Coexistent GLIM-Defined Malnutrition and Sarcopenia Increase the Long-Term Mortality Risk in Hospitalized Patients with Decompensated Cirrhosis.

INTRODUCTION: The synergistic impact of coexistent malnutrition and sarcopenia on morality in hospitalized patients with decompensated cirrhosis remains elusive. This prospective cohort study aimed to delineate the prevalence concerning coexistence of malnutrition and sarcopenia and the prognosticating role on long-term mortality among cirrhosis. METHODS: Adult cirrhotic patients with decompensated episodes between 2019 and 2021 were consecutively enrolled. Malnutrition and sarcopenia were diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm, respectively. The entire cohort was divided into three groups: non-malnutrition and non-sarcopenia (NN), malnutrition or sarcopenia, and coexistent malnutrition and sarcopenia (MS). Log-rank test and multivariate Cox regression model were utilized to evaluate survival status and independent risk factors for mortality, respectively. RESULTS: Our findings indicated that malnutrition manifested in 44.6% of inpatients with decompensated cirrhosis, while sarcopenia presented in 16.4% of the entire cohort, indicative of a prevalence of 14.7% regarding coexistent malnutrition and sarcopenia. The Kaplan-Meier graphic demonstrated a significant difference regarding survival curves among the three groups, referring to the MS group presented with the lowest survival rate (log-rank test: p < 0.001). Moreover, coexistent malnutrition and sarcopenia were associated with nearly 4 times higher mortality risk (model 1: hazard ratio [HR] = 3.31, 95% confidence interval [CI]: 1.20-9.13, p = 0.020; model 2: HR = 4.34, 95% CI: 1.52-12.4, p = 0.006) in comparison with patients without any condition (NN group). CONCLUSIONS: Malnutrition and sarcopenia had superimposed negative impacts on inpatients with decompensated cirrhosis. It is imperative to identify this vulnerable subset to provide prompt therapeutic intervention for better prognosis.

Relationship between seaweeds consumption and hyperuricaemia in general adults: a Population-based study from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) cohort study.

Seaweeds have numerous biologically active ingredients, such as polysaccharides, polyphenols and carotenoids, that are beneficial to human health. Although these benefits might be related to the synthesis, secretion or reabsorption of uric acid, no studies have explored the relationship between seaweeds consumption and hyperuricaemia (HUA) in the general population. The aim of this study was to investigate whether seaweeds consumption is related to HUA in a large-scale adult population. A cross-sectional study was conducted with 32 365 adults (17 328 men and 15 037 women) in Tianjin, People's Republic of China. Frequency of seaweeds consumption was assessed by a validated self-administered FFQ. HUA was defined as serum uric acid levels >420 µmol/L in men and >350 µmol/L in women. The association between seaweeds consumption and HUA was assessed by multiple logistic regression analysis. Restricted cubic spline functions were used for non-linearity tests. The prevalence of HUA in men and women was 21·17 % and 5·93 %, respectively. After adjustments for potential confounding factors, the OR (95 % CI) for HUA across seaweed consumption (g/1000 kcal per d) were 1·00 (reference) for level 1, 0·91 (95 % CI 0·81, 1·02) for level 2; 0·90 (95 % CI 0·81, 1·01) for level 3; 0·86 (95 % CI 0·78, 0·97) for level 4 in men and 0·90 (95 % CI 0·73, 1·10) for level 2; 0·82 (95 % CI 0·67, 1·00) for level 3; 0·84 (95 % CI 0·68, 1·03) for level 4 in women, respectively. A negative correlation between seaweeds consumption and HUA in males but not in females was observed. Further studies are needed to explore the causal relationship.

Association between consumption of ultra-processed foods and hyperuricemia: TCLSIH prospective cohort study.

BACKGROUND AND AIMS: Emerging evidence suggests that consumption of ultra-processed foods (UPF) plays a role in the development of chronic diseases, but evidence of their influence on hyperuricemia is limited. We therefore designed a cohort study to examine whether UPF consumption increase the risk of hyperuricemia in adults. METHODS AND RESULTS: This was a prospective study (n = 18,444) performed in Tianjin, China from 2013 to 2019. Participants that were aged 18 years and over and with no history of hyperuricemia, were followed up for 1-6 years (median follow-up duration = 4.2 years). UPF consumption was assessed by a validated semi-quantitative food frequency questionnaire. Hyperuricemia was defined as serum uric acid levels ≥7.0 mg/dL in males and ≥ 6 mg/dL in females. Multivariable Cox proportional hazards regression models were used to assess the association between UPF consumption and the risk of hyperuricemia. Restricted cubic spline regression was used to estimate the dose-response association between UPF consumption and risk of hyperuricemia. During follow-up period, the incidence of hyperuricemia was 20.3% in general population (27.7% in males and 13.2% in females). In the final multivariate models, the hazard ratios (95% confidence interval) for hyperuricemia across energy adjusted UPF consumption quartiles were 1.00 (reference), 1.04 (0.94, 1.14), 1.11 (1.01, 1.23), 1.16 (1.05, 1.28) (p for trend = 0.02) in general population. CONCLUSIONS: This population-based prospective cohort study suggests that increased consumption of UPF is independently associated the risk of hyperuricemia.

Sugar-containing carbonated beverages consumption is associated with hyperuricemia in general adults: A cross-sectional study.

BACKGROUND AND AIMS: Research evidence supports a positive link between sugar-containing soft beverages and hyperuricemia. However, data thus far are mostly from Caucasian populations. And in sugar-containing soft beverages overall, sugar-containing carbonated beverages are purchased most often. Therefore, we investigated whether the high consumption of sugar-containing carbonated beverages was associated with the prevalence of hyperuricemia among adults in China. METHODS AND RESULTS: A cross-sectional study was conducted with 25,507 adults (13,013 men and 12,494 women) in Tianjin, China. Sugar-containing carbonated beverages intake was assessed by a validated semi-quantitative food frequency questionnaire. Hyperuricemia was defined as serum uric acid levels ≥7.0 mg/dL in men and ≥ 6 mg/dL in women. The association between carbonated beverages consumption and hyperuricemia was assessed by multiple logistic regression analysis. The prevalence of hyperuricemia in men and women was 23.4% and 8.2%, respectively. After adjustments for potential confounding factors, the odds ratios (95% confidence interval) for hyperuricemia across sugar-containing carbonated beverages consumption were 1.00 (reference) for almost never, 1.18 (1.05, 1.32) for <1-3 cups/week, 1.49 (1.25, 1.77) for ≥4 cups/week in men (P for trend < 0.005) and 1.11 (0.91, 1.34) for <1-3 cups/week (P for trend = 0.27), 1.70 (1.23, 2.31) for ≥4 cups/week in women (P for trend < 0.001), respectively. CONCLUSIONS: This cross-sectional survey demonstrated that increased consumption of sugar-containing carbonated beverages is associated with hyperuricemia among adults in China. Restricted sugar-containing carbonated beverages intake might be beneficial to the prevention of hyperuricemia in the general population.

Association of dietary patterns with depressive symptoms in Chinese postmenopausal women.

Many components in diet have regulated oxidative stress, inflammatory reaction and even balance oestrogen levels. Because these factors are closely associated with depressive symptoms in postmenopausal women, it is considered that dietary factors are able to prevent and control depressive symptoms. On the other hand, a dietary pattern that considers the correlations and synergies between foods and nutrients is expected to have a greater impact on disease risk. The aim of the present study is to evaluate whether dietary patterns are associated with depressive symptoms in Chinese postmenopausal women. A cross-sectional study of 2051 postmenopausal women (mean age: 58·8 (sd 7·4) years) was conducted in Tianjin, China. Dietary consumption was assessed by a valid self-administered FFQ. Principal component analysis was used to derive three major dietary patterns: 'healthy', 'sweets' and 'traditional Tianjin' from eighty-eight food items. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale, and cut-off point of 48 indicating serious depressive symptoms. The association between quartile of dietary patterns and depressive symptoms was assessed using multiple logistic regression analysis. The multivariable-adjusted OR of having depressive symptoms for increasing quartile of dietary patterns were as follows: healthy, 1·00, 0·79 (95 % CI 0·49, 1·28), 0·62 (95 % CI 0·37, 1·04) and 0·57 (95 % CI 0·33, 0·97); sweets, 1·00, 0·75 (95 % CI 0·42, 1·3), 1·08 (95 % CI 0·64, 1·81) and 1·66 (95 % CI 1·03, 2·71); and traditional Tianjin, 1·00, 1·02 (95 % CI 0·58, 1·79), 0·96 (95 % CI 0·54, 1·71) and 2·53 (95 % CI 1·58, 4·16), respectively. The present study demonstrated that a healthy dietary pattern was inversely associated with depressive symptoms. On the contrary, greater adherence to sweets and traditional Tianjin dietary patterns was associated with a higher prevalence of depressive symptoms.

Soft drinks consumption is associated with nonalcoholic fatty liver disease independent of metabolic syndrome in Chinese population.

PURPOSE: Excessive consumption of soft drinks is associated with nonalcoholic fatty liver disease (NAFLD). However, the association between soft drinks consumption and NAFLD is unclear in non-Caucasian adults with relatively low soft drinks consumption. The aim of this study was to assess the association between soft drinks consumption and NAFLD in Chinese adults. METHODS: A cross-sectional study was conducted with 26,790 adults living in Tianjin, China. NAFLD (with elevated alanine aminotransferase [ALT]) was diagnosed by the liver ultrasonography and serum ALT concentrations. Soft drinks consumption was assessed using a validated self-administered food frequency questionnaire, and it was summarized as three categories for analysis: almost never (reference), <1 cup/week, and ≥1 cups/week. Metabolic syndrome (MetS) was defined according to the criteria of the American Heart Association scientific statements of 2009. The association between soft drinks consumption and NAFLD was assessed by multiple logistic regression analysis. RESULTS: The prevalence of NAFLD and NAFLD with elevated ALT was 27.1 and 6.5%, respectively. After adjustment for potential confounding variables (including MetS), the odds ratios (95% confidence intervals) for NAFLD or NAFLD with elevated ALT across soft drinks consumption were 1.00 (reference) for almost never, 1.14 (1.02-1.27) or 1.16 (0.98-1.37) for <1 cup/week, and 1.26 (1.14-1.40) or 1.32 (1.13-1.53) for ≥1 cups/week (both P for trend <0.001), respectively. CONCLUSIONS: This is the first study to demonstrate that soft drinks consumption is associated with NAFLD independent of MetS in Chinese adults with relatively low soft drinks consumption. These results suggest that reducing soft drinks consumption might be beneficial to the prevention of NAFLD.

Global Leadership Initiative on Malnutrition-defined malnutrition coexisting with visceral adiposity predicted worse long-term all-cause mortality among inpatients with decompensated cirrhosis.

BACKGROUND/OBJECTIVES: Malnutrition coexisting with abdominal adipose tissue accumulation bring a double burden on prognosis. More recently, the Global Leadership Initiative on Malnutrition (GLIM) has reached a novel consensus concerning the diagnostic criteria, that is, a two-step modality combining nutritional risk screening and subsequent phenotypic/etiologic parameters for comprehensive evaluation in hopes of harmonizing the malnutrition diagnosis. We aimed to elucidate their synergistic impact among inpatients with decompensated cirrhosis concerning long-term mortality. SUBJECTS/METHODS: Malnutrition, visceral obesity, and visceral adiposity were defined by the Global Leadership Initiative on Malnutrition (GLIM), visceral fat area (VFA), and visceral to subcutaneous adipose tissue area ratio (VSR) on computed tomography, respectively. Accordingly, the patients were categorized into different groups given their nutritional status and visceral obesity/adiposity. Multivariate Cox regression was performed to identify independent risk factors associated with 1-year all-cause mortality. Kaplan-Meier curves with log-rank tests were compared among distinct groups. RESULTS: Totally, 295 patients were recruited. GLIM, VFA, and VSR identified 131 (44.4%), 158 (53.6%), and 59 (20%) patients with malnutrition, visceral obesity and visceral adiposity, respectively. Malnutrition coexisted with visceral obesity in 55 (MO group) relative to visceral adiposity in 40 patients (MA group). Multivariate Cox analysis showed that MA (hazard ratio: 2.48; 95% confidence interval: 1.06, 5.79; P = 0.036) was independently associated with dire outcome rather than MO. Moreover, patients with cirrhosis in the MA group had the worst survival status when compared with other groups (log-rank test: P < 0.001). CONCLUSIONS: The current study indicated that coexisting GLIM-defined malnutrition and VSR-defined visceral adiposity were in relation to worse long-term mortality among inpatients. It is imperative to delicately manage nutritional status and provide personalized treatment in this vulnerable subgroup for achieving better prognosis.

Association Between Quality of Life Defined by EuroQol Group 5 Dimension and Composite Inferior Outcome Among Inpatients with Cirrhosis.

Purpose: The utility of the EuroQol Group 5 Dimension (EQ-5D) measuring health-related quality of life (HRQoL) has been verified; however, knowledge gaps remain concerning predictive performance in cirrhosis. We aimed to identify the optimal threshold for risk stratification and the pronounced domain in the EQ-5D linked to inferior outcomes. Patients and Methods: The X-tile project was used to obtain a threshold, considering the composite outcome of 1-year all-cause mortality or readmission. A restricted cubic spline (RCS) was performed to test the non-linear relationship between the EQ-5D utility value and the primary outcome. Six multivariate Cox regression models incorporating EQ-5D utility value and each of the five domains were constructed. Setting/Participants: Totally, 420 patients with cirrhosis were recruited. Results: The median utility value of the study population was 0.77 and 59.8% reported impairment in minimal one EQ-5D domain. RCS indicated a linear relationship between the utility value and composite inferior outcome. X-tile pinpointed a utility value of 0.59 stratifying populations into high- and low-risk groups based on the outcome. Inpatients with cirrhosis and deteriorated HRQoL (utility value ≤0.59) were at higher risk of death or readmission (adjusted HR: 2.18, P < 0.001). Furthermore, mobility and usual activities were the most pronounced domains associated with composite inferior outcome. Conclusion: A utility value ≤0.59 can identify cirrhotic inpatients exhibiting compromised HRQoL and mortality/readmission risk. It is tempting to reverse the decreased HRQoL by applying longitudinal measurements and keeping surveillance on utility value, while interventions appear to mainly focus on improving mobility and usual activities.

Does decreasing serum uric acid level prevent hypertension? - a nested RCT in cohort study: rationale, methods, and baseline characteristics of study cohort.

BACKGROUND: Previous epidemiologic studies have demonstrated an association between uric acid and hypertension. Our objective was to conduct a prospective cohort study with a nested randomised controlled trial (RCT in cohort) that aims to identify the association of hyperuricemia with the development of hypertension and to examine the efficacy of dietary intervention in lowering uric acid level and prevention of hypertension. METHODS/DESIGN: Participants were considered eligible to enrol for this cohort study if they were not diagnosed with hypertension until their last routine health examination. The characteristics of the eligible participants were analyzed. After enrolment, participants with prehypertension and hyperuricemia simultaneously were randomly distributed to either the intervention group or the control group. An education package of dietary intervention for lowering uric acid was delivered to the intervention group. The primary evaluation criterion was the first manifestation of hypertension. DISCUSSION: Based on the results of their health examination in 2010, 19, 724 subjects met the inclusion criteria and this source population guaranteed the required minimum sample size for this study. The baseline characteristics of the study cohort showed that hyperuricemia was associated with prehypertension, and was independent of age, body mass index (BMI), and abdominal obesity in females; however, in males it was contrary.The impact of lowering uric acid on the prevention of hypertension is still inconclusive. This RCT in cohort study provides important data on the prevention of hypertension, especially in patients with a high risk for hypertension development. Results are expected to be available in 2015. TRIAL REGISTRATION: The study is registered with the Chinese Clinical Trial Registry (ChiCTR-TRC-12002925).

The Ovotransferrin-Derived Peptide IRW Attenuates Lipopolysaccharide-Induced Inflammatory Responses.

IRW (Ile-Arg-Trp), a bioactive peptide isolated from egg ovotransferrin, has been shown to exert anti-inflammatory effects. In this study, the effects of IRW on inflammatory cytokines and microbiota were explored in human umbilical vein endothelial cells (HUVECs) and a lipopolysaccharide (LPS)-induced rat model of inflammatory peritonitis. Rats were injected intraperitoneally with LPS to establish peritonitis. HUVECs were exposed to IRW for 12 h before introducing LPS. Notably, IRW exerted beneficial effects against LPS-induced peritonitis, specifically, by reducing the serum levels of tumour necrosis factor (TNF)-α and interleukin (IL)-6 and myeloperoxidase (MPO) activity (P<0.05). A faecal microbiota analysis revealed that IRW significantly increased the Shannon and decreased the Simpson indices (P<0.05). Furthermore, IRW treatment significantly inhibited the LPS-induced enhancement of TNF-α, IL-8, intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) expression in HUVECs (P<0.05). In conclusion, IRW supplementation inhibited the inflammatory mediator synthesis and LPS-induced inflammatory responses and influenced the gut microbiota.

Chlorogenic Acid Ameliorates Colitis and Alters Colonic Microbiota in a Mouse Model of Dextran Sulfate Sodium-Induced Colitis.

This study evaluated the mitigating effects of dietary chlorogenic acid (CGA) on colon damage and the bacterial profile in a mouse model of dextran sulfate sodium (DSS)-induced colitis. C57BL/6J mice were randomly assigned to receive one of the following treatments: (i) basal diet; (ii) basal diet with 2% CGA; (iii) basal diet with 2.5% DSS or (iv) basal diet with 2% CGA and 2.5% DSS. Following a 2-week pre-treatment period, mice in the DSS and CGA-DSS groups received 2.5% DSS in drinking water for 5 days, while the other two groups received sterile water. Compared to DSS alone, CGA was found to reduce the disease activity index, myeloperoxidase activity and tumor necrosis factor-α levels in colon tissues (P < 0.05). CGA also ameliorated DSS-induced inflammatory responses, reduced colon shortening and decreased the histological scores (P < 0.05). In an evaluation of the relative abundances of bacteria in the fecal microbiota, we found that CGA reversed the decrease in diversity caused by DSS and improved the relative abundance of organisms in the genus Lactobacillus (P < 0.05). These results indicate that CGA maintains intestinal health and reduces DSS-induced colon injury by decreasing the production of pro-inflammatory cytokines and restoring intestinal microbial diversity.

Relationship of serum immunoglobulin levels to blood pressure and hypertension in an adult population.

Evidence suggests long-term chronic inflammation, as the pathological basis of formation and development, plays an important part in atherosclerosis. Immunoglobulins (Igs) provided key information on the humoral immune status. However, few studies have evaluated the correlation between Igs and hypertension and blood pressure (BP) in a general population. We designed a cross-sectional study to evaluate whether serum Ig levels are related to BP and the prevalence of hypertension. About 12,373 participants in Tianjin, China were recruited for this study. Hypertension was diagnosed according to the criteria of the JNC 7 and serum levels of Igs were determined by the immunonephelometric technique. Multiple logistic regression analysis and analysis of covariance were used to assess relationships between serum Ig concentrations and the prevalence of hypertension and BP. The overall prevalence of hypertension was 35.5%. The means (standard deviation) of immunoglobulins [immunoglobulin G (IgG), immunoglobulin E (IgE), immunoglobulin M (IgM), and immunoglobulin A (IgA)] were 1206.0 (249.0) mg/dL, 93.8 (235.4) IU/mL, 105.3 (56.8) mg/dL, and 236.7 (98.1) mg/dL, respectively. The multivariable-adjusted odds ratios (95% confidence interval) of hypertension for the highest immunoglobulins (IgG, IgE, IgM, and IgA) quintile, when compared to the lowest quintile were 1.10 (0.96-1.26), 1.04 (0.91-1.19), 0.83 (0.72-0.96), and 1.32 (1.15-1.51), respectively. Decreased IgM and increased IgG and IgA were related to a higher prevalence of hypertension. IgM was negatively correlated with BP, while IgG and IgA were positively correlated with BP.

Pictograms to Provide a Better Understanding of Gastroesophageal Reflux Symptoms in Chinese Subjects.

OBJECTIVE: To explore whether pictograms could help people understand reflux symptoms. METHODS: Gastroenterologists (n = 28), non-GI physicians (n = 30), healthy people without medical education (n = 34), patients with gastrointestinal reflux disease (GERD) (n = 45), and general people (n = 100) were included. Pictograms denoting classic reflux symptoms (sour regurgitation, heartburn, retrosternal pain, and regurgitation) were created by the joint efforts of an artist and a gastroenterologist. The subjects were asked to tell the meaning of each card within 30 s. RESULTS: Compared with the physicians, healthy people without medical education tended to make mistakes in the understanding of the terms of reflux symptoms. Among GERD patients, all the terms of reflux symptoms could be understood accurately. Compared with that of non-GI physicians, GI physician had a higher accuracy in the understanding of the term regurgitation (P < 0.05). Pictograms denoting reflux symptoms could be understood accurately in all four groups. A sample from the general population showed that the recognition of the pictogram was more accurate than the recognition of the terms. CONCLUSIONS: Pictograms could help ordinary people who do not have medical education to understand reflux symptoms more accurately in China. Compared with abstract terms, pictograms could be useful for epidemiological studies and diagnosis of GERD in the community.

Relationship between serum uric acid and metabolic syndrome: an analysis by structural equation modeling.

OBJECTIVE: To investigate the nature of the relationships between uric acid and metabolic syndrome (MetS) components. METHODS: Body mass index, waist circumference, serum uric acid, fasting glucose, lipid profiles, and blood pressure were measured in 13,811 subjects aged between 18 and 85 years of age. Two structural equation models (SEMs) were used to test a hypothesis regarding the linking roles of uric acid in the occurrence of MetS components in male and female separately. RESULTS: The findings of the SEM demonstrated that increased uric acid level was associated with fasting glucose (beta = 0.221, P < .001), blood pressure (beta = 0.158, P < .001), and lipid profiles (beta = 0.391, P < .001) in women. Increased uric acid level was associated with decreased fasting glucose (beta = -0.071, P < .001) and increased lipid profiles (beta = 0.352, P < .001) in men. The association was stronger between uric acid and lipid profiles than those between uric acid and other MetS components. CONCLUSION: By using SEM, we were able to confirm the intimate relationships between uric acid and MetS components, particularly in women. The associations between uric acid and MetS components were gender specific, and the nature of such association requires further exploration.

[Correlation of E-cadherin hypermethylation to tumorigenesis and development of gastric cancer].

BACKGROUND & OBJECTIVE: CpG island hypermethylation in promoter region of E-cadherin (E-cad) gene plays an important role in tumorigenesis of many tumors. This study was to explore the correlation of E-cadherin hypermethylation to tumorigenesis and development of gastric cancer. METHODS: Methylation-specific polymerase chain reaction (MSP) was used to detect the methylation of E-cad gene in 41 specimens of gastric cancer, 40 specimens of premalignant gastric lesions and 38 specimens of normal gastric tissues. The expression of E-cad protein was detected by SP immunohistochemistry. RESULTS: The positive rate of E-cad gene methylation was significantly higher in gastric cancer than in premalignant lesions and normal tissues (19.5% vs. 2.5% and 0.0%, P<0.05). The positive rate of E-cad protein was significantly lower in gastric cancer tissues than in premalignant lesions and normal tissues (70.7% vs. 97.5% and 100.0%, P<0.05). The positive rate of E-cad gene methylation was significantly higher in poorly differentiated cancer tissues than in well differentiated cancer tissues (43.8% vs. 4.0%, P<0.05), significantly higher in gastric cancer tissues with lymph node metastasis than in those without lymph node metastasis (33.3% vs. 5.0%, P<0.05), and significantly higher in gastric cancer tissues with serosa invasion than in those without serosa invasion (35.0% vs. 4.8%, P<0.05). The positive rate of E-cad protein was significantly lower in gastric cancer tissues with E-cad gene methylation than in those without E-cad gene methylation (0.0% vs. 87.9%, P<0.05). CONCLUSION: CpG island hypermethylation of E-cad gene exists in gastric cancer, which down-regulates E-cad expression and might be involved in tumorigenesis and development of gastric cancer.