Classifying Chinese Medicine Constitution Using Multimodal Deep-Learning Model

OBJECTIVE

To develop a multimodal deep-learning model for classifying Chinese medicine constitution, i.e., the balanced and unbalanced constitutions, based on inspection of tongue and face images, pulse waves from palpation, and health information from a total of 540 subjects.

METHODS

This study data consisted of tongue and face images, pulse waves obtained by palpation, and health information, including personal information, life habits, medical history, and current symptoms, from 540 subjects (202 males and 338 females). Convolutional neural networks, recurrent neural networks, and fully connected neural networks were used to extract deep features from the data. Feature fusion and decision fusion models were constructed for the multimodal data.

RESULTS

The optimal models for tongue and face images, pulse waves and health information were ResNet18, Gate Recurrent Unit, and entity embedding, respectively. Feature fusion was superior to decision fusion. The multimodal analysis revealed that multimodal data compensated for the loss of information from a single mode, resulting in improved classification performance.

CONCLUSIONS

Multimodal data fusion can supplement single model information and improve classification performance. Our research underscores the effectiveness of multimodal deep learning technology to identify body constitution for modernizing and improving the intelligent application of Chinese medicine.

Effects of mind-body exercise on body constitution and circadian rhythm in people with suboptimal health status

BACKGROUND

Suboptimal health status (SHS) is a dynamic state in which people have not been diagnosed with a disease but tend to develop diseases. People with SHS are more prone to conditions such as cardiovascular disease and metabolic syndrome. Suitable interventions in people with SHS can prevent disease development. SHS is correlated with traditional Chinese medicine (TCM)-based constitutions, including Yang-Xu (yang deficiency), Yin-Xu (yin deficiency), and stasis types. The circadian rhythm is a potential biomarker of health and metabolism. Baduanjin exercise, a kind of mind-body exercise, has been regarded to adjust body constitution and metabolism, but few studies have evaluated the effects of Baduanjin exercise on body constitution and circadian rhythms. Therefore, this randomized controlled trial investigated the effects of Baduanjin exercise on body constitution and circadian rhythms in people with SHS.

METHODS

Seventy-six participants with SHS were divided into the Baduanjin exercise and control groups (watching a Baduanjin video), with the interventions lasting 12 weeks. The Body Constitution Questionnaire (BCQ), SHS Questionnaire-25 (SHSQ-25), and actigraphy for circadian rhythm measurement were conducted.

RESULTS

The scores of SHSQ-25, Yang-Xu, Yin-Xu, and BCQ stasis decreased significantly after 12 weeks in the Baduanjin exercise group, but not in the control group. Interdaily stability of the circadian rhythm increased significantly in the Baduanjin exercise group but not in the control group.

CONCLUSION

This is the first report of improved health status, modulated body constitution, and increased interdaily stability of the circadian rhythm in participants with SHS who practiced Baduanjin exercise.

A bidirectional Mendelian randomisation study to evaluate the relationship between body constitution and hearing loss

Hearing loss and hearing disorders represent possible mediating pathways in the associations between noise exposures and non-auditory health outcomes. In this context, we assessed whether the noise-obesity associations should consider hearing functions as possible mediators and applied Mendelian randomisation (MR) to investigate causal relationships between body constitution and hearing impairments. We obtained genetic associations from publicly available summary statistics from genome-wide association studies in European ancestry adult populations (N= from 210,088 to 360,564) for (i) body constitution: body mass index (BMI), waist circumference (WC) and body fat percentage (BFP), and (ii) hearing loss: sensorineural hearing loss, noise-induced hearing loss, and age-related hearing impairment (ARHI). We employed colocalisation analysis to investigate the genetic associations for BMI and ARHI liability within an FTO locus. We conducted bi-directional MR for the 'forward' (from body constitution to hearing) and 'reverse' directions. We applied the random effects inverse variance-weighted method as the main MR method, with additional sensitivity analyses. Colocalisation analysis suggested that BMI and ARHI shared a causal variant at the FTO gene. We did not find robust evidence for causal associations from body constitution to hearing loss and suggested that some associations may be driven by FTO variants. In the reverse analyses, ARHI was negatively associated with BMI [effect size - 0.22 (95% CI - 0.44 to - 0.01)] and BFP [effect size - 0.23 (95% CI - 0.45 to 0.00)], supporting the notion that ARHI may diminish body constitution. Finally, our data suggest that there is no strong evidence that hearing explains the association between noise exposure and body constitution.

Traditional Chinese Medicine constitution among patients with allergic rhinitis and its correlation with anxiety and depression

OBJECTIVE

To preliminary investigate the distribution of Traditional Chinese Medicine (TCM) constitution among patients with allergic rhinitis (AR) and reveal the related factors with anxiety and depression.

METHODS

Between July 2020 and June 2021, specialist doctor recruited AR patients in Beijing and Shanghai. A total of 630 patients admitted to participate in the survey, and 516 (81.9%) (male 54.3%, female 45.7%) participants completed the questionnaires. Three scales including Constitution in Chinese Medicine Questionnaire (CCMQ), Generalized Anxiety Disorder Questionnaire (GAD-7) and The Patient Health Queationaire-9 (PHQ-9) were applied. The χ2 and the Fisher's exact test were used to evaluate the classification data, multivariate logistic regression was used to explore the related factors of anxiety and depression.

RESULTS

According to 516 AR patients, the most commonly first-constitution was Yang-deficiency (22.1%) and frequent of all constitutions was inherited-special (21.6%). One third of AR patients (33.5%) suffered from anxiety, nearly half of AR patients (46.5%) were found to be depressive. Inherited-special (27.7%) was the most common constitution in patients with anxiety whereas Yang-deficiency (26.7%) was most common constitution in patients with depression. Sex, duration of symptoms, balanced, Qi-deficiency, phlegm-dampness, Qi-stagnation, and inherited-special constitutions were related with anxiety; Sex, income, duration of symptoms, balanced, Qi-deficiency, Yang-deficiency, phlegm-dampness, Qi-stagnation, and inherited-special constitutions were related with depression.

CONCLUSIONS

According to our study, the commonly constitution types of AR were Yang-deficiency and inherited-special. We found that the prevalence value of anxiety and depression were high. People with Qi-deficiency, phlegm-dampness, Qi-stagnation, and inherited-special constitutions were more likely to have mental problems than the others. Controlling these influential factors might be beneficial for clinical health management of AR patients, and the government should apply appropriate mental health treatment services to offer psychiatric support.

Association between traditional Chinese medicine body constitution deviation and chronic pelvic pain: A cross-sectional study

OBJECTIVE

Chronic pelvic pain (CPP) is one of the most challenging conditions that physicians and patients face nowadays. This study aimed to assess the traditional Chinese medicine (TCM) body constitution profiles, demographic characteristics, and lifestyle of women suffering from CPP.

MATERIALS AND METHODS

This study included 378 female patients of reproductive potential from a single Obstetrics and Gynecology clinic in Taiwan. Data were collected using the Short Form 36 Health Survey Questionnaire (SF-36), the TCM Body Constitution Deviation (BCQ-44) Questionnaire, and the Behavior Rating Scale. The chi-squared test, the Kruskal-Wallis test, the Mann-Whitney U test, and Spearman's correlation were used to analyze the data.

RESULTS

TCM body composition deviation was correlated with the level of pain in patients with CPP. Moreover, the quality of life (QOL) of these patients was found to be affected by the level of pain. Additionally, the QOL was correlated with the TCM body composition deviation profile.

CONCLUSION

The TCM BCQ-44 can be used in the medical practice to assess patients' health status and can also serve as a guide to address the risk factors for CPP.

Association of traditional Chinese medicine body constitution and cold syndrome with leukocyte mitochondrial functions: An observational study

Body constitution in traditional Chinese medicine (TCM) refers to the holistic and relatively durable state of an individual, based on the qi and blood assessment, and TCM syndrome is defined as the theoretical abstraction of disease-symptom profiles. The biological basis as related to mitochondria, which produce most of the cellular energy, has not been well studied. This study aimed to elucidate the association of mitochondrial function with TCM body constitution and cold syndrome. Body constitution and cold syndrome in TCM were assessed using the Constitution in Chinese Medicine Questionnaire (CCMQ). The mitochondrial function of peripheral leukocytes was evaluated based on oxygen consumption rate (OCR) and enzyme activity; OCR reflects mitochondrial activity and the capacity to produce adenosine triphosphate (ATP). Cellular adenosine nucleotides and malondialdehyde levels were determined using high-performance liquid chromatography to assess the potential bioenergetic mechanisms. A total of 283 adults participated in this study. Leukocytes from subjects with a balanced constitution had higher OCRs than those with unbalanced constitutions. Yang deficiency and cold syndrome also demonstrated lower energy metabolism, as indicated by reduced basal metabolic rate and cellular levels of ATP and malondialdehyde. Decreased mitochondrial enzyme activity has been observed in individuals with the cold syndrome. Unbalanced body constitutions in TCM impair mitochondrial function in leukocytes, which may contribute to the high disease susceptibility. Cold syndrome is characterized by reduced mitochondrial mass, which may explain its symptoms of low-energy metabolism and cold intolerance.

Traditional Chinese medicine body constitution predicts new-onset diabetic albuminuria in patients with type 2 diabetes: Taichung diabetic body constitution prospective cohort study

This prospective cohort study explored whether body constitution (BC) independently predicts new-onset albuminuria in persons with type 2 diabetes mellitus (T2DM) enrolled in the diabetes care management program (DCMP) of a medical center, providing evidence of integrating traditional Chinese medicine into DCMP for improving care quality. Persons with T2DM (n = 426) originally without albuminuria enrolled in DCMP were recruited in 2010 and were then followed up to 2015 for detecting new-onset albuminuria. The participants received urinalysis and blood test annually. Albuminuria was determined by an elevated urinary albumin/creatinine ratio (≥ 30 µg/mg), and poor glucose control was defined as Glycosylated hemoglobin above or equal to 7%. BC type (Yin deficiency, Yang deficiency, and phlegm stasis) was assessed using a well-validated body constitution questionnaire at baseline. Risk factors for albuminuria (sociodemographic factors, diabetes history, lifestyle behaviors, lipid profile, blood pressure, and kidney function) were also recorded. Hazard ratios (HR) of albuminuria for BC were estimated using multivariate Cox proportional hazards model. During the 4-year follow-up period, albuminuria occurred in 30.5% of participants (n = 130). The HR indicated that Yin deficiency was significantly associated with an increased risk of new-onset albuminuria in persons with T2DM and good glucose control after adjustment for other risk factors (HR = 2.09; 95% confidence interval = 1.05-4.17, P = .04), but not in those with poor glucose control. In persons with T2DM and poor glucose control, phlegm stasis was also significantly associated with a higher risk of albuminuria (2.26; 1.03-4.94, P = .04) after multivariate adjustment, but not in those with good glucose control. In addition to already-known risk factors, BC is an independent and significant factor associated with new-onset albuminuria in persons with T2DM. Our results imply Yin deficiency and phlegm stasis interacting with glucose control status may affect new-onset albuminuria in persons with T2DM.

Current Status of Objectification of Four Diagnostic Methods on Constitution Recognition of Chinese Medicine

Chinese medicine (CM) has thousands of years of experience in prevention of diseases. As for CM, people's constitution is closely related to their health status, thus recognition of CM constitution is the fundamental and core content of research on constitution types. With development of technologies such as sensors, artificial intelligence and big data, objectification of the four diagnostic methods of CM has gradually matured, bringing changes in the mindset and innovations in technical means for recognition of CM constitution. This paper presents a systematic review of the latest research trends in constitution recognition based on objectification of diagnostic methods in CM.

Approaches to Identify Factors Associated with Pubertal Timing in Self-Limited Delayed Puberty

INTRODUCTION

Children with self-limited delayed puberty (DP) (constitutional delay) enter puberty after variable waiting times, and the factors associated with their eventual pubertal timing are not well understood.

METHODS

We conducted a retrospective study of 99 girls and 228 boys with self-limited DP at an academic medical center between 2000 and 2015. To define features and potential subtypes of self-limited DP, we performed group-based trajectory modeling on childhood growth and latent-variable factor analysis on clinical characteristics. We then conducted time-to-event analyses to identify associations with pubertal timing.

RESULTS

We identified two distinct growth trajectories in individuals with self-limited DP: one with stable and the other with declining height percentiles. Latent-variable factor analysis identified five factors underlying clinical variation that appear to correspond to genetic height potential, body mass index, childhood growth, parental pubertal delay, and medical issues (attention-deficit/hyperactivity disorder and inhaled glucocorticoid use). We observed correlations between pubertal timing and bone age (p = 0.01), childhood height (p = 0.004), and midparental target height (p < 0.001), but not with parental pubertal delay or with testosterone treatment in boys.

CONCLUSIONS

By illustrating the heterogeneity within self-limited DP and identifying factors underlying this heterogeneity, our study suggests that there may be multiple causes of self-limited DP. However, our ability to determine when puberty will eventually occur remains limited. Dissecting self-limited DP into its component subtypes may inform future studies of the mechanisms contributing to pubertal delay as well as studies of the short- and long-term outcomes of self-limited DP.

Facial and body sexual dimorphism are not interconnected in the Maasai

BACKGROUND

In this paper, we investigate facial sexual dimorphism and its' association with body dimorphism in Maasai, the traditional seminomadic population of Tanzania. We discuss findings on other human populations and possible factors affecting the developmental processes in Maasai.

METHODS

Full-face anthropological photographs were obtained from 305 Maasai (185 men, 120 women) aged 17-90 years. Facial shape was assessed combining geometric morphometrics and classical facial indices. Body parameters were measured directly using precise anthropological instruments.

RESULTS

Sexual dimorphism in Maasai faces was low, sex explained 1.8% of the total shape variance. However, male faces were relatively narrower and vertically prolonged, with slightly wider noses, narrower-set and lower eyebrows, wider mouths, and higher forehead hairline. The most sexually dimorphic regions of the face were the lower jaw and the nose. Facial width-to-height ratio (fWHR), measured in six known variants, revealed no significant sexual dimorphism. The allometric effects on facial traits were mostly related to the face growth, rather than the growth of the whole body (body height). Significant body dimorphism was demonstrated, men being significantly higher, with larger wrist diameter and hand grip strength, and women having higher BMI, hips circumferences, upper arm circumferences, triceps skinfolds. Facial and body sexual dimorphisms were not associated.

CONCLUSIONS

Facial sex differences in Maasai are very low, while on the contrary, the body sexual dimorphism is high. There were practically no associations between facial and body measures. These findings are interpreted in the light of trade-offs between environmental, cultural, and sexual selection pressures.

An anthropometric study of sexual orientation and gender identity in Thailand

The biodevelopment of psychological sex differentiation is putatively reflected in several anthropometrics. We examined eight anthropometrics in 1404 Thai participants varying in sex, sexual orientation, and gender identity/expression: heterosexual men and women, gay men, lesbian women, bisexual women, sao praphet song (transgender birth-assigned males), toms (transgender birth-assigned females), and dees (birth-assigned females attracted to toms). Exploratory factor analyses indicated the biomarkers should be analyzed independently. Using regressions, in birth-assigned males, less male-typical second-to-fourth digit ratios in the left hand were associated with sexual orientation towards men regardless of gender identity/expression, whereas shorter height and long-bone growth in the arms and legs were more evident among sao praphet song-who are both sexually oriented towards men and markedly feminine. In birth-assigned females, there were no clear sexual orientation effects, but there were possible gender-related effects. Groups of individuals who tend to be more masculine (i.e., toms, lesbians) showed more male-typical patterns on weight and leg length than some groups of individuals who tend to be less masculine (i.e., heterosexual women, dees). Thus, it appears the various anthropometrics inform separate biodevelopmental processes that differentially relate to sexual orientation and gender identity/expression depending on the measure in question as well as birth-assigned sex.

The Association Between Traditional Chinese Medicine Body Constitution Deviation and Essential Hypertension: A Case-Control Study

BACKGROUND

The prevention and treatment of hypertension is valued globally. The World Health Organization advocates combining traditional medicines in the prevention and treatment of diseases. Traditional Chinese medicine (TCM) assumes that diseases originate from the attenuation of one's body constitution. A few studies have found that hypertension is correlated with TCM body constitution. However, body constitution is also affected by living environment. Therefore, investigating the correlation between deviations in body constitution and essential hypertension in different living environments is necessary to provide the basis for using TCM in combination with conventional Western medicine to prevent and treat hypertension.

PURPOSE

The aim of this study was to explore the association between TCM body constitution deviation and essential hypertension.

METHODS

A case-control study was designed. Participants were selected from the outpatient clinics and neighboring communities of a regional teaching hospital in southern Taiwan. The study included 210 hypertension and 210 nonhypertension cases. Blood pressures were measured using an electronic sphygmomanometer to confirm the presence or absence of hypertension. The TCM Body Constitution Questionnaire, demographic datasheet, and hypertension-related factors questionnaire were used to collect data.

RESULTS

A higher proportion of patients with body constitution deviation were found in the hypertension group than the nonhypertension group. The proportions of patients with Yin-Xu, Yang-Xu, and stasis constitution were 44.8%, 32.4%, and 30.6%, respectively, in the hypertension group and 28.6%, 25.2%, and 19.6%, respectively, in the nonhypertension group. After performing univariate analysis, the results showed significant differences between the two groups in terms of average body mass index; emotional traits of anger, worry, and fear; hyperlipidemia; hyperuricemia; Yin-Xu constitution; and stasis constitution. However, the multivariate analysis revealed having a Yin-Xu constitution to be a risk factor of essential hypertension after adjusting for age, gender, body mass index, emotional traits, drinking habit, hyperlipidemia, and hyperuricemia.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results suggest that Yin-Xu and stasis constitutions are respectively associated with essential hypertension. The findings offer a valuable reference to governments and healthcare professionals to prevent the risk of essential hypertension. Screening and healthcare measures for TCM Yin-Xu or stasis constitution may be included in related prevention plans to minimize public exposure to the risk factors of essential hypertension.

The Unfolding Method to Explore Health-Related Quality of Life Constructs in a Chinese General Population

OBJECTIVES

Health-related quality of life (HRQOL) is a complicated concept that can be measured using multiple health items. Although HRQOL is closely associated with people's subjective assessment of their own health, a limited number of studies have investigated which health items are considered most important and relevant by the general population. Even fewer empirical studies have investigated how HRQOL is understood in non-Western populations. This study used multidimensional unfolding analysis in a Chinese general population to explore the constructs of HRQOL.

METHODS

A scoping review of Chinese generic HRQOL measures and a series of qualitative interviews produced a list of 42 potentially important health items in a Chinese cultural setting; 110 Chinese participants in face-to-face interviews ranked the health items from most important to least important. Responses were coded into a rectangular 110 × 42 matrix, and multidimensional unfolding was conducted to analyze participants' preferences for health items.

RESULTS

It was found that demographic characteristics and one's health condition affected views of HRQOL. Meanwhile, 3 health items were considered to be most important across the whole sample: sleep quality, body constitution, and spiritual appearance.

CONCLUSION

This study used a novel approach to explore how people coming from a Chinese cultural setting may perceive HRQOL and which aspects of HRQOL are most important to them. The study shows that multidimensional unfolding is a feasible approach to assess preferences in a general population. Future studies using this approach are recommended to further explore the constructs of HRQOL in other general populations.

Traditional Chinese Medicine Body Constitutions and Psychological Determinants of Depression among University Students in Malaysia: A Pilot Study

Depression is commonly observed in university students, who are a high risk group for developing psychiatric disorders during adulthood. This study aimed to determine the prevalence of depression and its traditional Chinese medicine body constitutions and psychological determinants among university students in Malaysia. A cross-sectional pilot study was conducted between 9 and 28 September 2020 among 80 university students in Malaysia. Participants completed online survey questionnaires, including the validated Patient Health Questionnaire (PHQ-9), Constitution in Chinese Medicine Questionnaire (CMCQ), Dysfunctional Attitude Scale (DAS), Depression Anxiety Stress Scale (DASS-21) stress subscale, Perceived Stress Scale (PSS-10), and Rosenberg Self-Esteem Scale (RSES), which assess depression, body constitution, dysfunctional attitude, stress, perceived stress, and self-esteem. Multiple linear regression analyses were performed to determine the associated risk factors for depression. The overall prevalence of depression among university students was 33.8%. The multiple regression analysis showed a significant relationship between depression and qi-stagnation constitution (B = 0.089, p = 0.011), balanced constitution (B = -0.077, p = 0.049), and self-esteem (B = -0.325, p = 0.001). Our findings suggest that some traditional Chinese medicine body constitutions and self-esteem are significant risk factors affecting depression among university students. Identifying risk factors of depression is vital to aid in the early detection of depression among university students.

Body Habitus Across the Lifespan and Risk of Pituitary Adenoma

CONTEXT

No studies have examined the association between body habitus and incidence of pituitary adenoma.

OBJECTIVE

To determine if body mass index (BMI), waist circumference, body somatotype, or height are associated with risk of pituitary adenoma.

DESIGN

Pooled analysis of 3 prospective cohort studies.

SETTING

Population-based study.

PARTICIPANTS

Participants of the Nurses' Health Study (NHS), Nurses' Health Study II (NHSII), and the Health Professionals Follow-Up Study (HPFS), totaling 284 946 American health professionals.

EXPOSURES

BMI, waist circumference, body somatotype, and height.

OUTCOME MEASURES

Self-reported incident pituitary adenoma. Multivariable (MV)-adjusted hazard ratios (HRs) of pituitary adenoma were estimated using Cox proportional hazards models.

RESULTS

During 7 350 156 person-years of follow-up, 387 incident pituitary adenomas were reported. Comparing BMI of ≥30 to <25 kg/m2, higher adult BMI was associated with higher risk of pituitary adenoma (MV HR = 1.74; 95% CI, 1.33-2.28), as was higher maximum adult BMI (MV HR = 1.76; 95% CI, 1.34-2.30), higher waist circumference (MV HR = 1.06; 95% CI, 1.04-1.09 per inch), and higher BMI during early adulthood (at age 18 to 21, MV HR = 2.65; 95% CI, 1.56-4.49). Taller adult height was associated with pituitary adenoma (MV HR = 1.05; 95% CI, 1.01-1.09 per inch). Overall findings were similar in women and men, although power was limited in men (n = 62 cases). Sensitivity analyses demonstrated that the association between adult BMI and pituitary adenoma extended to at least 14 years prior to diagnosis and that the results were not affected when analyses were restricted to participants with similar healthcare utilization.

CONCLUSION

Higher BMI and waist circumference, from early adulthood to the time of diagnosis, were associated with higher risk of pituitary adenoma.

Pre-diabetes prevalence and associated factors in New Zealand school children: a cross-sectional study

AIMS

The incidence of pre-diabetes and type 2 diabetes mellitus (T2DM) is increasing in children. Early identification of pre-diabetes is an important first step in preventing the progression to T2DM. The aim was to investigate the association of selected factors with pre-diabetes in children.

METHODS

This data were from a subset of the 685 children recruited for the Children's Bone Study, a cross-sectional study of children aged 8-11 years in Auckland, New Zealand. Glycated haemoglobin (HbA1c) was measured from a finger-prick blood test. Children were classified as normoglycaemic (HbA1c≤39mmol/mol) and pre-diabetic (HbA1c>39mmol/mol). Anthropometry included weight, height, waist circumference (WC) and percentage body fat (%BF) measured using bioelectrical impedance analysis. Information about age, gender, ethnicity and physical activity was collected by questionnaires.

RESULTS

HbA1c was measured in 451 children (10.4±0.6years, 45% male). Pre-diabetes was present in 71 (16%) children and was greatest in South Asian (n=13, 30%), Pacific Island (n=29, 27%) and Māori (n=10, 18%) children, compared with European children (n=10, 6.0%) (P< 0.001). South Asian and Pacific Island ethnicity, high WC, high %BF and low physical activity were associated with pre-diabetes.

CONCLUSIONS

Factors associated with pre-diabetes in children were ethnicity, anthropometric measures and physical-activity levels. The prevalence of pre-diabetes in children of South Asian and Pacific Island ethnicities suggests the need for appropriate and timely identification and intervention to halt the progression to T2DM.

The centenary of the Harris-Benedict equations: How to assess energy requirements best? Recommendations from the ESPEN expert group

BACKGROUND & AIMS

The year 2019 marked the centenary of the publication of the Harris and Benedict equations for estimation of energy expenditure. In October 2019 a Scientific Symposium was organized by the European Society for Clinical Nutrition and Metabolism (ESPEN) in Vienna, Austria, to celebrate this historical landmark, looking at what is currently known about the estimation and measurement of energy expenditure.

METHODS

Current evidence was discussed during the symposium, including the scientific basis and clinical knowledge, and is summarized here to assist with the estimation and measurement of energy requirements that later translate into energy prescription.

RESULTS

In most clinical settings, the majority of predictive equations have low to moderate performance, with the best generally reaching an accuracy of no more than 70%, and often lead to large errors in estimating the true needs of patients. Generally speaking, the addition of body composition measurements did not add to the accuracy of predictive equations. Indirect calorimetry is the most reliable method to measure energy expenditure and guide energy prescription, but carries inherent limitations, greatly restricting its use in real life clinical practice.

CONCLUSIONS

While the limitations of predictive equations are clear, their use is still the mainstay in clinical practice. It is imperative to recognize specific patient populations for whom a specific equation should be preferred. When available, the use of indirect calorimetry is advised in a variety of clinical settings, aiming to avoid under-as well as overfeeding.

Association between hypertension-mediated organ damage and obesity defined by novel anthropometric indices in community-dwelling elderly individuals

OBJECTIVE

Body mass index (BMI), the most common anthropometric index, has recently been challenged by two emerging parameters: a body shape index (ABSI) and body roundness index (BRI). The purpose of this study was to explore the associations of hypertension-mediated organ damage (HMOD) with conventional and novel anthropometric parameters.

METHODS

This is a multistage community-based observational and cross-sectional study. A total of 3077 elderly Chinese individuals (mean age 70.92 ± 5.84, 1329 (43%) men) from the communities in the northern area of Shanghai were enrolled from June 2014 to August 2019. Waist-to-hip ratio (WHR), ABSI and BRI were calculated with validated formulas. HMOD, including left ventricular hypertrophy (LVH), arterial stiffness (AS), lower limb atherosclerosis (LLA), and microalbuminuria (MAU), was assessed using standardized methods. Correlation and multivariable linear and logistic regression analyses were performed to detect the relations between HMOD and anthropometric indices.

RESULTS

In the total population, compared to those with ABSI, BRI and WHR in the lowest quartiles, participants with values in the highest quartiles exhibited a significantly higher risk of LVH, AS and MAU independent of BMI and other confounders (all P for trend <0.01). In females but not in males, compared to BMI, BRI and WHR had a greater area under the curve (AUC) for detecting HMOD. In the further stepwise logistic regression with all anthropometric indices put into models simultaneously, only BRI remained in the LVH (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.30-1.55) and LLA (OR: 1.48, 95% CI: 1.23-1.77) models, and WHR remained in the AS (OR: 1.30, 95% CI: 1.18-1.43) and MAU (OR: 1.48, 95% CI: 1.28-1.72, all P < 0.01) models.

CONCLUSION

Compared to BMI, the novel anthropometric parameter BRI, together with the conventional parameter WHR, exhibits a closer relationship with HMOD in the elderly population, especially in females.

The Nutritional Status of Individuals Adopted Internationally as Children: A Systematic Review

Since 1955, international adoption has been a way of finding homes for children who have been orphaned or abandoned. We aimed to describe the nutritional status of individuals adopted internationally and their long-term nutritional and health outcomes. We searched four databases for articles published from January 1995 to June 2020, which included information on anthropometric or micronutrient status of children adopted internationally (CAI). Mean Z-scores on arrival to adoptive country ranged from -2.04 to -0.31 for weight for age; -0.94 to 0.39 for weight for height; -0.7 to 0 for body mass index; -1.89 to -0.03 for height for age; -1.43 to 0.80 for head circumference for age. Older children, those adopted from institutionalized care or with underlying disability, were more likely to be malnourished. Though long-term data was scarce, mean Z-scores post-adoption ranged from -0.59 to 0.53 for weight for age; -0.31 to 1.04 for weight for height; 0.39 to 1.04 for body mass index; -1.09 to 0.58 for height for age; -0.06 to 1.23 for head circumference for age. We conclude that though CAI are at high risk of malnutrition at baseline, marked catch-up growth is possible, including for those older than two years of age on arrival. This has implications not only for CAI but for the wider population of malnourished children worldwide. Research on how to optimize catch-up growth is a priority.

Association between dry eye and traditional Chinese medicine body constitutions: A Taiwanese adults study

In the theory of traditional Chinese medicine (TCM), except for the balanced constitution, other constitutions are unbalanced and may lead to susceptibility to certain diseases. This study made the first efforts to explore the relationship between TCM constitutions and the dry eye condition.This cross-sectional study collected information from 2760 subjects aged 30 to 70 years who had participated in a questionnaire survey conducted by Taiwan Biobank (TWB) in 2012 to 2017. The questionnaire included questions on basic demographic characteristics, chronic diseases, depression, blood lipid levels, lifestyles, and drug allergies, as well as a TCM constitution scale developed by a research team of TCM constitution and syndrome at China Medical University College of Chinese Medicine.Unadjusted and stratified multiple logistic regression analyses were performed to explore the relationships between TCM constitutions and dry eye. The analysis revealed that subjects falling into the constitution category of Yang deficiency, Yin deficiency, or Phlegm stasis were more likely to develop dry eyes (crude odds ratio [OR] = 1.741, 95% confidence interval [CI] = 1.361-2.227; crude OR = 2.4821, 95% CI = 1.968-3.131; and crude OR = 2.082, 95% CI = 1.597-2.714, respectively). After adjusting for important risk factors (demographic characteristics, chronic diseases, blood lipid levels, lifestyles, depression, and drug allergies), subjects with an unbalanced constitution were 1.6 to 2.5 times more likely to develop dry eye than those with a balanced constitution.These results confirm a high correlation of TCM constitution with dry eye. Considering that the current treatment outcome is not fully satisfactory to the patients with dry eyes, integration of TCM and Western medicine may be an alternative treatment option. Individualized treatments and lifestyle recommended should be provided to patients with different TCM constitutions to alleviate dry eye symptoms.

Prevalence and Predictors of Overweight and Obesity among Young Children in the Children's Healthy Living Study on Guam

This study is part of the Children's Healthy Living program in U.S. Affiliated Pacific region. The objectives were to estimate overweight and obesity (OWOB) prevalence and identify possible related risk factors among ethnic groups in Guam. In 2013, 865 children (2-8 years) were recruited via community-based sampling from select communities in Guam. Children's demographic and health behavior information; dietary intake; and anthropometric measurements were collected. Logistic regression, odds ratio, t-tests, and chi-square tests were used to determine differences and assess covariates of OWOB. The results indicate that 58% of children were living below the poverty level, 80% were receiving food assistance, and 51% experienced food insecurity. The majority of children surveyed did not meet recommendations for: sleep duration (59.6%), sedentary screen-time (83.11%), or fruit (58.7%) and vegetable (99.1%) intake, and consumed sugar sweetened beverages (SSB) (73.7%). OWOB affected 27.4% of children. Children affected by OWOB in this study were statistically more likely (p = 0.042) to suffer from sleep disturbances (p = 0.042) and consume marginally higher amounts (p value = 0.07) of SSB compared to children with healthy weight. Among Other Micronesians, children from families who considered themselves 'integrated' into the culture were 2.05 (CI 0.81-5.20) times more likely to be affected by OWOB. In conclusion, the OWOB prevalence among 2-8-year-olds in Guam was 27.4%; and compared with healthy weight children, children with OWOB were more likely to have educated caregivers and consume more SSBs. Results provide a basis for health promotion and obesity prevention guidance for children in Guam.

Serum Uric Acid Is Positively Associated with Muscle Mass and Strength, but Not with Functional Capacity, in Kidney Transplant Patients

Background: Our aim was to associate serum uric acid (UA) with muscle mass, strength and functional capacity in kidney transplant patients (KTPs). Methods: A cross-sectional study was performed on 113 KTPs. The fat-free mass and total and appendicular muscle mass were estimated by performing a bioelectrical impedance analysis. The strength was evaluated using the handgrip strength test (HGS) and the five times sit to stand test (5STS). The functional capacity was evaluated using the 4 m walk test and the short physical performance battery (SPPB). Results: Linear regression showed that the UA levels were positively associated with the muscle mass, fat-free mass, appendicular muscle mass, muscle mass index and appendicular muscle mass index. The 5STS results (seconds) were inversely associated with the UA levels, showing that individuals with higher UA were more likely to have more strength. However, UA was not associated with the HGS, 4 m walk test and SPPB results. Conclusion: UA levels were positively associated with muscle mass and strength, but not with functional capacity, in KTPs.

Do Parent-Child Dyads with Excessive Body Mass Differ from Dyads with Normal Body Mass in Perceptions of Obesogenic Environment?

Background: This study addressed differences between parent–child dyads with excessive body mass (overweight or obesity) and dyads with normal body mass in obesity determinants, derived from social-ecological models. It was hypothesized that parents and their 5–11 years-old children with excessive body mass would (1) report lower availability of healthy food at home, (2) perceive fewer school/local community healthy eating promotion programs, (3) report lower persuasive value of food advertising. Methods: Data were collected twice (T1, baseline; T2, 10-month follow-up), including n = 129 parent–child dyads with excessive body mass and n = 377 parent–child dyads with normal body mass. Self-reported data were collected from parents and children; with body weight and height assessed objectively. General linear models (including analysis of variance with repeated measures) were performed to test the hypotheses. Results: Compared to dyads with normal body mass, dyads of parents and children with excessive body mass perceived lower availability of healthy food at home and fewer healthy eating promotion programs at school/local community (T1 and T2). These effects remained significant after controlling for sociodemographic variables. No significant differences in persuasive value of food advertising were found. Conclusions: Perceptions of availability of healthy food at home and healthy nutrition promotion may be relatively low in parent–child dyads with excessive weight which, in turn, may constitute a risk factor for maintenance of obesity.

Normalized Indices Derived from Visceral Adipose Mass Assessed by Magnetic Resonance Imaging and Their Correlation with Markers for Insulin Resistance and Prediabetes

Visceral adipose tissue (VAT) plays an important role in the pathogenesis of insulin resistance (IR), prediabetes and type 2 diabetes. However, VAT volume alone might not be the best marker for insulin resistance and prediabetes or diabetes, as a given VAT volume may impact differently on these metabolic traits based on body height, gender, age and ethnicity. In a cohort of 1295 subjects from the Tübingen Diabetes Family Study (TDFS) and in 9978 subjects from the UK Biobank (UKBB) undergoing magnetic resonance imaging for quantification of VAT volume, total adipose tissue (TAT) in the TDFS, total abdominal adipose tissue (TAAT) in the UKBB, and total lean tissue (TLT), VAT volume and several VAT-indices were investigated for their relationships with insulin resistance and glycemic traits. VAT-related indices were calculated by correcting for body height (VAT/m:VAT/body height; VAT/m²:VAT/(body height)², and VAT/m³:VAT/(body height)³), TAT (%VAT), TLT (VAT/TLT) and weight (VAT/WEI), with closest equivalents used within the UKBB dataset. Prognostic values of VAT and VAT-related indices for insulin sensitivity, HbA1c levels and prediabetes/diabetes were analyzed for males and females. Males had higher VAT volume and VAT-related indices than females in both cohorts (p < 0.0001) and VAT volume has shown to be a stronger determinant for insulin sensitivity than anthropometric variables. Among the parameters uncorrected VAT and derived indices, VAT/m³ most strongly correlated negatively with insulin sensitivity and positively with HbA1c levels and prediabetes/diabetes in the TDFS (R² = 0.375/0.305 for females/males for insulin sensitivity, 0.178/0.148 for HbA1c levels vs., e.g., 0.355/0.293 and 0.144/0.133 for VAT, respectively) and positively with HbA1c (R² = 0.046/0.042) in the UKBB for females and males. Furthermore, VAT/m³ was found to be a significantly better determinant of insulin resistance or prediabetes than uncorrected VAT volume (p < 0.001/0.019 for females/males regarding insulin sensitivity, p < 0.001/< 0.001 for females/males regarding HbA1c). Evaluation of several indices derived from VAT volume identified VAT/m³ to correlate most strongly with insulin sensitivity and glucose metabolism. Thus, VAT/m³ appears to provide better indications of metabolic characteristics (insulin sensitivity and pre-diabetes/diabetes) than VAT volume alone.

The Relationship between Protein Intake and Source on Factors Associated with Glycemic Control in Individuals with Prediabetes and Type 2 Diabetes

Type 2 diabetes (T2D) is a major contributor to morbidity and mortality largely due to increased cardiovascular disease risk. This study examined the relationships among protein consumption and sources on glycemic control and cardiovascular health in individuals with prediabetes and T2D. Sixty-two overweight or obese participants with prediabetes or T2D, aged 45–75 years were stratified into the following three groups based on protein intake: <0.8 g (gram)/kg (kilogram) body weight (bw), ≥0.8 but <1.0 g/kg bw, and ≥1.0 g/kg bw as below, meeting, and above the recommended levels of protein intake, respectively. Body mass, body mass index (BMI), hip circumference (HC), waist circumference (WC), lean mass, and fat mass (FM) were significantly higher in participants who consumed below the recommended level of protein intake as compared with other groups. Higher animal protein intake was associated with greater insulin secretion and lower triglycerides (TG). Total, low-density, and high-density cholesterol were significantly higher in participants who met the recommended protein intake as compared with the other groups. These data suggest that high protein consumption is associated with lower BMI, HC, WC, and FM, and can improve insulin resistance without affecting lipid profiles in this population. Furthermore, higher intake of animal protein can improve β-cell function and lower plasma TG.

Effects of Modern Food Retailers on Adult and Child Diets and Nutrition

In many developing countries, food environments are changing rapidly, with modern retailers-such as supermarkets-gaining in importance. Previous studies have suggested that the rise of modern retailers contributes to overweight and obesity. Effects of modern retailers on dietary quality have not been analyzed previously due to the unavailability of individual-level dietary data. Here, we address this research gap with data from randomly selected households in Lusaka, Zambia. Anthropometric and food-intake data from 930 adults and 499 children were analyzed to estimate effects of purchasing food in modern retailers on body weight, height, and dietary quality while controlling for income and other confounding factors. The food expenditure share spent in modern retailers was found to be positively associated with overweight in adults, but not in children. For children, a positive association between expenditures in modern retailers and height was identified. Modern retailers contribute to higher consumption of ultra-processed foods and calories. But they also increase protein and micronutrient intakes among adults and children, mainly through higher consumption of meat and dairy. The findings underline that modern retailers can influence diets and nutrition in positive and negative ways. Differentiated regulatory policies are needed to shape food environments for healthy food choices and nutrition.

Eveningness in Energy Intake among Adolescents with Implication on Anthropometric Indicators of Nutritional Status: The CRO-PALS Longitudinal Study

Shifting of energy intake towards a later time in the day is associated with an increased risk of obesity in adults. However, there is a lack of data for adolescents. The aim of this study was to investigate adolescents eveningness in energy intake (EV) and its association with anthropometric indicators of nutritional status. This investigation was based on results from the Croatian physical activity in adolescence longitudinal study (CRO-PALS). The cohort included 607 adolescents (50.25% females and 49.75% males) who were assessed at the age of 15/16 and 18/19. A single multi-pass 24-h recall was used as a dietary assessment method, while anthropometric indicators of nutritional status included body mass index (BMI), waist to hip ratio (WHR) and the sum of four skinfolds. The School Health Action, Planning and Evaluation System (SHAPES) questionnaire was used to assess active daily energy expenditure and sedentary behaviors. EV was significantly higher at 18/19 years compared to 15/16 years in whole population (p < 0.01), among male adolescents (p < 0.01), but not among female adolescents (p > 0.05). Although a significant correlation between EV and WHR was found in females at the age of 15/16 (p < 0.01), the results of this study suggest that EV has no or a minor effect on anthropometric indicators of nutritional status in adolescence.

Association between Geriatric Nutrition Risk Index and Skeletal Muscle Mass Index with Bone Mineral Density in Post-Menopausal Women Who Have Undergone Total Thyroidectomy

Background: Osteoporosis is highly prevalent in postmenopausal women and may result in fractures and disabilities. Total thyroidectomy has also been associated with loss of bone mass. The aim of this cross-sectional study was to evaluate associations among nutritional status, skeletal muscle index and markers of bone turnover to bone mineral density in postmenopausal women who had undergone total thyroidectomy. Methods: Fifty postmenopausal women who had undergone total thyroidectomy were included. Body composition was measured using dual-energy X-ray absorptiometry (DXA). The Geriatric Nutritional Risk Index (GNRI) was calculated using baseline body weight and serum albumin level. Skeletal muscle mass index was calculated as the appendicular skeletal muscle mass (ASM) divided by the height squared and assessed using DXA. Results. Multivariate stepwise linear regression analysis showed that a low GNRI was significantly associated with low lumbar spine bone mineral density (BMD) and T-score, and that a low ASM/height² was significantly associated with low femoral neck BMD and T-score. A low vitamin D level was significantly associated with low femoral neck BMD and T-score and low total hip BMD and T-score. A high bone alkaline phosphatase (ALP) level was significantly associated with low femoral neck T-score and low total hip BMD and T-score. A low insulin-like growth factor-1 (IGF-1) was significantly associated with low total hip BMD and T-score. Conclusion: In the postmenopausal women who had undergone total thyroidectomy in this study, BMD was positively associated with GNRI, skeletal muscle mass index, and levels of vitamin D and serum IGF-1, and inversely associated with bone ALP level. Nutritional status, skeletal muscle mass index and bone turnover biomarkers can be used to early identify patients with a high risk of osteoporosis in this high-risk group.

Dietary Habits, Anthropometric Features and Daily Performance in Two Independent Long-Lived Populations from Nicoya peninsula (Costa Rica) and Ogliastra (Sardinia)

(1) Background: Longevity Blue Zones (LBZs) are populations characterized by exceptional longevity. The purpose of this cross-sectional study was to compare the food habits of two representative samples of the oldest old subjects from the population residing in the LBZs of Nicoya peninsula (Costa Rica) and in the mountainous part of Ogliastra (Sardinia, Italy). (2) Methods: Data were collected using validated tools, including a food frequency questionnaire, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) scales for functional autonomy, body mass index, and waist and limbs circumferences. (3) Results: A total of 210 subjects, 60 (31 male) from Nicoya (age range 80–109 years), and 150 (61 male) from Ogliastra (age 90–101 years) were included in the study. In both populations, the highest frequencies of consumption were recorded for plant-derived foods (cereals 60–80% daily, legumes ≥ 80% daily in Nicoya, ≥ 60% 2–5 servings/week in Ogliastra), followed by those of animal origin (dairy products, meat) ≥60% and 80% daily, in Nicoya and Ogliastra, respectively. The frequency of milk consumption showed a positive correlation with BADL (ρ = 0.268 for Nicoya and ρ = 0.214 for Ogliastra) and IADL scores (ρ = 0.466 for Nicoya and ρ = 0.471 for Ogliastra), whereas legumes consumption correlated negatively with self-rated health (ρ = −0.264) and IADL (ρ = −0.332). (4) Conclusions: Our results indicate that the dominant dietary model among the elderly of Nicoya and Ogliastra is a plant-based diet complemented by a non-negligible consumption of animal products, mostly dairy products. Further prospective studies are needed to ascertain a possible cause–effect relationship between food habits and increased likelihood of reaching advanced age.

A Nutrigenetic Approach to Investigate the Relationship between Metabolic Traits and Vitamin D Status in an Asian Indian Population

Studies in Asian Indians have examined the association of metabolic traits with vitamin D status. However, findings have been quite inconsistent. Hence, we aimed to explore the relationship between metabolic traits and 25-hydroxyvitamin D [25(OH)D] concentrations. We investigate whether this relationship was modified by lifestyle factors using a nutrigenetic approach in 545 Asian Indians randomly selected from the Chennai Urban Rural Epidemiology Study (219 normal glucose tolerant individuals, 151 with pre-diabetes and 175 individuals with type 2 diabetes). A metabolic genetic risk score (GRS) was developed using five common metabolic disease-related genetic variants. There was a significant interaction between metabolic GRS and carbohydrate intake (energy%) on 25(OH)D (Pinteraction = 0.047). Individuals consuming a low carbohydrate diet (≤62%) and those having lesser number of metabolic risk alleles (GRS ≤ 1) had significantly higher levels of 25(OH)D (p = 0.033). Conversely, individuals consuming a high carbohydrate diet despite having lesser number of risk alleles did not show a significant increase in 25(OH)D (p = 0.662). In summary, our findings show that individuals carrying a smaller number of metabolic risk alleles are likely to have higher 25(OH)D levels if they consume a low carbohydrate diet. These data support the current dietary carbohydrate recommendations of 50%-60% energy suggesting that reduced metabolic genetic risk increases 25(OH)D.

Outcome measures evaluating physical functioning and their measurement properties in adolescent idiopathic scoliosis: a protocol for a systematic review

INTRODUCTION

Physical functioning (PF) is the ability to carry out the physical activity of daily living. It is an important outcome that provides a meaningful evaluation of individuals' life. PF can be assessed using patient-reported outcome measures, performance-based outcome measures or body structure and function measure. Measures need to be valid, reliable and responsive to change to evaluate the effects of an intervention. Adolescent idiopathic scoliosis (AIS) is the most common deformity among the paediatric population and impacts on individuals' lives. This systematic review will appraise evidence on the measurement properties of PF tools in individuals with AIS.

METHODS/ANALYSIS

A protocol for systematic review and meta-analysis informed by Cochrane guidelines is reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. MEDLINE, PsycINFO, EMBASE, CINAHL, SPORTdiscus, Web of Science and PubMed will be searched in two stages, from inception until December 2019. Search 1 will inventory all studies that assessed PF in participants with AIS, without any limitations. The search terms will be scoliosis, adolescent and PF-related terms. Search 2 will include studies which investigated instrument measurement properties in the same population for measures identified in search one. Two reviewers will independently perform study selection, data extraction, risk of bias and overall quality assessment. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias and a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines will be used. A meta-analysis will be conducted if possible, or the evidence will be synthesised and summarised per measurement property per outcome measure per measurement type.

ETHICS AND DISSEMINATION

This review will provide recommendations for practice and future research, considering psychometric properties of outcome measures of PF in AIS. The results of this study will be disseminated through a peer-reviewed publication and conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42019142335.

Effect of body condition on intestinal permeability in horses

OBJECTIVE

To investigate effects of body condition on permeability of intestinal mucosa in horses.

ANIMALS

13 horses (7 obese and 6 lean) from 8 to 15 years of age.

PROCEDURES

Body condition score was assessed, and an oral sugar test (OST) was performed to evaluate glucose and insulin dynamics. Horses were allowed a 2-week diet acclimation period and were then euthanized. Tissue samples were collected from the jejunum, ileum, cecum, pelvic flexure, right dorsal colon, and rectum. Mucosal permeability was assessed by measuring transepithelial resistance and lipopolysaccharide (LPS) flux across tissue samples mounted in Ussing chambers.

RESULTS

5 obese horses and 1 lean horse had evidence of insulin dysregulation, whereas 1 obese and 5 lean horses had no abnormalities in results of the OST. Results for the OST were not available for 1 obese horse. Mucosal transepithelial resistance did not differ in any intestinal segment between obese and lean horses. Obese horses had a significantly higher LPS flux across jejunal mucosa, compared with results for lean horses, but there were no significant differences between obese and lean horses for other intestinal segments.

CONCLUSIONS AND CLINICAL RELEVANCE

Obese horses may have had greater paracellular mucosal permeability of jejunal mucosa to LPS, compared with that for lean horses. This finding was consistent with data for the gastrointestinal mucosa of humans and mice and supported the hypothesis that obese horses may be at higher risk from chronic exposure to increased amounts of LPS, compared with the risk for lean horses.

The association of body composition with the risk of gestational diabetes mellitus in Chinese pregnant women: A case-control study

Studies have found that the measurement of body composition can be used to identify the gestational diabetes mellitus (GDM) risk in pregnant women. However, few studies focused on the relationship between body composition and GDM development in low GDM risk population. Thus, the objective of this study was to examine the association between body composition and the development of GDM in pregnant women with low risk of gestational diabetes.A retrospective case-control study was conducted. We reviewed the medical records of 3965 pregnant women who had body composition measurement from March, 2016 to May, 2018 in our hospital. Their sociodemographic, clinical data, and body composition information were collected from medical record. Multiple logistic regression analyses were used.A total of 2698 subjects were eligible for the study. The mean age of the gravidas was 30.95 ± 4.01 years old. Of all gravidas, 462 had gestational diabetes. Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy body mass index (BMI) (odds ratio = 1.786, 95% confidence interval = 1.112-2.866, P = .02). The age and extracellular water/intracellular water ratio were independently associated with gestational diabetes.Percentage body fat was the strongest risk factor for gestational diabetes after adjusting pre-pregnancy BMI. Assessment of body composition may provide important guidance to identify gestational diabetes in pregnant women with low gestational diabetes risk.

Preoperative predictors of postoperative complications after gastric cancer resection

Risk management is becoming an increasingly important healthcare issue. Gastrectomy with lymphadenectomy is still the mainstay of treatment for localized gastric cancer, but it is sometimes associated with postoperative complications that compromise the patient’s quality of life, tolerability of adjuvant treatment, and prognosis. Parameters based exclusively on preoperative factors can identify patients most at risk of postoperative complications, whereby surgeons can provide the patient with precise informed consent information and optimal perioperative management. Ultimately, these predictive tools can also help minimize medical costs. In this context, many studies have identified factors that predict postoperative complications, including indicators based on body constitution, nutrition, inflammation, organ function and hypercoagulation. This review presents our current understanding and discusses some future perspectives of preoperatively identified factors predictive of complications after resection for gastric cancer.

Physical Condition Factors that Predict a Better Quality of Life in Women with Fibromyalgia

What physical qualities can predict the quality of life (QoL) in women with fibromyalgia (FM)? QoL is a very complex outcome affected by multiple comorbidities in people with fibromyalgia. This study aims to determine which physical qualities can predict the quality of life in women with FM. Also, a comparison between the physical qualities of women with FM and healthy counterparts was conducted. In total, 223 women participated in this cross-sectional study, 123 with FM, with ages ranging between 45 and 70 years. The study was conducted at several fibromyalgia associations and specialized medical units. QoL was measured as the main outcome. In addition, functional capacity, muscular strength, maintenance of thoracic posture, postural control, flexibility, pain threshold, and anxiety were measured. Prediction of the QoL was conducted with multiple linear regression analysis and comparison between groups, using the Mann–Whitney U test. There were significant differences between groups in all the variables measured (p < 0.01). The multiple linear regression model showed that factors influencing QoL in women with FM for all the variables measured were functional capacity, handgrip strength and bicep strength, maintenance of thoracic posture, pain threshold, and anxiety (R² = 0.53, p < 0.05). To conclude, women with FM show a significantly lower QoL than their healthy counterparts, and the factors that predict their perceived QoL are functional capacity, muscular strength, postural maintenance, pain threshold, and anxiety.

Greenhouse gases, nutrients and the carbonate system in the Reloncaví Fjord (Northern Chilean Patagonia): Implications on aquaculture of the mussel, Mytilus chilensis, during an episodic volcanic eruption

This study investigates the immediate and mid-term effects of the biogeochemical variables input into the Reloncaví fjord (41°40'S; 72°23'O) as a result of the eruption of Calbuco volcano. Reloncaví is an estuarine system supporting one of the largest mussels farming production within Northern Chilean-Patagonia. Field-surveys were conducted immediately after the volcanic eruption (23-30 April 2015), one month (May 2015), and five months posterior to the event (September 2015). Water samples were collected from three stations along the fjord to determine greenhouse gases [GHG: methane (CH₄), nitrous oxide (N₂O)], nutrients [NO₃^-, NO₂^-, PO₄^3-, Si(OH)₄, sulphate (SO₄^2-)], and carbonate systems parameters [total pH (pHT), temperature, salinity, dissolved oxygen (O₂), and total alkalinity (AT)]. Additionally, the impact of physicochemical changes in the water column on juveniles of the produced Chilean blue mussel, Mytilus chilensis, was also studied. Following the eruption, a large phytoplankton bloom led to an increase in pH_T, due to the uptake of dissolved-inorganic carbon in photic waters, potentially associated with the runoff of continental soil covered in volcanic ash. Indeed, high surface SO₄^2- and GHG were observed to be associated with river discharges. No direct evidence of the eruption was observed within the carbonate system. Notwithstanding, a vertical pattern was observed, with an undersaturation of aragonite (Ω_Ar < 1) both in brackish surface (<3 m) and deep waters (>10 m), and saturated values in subsurface waters (3 to 7 m). Simultaneously, juvenile mussel shells showed maximized length and weight at 4 m depth. Results suggest a localized impact of the volcanic eruption on surface GHG, nutrients and short-term effects on the carbonate system. Optimal conditions for mussel calcification were identified within a subsurface refuge in the fjord. These specific attributes can be integrated into adaptation strategies by the mussel aquaculture industry to confront ocean acidification and changing runoff conditions.

Pattern identification of lung cancer patients based on body constitution questionnaires (BCQ) and glycoproteomics for precision medicine

BACKGROUND

The patient's pattern identification has been used for personalized medicine in traditional Korean medicine (TKM) and aims for patient-specific therapy by Korean medical doctors. The pattern identification in this trial will be diagnosed from body constitution questionnaire (BCQ) with a more objective diagnosis of it but this method still needs a more concrete scientific basis. Glycoproteins are well-known to be associated with diseases (especially cancers) so glycoproteomics can be applied to differentiate pattern identification types of lung cancer patients. Thus, for the first time proteomics approach will be applied to the pattern identification by comparing BCQ assessment in order to establish a scientific basis with clinical proteomics for precision medicine.

METHODS

This observational trial will at first diagnose the pattern identification types of lung cancer patients with BCQ assessment and then elucidate their relationships with proteomics. Blood samples will be collected before surgery along with clinical information of participants. The patients' pattern identification in TKM will be diagnosed from BCQ assessment. Then, lung cancer patients will be divided and pooled into 3 lung cancer entire (LCE) groups according to their pattern identification types (Xu, Stasis, or Gentleness). Three lung cancer representative (LCR) groups will be selected and pooled from each LCE group by selecting those with the same control factors. The 3 LCE groups and the 3 LCR groups from lung cancer patients will be independently analyzed through the glycoproteomics approach based on the patients' pattern identification. Glycoproteins from the 6 groups will be identified through proteomics approach and then categorized for analysis.

DISCUSSION

This study intends to diagnose pattern identification of patients in TKM with BCQ assessment and proteomics approach. The identification of the glycoproteins in each group will lead to the scientific foundation of personalized medicine in TKM according to patients' pattern identification for lung cancer therapy. We intend to(1) diagnose the pattern identification types of lung cancer patients with BCQ under the framework of TKM;(2) evaluate BCQ assessment with glycoproteomics approach for precision medicine.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03384680. Registered 27 December 2017. Retrospectively registered.

The Relationship between Body Fat Percentage and Some Anthropometric and Physical Fitness Characteristics in Pre- and Peripubertal Boys

The main aim of this study was to compare anthropometric and physical fitness indicators of boys of the same chronical age but with different fat percentages. Subjects were Hungarian boys aged 9⁻13 years (N = 6919). Anthropometry was measured according the guidelines of the International Biological Program. Relative body fat was estimated by Drinkwater⁻Ross's method (1980); Conrad's growth type of physique was also estimated (1963). Physical fitness was tested with 30 m dash (s), standing long jump (cm), fistball throw (m), and 1200 m run (s). Subjects of each cohort were grouped into seven subgroups with fat percentage ranges of 4%. Differences between subgroups were tested by one-way ANOVA. In the case of a significant F-test, Tukey's post-hoc tests were used. The level of effective random error was set at 5% in all significance tests (p < 0.05). Except for the three groups with low fat percentages, values of body weight, stature, body mass index, and plastic and metric indexes were significantly higher; results of 30 m, 1200 m running, and standing long jump were worse in all groups with higher fat percentages. An interesting finding of the current study is that body fat percentage also influenced the physical fitness of non-overweight and obese children as well when using merely the 4% ranges in grouping by fatness. The lower the fat the better the physical fitness was in this sample of pre- and peripubertal boys.

Reliability Measures in Distorting Body-Image

This study is the first to make a direct comparison between the distorting mirror and the distorting videocamera with the same group of nonclinical subjects. It also establishes the internal consistency, the test-retest reliability and the convergent validity of both techniques. Analysis indicates, as with other studies, that perceived image is consistently over-estimated and ideal image is consistently underestimated by both techniques. With the distorting mirror, the frontal orientation is repeatable over four days and with the video the profile is the more reliable orientation. A comparison between profile and frontal orientations on any single test occasion (internal consistency) indicates that the results correlate well so either orientation is acceptable for experimental purposes. The extent to which both techniques were measuring the same aspect (convergent validity) was more marked for the ideal image. A researcher using the distorting mirror can be confident that the ideal image is reliable over time using either orientation but that the perceived image requires a frontal orientation. The frontal or profile orientation is acceptable for the ideal image using the distorting video, but the profile orientation is advisable if one wishes a reliable perceived image. The researcher should also be cautious in assuming that both techniques are measuring an identical body-image construct.

Body condition, rather than size, predicts risk-taking and resource holding potential in hatchery reared juvenile lake sturgeon Acipenser fulvescens

To test how body size might influence lake sturgeon Acipenser fulvescens anti-predator behaviour, asymmetrically body-size-matched individuals were exposed to conspecific chemical alarm cues with the presence or absence of food. Additionally, to test resource holding potential (RHP), hatchery-reared juvenile A. fulvescens were asymmetrically (c. 60% mass difference) and symmetrically (c. 3% mass difference) size matched in individual tanks. Results suggest that A. fulvescens of higher body condition, rather than body length or mass, may take greater risks when presented with foraging opportunities and realize a higher RHP. As hatcheries are likely to select individuals of higher body condition, more research is necessary to understand the role body condition may have on behavioural responses and ensuing fitness post-release.

Visual Function and Fundus Morphology in Relation to Growth and Cardiovascular Status in 10-Year-Old Moderate-to-Late Preterm Children

PURPOSE

To study visual function and ocular fundus morphology in relation to growth, metabolic status, and blood pressure in moderate-to-late preterm (MLP) children at 10 years of age.

DESIGN

Prospective cohort study.

METHODS

In this population-based observational study, nonsyndromic MLP children born in Gothenburg, Sweden, were examined neonatally in the years 2002-2003 concerning length, weight, head circumference, and insulin-like growth factor I (IGF-I). At 10 years of age, 33 children (10 girls) were examined regarding previously mentioned variables, and regarding visual acuity, refraction, fundus morphology, IGF binding protein 3, leptin, adiponectin, and blood pressure. An age- and sex-matched control group consisted of 28 children (9 girls).

RESULTS

Myopia was more commonly found in MLP children than in controls (P = .004, 95% CI 1.8 to 49.8). The MLP group had smaller optic disc area (P = .01, 95% CI -0.5 to -0.1), smaller rim area (P = .001, 95% CI -0.5 to -0.2), fewer branching points (P = .0001, 95% CI -5.7 to -2.1), and higher index of tortuosity of arteries (P = .03, 95% CI 0.002 to 0.03) and veins (P = .02, 95% CI 0.003 to 0.02). Refraction correlated with IGF-I (P = .0005, r_s = 0.60 in right eye, and P = .002, r_s = 0.55 in left eye) at 10 years of age. Tortuosity of arteries at assessment correlated with neonatal IGF-I levels (P = .03, r_s = -0.39). Tortuosity of veins correlated with a leptin/adiponectin ratio at assessment (P = .04, r_s = 0.37).

CONCLUSION

The findings suggest that being born MLP is associated with myopia, smaller optic disc and rim areas, and abnormal retinal vascularization. Furthermore, metabolic status and growth factors seem to have an impact on ocular development.

Reference equation for the incremental shuttle walk test in Japanese adults

BACKGROUND

The incremental shuttle walk test (ISWT) is widely used in clinical and research settings. However, there are no reference equations to predict the walk distance achieved in the ISWT (ISWD) for healthy Japanese adults. We aimed to establish a reference equation for the ISWD prediction in Japanese adults.

METHODS

The sample comprised 590 healthy Japanese subjects (237 male). All subjects performed the ISWT twice, and their anthropometric and demographic data were collected, including gender, age, height, weight, and body mass index (BMI).

RESULTS

Subjects walked 640 [490-793] m in the ISWT. The ISWD correlated (p < 0.001 for all) with age (r = - 0.51), gender (r = 0.56), weight (r = 0.39), and height (r = 0.62), but not with BMI (r = - 0.01, p = 0.74). The stepwise multiple regression model showed that age, gender, and height were independent contributors to the ISWT in healthy subjects, explaining 50% of the variability. The reference equation for the ISWD was: ISWD(m) = - 4.894 - 4.107 × Age (years) + 131.115 × Gender + 4.895 × Height (cm), where male gender = 1.

CONCLUSION

We have established a reference equation for the ISWD prediction in Japanese adults. The prediction accuracy was high (R² = 50%), and a reference equation was established using anthropometric and demographic variables that can be easily assessed in clinical settings. The reference equation developed in this study will be useful for evaluating the magnitude of exercise intolerance in Japanese adults.

Association between blood marker analyses regarding physical fitness levels in Spanish older adults: A cross-sectional study from the PHYSMED project

Biomarkers have been postulated as essential variables to measure the effects of exercise on the human body. To investigate the relationship between physical fitness (PF) and blood biomarkers that are associated with disease risk in Spanish older adults, four hundred and twenty-nine adults (57% females) aged older than 55 years from a cross-sectional study were included. A battery of PF test was performed, and participants were divided into 3 groups: low, medium and high fitness. Blood samples were collected, and subjects were also grouped based on a particular biomarker being within its reference range. Furthermore, drug intake and dietary intake were considered for each participant. Higher concentrations out of the reference range were observed for vitamin 25(OH)D (67.9%) and total cholesterol (TC) (58.6%). Participants from the low PF group presented lower significant concentrations out of the reference range for vitamin B₁₂ and triglycerides; however, participants in the low PF group showed higher significant concentrations out of the reference range for total homocysteine, creatinine, TC, HDL-cholesterol and LDL-cholesterol (LDL-c) than those in the high PF group (all p<0.05). Considering drugs related to blood lipid modifications, subjects who regularly consumed lipid reducers presented higher significant concentrations out of the reference range for TC and LDL-c than participants who did not take these drugs (p<0.01). Participants from the high PF group presented better blood marker profiles, namely, lower blood markers related to disease risk out of the reference range. These blood markers could be used as a routine method for considering PF groups in older adults.

Affective response during physical activity: Within-subject differences across phases of behavior change

OBJECTIVE

Affective response during physical activity may be a key factor reinforcing future behavior. However, little is known about how affective responses during physical activity may differ across phases of behavior change. This study used real-time Ecological Momentary Assessment (EMA) to examine within-subject differences in affective response during physical activity in daily life as individuals transitioned across phases of behavior change.

METHOD

A sample of 115 adults (M = 41.0 years, 74% female) participated in an intensive longitudinal study with measurement bursts at 0, 6, and 12-months. Each burst consisted of 8 randomly-prompted EMA occasions per day across 4 days. EMA self-report items assessed current activity level (i.e., physical activity or nonphysical activity), and positive and negative affect. Questionnaires measured phase of behavior change (e.g., preaction [no regular physical activity], action [regular physical activity <6 months], and maintenance [regular physical activity ≥6 months]) at each burst. Three-level (Level-1 = occasion, Level-2 = burst, Level-3 = person) linear regression models tested Phase of Change (Level-2, within-subject) × Physical Activity Level (Level-1, within-subject) interactions controlling for day of week, time of day, and sex.

RESULTS

Positive affective response during physical activity (vs. nonphysical activity) was higher when individuals were in preaction phases (vs. action). Negative affective response during physical activity (vs. nonphysical activity) was lower when individuals were in the maintenance phase (vs. action).

CONCLUSIONS

Long-term maintenance of physical activity may be particularly challenging, given the lack of positive reinforcement that is thought to be needed to sustain behavior. (PsycINFO Database Record

CNN-Based Multimodal Human Recognition in Surveillance Environments

In the current field of human recognition, most of the research being performed currently is focused on re-identification of different body images taken by several cameras in an outdoor environment. On the other hand, there is almost no research being performed on indoor human recognition. Previous research on indoor recognition has mainly focused on face recognition because the camera is usually closer to a person in an indoor environment than an outdoor environment. However, due to the nature of indoor surveillance cameras, which are installed near the ceiling and capture images from above in a downward direction, people do not look directly at the cameras in most cases. Thus, it is often difficult to capture front face images, and when this is the case, facial recognition accuracy is greatly reduced. To overcome this problem, we can consider using the face and body for human recognition. However, when images are captured by indoor cameras rather than outdoor cameras, in many cases only part of the target body is included in the camera viewing angle and only part of the body is captured, which reduces the accuracy of human recognition. To address all of these problems, this paper proposes a multimodal human recognition method that uses both the face and body and is based on a deep convolutional neural network (CNN). Specifically, to solve the problem of not capturing part of the body, the results of recognizing the face and body through separate CNNs of VGG Face-16 and ResNet-50 are combined based on the score-level fusion by Weighted Sum rule to improve recognition performance. The results of experiments conducted using the custom-made Dongguk face and body database (DFB-DB1) and the open ChokePoint database demonstrate that the method proposed in this study achieves high recognition accuracy (the equal error rates of 1.52% and 0.58%, respectively) in comparison to face or body single modality-based recognition and other methods used in previous studies.

Repeatability, reproducibility and consistency of horse shape data and its association with linearly described conformation traits in Franches-Montagnes stallions

Linear description (LD) of conformation traits was introduced in horse breeding to minimise subjectivity in scoring. However, recent studies have shown that LD traits show essentially the same problems as traditionally scored traits, such as data converging around the mean value with very small standard deviations. To improve the assessment of conformation traits of horses, we investigated the application of the recently described horse shape space model based upon 403 digitised photographs of 243 Franches-Montagnes (FM) stallions and extracted joint angles based on specific landmark triplets. Repeatability, reproducibility and consistency of the resulting shape data and joint angles were assessed with Procrustes ANOVA (Rep) and intra-class correlation coefficients (ICC). Furthermore, we developed a subjective score to classify the posture of the horses on each photograph. We derived relative warp scores (PCs) based upon the digitised photos conducting a principal component analysis (PCA). The PCs of the shapes and joint angles were compared to the posture scores and to the linear description data using linear mixed effect models including significant posture scores as random factors. The digitisation process was highly repeatable and reproducible for the shape (Rep = 0.72–0.99, ICC = 0.99). The consistency of the shape was limited by the age and posture (p < 0.05). The angle measurements were highly repeatable within one digitiser. Between digitisers, we found a higher variability of ICC values (ICC = 0.054–0.92), indicating digitising error in specific landmarks (e.g. shoulder point). The posture scores were highly repeatable (Fleiss’ kappa = 0.713–0.857). We identified significant associations (p_(X²₎ < 0.05) with traits describing the withers height, shoulder length and incline, overall leg conformation, walk and trot step length. The horse shape data and angles provide additional information to explore the morphology of horses and therefore can be applied to improve the knowledge of the genetic architecture of LD traits.

Body composition measurements and risk of hematological malignancies: A population-based cohort study during 20 years of follow-up

High body mass index (BMI) is associated with development of hematological malignancies (HMs). However, although BMI is a well-established measurement of excess weight, it does not fully reflect body composition and can sometimes misclassify individuals. This study aimed at investigating what body composition measurements had highest association with development of HM. Body composition measurements on 27,557 individuals recorded by healthcare professionals as part of the Malmö Diet and Cancer study conducted in Sweden between 1991–1996 were matched with data from national registers on cancer incidence and causes of death. Cox regression models adjusted for age and sex were used to test the association between one standard deviation increments in body composition measurements and risk of HM. During a median follow-up of 20 years, 564 persons developed an HM. Several body composition measurements were associated with risk of developing an HM, but the strongest association was found for multiple myeloma (MM). Waist circumference (HR 1.31, p = 0.04) and waist-hip ratio (HR 1.61, p = 0.05) had higher risk estimates than BMI (HR 1.18, p = 0.07) for MM. In conclusion, our study shows that measurements of abdominal adiposity better predict the risk of developing HM, particularly MM, compared to BMI.

The lingering impact of stress: brief acute glucocorticoid exposure has sustained, dose-dependent effects on reproduction

Acutely stressful experiences can have profound and persistent effects on phenotype. Across taxa, individuals differ remarkably in their susceptibility to stress. However, the mechanistic causes of enduring stress effects, and of individual differences in stress susceptibility, are poorly understood. Here, we tested whether brief, acute increases in glucocorticoid hormones have persistent effects on phenotype, and whether effects differ according to the magnitude or duration of elevation. We used a novel method to non-invasively manipulate hormone levels on short time scales: the application of corticosterone gel to a model egg secured in the nest. Free-living female tree swallows (Tachycineta bicolor) exposed to several brief corticosterone increases during incubation showed dose-dependent differences in behaviour throughout the reproductive period. Birds receiving treatments that simulated higher or longer acute stress responses later provisioned larger broods at lower rates; the resulting offspring were smaller in size. Treatment did not influence female body condition, oxidative stress, reproductive success or inter-annual survival, but exposed females maintained higher baseline corticosterone after treatments ceased. Overall, these results indicate that brief, acute elevations in glucocorticoids in adulthood can have long-term consequences. Furthermore, individuals that mount a greater or longer acute stress response may be more likely to experience lingering effects of stress.

The effect of obesity and components of metabolic syndrome on leptin levels in Saudi women

BACKGROUND

Leptin levels are reported to be increased with excessive body fat and is a potential determinant of obesity and its complications. Our Objective is to evaluate the relationship between leptin levels and BMI, waist circumference and metabolic syndrome components in normal and obese females classified according to their BMI.

SUBJECTS AND METHODS

A total of 136 female subjects aged between 20 and 60 years were recruited for the current study. Anthropometric measures included body mass index and waist circumference. The blood samples were used for estimation of plasma fasting blood glucose and serum was used for estimation of triglycerides, total cholesterol, low and high density lipoproteins, and total leptin.

RESULTS

Correlation between glucose and lipids profile with waist circumference among the whole study group (obese and non-obese) is reflecting that a strong positive correlation between BMI and blood glucose, serum TGs, cholesterol and LDL, a negative correlation was reported between BMI and serum HDL. Mean of leptin concentrations in two groups were found to be 5.77 ng/ml (±1.00) in non-obese and 28.89 ng/ml (±4.91) in the obese with metabolic syndrome. Leptin had a positive correlations with triglycerides (r = 0.84, p < 0.001), total cholesterol (r = 0.77, p < 0.001), LDL (r = 0.83, p < 0.001), waist circumference (r = 0.86, p < 0.001) and BMI (r = 0.72, p < 0.001) in the test group. a negative correlation was reported between BMI and serum HDL (r = -0.48, p < 0.001).

CONCLUSION

Leptin levels were high in Saudi women with high BMI and waist circumference. There was a significant correlation between leptin levels and Obesity.