Identification and prediction of frailty among community-dwelling older Japanese adults based on Bayesian network analysis: a cross-sectional and longitudinal study.

BACKGROUND: Frailty is a multifactorial syndrome; through this study, we aimed to investigate the physiological, psychological, and social factors associated with frailty and frailty worsening in community-dwelling older adults. METHODS: We conducted a cross-sectional and longitudinal study using data from the "Community Empowerment and Well-Being and Healthy Long-term Care: Evidence from a Cohort Study (CEC)," which focuses on community dwellers aged 65 and above in Japan. The sample of the cross-sectional study was drawn from a CEC study conducted in 2014 with a total of 673 participants. After excluding those who were frail during the baseline assessment (2014) and at the 3-year follow-up (2017), the study included 373 participants. Frailty assessment was extracted from the Kihon Checklist, while social relationships were assessed using the Social Interaction Index (ISI). Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression and their predictive abilities were tested. Factors associated with frailty status and worsening were identified through the Maximum-min Hillclimb algorithm applied to Bayesian networks (BNs). RESULTS: At baseline, 14.1% (95 out of 673) participants were frail, and 24.1% (90 out of 373) participants experienced frailty worsening at the 3-years follow up. LASSO regression identified key variables for frailty. For frailty identification (cross-sectional), the LASSO model's AUC was 0.943 (95%CI 0.913-0.974), indicating good discrimination, with Hosmer-Lemeshow (H-L) test p = 0.395. For frailty worsening (longitudinal), the LASSO model's AUC was 0.722 (95%CI 0.656-0.788), indicating moderate discrimination, with H-L test p = 0.26. The BNs found that age, multimorbidity, function status, and social relationships were parent nodes directly related to frailty. It revealed an 85% probability of frailty in individuals aged 75 or older with physical dysfunction, polypharmacy, and low ISI scores; however, if their social relationships and polypharmacy status improve, the probability reduces to 50.0%. In the longitudinal-level frailty worsening model, a 75% probability of frailty worsening in individuals aged 75 or older with declined physical function and ISI scores was noted; however, if physical function and ISI improve, the probability decreases to 25.0%. CONCLUSION: Frailty and its progression are prevalent among community-dwelling older adults and are influenced by various factors, including age, physical function, and social relationships. BNs facilitate the identification of interrelationships among these variables, quantify the influence of key factors. However, further research is required to validate the proposed model.

Resveratrol inhibits neural apoptosis and regulates RAX/P-PKR expression in retina of diabetic rats.

PURPOSE: This study was to investigate the effect of resveratrol (RSV) administration on diabetes-induced neural apoptosis and on RNA-dependent-protein-kinase (PKR)-associated protein X (RAX), PKR and phosphorylated PKR (P-PKR) expression and distribution in retina of diabetic rats. METHODS: Retina was obtained from normal and diabetic Sprague-Dawley rats with or without RSV (5 and 10 mg/kg/d) treatment at 30-, 32-, 34- and 36-weeks. Apoptosis of retinal neural cells and distribution of RAX/P-PKR was assessed by TUNEL and immunofluorescence methods. Expression of RAX, PKR and P-PKR was evaluated by qRT-PCR and western-blotting methods. RESULTS: Our study showed that the TUNEL-positive cells were mainly localized in ganglion cells layer (GCL), inner nuclear layer (INL) and outer nuclear layer (ONL) of the diabetic rat's retina at 30-, 32-, 34- and 36-weeks. RSV administration effectively suppressed the neural apoptosis in GCL, INL and ONL. Almost no TUNEL-positive cells were observed in retina of normal control and RSV-treated normal control rats. Our study also showed that the expression level of RAX, P-PKR in diabetic rats retina at 30-, 32-, 34-, and 36-weeks was elevated. With supplementation of 5 and 10 mg/kg/d RSV, the expression level of RAX and P-PKR was decreased (P < 0.05). The expression level of RAX and P-PKR in the retina of normal control rats was not altered by RSV. The expression level of PKR was not altered by streptozotocin injection and RSV treatment. CONCLUSIONS: Our results suggested that RSV attenuates retinal neural apoptosis in diabetic rats retina may be via regulation RAX/P-PKR expression.

Association of gestational weight gain with cesarean section: a prospective birth cohort study in Southwest China.

BACKGROUND: Cesarean section (CS) is a rising public health issue globally, and is particularly serious in China. Numerous studies have suggested that gestational weight gain (GWG) control may be an effective way to reduce the rate of CS. However, rare study has examined the association between GWG and CS among women in Southwest China. We proposed to examine their association based on a prospective birth cohort, and further to explore the optimal GWG range. METHODS: We retrieved data from a prospective birth cohort from Sichuan Provincial Hospital for Women and Children, Southwest China. Unconditional multivariable logistic regression was used to examine the association between GWG and CS by adjusting for potential confounders. In one analysis, we incorporated the GWG as a categorical variable according to the Institute of Medicine (IOM) recommendation, similar to the method used in the majority of previous studies. In the other analysis, we directly incorporated GWG as a continuous variable and natural cubic splines were used to characterize the potential nonlinear exposure-response relationship, aiming to identify the optimal GWG. We further stratified the above analysis by pre-pregnancy BMI and GDM, and then a heterogeneity test based on a multivariate meta-analysis was conducted to examine whether the stratum specific estimations agreed with each other. RESULTS: A total of 1363 participants were included. By adopting the IOM recommendation, the adjusted OR of CS was 0.63 (0.47, 0.84) for insufficient GWG and 1.42 (1.06, 1.88) for excessive GWG. After stratification by pre-pregnancy BMI, we found a higher risk of CS in associated with excessive GWG in the stratum of underweight compared with the other strata, which implied that pre-pregnancy BMI may be an effect modifier. By applying a flexible spline regression, the optimal GWG levels in terms of reducing the CS rate based on our data were more stringent than those of IOM recommendation, which were 9-12 kg for underweight women, < 19 kg for normal weight women and < 10 kg for overweight/obese women. CONCLUSIONS: These results suggested that a more stringent recommendation should be applied in Southwest China, and that more attention should be given to underweight women.

Comparative Survey on Nutrition Risk and Nutrition Support Among Hospitalized General Surgery Patients Over a 7-Year Period.

BACKGROUND: In China, the trend of the prevalence of nutrition risk and malnutrition among the patients in hospitals has changed dramatically in the past few years. The aim of this study was to compare the prevalence of nutrition risk, undernutrition, and the application of nutrition support among hospitalized general surgery patients over a 7-year period from 2010 to 2017. METHODS: A total of 810 consecutive inpatients who met the inclusion criteria upon admission and provided informed consent were recruited from March to December 2017. Nutrition risk was screened using the Nutritional Risk Screening 2002 tool. All the data collected in 2017 were compared with the data collected in 2010. RESULTS: The prevalence of undernutrition among the surgical patients in 2017 (12.8%) was lower than that in 2011 (15.5%) (P < .05), whereas the prevalence of nutrition risk in 2017 (42.6%) was higher than that in 2011 (30.4%) (P < .01). The application of nutrition support, including parenteral nutrition and enteral nutrition, among the patients in 2017 was higher than that in 2010 (P < .05). In 2017, 70.7% of the patients who were at nutrition risk received nutrition support, whereas only 48.9% of patients at nutrition risk did in 2010 (P < .05). Moreover, 26.9% of patients without nutrition risk received nutrition support in 2017 compared with 18.0% of patients in 2010. CONCLUSIONS: The nutrition statuses among surgical inpatients changed from 2010 to 2017. The prevalence of undernutrition was reduced, whereas the prevalence of nutrition risk increased. The application of nutrition support increased significantly, whereas inappropriate application of nutrition support still existed in our hospital. More attention should be paid to the nutrition-related issues of general surgery inpatients in the future.

Resveratrol Inhibits Diabetic-Induced Müller Cells Apoptosis through MicroRNA-29b/Specificity Protein 1 Pathway.

The aim of this study was to evaluate the anti-apoptosis effects of resveratrol (RSV) on diabetic rats retinal Müller cells in vivo and in vitro and to further investigate the roles of microRNA-29b (miR-29b)/specificity protein 1 (SP1) in the anti-apoptosis mechanism of RSV. Retina was obtained from normal and diabetic rats with or without RSV (5 and 10 mg/kg/day) treatments at 1-7 months. TdT-mediated dUTP-biotin nick end labeling (TUNEL) and Annexin V/PI staining were used to detect apoptosis. Immunofluorescence was used to assess distribution of SP1 in retina. MiR-29b and SP1 messenger RNA (mRNA) expression was evaluated by quantitative real-time polymerase chain reaction (qRT-PCR). SP1, Bax, and bcl-2 protein expression was evaluated by western blotting. Caspase-3 activity was detected by assay kit. Our study showed that the TUNEL-positive cells were mainly localized in the inner nuclear layer (INL) of retina and RSV administration effectively suppressed streptozotocin (STZ)-induced apoptosis of retinal cells in INL in vivo (P < 0.001). Our study also showed that RSV administration effectively suppressed high glucose (HG)-induced retinal Müller cells' apoptosis in vitro (P < 0.001). Furthermore, our study revealed that the diabetes-induced downregulated expression of miR-29b and upregulated expression of SP1 could be rescued by RSV in vivo and in vitro (P < 0.05). The anti-apoptosis effect and downregulated SP1 expression effect of RSV was prevented by miR-29b inhibitor (P < 0.05). MiR-29b mimic increased the above-mentioned effects of RSV (P < 0.001). These findings indicate that RSV is a potential therapeutic option for diabetic retinopathy (DR) and that miR-29b/SP1 pathway play roles in the anti-apoptosis mechanism of RSV.

[Association between complementary feeding frequency and growth of infants and young children aged 6 -24 months old in urban and rural areas of southwest China].

OBJECTIVE: To study the association between complementary feeding frequency (CFF) and growth of infants and young children. METHODS: 3644 infants and young children aged 6 - 24 months from Chengdu, Kunming and Guiyang were selected by stratified random cluster sampling. Data on breastfeeding and formula feeding and complementary feeding for children were collected through the questionnaires. Complementary feeding frequency was assessed using a comprehensive evaluation system. Body weight and length for them were measured. Length for age Z-score (LAZ), weight for age Z-score (WAZ) and weight for length Z-score (WLZ) were calculated. The Spearman rank correlation analysis was used to identify the association between complementary feeding frequency and growth of children. The trend Chi-Square test was used to identify the relationship between complementary feeding frequency and the rate of stunted growth. RESULTS: This study indicated that CFF level was significantly positive associated with WLZ and WAZ in the group of breastfeeding and formula feeding less than three times per day in urban and rural groups, correlation coefficients were 0.10 and 0.11 in urban group and 0.20 and 0.14 in rural group respectively (P < 0.05). Prevalence of wasting reduced with CFF level increasing in rural group. The Z-score did not show significant correlation with CFF level in the group of breastfeeding and formula feeding more than or equal to three times per day in urban and rural groups. CONCLUSION: Complementary feeding frequency is related to growth of infants and young children, especially in rural area of southwest China. The rate of wasting could be controlled by improving complementary feeding frequency of infants and young children.

Maternal reported indicators and causes of insufficient milk supply.

BACKGROUND: Although the breastfeeding initiation rate is high in China, exclusivity is low. Not having enough breast milk has been frequently reported as a reason for supplementing and weaning. OBJECTIVE: The objective was to explore maternal perception of indicators and causes of self-reported insufficient milk supply (IMS) among a sample of southwestern Chinese mothers. METHODS: This was a cross-sectional study, conducted in a hospital in Chengdu, China. RESULTS: The majority of mothers were of Han ethnicity and primiparous. Most initiated breastfeeding (n = 325, 95.3%). Among mothers who had weaned by the time of questionnaire completion, more than half (n = 52) reported IMS as a reason, and 53.8% of these mothers reported this occurring during the first 2 days postpartum. Mothers often identified IMS by using less sensitive indicators of adequate intake such as receiving a hungry look from the infant after nursing (34.6%) and not feeling the presence of milk (28.8%). More sensitive indicators of adequate intake, such as the number of wet/soiled diapers, were not reported. More than a third of mothers (39.2%) could not express a reason for the occurrence of IMS. Among those who identified reasons, nearly one-fourth of mothers attributed IMS, at least partially, to dietary factors such as poor appetite (23.5%). CONCLUSION: Self-reported IMS appears to be a common barrier to breastfeeding continuation among this sample of Chinese mothers. Culturally appropriate intervention, designed to inform mothers how to correctly identify and address IMS, might be an effective strategy to support optimal infant-feeding behaviors in China.

Breastfeeding Knowledge, Attitudes, and Intention in a Sample of Undergraduate Students in Mainland China.

BACKGROUND: Despite the high breastfeeding initiation rate in China (> 90%), the low exclusivity rate is of concern. Some traditional behaviors, combined with increasing popularity of infant formula, may negatively affect future breastfeeding rates. As suggested by the theory of planned behavior, understanding breastfeeding beliefs of young adults may help identify and address misperceptions of future parents, supporting maintenance of the current initiation rate while increasing rates of exclusivity and duration. No research has evaluated these factors among young adults in Mainland China. OBJECTIVE: The objective was to explore any relationships between breastfeeding knowledge, attitudes, previous experiences, and future intention among undergraduate students in Mainland China. METHODS: This was a cross-sectional, quantitative study conducted from May to June 2012. A convenience sample of 395 students from a major public university in southwest China participated in the survey. RESULTS: Breastfeeding knowledge was moderate (76.7% of total score), and breastfeeding was considered to be painful (34.2%), to make breasts sag (43.1%), and to restrict the freedom of mothers (52.5%). In addition, 58.2% of students reported that they would feel embarrassed if they or their partners were to breastfeed in public, and acceptability of breastfeeding in public was low (34.7%). Three-fourths of the students (75.1%) expressed future breastfeeding intent, though males were more likely to report this intention (ie, to support a partner in breastfeeding) than were females (81.3% vs 71.7%, P = .04). CONCLUSION: To create a more breastfeeding-friendly culture, future research is warranted to explore these negative beliefs about breastfeeding and to counter misunderstandings among future parents in Mainland China.

[Duration of breastfeeding and its relevant influencing factors in urban and rural areas of Chengdu].

OBJECTIVE: To investigate the status and relevant factors influencing the duration of breastfeeding in urban and rural areas of Chengdu, China. METHODS: 1178 infants and young children aged 6-24 months were selected by stratified cluster random sampling. Breastfeeding information for subjects was obtained by interviewing mothers with a questionnaire. Kaplan-Meier method and Cox proportional hazard model were used to identify the factors associated with the termination of breastfeeding. RESULTS: The median of the duration for breastfeeding was 6.0 months in the urban group and 8.0 months in the rural group (P < 0.05). This study showed that the cost of food consumed by baby was negatively correlated with breastfeeding duration, but the maternity leave was positively correlated with breastfeeding duration. CONCLUSION: Breastfeeding duration for children in Chengdu was insufficient. Intervention program should be implemented to improve breastfeeding status.

[Comprehensive evaluation of complementary feeding behavior for infants in urban and rural areas of Chengdu in 2011].

OBJECTIVE: To study the status and problems of complementary feeding behavior for infants aging between 6 - 24 month-old in urban and rural areas of Chengdu in 2011. METHODS: A total of 1283 infants aging between 6 - 24 month-old, including 601 from urban area and 682 from rural area, were randomly selected by stratified cluster random sampling method, and divided into three groups as 6 - 8, 9 - 11 and 12 - 24 month-old groups, between March and April in 2011. Information of complementary feeding behavior were collected by questionnaire, and then assessed, quantified and compared by standards. The evaluation system was established (the total score was 24), and was used to assess among children aging 6 to 24 month-old in urban and rural areas in Chengdu. RESULTS: The average score for infants in Chengdu was 18.6 ± 2.5, accounting for 77.6% of the total score. The scores of food selection and preparation were highest (90.7% of total score) among the behavior, and the scores of caregiver's behavior, infants behavior, feeding environment and environmental hygiene were low (about 75.2% - 77.6% of total score). The average score in urban and rural groups were separately 19.8 ± 2.1 and 17.6 ± 2.4, the score in urban group was higher than that in rural group (P < 0.05), occupying total score 82.3%, 73.4%, respectively. The average score in 6 - 8 month, 9 - 11 month and 12 - 24 month groups were separately 18.9 ± 2.3, 19.1 ± 2.4, and 18.2 ± 2.6, occupying total score 78.9%, 79.4% and 75.7%, respectively. The score in 6 - 8 and 9 - 11 month groups were higher than that in 12 - 24 month group (P < 0.01). The pass rate (above 60% of total score) was 94.2% and excellent rate (above 80% of total score) was 44.8% in Chengdu. The excellent rate in urban and rural groups were separately 65.7% and 26.4% (χ(2) = 199.825, P < 0.01). CONCLUSION: The complementary feeding behavior for infants was not optimistic in Chengdu, and the behavior was even worse in rural areas and among elder infants groups.

The effect of n-3 polyunsaturated fatty acids on plasma lipids and lipoproteins in patients with chronic renal failure--a meta-analysis of randomized controlled trials.

OBJECTIVE: To systemically review and analyze the effect of n-3 polyunsaturated fatty acid (PUFA) consumption on plasma lipids and lipoproteins in patients with end-stage renal disease. DESIGN: Systemic review, with meta-analysis of randomized controlled clinical trials. METHODS: We performed a systemic review and meta-analysis of the lipid-modulating effects of n-3 PUFAs by combining evidences from 10 randomized controlled trials including 557 patients with end-stage renal disease. RESULTS: Pooled analysis revealed that n-3 PUFA intake significantly reduced serum triglyceride levels by -0.78 mmol/L (95% confidence interval: -1.12 to -0.44 mmol/L, P < .0001). Consumption of n-3 PUFAs also reduced the plasma low-density lipoprotein cholesterol levels by -0.09 mmol/L and elevated plasma high-density lipoprotein cholesterol levels by -0.25 mmol/L, but these changes were not statistically significant. Plasma levels of total cholesterols were elevated in both n-3 PUFA and control groups, with a lesser increase in the n-3 PUFA group, without statistical significance. Metaregression showed no correlation between the amounts or duration of n-3 PUFA intake and their lipid-modulating effects. CONCLUSIONS: In our meta-analysis, n-3 PUFA consumption significantly lowered the serum triglyceride levels. No significant changes were found on the degrees of low-density lipoprotein cholesterol reduction and total cholesterol or high-density lipoprotein cholesterol elevation effects.