rejection, nervous system symptoms, body temperature), hospital stays, mortality, medicine curative effects, adverse reactions, complications, and levels of serum CRP, PCT, and hs-CRP of patients before and after treatment were compared between the two groups.

RESULTS

The improvement time of clinical symptoms like body temperature, milk rejection, and neurological symptoms, as well as hospital stays in group A were lower than those in group B (p<0.05); the total effective rate of medicine curative effects in group B was better than that in group A (p<0.05); there was no significant difference in levels of serum CRP, PCT, and hs-CRP between the two groups before treatment (p>0.05); after treatment, levels of serum CRP, PCT, and hs-CRP in both groups decreased significantly, and levels of serum CRP, PCT, and hs-CRP in group B decreased more significantly than those in group A (p<0.05).

CONCLUSIONS

Cefotaxime combined with gamma globulin in the treatment of patients with neonatal septicemia has short improvement time in clinical symptoms, high total effective rate of drugs, low mortality, fewer adverse reactions and complications, and can significantly reduce levels of serum CRP, PCT, and hs-CRP, which is worthy of further promotion and application in clinical practice.

Psychometric properties of the perceived stress scale in a community sample of Chinese

BACKGROUND

The Perceived Stress Scale (PSS) is a globally used and self-report scale measuring perceived stress. Three versions of PSS (PSS-14, PSS-10 and PSS-4) are available which comprise 14, 10 and 4 items respectively. However, the Chinese version of the PSS has not yet been validated in a large community-based general population. The aims of this study were to evaluate the psychometric properties of the Chinese PSS in a large community-based general population and to compare the appropriateness of the three versions of PSS.

METHODS

A total of 9507 adults with at least a junior high school education and completed PSS-14 from the China Health and Nutrition Survey were involved in this study. The internal consistency reliability of PSS was assessed using Cronbach's alpha coefficient and confirmatory factor analysis was employed to test the construct validity. Modification index was used for model extension and the critical ratio was used for model restriction.

RESULTS

The internal consistency coefficients were satisfactory for PSS-14 and PSS-10, but not for PSS-4. The corresponding Cronbach's alpha were 0.830, 0.754 and 0.473 respectively. A 2-factor structure was confirmed for the PSS-14 and PSS-10, and all items' standardized factor loadings exceeded 0.4 for either negative or positive factors. Given that item 12 loaded on both negative and positive factors for PSS-14 and the goodness of fit for PSS-14 was not acceptable, PSS-13 (PSS-14 excluding item 12) was studied. The construct validities of PSS-13 and PSS-10 were satisfactory, but the goodness of fit for PSS-10 were better than that for PSS-13.

CONCLUSIONS

PSS-13 (PSS-14 excluding item 12) and PSS-10 have satisfactory psychometric properties. PSS-10 are more applicable to measure the perceived stress than PSS-13 in a large community-based general population in China.

Trends in Leisure-Time Physical Activity Among Chinese Adults - China, 2000-2015

What is already known about this topic?

The monitoring report on nutrition and health status of Chinese residents from 2010 to 2013 reported that the participation rate of leisure-time physical activity (LTPA) was 13.8% among those 6 years and older.

What is added by this report?

Among 18 years old and older, the age-standardized LTPA prevalence increased from 7.13% in 2000 to 11.79% in 2011 before dropping to 7.33% in 2015.

What are the implications for public health practice?

As levels of LTPA participation are low, further research is necessary to develop and test valid interventions to encourage people to take part in more LTPA especially for residents in rural areas and with low-income.