Breastfeeding in infancy and mortality in middle and late adulthood: A prospective cohort study and meta-analysis.

BACKGROUND: Breastfeeding in infancy is associated with a lower risk of mortality among children, but the impact on mortality in middle and late adulthood remains unknown. OBJECTIVES: To assess the association between breastfeeding in infancy and mortality in middle and late adulthood. METHODS: We included 383,627 participants aged 40-73 from the UK Biobank (2006-2010) and followed up until 2021. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality according to breastfeeding in infancy were estimated with Cox proportional hazards regression models. We further did a meta-analysis, including results from our present study and three other cohort studies (PROSPERO; number CRD42022348925). RESULTS: During a total of 4732,751 person-years of follow-up, 25,581 deaths were identified. Breastfeeding in infancy was associated with lower risks of mortality in middle and late adulthood, with adjusted HRs (95% CIs) of 0.95 (0.93-0.98) for all-cause mortality; 0.91 (0.87-0.96) for cardiovascular mortality and 0.94 (0.874-0.999) for respiratory mortality. Specifically, the association with mortality seemed to attenuate with age - stronger in middle-aged adults than in older adults. A similar association between breastfeeding in infancy and all-cause mortality was found in the meta-analysis. CONCLUSION: Breastfeeding in infancy is associated with a lower risk of mortality - even decades later - in middle and late adulthood.

Nonalcoholic fatty liver disease (NAFLD) detection and deep learning in a Chinese community-based population.

OBJECTIVES: We aimed to develop and validate a deep learning system (DLS) by using an auxiliary section that extracts and outputs specific ultrasound diagnostic features to improve the explainable, clinical relevant utility of using DLS for detecting NAFLD. METHODS: In a community-based study of 4144 participants with abdominal ultrasound scan in Hangzhou, China, we sampled 928 (617 [66.5%] females, mean age: 56 years ± 13 [standard deviation]) participants (2 images per participant) to develop and validate DLS, a two-section neural network (2S-NNet). Radiologists' consensus diagnosis classified hepatic steatosis as none steatosis, mild, moderate, and severe. We also explored the NAFLD detection performance of six one-section neural network models and five fatty liver indices on our data set. We further evaluated the influence of participants' characteristics on the correctness of 2S-NNet by logistic regression. RESULTS: Area under the curve (AUROC) of 2S-NNet for hepatic steatosis was 0.90 for ≥ mild, 0.85 for ≥ moderate, and 0.93 for severe steatosis, and was 0.90 for NAFLD presence, 0.84 for moderate to severe NAFLD, and 0.93 for severe NAFLD. The AUROC of NAFLD severity was 0.88 for 2S-NNet, and 0.79-0.86 for one-section models. The AUROC of NAFLD presence was 0.90 for 2S-NNet, and 0.54-0.82 for fatty liver indices. Age, sex, body mass index, diabetes, fibrosis-4 index, android fat ratio, and skeletal muscle via dual-energy X-ray absorptiometry had no significant impact on the correctness of 2S-NNet (p > 0.05). CONCLUSIONS: By using two-section design, 2S-NNet had improved the performance for detecting NAFLD with more explainable, clinical relevant utility than using one-section design. KEY POINTS: • Based on the consensus review derived from radiologists, our DLS (2S-NNet) had an AUROC of 0.88 by using two-section design and yielded better performance for detecting NAFLD than using one-section design with more explainable, clinical relevant utility. • The 2S-NNet outperformed five fatty liver indices with the highest AUROCs (0.84-0.93 vs. 0.54-0.82) for different NAFLD severity screening, indicating screening utility of deep learning-based radiology may perform better than blood biomarker panels in epidemiology. • The correctness of 2S-NNet was not significantly influenced by individual's characteristics, including age, sex, body mass index, diabetes, fibrosis-4 index, android fat ratio, and skeletal muscle via dual-energy X-ray absorptiometry.

Combining gene expression signature with clinical features for survival stratification of gastric cancer.

The AJCC staging system is considered as the golden standard in clinical practice. However, it remains some pitfalls in assessing the prognosis of gastric cancer (GC) patients with similar clinicopathological characteristics. We aim to develop a new clinic and genetic risk score (CGRS) to improve the prognosis prediction of GC patients. We established genetic risk score (GRS) based on nine-gene signature including APOD, CCDC92, CYS1, GSDME, ST8SIA5, STARD3NL, TIMEM245, TSPYL5, and VAT1 based on the gene expression profiles of the training set from the Asian Cancer Research Group (ACRG) cohort by LASSO-Cox regression algorithms. CGRS was established by integrating GRS with clinical risk score (CRS) derived from Surveillance, Epidemiology, and End Results (SEER) database. GRS and CGRS dichotomized GC patients into high and low risk groups with significantly different prognosis in four independent cohorts with different data types, such as microarray, RNA sequencing and qRT-PCR (all HR > 1, all P < 0.001). Both GRS and CGRS were prognostic signatures independent of the AJCC staging system. Receiver operating characteristic (ROC) analysis showed that area under ROC curve of CGRS was larger than that of the AJCC staging system in most cohorts we studied. Nomogram and web tool (http://39.100.117.92/CGRS/) based on CGRS were developed for clinicians to conveniently assess GC prognosis in clinical practice. CGRS integrating genetic signature with clinical features shows strong robustness in predicting GC prognosis, and can be easily applied in clinical practice through the web application.

Association between napping status and depressive symptoms in urban residents during the COVID-19 epidemic.

: To explore the association between napping status and depressive symptoms in urban residents during the coronavirus disease 2019 (COVID-19) epidemic. : The survey was embedded in the Wellness Living Laboratory-China (WELL China) cohort study. Health and lifestyle information during the COVID-19 epidemic were obtained via the telephone interview from April 8, 2020 to May 29, 2020. A total of 3075 residents aged 18 to from Gongshu district of Hangzhou city with complete data were included in the analyses. The World Health Organization-Five Well-being Index (WHO-5) was used to measure depressive symptoms. Multiple logistic regression model was used to assess the association between napping status and depressive symptoms in the participants. : The prevalence of depressive symptoms was 20.6% in the participants during the epidemic. Daytime napping behavior, especially napping time ≤30 min, was associated with a lower risk of prevalent depressive symptoms (=0.61, 95%: 0.47-0.79, <0.01) and incident depressive symptoms in the population (=0.66, 95%: 0.50-0.88, <0.01). Among those with depressive symptoms at baseline, napping time ≤ was beneficial for the outcome of depressive symptoms (=0.42, 95%: 0.21-0.82, <0.05). : One in five urban residents have depressive symptoms during the COVID-19 epidemic, and a short nap during the day may be a protective factor against depressive symptoms.

Changes in maternal age and prevalence of congenital anomalies during the enactment of China's universal two-child policy (2013-2017) in Zhejiang Province, China: An observational study.

BACKGROUND: China implemented a partial two-child policy (2013) followed by a universal two-child policy (2015), replacing the former one-child policy mandated by the government. The changes affect many aspects of China's population as well as maternal and infant health, but their potential impact on birth defects (BDs) remains unknown. In this study, we investigated the associations of these policy changes with BDs in Zhejiang Province, China. METHODS AND FINDINGS: We used data from the BD surveillance system in Zhejiang Province, China, which covers 90 hospitals in 30 urban districts and rural counties, capturing one-third of the total births in this province. To fully consider the time interval between conception and delivery, we defined the one-child policy period as data from 2013 (births from October 2012 to September 2013), the partial two-child policy period as data from 2015 (births from October 2014 to September 2015), and the universal two-child policy period as data from 2017 (births from October 2016 to September 2017). Data from 2009 and 2011 were also used to show the changes in the proportion of births to women with advanced maternal age (35 years and older) prior to the policy changes. Main outcome measures were changes in the proportion of mothers with advanced maternal age, prevalence of BDs, rankings of BD subtypes by prevalence, prenatal diagnosis rate, and live birth rate of BDs over time. A total of 1,260,684 births (including live births, early fetal losses, stillbirths, and early neonatal deaths) were included in the analyses. Of these, 644,973 (51.16%) births were to women from urban areas, and 615,711 (48.84%) births were to women from rural areas. In total, 135,543 (10.75%) births were to women with advanced maternal age. The proportion increased by 85.68%, from 8.52% in 2013 to 15.82% in 2017. However, it had remained stable prior to policy changes. Overall, 23,095 BDs were identified over the policy changes (2013-2017). The prevalence of BDs during 2013, 2015, and 2017 was 245.95, 264.86, and 304.36 per 10,000 births, respectively. Trisomy 21 and other chromosomal defects increased in both risk and ranking from 2013 to 2017 (crude odds ratio [95% confidence interval] 2.13 [1.75-2.60], from ranking 10th to 5th, and 3.63 [2.84-4.69], from ranking 16th to 6th, respectively). The prenatal diagnosis rate increased by 3.63 (2.2-5.1) percentage points (P < 0.001), from 31.10% to 34.72%, and identification of BDs occurred 1.88 (1.81-1.95) weeks earlier (P < 0.001). The live birth rate for infants with BDs born before 28 gestational weeks increased from 1.29% to 11.45%. The major limitations of this observational study include an inability to establish causality and the possible existence of unknown confounding factors, some of which could contribute to BDs. CONCLUSIONS: In this study, we observed significant increases in maternal age and the prevalence of total and age-related anomalies following China's new two-child policy. Increases in live birth rate for infants with BDs born before 28 gestational weeks suggest that healthcare for very preterm births with BDs may be warranted in the future, as well as updating the definition of perinatal period.

Sex differences in the association between socioeconomic status and diabetes prevalence and incidence in China: cross-sectional and prospective studies of 0.5 million adults.

AIMS/HYPOTHESIS: China has undergone rapid socioeconomic transition accompanied by lifestyle changes that are expected to have a profound impact on the health of its population. However, there is limited evidence from large nationwide studies about the relevance of socioeconomic status (SES) to risk of diabetes. We describe the associations of two key measures of SES with prevalent and incident diabetes in Chinese men and women. METHODS: The China Kadoorie Biobank study included 0.5 million adults aged 30-79 years recruited from ten diverse areas in China during 2004-2008. SES was assessed using the highest educational level attained and annual household income. Prevalent diabetes was identified from self-report and plasma glucose measurements. Incident diabetes was identified from linkage to disease and death registries and national health insurance claim databases. We estimated adjusted ORs and HRs for prevalent and incident diabetes associated with SES using logistic and Cox regression models, respectively. RESULTS: At baseline, 30,066 (5.9%) participants had previously diagnosed (3.1%) or screen-detected (2.8%) diabetes among 510,219 participants included for cross-sectional analyses. There were 480,153 people without prevalent diabetes at baseline, of whom 9544 (2.0%) had new-onset diabetes during follow-up (median 7 years). Adjusted ORs (95% CIs) for prevalent diabetes, comparing highest vs lowest educational level, were 1.21 (1.09, 1.35) in men and 0.69 (0.63, 0.76) in women; for incident diabetes, the corresponding HRs were 1.27 (1.07, 1.51) and 0.80 (0.67, 0.95), respectively. For household income, the adjusted ORs for prevalent diabetes, comparing highest vs lowest categories, were 1.45 (1.34, 1.56) in men and 1.26 (1.19, 1.34) in women; for incident diabetes, the HRs were 1.36 (1.19, 1.55) and 1.06 (0.95, 1.17), respectively. CONCLUSIONS/INTERPRETATION: Among Chinese adults, the associations between education and diabetes prevalence and incidence differed qualitatively between men and women, whereas higher household income was positively associated with diabetes prevalence and incidence in both sexes, with a stronger relationship in men than in women.

A Single Nucleotide Polymorphism in the FADS1 Gene is Associated with Plasma Fatty Acid and Lipid Profiles and Might Explain Gender Difference in Body Fat Distribution.

BACKGROUND: Genotyping of the rs174547 polymorphism in the fatty acid desaturase 1 gene (FADS1) shows that it is associated with the FA composition of plasma phospholipids and lipid metabolic indices among several ethnic groups. However, this association requires further confirmation in the Chinese population, and little is known about the effect of polymorphisms in fatty acid-related genes on body fat distribution. METHODS: Anthropometric measurements of 951 Chinese adults aged 18-79 were obtained and body fat distribution was estimated using dual-energy X-ray absorptiometry. The FA composition of plasma phospholipids was measured by gas chromatography. Multiple linear regression assessed whether the rs174547 genotype was associated with FA composition, body fat distribution, and metabolic traits in additive, dominant, and recessive models. RESULTS: The rs174547 C minor allele was associated with a higher proportion of linoleic acid, lower arachidonic acid and docosahexaenoic acid, as well as lower delta-6-desaturase and delta-5-desaturase activity. Female C allele carriers had lower android fat percentages and lower levels of low-density lipoprotein-cholesterol, while male C allele carriers had lower gynoid fat percentages and higher triglyceride after adjusting for age, income, BMI, behavioral risk factors, and regional fat percentages. CONCLUSION: An association of FADS1 rs174547 with the FA composition of plasma phospholipids was identified among this Chinese adult population. The association with body fat distribution and lipid metabolic indices differed between men and women, which might explain sexual differences in body fat distribution and lipid metabolism.

Plasma nutrient biomarkers are associated with waist-to-height ratio in youth with type 1 diabetes.

BACKGROUND: Plasma fatty acids (FAs) and micronutrients have been associated with central obesity in adults; however, previous studies of these associations in adults have yielded mixed results. In addition, no comparable research has been conducted among youth with type 1 diabetes (T1D). OBJECTIVE: We investigated the cross-sectional and longitudinal associations between plasma nutrient biomarkers and waist-to-height ratio (WHtR) in youth with T1D. METHODS: These analyses included 1324 youth aged 3-20 y at T1D diagnosis with a baseline visit in the SEARCH (Search for Diabetes in Youth) Study and a subset of 1178 of these youth with a follow-up visit an average of 23 mo (range: 16-40 mo) after their baseline visit. Plasma phospholipid FAs and vitamins were measured, and estimated desaturase activities were calculated at baseline. Anthropometric measurements and diabetes-related assessments were collected at each visit. Multiple linear regression was used to examine the association between plasma nutrient biomarkers and WHtR. RESULTS: In cross-sectional analysis, plasma palmitic acid (P = 0.004), dihomo-γ-linolenic acid (DGLA; P = 0.017) and Δ6 desaturase (D6D; P = 0.006) were positively correlated with WHtR after adjustment of confounders. Oleic acid (OA; P = 0.002), linoleic acid (LA; P = 0.015), Δ9 desaturase 18 (D9D-18; P = 0.027), and vitamin D (P < 0.0001) were negatively correlated with WHtR after adjustment. Weight status was an effect modifier (P < 0.05). In normal-weight youth, vitamin D (P = 0.003) was negatively associated with WHtR. In obese youth, stearic acid (P = 0.037), DGLA (P < 0.0001), and D6D (P < 0.0001) were positively associated and OA (P = 0.0008), D9D-18 (P = 0.0006), and vitamin D (P < 0.0001) were negatively associated with WHtR. In longitudinal analysis, baseline linoleic acid (P = 0.018), n-6:n-3 (ω-3:ω-6) FA ratio (P = 0.029), vitamin D (P = 0.003), and vitamin E (P < 0.0001) were negatively correlated with WHtR at follow-up only in obese participants. CONCLUSIONS: In T1D youth, plasma FAs and vitamins are associated with WHtR and are modified by weight status. These associations are particularly marked in obese youth.

Duration of television viewing and bone mineral density in Chinese women.

Studies on the relationship between television (TV) viewing and bone mineral density (BMD) in adults are limited. The purpose of this study was to examine whether longer duration of TV viewing increased the risk of lower BMD in Chinese women. A total of 626 female adults were voluntarily recruited into the study. Anthropometric measurements were obtained using standard procedures. Body composition including total body and regional BMD was estimated using dual-energy X-ray absorptiometry. The duration of TV viewing was categorized into 4 groups: <1 h, 1 to <2 h, 2 to <3 h, and ≥3 h. Multiple linear regression models were applied to analyze the associations between duration of TV viewing and total and regional BMD in all subjects and in subjects stratified by age of 45 years, respectively. After adjusting for age, BMI, alcohol use, smoking, education, income, urbanicity, leisure time physical activity, occupational physical activity, and menopause, the significant trend of pelvic BMD across categories of TV viewing was observed in all subjects (p < 0.05). Further analysis revealed that women aged <45 years, the 1 to <2 h group, the 2 to <3 h group, and the ≥3 h group were significantly associated with lower total body and regional BMD compared to women aged <45 years in the <1 h group. We concluded that the duration of TV viewing was negatively associated with BMD in Chinese women, especially in those aged 18-44 years. It might be sensible to reduce TV viewing time to prevent bone loss in young women.

Association of regional body fat with metabolic risks in Chinese women.

OBJECTIVE: To investigate the association of regional fat depots with metabolic risk factors in Chinese women. DESIGN: Total and regional fat depots including android fat and gynoid fat were measured by dual-energy X-ray absorptiometry. Central fat distribution was defined as android:gynoid fat ratio. Metabolic risk factors were defined as elevated TAG, reduced HDL-cholesterol, elevated blood pressure and elevated fasting plasma glucose. Logistic regression analyses were performed to examine the associations of regional fat depots with metabolic risk factors. The odds ratios of metabolic risks were further calculated according to tertiles of android fat and gynoid fat. SETTING: Participants were recruited from a community-based cross-sectional study. Face-to-face questionnaires, anthropometric and dual-energy X-ray absorptiometry measures were conducted. SUBJECTS: Chinese women (n 609) aged 18-79 years. RESULTS: Android fat and android:gynoid fat ratio were associated with significantly increased odds (OR = 1·4-3·7; P < 0·01) for almost all risk factors, whereas gynoid fat was independently associated with significantly decreased odds (OR = 0·3-0·6; P < 0·01). The inverse associations of gynoid fat with metabolic risk factors remained after adjusting for android fat. Even if their android fat level was in high, women in the highest tertile of gynoid fat had lower odds of having at least two metabolic risk factors compared with women in the lowest gynoid fat tertile (P for trend < 0·01). CONCLUSIONS: There were opposite associations of android and gynoid fat with metabolic risks in Chinese women. Gynoid fat rather than android fat might be a more important inclusion in metabolic disease risk evaluation in female Asians.

Central fat accumulation associated with metabolic risks beyond total fat in normal BMI Chinese adults.

OBJECTIVE: To investigate the association of central fat with metabolic risks in normal BMI Chinese people. METHODS: Normal BMI subjects (18.5 ≤ BMI < 24, n = 520) aged 18-82 years were included. Blood pressure, triglycerides, high-density lipoprotein cholesterol and fasting plasma glucose were collected as metabolic risk factors. Dual-energy X-ray absorptiometry was used to measure total and central fat. Central fat was indicated as percent trunk fat (%TF) and android/gynoid fat ratio. Multiple adjusted regression models were applied to investigate the association of total and central fat with metabolic risk factors. The assessment values of these fat measures were further compared by receiver-operating characteristic (ROC) curves. RESULTS: Both total and central fat were correlated with metabolic risk factors. After adjusting for BMI, the significant association of percent body fat (%BF) with metabolic risks diminished, whereas %TF and android/gynoid fat ratio were still correlated. When BMI was replaced with %BF in the models, the results remained unchanged. ROC analysis showed the areas under the curve (AUCs) of total and central fat for at least two metabolic risk factors were comparable in men. However, in women, the AUCs of %TF and android/gynoid fat ratio were significantly greater than those of BMI, %BF and waist circumference. CONCLUSIONS: Central fat accumulation had a stronger association with metabolic risks than total fat in normal BMI Chinese adults, particularly in women. Central fat had more important implications in assessing 'metabolically obese' individuals among normal BMI subjects.

Nut consumption, gut microbiota, and body fat distribution: results of a large, community-based population study.

OBJECTIVE: We aimed to investigate the relationships among nut consumption, gut microbiota, and body fat distribution. METHODS: We studied 2255 Chinese adults in the Lanxi Cohort living in urban areas in Lanxi City, China. Fat distribution was assessed by dual-energy x-ray absorptiometry, and nut consumption was assessed using food frequency questionnaires. 16S ribosomal RNA (rRNA) sequencing was performed on stool samples from 1724 participants. Linear regression and Spearman correlation were used in all analyses. A validation study was performed using 1274 participants in the Lanxi Cohort living in rural areas. RESULTS: Nut consumption was beneficially associated with regional fat accumulation. Gut microbial analysis suggested that a high intake of nuts was associated with greater microbial α diversity. Six genera were found to be associated with nut consumption, and the abundance of genera Anaerobutyricum, Anaerotaenia, and Fusobacterium was significantly associated with fat distribution. Favorable relationships between α diversity and fat distribution were also observed. Similar relationships between gut microbiota and fat distribution were obtained in the validation analysis. CONCLUSIONS: We have shown that nut consumption is beneficially associated with body fat distribution and gut microbiota diversity and taxonomy. Furthermore, the microbial features related to high nut intake are associated with a favorable pattern of fat distribution.

Association of dietary overall antioxidant intake with all-cause and cause-specific mortality among adults with depression: evidence from NHANES 2005-2018.

Higher intakes of individual antioxidants such as vitamins A, C, and E have been linked to mortality in the general population, but the association of overall antioxidant intake with mortality especially in depressed adults remains unclear. We aimed to investigate whether the dietary overall antioxidant intake is associated with all-cause and cause-specific mortality among depressed adults. This study included 3051 US adults with depression, who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Patient Health Questionnaire-9 (PHQ-9) was used to define depression and evaluate depression severity. The dietary antioxidant quality score (DAQS) and dietary antioxidant index (DAI) were calculated based on the intakes of vitamins A, C, and E, zinc, selenium, and magnesium. A higher DAQS and DAI were significantly associated with lower depression scores (PHQ-9) (all P-trend < 0.05). For individual antioxidants, significant negative associations of vitamins A and E with all-cause mortality were observed. For overall antioxidant intake, the DAQS and DAI were inversely associated with all-cause and cancer mortality. Compared with participants in the lowest categories of DAQS and DAI, the corresponding HRs (95% CIs) in the highest categories were 0.63 (0.42-0.93) and 0.70 (0.49-0.98) for all-cause mortality and 0.39 (0.17-0.87) and 0.43 (0.21-0.88) for cancer mortality, respectively. The overall dietary antioxidant intake was beneficially associated with all-cause and cancer mortality in depressed adults. These findings suggest that comprehensive dietary antioxidant intake may improve depressive symptoms and lower mortality risk among adults with depression.

Gut Microbiota and Adipose Tissue Microenvironment Interactions in Obesity.

Obesity is an increasingly serious global health problem. Some studies have revealed that the gut microbiota and its metabolites make important contributions to the onset of obesity. The gut microbiota is a dynamic ecosystem composed of diverse microbial communities with key regulatory functions in host metabolism and energy balance. Disruption of the gut microbiota can result in obesity, a chronic metabolic condition characterized by the excessive accumulation of adipose tissue. Host tissues (e.g., adipose, intestinal epithelial, and muscle tissues) can modulate the gut microbiota via microenvironmental interactions that involve hormone and cytokine secretion, changes in nutrient availability, and modifications of the gut environment. The interactions between host tissues and the gut microbiota are complex and bidirectional, with important effects on host health and obesity. This review provides a comprehensive summary of gut microbiota changes associated with obesity, the functional roles of gut microbiota-derived metabolites, and the importance of the complex interactions between the gut microbiota and target tissues in the pathogenesis of obesity. It places particular emphasis on the roles of adipose tissue microenvironment interactions in the onset of obesity.

Differences in prenatal diagnosis rate of congenital anomalies associated with singletons and multiple births: An observational study of more than 1.9 million births in Zhejiang Province, eastern China, during 2012-2018.

OBJECTIVE: To characterize differences in the prenatal detection of congenital anomalies (CAs) associated with singleton and multiple births. METHODS: This observational study covered all births registered in the CA surveillance system in Zhejiang Province of China during 2012-2018. Differences in the incidence and characteristics between singletons and multiple births with CAs were tested. Multivariate logistic regression models were performed to explore the associations of prenatal detection rate of CAs with multiple births. RESULTS: Totals of 49 872 singletons and 3324 multiple births with CAs were analyzed. The mean incidences of CA for single and multiple births were 27.12 and 54.42 per 1000 births, respectively. After adjustment for covariates, CAs associated with multiple births were less likely to be diagnosed prenatally (adjusted odds ratio [OR] 0.38, 95% confidence interval [CI] 0.34-0.43), as were congenital heart defects, congenital hydrocephalus, cleft lip with cleft palate, cleft lip without cleft palate, limb reduction defects, congenital diaphragmatic hernia, trisomy 21 syndrome, congenital malformation of the urinary system, and other chromosomal malformation, compared with singletons with CAs. CONCLUSION: Multiple birth is associated with a significantly higher risk of CA, but a significantly lower prenatal diagnosis rate. Therefore, the healthcare of women with multiple pregnancy and their fetuses should be strengthened.

Cross-sectional and longitudinal associations between body flexibility and sarcopenia.

BACKGROUND: The associations between body flexibility and sarcopenia were not well understood. This study aimed to explore the cross-sectional and longitudinal associations of flexibility with sarcopenia. METHODS: Our study selected participants aged 50-80 from the WELL-China cohort and the Lanxi cohort. Participants from the urban area of the Lanxi cohort were followed up 4 years later. Body flexibility was measured by the sit-and-reach test. Muscle mass was evaluated by dual-energy X-ray absorptiometry. Muscle strength was evaluated using handgrip strength. Sarcopenia was defined as having both low muscle mass and low muscle strength. We used multivariable logistic regressions to assess the cross-sectional associations of body flexibility with low muscle mass, low muscle strength and sarcopenia. We also used multivariable logistic regressions to explore the associations of baseline flexibility and 4-year changes in flexibility with incident low muscle mass, low muscle strength and sarcopenia. RESULTS: A total of 9453 participants were enrolled in the cross-sectional study, and 1233 participants were included in the longitudinal analyses. In the cross-sectional analyses, compared with low body flexibility, high body flexibility was inversely associated with low muscle mass (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.50-0.68; P < 0.001), low muscle strength (OR, 0.62; 95% CI, 0.55-0.69; P < 0.001) and sarcopenia (OR, 0.52; 95% CI, 0.41-0.65; P < 0.001), and these associations did not differ in different age groups, sex or physical activity levels. In the longitudinal analyses, compared with participants with low body flexibility, participants with high body flexibility had lower risk of the incident low muscle strength (OR, 0.53; 95% CI, 0.38-0.74; P < 0.001) and sarcopenia (OR, 0.36; 95% CI, 0.21-0.61; P < 0.001), but not incident low muscle mass (OR, 0.59; 95% CI, 0.33-1.06; P = 0.076). Every 1-cm increase in flexibility during 4 years was associated with reduced risk of incident low muscle mass (OR, 0.96; 95% CI, 0.93-1.00; P = 0.025), low muscle strength (OR, 0.96; 95% CI, 0.94-0.98; P = 0.002) and sarcopenia (OR, 0.96; 95% CI, 0.93-0.99; P = 0.007). CONCLUSIONS: High flexibility was associated with reduced risk of incident low muscle strength and sarcopenia. Increases in flexibility were associated with reduced risk of incident low muscle mass, low muscle strength and sarcopenia. Flexibility exercises and monitoring the dynamic change of flexibility might be helpful in preventing sarcopenia among adults aged 50 years or over.

Protein-to-carbohydrate ratio is informative of diet quality and associates with all-cause mortality: Findings from the National Health and Nutrition Examination Survey (2007-2014).

Background: Dietary protein and carbohydrate intake and health outcomes have received extensive attention in recent years. However, the nutritional context in which these associations occur is less studied. Objectives: We aimed to examine the dietary context associating protein-to-carbohydrate ratio and all-cause mortality in US adults. Methods: Data from 17,814 adults enrolled in the 2007-2014 NHANES was analyzed. Information on mortality was obtained from the US mortality registry updated in December 2015. Diet quality was assessed using the Healthy Eating Index (HEI) and Total Nutrients Index (TNI). ANCOVA was used to test the mean differences in HEI and TNI scores across %E P:C quintiles. Linear regression examined the association of HEI and TNI with %E P:C. Cox proportional hazards regression evaluated the association between %E P:C and all-cause mortality. A restricted cubic spline examined the non-linear relationship between %E P:C and death. Results: Low %E P:C was associated with lower HEI and TNI scores while higher %E P:C was associated with healthier HEI and TNI scores. HEI and TNI were positively associated with %E P:C (ß = 0.22, 95% CI: 0.19-0.25, and ß = 0.16, 95% CI: 0.14-0.18), respectively. Low %E P:C was associated with an increased risk of death from all-cause. The higher HRs (95% CIs) of all-cause mortality were 1.97(1.46-2.65), and 7.35 (2.57-21.03) in the second quintile for the age-sex-ethnicity model, and the fully adjusted model, respectively. There was a significant reverse U-shape relationship between %E P:C and all-cause mortality with P, non-linearity < 0.001. Conclusion: This study indicates that a low %E P:C that gives emphasis to unhealthy foods increases the risk of death. Hence, it would be useful to consider the complete diet associated with protein intake when making dietary recommendations for populations.

Sarcopenia and sarcopenic obesity after cholecystectomy: A population-based study.

OBJECTIVE: The present study aimed to investigate the associations of cholecystectomy with low muscle mass, low muscle strength, sarcopenia, and sarcopenic obesity. METHODS: This population-based study included data from 4,909 participants aged 18 to 80 years. History of cholecystectomy was diagnosed using abdominal ultrasonography. Muscle mass was evaluated using a dual-energy x-ray absorptiometry scan, and muscle strength was evaluated using an electronic hand dynamometer. Sarcopenia was defined as the presence of both low muscle mass and low muscle strength. Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Multivariable logistic regression models were performed to investigate the associations of cholecystectomy with low muscle mass, low muscle strength, sarcopenia, and sarcopenic obesity. RESULTS: Participants with history of cholecystectomy were more likely than those without to have low muscle mass, low muscle strength, and sarcopenia. Furthermore, compared with cholecystectomy that occurred within 7 years (7 years is the median interval between cholecystectomy and the physical examination), participants with cholecystectomy that occurred more than 7 years ago had higher odds of sarcopenia. Finally, whether obesity was defined by BMI or body fat percentage, cholecystectomy was positively associated with sarcopenic obesity. CONCLUSIONS: Cholecystectomy is associated with low muscle mass, low muscle strength, sarcopenia, and sarcopenic obesity.

LncRNA and mRNA expression profiles in brown adipose tissue of obesity-prone and obesity-resistant mice.

Obesity-prone or obesity-resistant phenotypes can exist in individuals who consume the same diet type. Brown adipose tissue functions to dissipate energy in response to cold exposure or overfeeding. Long noncoding RNAs play important roles in a wide range of biological processes. However, systematic examination of lncRNAs in phenotypically divergent mice has not yet been reported. Here, the lncRNA expression profiles in BAT of HFD-induced C57BL/6J mice were investigated by high-throughput RNA sequencing. Genes that play roles in thermogenesis and related pathways were identified. We found lncRNA (Gm44502) may play a thermogenic role in obesity resistance by interacting with six mRNAs. Our results also indicated that seven differentially expressed lncRNAs (4930528G23Rik, Gm39490, Gm5627, Gm15551, Gm16083, Gm36860, Gm42002) may play roles in reducing heat production in obesity susceptibility by interacting with seven differentially expressed mRNAs. The screened lncRNAs may participate in the pathogenesis of weight regulation and provide insight into obesity therapy.