The association of dietary inflammatory potential with sarcopenia in Chinese community-dwelling older adults.

BACKGROUND: Dietary-induced inflammation is potentially associated with sarcopenia. Nevertheless, few studies have investigated the structure of the inflammatory diet and its correlation with muscle function and performance in both the upper and lower limbs. This study was performed to explore the association of the dietary inflammatory index (DII) with sarcopenia and its diagnostic parameters. METHODS: We conducted a cross-sectional survey on a sample of 515 Chinese community-dwelling older adults selected through multistage cluster sampling from three districts in Shanghai. DII scores were calculated using a validated food frequency questionnaire. Sarcopenia and its diagnostic parameters were determined based on the definition set by the Asian Working Group on Sarcopenia (AWGS). RESULTS: The mean age of study participants was 71.31 ± 4.71 years. The prevalence of sarcopenia in the cohort was 12.4%. Older adults in the highest DII quartile had a 3.339 times increased risk of sarcopenia compared to those in the lowest quartile (OR Quartile4vs1:3.339, 95%CI: 1.232, 9.052, p-trend: 0.004) after adjusting for confounding factors. Additionally, a more pro-inflammatory diet was associated with lower appendicular skeletal muscle index (ASMI) (OR Quartile4vs1: 3.005, 95%CI: 1.275, 7.318, p-trend: 0.005), a higher 5-times sit-stand test time score (OR Quartile4vs1: 4.942, 95%CI: 1.745, 13.993, p-trend: 0.005), and lower gait speed (OR Quartile4vs1: 2.392, 95%CI: 1.104, 5.185, p-trend: 0.041) after adjusting for confounding factors. However, there was no significant association between DII, handgrip strength, and Short Physical Performance Battery (SPPB) score in either the unadjusted or adjusted model. CONCLUSION: This study found that the association between consuming a more pro-inflammatory diet and sarcopenia in Chinese community-dwelling older adults was mainly due to underlying low intakes of dietary energy, protein, and anti-inflammatory foods, and not due to the high intake of pro-inflammatory foods. Meanwhile, DII was more highly correlated with lower limb muscle strength and performance compared to upper limb muscle strength.

Meta-analysis of the association between dietary inflammatory index and cognitive health.

Background: Some studies have shown that a pro-inflammatory diet may be associated with cognitive function, but their conclusions have varied considerably. We here present a meta-analysis of the current published literature on DII score and its association with cognitive health. Methods: In this meta-analysis, the PubMed, Embase, Web of Science, and Cochrane databases were searched in September 2022. The reported indexes, specifically OR, RR, and ß, were extracted and analyzed using R version 3.1.0. Results: A total of 636 studies in databases were identified, and 12 were included in the meta-analysis. Higher DII was associated with an increased risk of AD and MCI (OR = 1.34; 95% CI = 1.21-1.49). Meanwhile, it may also cause global function impairment (categorical: OR = 1.63; 95% CI = 1.36-1.96) and verbal fluency impairment (continuous: OR = 0.18; 95% IC = 0.08-0.42). But there was no significant association between DII and executive function (categorical: OR = 1.12; 95% IC = 0.84-1.49; continuous: OR = 0.48; 95% IC = 0.19-1.21) or episodic memory (continuous: OR = 0.56; 95% IC = 0.30-1.03). Conclusion: A pro-inflammatory diet is related to AD, MCI, and the functions of some cognitive domains (specifically global function and verbal fluency). However, the current evidence on the role of diet-induced inflammation in different cognitive domains should be supported by further studies in the future.

Determinants Influencing the Adoption of Internet Health Care Technology Among Chinese Health Care Professionals: Extension of the Value-Based Adoption Model With Burnout Theory.

BACKGROUND: The global COVID-19 pandemic has been widely regarded as a catalyst for adopting internet health care technology (IHT) in China. IHT consists of new health care technologies that are shaping health services and medical consultations. Health care professionals play a substantial role in the adoption of any IHT, but the consequences of doing so can often be challenging, particularly when employee burnout is prevalent. Few studies have explored whether employee burnout influences the adoption intention of IHT in health care professionals. OBJECTIVE: This study aims to explain the determinants influencing the adoption of IHT from the perspective of health care professionals. To do so, the study extends the value-based adoption model (VAM) with consideration for employee burnout as a determining factor. METHODS: A cross-sectional web-based survey using a sample of 12,031 health care professionals selected through multistage cluster sampling from 3 provinces in mainland China was conducted. The hypotheses of our research model were developed based on the VAM and employee burnout theory. Structural equation modeling was then used to test the research hypotheses. RESULTS: The results indicate that perceived usefulness, perceived enjoyment, and perceived complexity positively correlate with perceived value (ß=.131, P=.01; ß=.638, P<.001; ß=.198, P<.001, respectively). Perceived value had a positive direct effect on adoption intention (ß=.725, P<.001), perceived risk negatively correlated with perceived value (ß=-.083, P<.001), and perceived value negatively correlated with employee burnout (ß=-.308, P<.001). In addition, employee burnout was negatively related to adoption intention (ß=-.170, P<.001) and mediated the relationship between perceived value and adoption intention (ß=.052, P<.001). CONCLUSIONS: Perceived value, perceived enjoyment, and employee burnout were the most important determinants of IHT adoption intention by health care professionals. In addition, while employee burnout was negatively related to adoption intention, perceived value inhibited employee burnout. Therefore, this study finds that it is necessary to develop strategies to improve the perceived value and reduce employee burnout, which will benefit the promotion of the adoption intention of IHT in health care professionals. This study supports the use of the VAM and employee burnout in explaining health care professionals' adoption intention regarding IHT.

Cognitive impairment is associated with sarcopenia mainly related to attention and calculation in hospitalized Chinese elderly men.

BACKGROUND AND OBJECTIVES: Sarcopenia and cognitive impairment are the most prevalent causes of disability in older individuals. The aim of this study was to assess the prevalence of sarcopenia and the association between cognitive impairment and sarcopenia in older patients. METHODS AND STUDY DESIGN: A cross-sectional study was undertaken, comprised 250 male patients aged 65 and over. Sarcopenia was defined using the diagnostic recommended consensus by the Asian Working Group for sarcopenia, and the participants were classified into the sarcopenia and non-sarcopenia groups according to this definition. The cognitive functions of older patients were assessed using the Mini-Mental State Examination (MMSE). After bivariate analyses, a multivariate logistic regression model was constructed to determine the association of study variables with sarcopenia. RESULTS: The prevalence of sarcopenia and cognitive impairment was 20.8% and 19.6% respectively. Additionally, we found 10.8% patients had nutritional risk, 19.6% patients had cognitive impairment in this study. Multivariate analysis identified age (OR: 1.11, 95% Cl 1.03, 1.19, p=0.008), cognitive impairment (OR: 4.06, 95% Cl 1.42, 11.6, p=0.009) and nutritional risk (OR: 13.7, 95% Cl 3.06, 61.2, p=0.001) were significantly associated with sarcopenia. The prevalence of sarcopenia significantly increased stepwise with lower MMSE score. Additionally, the score on the attention and calculation (OR=0.68, 95% Cl: 0.51, 0.91, p=0.009) subsection of the MMSE was associated with the presence of sarcopenia. MMSE score was correlated with the fat free mass, handgrip strength (p<0.05). CONCLUSIONS: Cognitive impairment, especially in the calculation and attention, and nutritional risk, are associated with sarcopenia in hospitalized Chinese male elderly. Adequate nutritional support may be the key to solving these diseases.

Development and validity of computerized neuropsychological assessment devices for screening mild cognitive impairment: Ensemble of models with feature space heterogeneity and retrieval practice effect.

OBJECTIVE: This study aimed to develop and validate computerized neuropsychological assessment devices for screening patients with mild cognitive impairment (MCI). METHODS: We conducted this study in three phases. Phase I involved the development of a conceptual framework of Memory Guard (MG) based on the principles of the cognitive design system (CDS). Phase II involved three steps of feature engineering: item development, filter, and wrapper. Based on the initial items, the number of items in each dimension was determined through analytic hierarchy process. We constructed an initial set with a total of 198 items with three levels of difficulty. Next, we performed feature selection through comprehensive reliability and validity tests, which resulted in the best item bank of 38 test items. The features for modeling were obtained from the best item bank (option scores, reading time scores and total time scores), demographic variables and their MoCA groups. Regarding the heterogeneity of the feature space, we combined the AdaBoost with the Naive Bayes classification algorithm as the decision model of MG. For the screening tool to be used repeatedly, the retrieval practice effect was considered in the design. Phase III involved the validation of measuring instruments. The features incorporated into the modeling process were optimized based on the classification accuracy and area under curve. We also verified the classification effect of the other three classification models with MG. RESULTS: After three steps of feature engineering, a total of 6 dimensions of cognitive areas were included in MG: orientation, memory, attention, calculation, recall, and language & executive function. 38 features were included in the model (17 features of option score, 20 features of time score, and 1 demographic feature). A total of 333 individuals from two communities in Shanghai and Henan province were included in the measuring instrument verification process. Women accounted for 68.2% of the sample. The median age was 63. 15.3% of the participants had bachelor's degrees or above and 111 participants lived in urban areas (33.3%). The results showed that MG had an accuracy of 93.75% and AUC of 0.923, with a sensitivity of 91.67% and a specificity of 95.45%. Compared to the other three classification models, MG that combined the AdaBoost with the Naive Bayes classification algorithm was the most accurate classifier. CONCLUSIONS: MG was proved to be reliable and valid in early screening for patients with MCI. MG that integrated heterogeneous features such as demography, option scores, and time scores had a better predictive performance for screening MCI.

Association between Dietary Inflammatory Index and Sarcopenia in Crohn's Disease Patients.

BACKGROUND: Chronic inflammation is a pathophysiological cause of sarcopenia in Crohn's disease (CD) patients. However, the potential impact of diet-related inflammation on sarcopenia has not yet been adequately investigated. We examined the associations between Dietary Inflammatory Index (DII) and sarcopenia in CD patients. METHODS: A total of 140 CD patients from Ruijin Hospital in Shanghai were included in this cross-sectional study. DII scores were calculated from the dietary data collected using a validated food frequency questionnaire (FFQ). Sarcopenia was determined according to the Asian Working Group for Sarcopenia. Multivariable logistic regression analyses were performed to determine the association between DII and sarcopenia. RESULTS: The mean DII score was 0.81 ± 2.13, ranging from -3.24 to 4.89. The overall prevalence of sarcopenia was 26.4%. The higher DII score significantly increased the risk of sarcopenia in CD patients (ORQuartile4vs1: 9.59, 95% CI: 1.69, 54.42, ptrend = 0.031) in the multivariable model after adjusting for more potential confounders. Moreover, CD patients with a lower DII had a significantly higher appendicular skeletal muscle mass index (ASMI, ORQuartile4vs1: 5.48, 95% CI: 1.51, 19.87, ptrend = 0.018) after adjusting for age, gender, BMI, smoking status and drinking status model. Yet, there were no significant differences between DII and ASMI after adjusting for more potential confounders. Additionally, no significant association was observed between DII and handgrip strength in the multivariable-adjusted models. CONCLUSIONS: Pro-inflammatory diet was associated with increased risk of sarcopenia in CD patients. CD patients should have a proper intake of energy and protein. These patients could also benefit from supplementation with enteral nutrition due to its anti-inflammatory potential.

The Influencing Factors of Nutrition and Diet Health Knowledge Dissemination Using the WeChat Official Account in Health Promotion.

Background: The promotion of a healthy diet via health education is a component of the "Healthy China 2030" plan. However, few studies have reported whether health knowledge about nutrition and diet has gained public attention, and whether it is needed by the public. Methods: The numbers of views, shares, and reads of articles published by the official WeChat account of a hospital in China were accessed. The influence index was obtained via the entropy analysis of these three indices. A questionnaire survey was developed based on the purpose of the study and the conclusion of the content analysis, which conducted to analyze users' requirements for health knowledge and their influencing factors. Moreover, risk factors were explored by logistic regression models. Results: Of the 103 articles considered in this study, four articles in the Top 10 were related to nutrition and diet. The influence index of nutrition and diet knowledge was found to be the highest in the content analysis (p < 0.05). The higher degrees of humor (ß = 0.224, p = 0.027), nutrition and diet articles (ß = 0.776, p = 0.034), and cover articles (ß = 0.312, p = 0.021) have significant influences on the influence index. In total, 581 questionnaires were obtained, and 78.1% of the respondents reported believing that the health knowledge of greatest concern was that related to nutrition and diet. Multivariate logistic regression analyses were conducted to explore the associations between the features of the articles and users reading nutrition and diet knowledge; it was found that gender (female, OR: 4.651, 95%Cl: 2.598, 8.325, and p < 0.001), age (young adult, OR: 0.358, 95%Cl: 0.266, 0.481, and p < 0.001), cancer precaution knowledge (OR: 4.333, 95%Cl: 2.262, 8.299, and p < 0.001), traditional Chinese medicine (OR: 2.121, 95%Cl: 1.064, 4.230, and p = 0.033), the knowledge acquisition approach [circle of friends (OR: 2.586, 95%Cl: 1.373, 4.868, and p = 0.003), social media (OR: 2.183, 95%Cl: 1.204, 3.960, and p = 0.010)), hospitals (OR: 3.194, 95%Cl: 1.793, 5.692, and p < 0.001), television media (OR: 4.348, 95%Cl: 2.341, 8.077, and p < 0.001)], and social media strategies [professionalism and authority (OR: 2.354, 95%Cl: 1.231, 4.505, and p = 0.006)] have statistically significant relationships with users reading nutrition and diet knowledge. Conclusion: Nutrition and diet knowledge could contribute to WeChat user engagement of health information dissemination. Nutrition professionals should improve the scientific popularization ability and effectively use social media for health promotion.

Maternal Neu5Ac Supplementation During Pregnancy Improves Offspring Learning and Memory Ability in Rats.

Sialic acids are postulated to improve cognitive abilities. This study aimed to evaluate the effects of sialic acid on behavior when administered in a free form as N-acetylneuraminic acid (Neu5Ac) to pregnant mothers or rat pups. The experiment involved 40 male 21-day-old rat pups and 20 15-day-pregnant rats that were randomized into four Neu5Ac treated groups: 0 (control), or 10, 20, and 40 mg/kg. Morris water maze test and shuttle box test were performed on the rat pups and maternal Neu5Ac-supplemented offspring on day 100 to evaluate their cognitive performance. The Neu5Ac levels in the cerebral cortex and hippocampus were tested with high-performance liquid chromatography-fluorescence detection (HPLC-FLD). We found that the maternal Neu5Ac-supplemented offspring showed better cognitive performance, less escape latency in the Morris water maze test, and less electric shock time shuttle box test, compared with the untreated control. In the meantime, the Neu5Ac level in the cerebral cortex and hippocampus of the offspring was higher in the Neu5Ac treatment group than that in the untreated control group. However, no significant differences were observed between rat pups in the treated and the untreated control groups in terms of cognitive performance and Neu5Ac content in the cerebral cortex and hippocampus. Maternal Neu5Ac supplementation during pregnancy could effectively promote the brain Neu5Ac content of the offspring and enhance their cognitive performance, but Neu5Ac had no such effect on rat pups while directly supplemented with Neu5Ac.

Body Mass Index and Disease Activity Are Associated With Moderate to Severe Disability in Crohn's Disease: A Cross-Sectional Study in Shanghai.

Background: The inflammatory bowel disease disability index (IBD-DI) was used to access body functional consequences and disease burden. However, Chinese population data are considerably limited. Objective: We aimed to screen for disability in patients with Crohn's disease (CD) and to assess potential associations with clinical parameters as well as indices related to sarcopenia. Methods: This cross-sectional study includes 146 CD patients from Ruijin Hospital in Shanghai, China. All patients were screened for disability and sarcopenia on the basis of the IBD-DI scale, and the criteria for Asian Working Group for Sarcopenia, respectively. Clinical and demographic variables were collected. Results: Approximately 52.05% of the subjects suffered from moderate or severe disabilities. The prevalence of sarcopenia (48.68 vs. 31.43%, P = 0.043), Patient-Generated Subjective Global Assessment score or PG-SGA≥4 (39.47 vs. 17.14%, P = 0.003), and high-level C- reactive protein (27.63 vs. 11.43%, P = 0.021) were higher in patients with moderate to severe disability than in those without to minimal disability. By multivariate regression modeling, the following were identified as independent factors related to moderate to severe disability: disease activity (OR:10.47, 95% CI: 2.09-52.42) and body mass index (BMI) (OR:4.11, 95% CI: 1.80-9.38). Conclusions: Disability is common in CD patients. Our study showed that moderate to severe disability is not directly associated with muscle mass or muscle quantity but is mostly correlated with disease activity as well as BMI. Thus, close monitoring and follow-up should be conducted on patients who are at high risk of disability, and effective measures should be taken, which may be the best way to prevent disability.

Combined Patient-Generated Subjective Global Assessment and body composition facilitates nutritional support in inflammatory bowel disease: an ambulatory study in Shanghai.

BACKGROUND AND OBJECTIVES: Malnutrition is commonly diagnosed in patients with inflammatory bowel disease (IBD). However, only few clinical studies have adequately explored the importance of body composition in the nutritional assessment of Chinese patients with IBD. METHODS AND STUDY DESIGN: A total of 78 IBD patients were enrolled, and Patient-Generated Subjective Global Assessment (PG-SGA) was used to assess malnutrition. Bioelectrical impedance analysis was used to analyze the body composition of IBD patients and their fat free mass indexes (FFMI) were also calculated. FFMI values <17 kg/m2 in men and <15 kg/m2 in women were considered low. Food consumption data were collected using the semi-quantitative food frequency questionnaire. RESULTS: Of the 78 patients, 49 (62.8%) had low-FFMI. Among the patients with PG-SGA <4, 12 (41.4%) had altered body composition with low-FFMI. FFMI negatively correlated with the PG-SGA scores and disease activity. No statistically significant differences in fat free mass (FFM) and skeletal muscle mass were observed between patients in the active phase and patients in remission (p>0.05). However, the fat mass and visceral fat area of patients in remission were higher than those of patients in the active phase (p<0.05). The average energy derived from fat, proteins and carbohydrates was 29.6±8.45%, 10.4±1.97% and 60.3±9.33%, respectively. CONCLUSIONS: Our study shows that 41.4% of IBD patients had altered body composition despite being well-nourished according to the PG-SGA. Patients in the remission phase presented with fat accumulation and their FFM remained low. The dietary pattern was not adequate among the IBD patients, especially regarding protein intake.