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Nutritional screening and assessment tools for patients with cirrhosis based on the Global Leadership Initiative on Malnutrition criteria.
He, Y, Hu, L, Wu, S, Li, L, Zhong, K, Li, J, Liu, N, Sun, X, Wang, Q, Sun, C, et al
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2024;(2):430-439
Abstract
BACKGROUND Malnutrition is highly prevalent and associated with complications and mortality in patients with cirrhosis. METHODS This was a prospective observational study. Patients with cirrhosis were screened using the Nutritional Risk Screening 2002, the Royal Free Hospital-Nutritional Prioritizing Tool and the Skeletal Muscle Index. Then, the sensitivity, specificity, positive and negative predictive values, and consistency with the Global Leadership Initiative on Malnutrition criteria results were calculated. We also analysed the association between nutritional status and short-term prognosis. RESULTS We enrolled 125 patients with cirrhosis, of whom 59.20% and 60.00% were malnourished based on the Global Leadership Initiative on Malnutrition criteria and Skeletal Muscle Index. Some 53.60% and 65.60%, respectively, were classified medium-to-high nutritional risk by Nutritional Risk Screening 2002 and the Royal Free Hospital-Nutritional Prioritizing Tool. The Royal Free Hospital-Nutritional Prioritizing Tool had the best predictive value, and it was more sensitive and had a better negative predictive value than the Nutritional Risk Screening 2002 Tool. The Skeletal Muscle Index also had good sensitivity and predictive value. The Royal Free Hospital-Nutritional Prioritizing Tool, Skeletal Muscle Index and Global Leadership Initiative on Malnutrition criteria showed high concordance. The 3- and 6-month mortality rates were significantly higher for patients with moderate-to-high nutritional risk or malnutrition, regardless of the tool. CONCLUSIONS When assessing cirrhosis with the Global Leadership Initiative on Malnutrition criteria, the Royal Free Hospital-Nutritional Prioritizing Tool is best for nutritional screening and the Skeletal Muscle Index is also a good nutritional assessment tool.
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Retinopathy is associated with impaired cognition in patients undergoing peritoneal dialysis.
Liao, J, Wei, Q, He, Y, Liao, Y, Xiong, Z, Wang, Q, Ding, D, Huang, X, Xiong, Z, Wu, Y
Renal failure. 2023;(2):2258989
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Abstract
Objective: Previous studies have shown a relationship between retinopathy and cognition including population with and without chronic kidney disease (CKD) but data regarding peritoneal dialysis (PD) are limited. This study aims to investigate the relationship between retinopathy and cognitive impairment in patients undergoing peritoneal dialysis (PD). Methods: In this observational study, we recruited a total of 107 participants undergoing PD, consisting of 48 men and 59 women, ages ranging from 21 to 78 years. The study followed a cross-sectional design. Retinal microvascular characteristics, such as geometric changes in retinal vascular including tortuosity, fractal dimension (FD), and calibers, were assessed. Retinopathy (such as retinal hemorrhage or microaneurysms) was evaluated using digitized photographs. The Modified Mini-Mental State Examination (3MS) was performed to assess global cognitive function. Results: The prevalence rates of retinal hemorrhage, microaneurysms, and retinopathy were 25%, 30%, and 43%, respectively. The mean arteriolar and venular calibers were 63.2 and 78.5 µm, respectively, and the corresponding mean tortuosity was 37.7 ± 3.6 and 37.2 ± 3.0 mm-1. The mean FD was 1.49. After adjusting for age, sex, education, mean arterial pressure, and Charlson index, a negative association was revealed between retinopathy and 3MS scores (regression coefficient: -3.71, 95% confidence interval: -7.09 to -0.33, p = 0.03). Conclusions: Retinopathy, a condition common in patients undergoing PD, was associated with global cognitive impairment. These findings highlight retinopathy, can serve as a valuable primary screening tool for assessing the risk of cognitive decline.
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Association between body fat composition and hyperhomocysteinemia in the analysis of the baseline data of the Northwest China Natural Population Cohort: Ningxia Project (CNC-NX).
Liu, W, Li, Q, Wang, Q, Ma, S, Yang, X, Zhang, J, Qiu, J, Li, J, Yang, C, Li, X, et al
Journal of clinical hypertension (Greenwich, Conn.). 2023;(6):573-581
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Abstract
The authors conducted an observational study to explore the association between body fat composition and the risk of hyperhomocysteinemia (HHcy) and their combined effect on the risk of developing cardiovascular disease (CVD). Adults aged 18-74 years from the Northwest China Natural Population Cohort: Ningxia Project (CNC-NX) were recruited in this study. Association between body fat composition and HHcy was evaluated by logistic regression model. Restricted cubic spline was used to find nonlinear association. The impact of the interaction between HHcy and body fat composition on CVD was evaluated using the addition interaction model and mediation effect model. In total, 16 419 participants were included in this research. Body fat percentage, visceral fat level, and abdominal fat thickness were positively associated with overall HHcy (p for trend < .001). Adjusted odds ratios (ORs) in quarter 4 were 1.181 (95% CI: 1.062, 1.313), 1.202 (95% CI: 1.085, 1.332), and 1.168 (95% CI: 1.055, 1.293) for body fat percentage, visceral fat level, and abdominal fat thickness, respectively, compared with those in quarter 1. Subgroup analysis indicated age, estimated glomerular filtration rate (eGFR), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and CVD were the interaction factors of body fat percentage, visceral fat level, abdominal fat thickness with HHcy (all p for interaction < .05). ORs of CVD were higher in participants with HHcy and high body fat. Body fat composition was positively associated with HHcy, indicating that reducing body, abdominal, and visceral fat content may lower the risk of HHcy and CVD.
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Increased nutrition risk is associated with a prolonged negative conversion of viral RNA in children and adolescents with COVID-19.
Cai, Y, Huang, Z, Wu, B, Wu, P, Zhang, Y, Lin, Y, Wang, Q, Liang, S, Chen, S
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2023;(5):1073-1081
Abstract
BACKGROUND This study aimed to determine the factors affecting the time to negative conversion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents, with particular reference to nutrition risk assessment on admission. METHODS This retrospective observational study was conducted in a sentinel hospital for novel coronavirus in Quanzhou, China. The study population comprised children and adolescents with COVID-19 admitted to the isolation wards between March 25 and April 12, 2022. Based on the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), nutrition risk screening was performed within 24 h of admission. Univariate and multivariate analyses were used to identify independent factors for the time to negative viral RNA conversion. RESULTS A total of 185 patients with confirmed COVID-19 were included in this study. The median time to viral RNA conversion (from the first day of a positive nucleic acid test to the first day of consecutive negative results) was 15 days (IQR 12-18 days), ranging from 4 to 25 days. High nutrition risk (hazard ratio [HR]: 0.543, 95% CI: 0.334-0.881) and fever (HR: 0.663; 95% CI: 0.483-0.910) were independent factors influencing the negative conversion of SARS-CoV-2 RNA. CONCLUSION High nutrition risk and fever were independently associated with delayed viral clearance in children and adolescents with SARS-CoV-2 infection, so these factors should be considered during the treatment plans for infected children and adolescents.
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Monitoring Spike Potential and Abrupt Impedance Rise with Concomitant Temperature/Contact Force Change for Timely Detection of the Occurrence of "Silent" or "Nonaudible" Steam Pop.
Di, C, Wang, Q, Wu, Y, Li, L, Lin, W
Journal of interventional cardiology. 2023;:8873404
Abstract
AIM: Steam pop (SP) during radiofrequency catheter ablation (RFCA) for pulmonary vein isolation (PVI) may cause cardiac perforation, which may require drainage and emergent thoracotomy or even lead to death. Data investigating the timely detection of the occurrence of "silent" or "nonaudible" SP events are limited. METHODS AND RESULTS A total of 516 consecutive atrial fibrillation (AF) patients who underwent index PVI were included in this retrospective observational study. The duration, power, impedance, temperature, and contact force (CF) of RFCA were continually monitored and recorded throughout the procedure. A total of 15 (2.9%) audible SP events occurred in 14 patients; 2 of the patients developed pericardial tamponade, 1 patient underwent drainage, and 1 patient underwent emergent thoracotomy. The time from RFCA initiation to the occurrence of audible SP was 19.4 ± 6.9 s. Abrupt temperature change occurred in 13 (86.7%) of the 15 SP events, of which 8 (53.3%) exhibited an abrupt temperature rise of 2.3 ± 1.0°C, 5 (33.3%) exhibited an abrupt temperature drop of 2.3 ± 1.3°C, and 2 (13.3%) exhibited no discernible temperature change. CONCLUSIONS In conclusion, simultaneously recorded spike potentials and abrupt impedance rise with concomitant temperature and/or CF change could be a feasible method for the timely detection of the occurrence of audible, "silent," or "nonaudible" SP events, particularly in regions where the risk of perforation may be of concern.
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The Clinical Application Value of the Prognostic Nutritional Index for the Overall Survival Prognosis of Patients with Esophageal Cancer: A Robust Real-World Observational Study in China.
Kang, J, Yang, G, Wang, D, Lin, Y, Wang, Q, Luo, H
Computational and mathematical methods in medicine. 2022;:3889588
Abstract
Esophageal cancer is a kind of cancer with high morbidity and mortality, which is accompanied by a profound poor prognosis. A prognostic nutritional index, based on serum albumin levels and peripheral lymphocyte count, has been confirmed to be significantly associated with various cancers. This study was aimed at exploring the prognostic significance of PNI in the overall survival prognosis of patients with esophageal cancer. As a real-world study based on the big database, clinical data of 2661 patients with esophageal cancer were evaluated retrospectively, and the individuals were randomly divided into training and testing cohorts. In these two cohorts, patients are classified into a high-risk group (PNI < 49) and a low-risk group (PNI ≥ 49). Univariate and multivariate analyses were performed to analyze the independent risk factors for the prognosis of esophageal cancer patients by using the Cox proportional hazards regression model. In this study, whether in the training cohort or the testing cohort, according to the univariate analysis, gender, tumor size, tumor grade, T stage, N stage, M stage, TNM stage, and PNI were significantly correlated with overall survival. Furthermore, the multivariate analysis showed that gender, T stage, N stage, M stage, TNM stage, and PNI were independent prognostic risk factors for esophageal cancer. PNI can be regarded as an independent prognostic factor combined with gender, T stage, N stage, M stage, and TNM stage, and it might be a novel reliable biomarker for esophageal cancer.
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High remnant cholesterol level is relevant to diabetic retinopathy in type 2 diabetes mellitus.
Shan, Y, Wang, Q, Zhang, Y, Tong, X, Pu, S, Xu, Y, Gao, X
Lipids in health and disease. 2022;(1):12
Abstract
BACKGROUND Diabetic retinopathy (DR) is the primary oculopathy causing blindness in diabetic patients. Currently, there is increasing interest in the role of lipids in the development of diabetic retinopathy, but it remains controversial. Remnant cholesterol (RC) is an inexpensive and easily measurable lipid parameter; however, the relationship between RC and DR in type 2 diabetes mellitus (T2DM) has not been elucidated. This research investigates the relevance between RC levels and DR severity while building a risk prediction model about DR. METHODS In this single-centre retrospective cross-sectional study. Each hospitalised T2DM patient had no oral lipid-lowering drugs in the past three months, and coronary angiography showed epicardial coronary artery stenosis of less than 50% and completed seven-field stereo photographs, fluorescein fundus angiography, and optical coherence tomography detection. The RC value is calculated according to the internationally recognised formula. Binary logistic regression was used to correct confounding factors, and the receiver operating characteristic (ROC) analysis was used to identify risk factors and assess the nomogram's diagnostic efficiency. RESULTS A total of 456 T2DM patients were included in the study. The RC levels in the DR team was higher [0.74 (0.60-1.12) mmo/l vs 0.54 (0.31-0.83) mmol/l P < 0.001] in the non-DR team. After adjusting for confounding elements, RC levels are still associated with DR risk (OR = 5.623 95%CI: 2.996-10.556 P < 0.001). The ratio of DR in every stage (except mild non-proliferative diabetic retinopathy) and DME in the high RC level team were further increased compared to the low-level team (all P < 0.001). After ROC analysis, the overall risk of DR was predicted by a nomogram constructed for RC, diabetes duration, and the neutrophil-lymphocyte ratio as 0.758 (95%CI 0.714-0.802 P < 0.001). CONCLUSIONS High RC levels may be a potential risk factor for diabetic retinopathy, and the nomogram does better predict DR. Despite these essential findings, the limitation of this study is that it is single-centred and small sample size analysis.
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Serum calcium-phosphorus product for predicting the risk of osteoporotic vertebral compression fractures in elderly patients: a retrospective observational study.
Ying, P, Gu, M, Jiang, X, Xu, Y, Tong, L, Xue, Y, Wang, Q, Huang, Z, Ding, W, Dai, X
Journal of orthopaedic surgery and research. 2022;(1):57
Abstract
BACKGROUND This study retrospectively analyzed and evaluated the potential correlations of serum calcium, serum phosphorus, and calcium-phosphorus product (Ca-P product) with the incidence of osteoporotic vertebral compression fractures (OVCFs), with the aim of exploring whether the Ca-P product can be used as a serological indicator to predict the risk of OVCFs. METHODS This study randomly enrolled 400 elderly patients in our hospital with OVCFs and 400 patients with hip and knee arthroplasty due to femoral head necrosis or osteoarthritis from August 2013 to April 2021. Age, sex, past medical history, and admission biochemical indicators, including albumin, blood urea nitrogen, serum creatinine, serum calcium and serum phosphorus, were collected for statistical analysis. RESULTS Albumin, serum calcium, serum phosphorus, Ca-P product, corrected serum calcium and corrected Ca-P product were lower in the OVCF group than in the non-OVCF group (P < 0.05). Multivariate logistic regression analysis showed that low values of serum calcium, serum phosphorus, Ca-P product, corrected blood calcium, and corrected Ca-P product can all be risk factors for OVCF. The ROC curve showed that the Ca-P product and corrected Ca-P product were effective in predicting the risk of OVCFs. The predictive value of the Ca-P product was the best; the cutoff point was 29.88, the sensitivity was 0.72 and the specificity was 0.62. The cutoff point of the corrected Ca-P product was 30.50, the sensitivity was 0.74, and the specificity was 0.62. CONCLUSION The Ca-P product and corrected Ca-P product can be used as serological indicators to predict the risk of OVCFs in elderly individuals. Early clinical interventions targeting this risk factor can further reduce the risk of OVCFs. Also, timely and regular testing of the serum calcium and phosphorus level is recommended and encouraged for this group of people.
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Associations between body composition, fat distribution and metabolic consequences of excess adiposity with severe COVID-19 outcomes: observational study and Mendelian randomisation analysis.
Gao, M, Wang, Q, Piernas, C, Astbury, NM, Jebb, SA, Holmes, MV, Aveyard, P
International journal of obesity (2005). 2022;(5):943-950
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BACKGROUND Higher body mass index (BMI) and metabolic consequences of excess weight are associated with increased risk of severe COVID-19, though their mediating pathway is unclear. METHODS A prospective cohort study included 435,504 UK Biobank participants. A two-sample Mendelian randomisation (MR) study used the COVID-19 Host Genetics Initiative in 1.6 million participants. We examined associations of total adiposity, body composition, fat distribution and metabolic consequences of excess weight, particularly type 2 diabetes, with incidence and severity of COVID-19, assessed by test positivity, hospital admission, intensive care unit (ICU) admission and death. RESULTS BMI and body fat were associated with COVID-19 in the observational and MR analyses but muscle mass was not. The observational study suggested the association with central fat distribution was stronger than for BMI, but there was little evidence from the MR analyses than this was causal. There was evidence that strong associations of metabolic consequences with COVID-19 outcomes in observational but not MR analyses. Type 2 diabetes was strongly associated with COVID-19 in observational but not MR analyses. In adjusted models, the observational analysis showed that the association of BMI with COVID-19 diminished, while central fat distribution and metabolic consequences of excess weight remained strongly associated. In contrast, MR showed the reverse, with only BMI retaining a direct effect on COVID-19. CONCLUSIONS Excess total adiposity is probably casually associated with severe COVID-19. Mendelian randomisation data do not support causality for the observed associations of central fat distribution or metabolic consequences of excess adiposity with COVID-19.
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Mendelian randomization analyses support causal relationships between blood metabolites and the gut microbiome.
Liu, X, Tong, X, Zou, Y, Lin, X, Zhao, H, Tian, L, Jie, Z, Wang, Q, Zhang, Z, Lu, H, et al
Nature genetics. 2022;(1):52-61
Abstract
The gut microbiome has been implicated in a variety of physiological states, but controversy over causality remains unresolved. Here, we performed bidirectional Mendelian randomization analyses on 3,432 Chinese individuals with whole-genome, whole-metagenome, anthropometric and blood metabolic trait data. We identified 58 causal relationships between the gut microbiome and blood metabolites, and replicated 43 of them. Increased relative abundances of fecal Oscillibacter and Alistipes were causally linked to decreased triglyceride concentration. Conversely, blood metabolites such as glutamic acid appeared to decrease fecal Oxalobacter, and members of Proteobacteria were influenced by metabolites such as 5-methyltetrahydrofolic acid, alanine, glutamate and selenium. Two-sample Mendelian randomization with data from Biobank Japan partly corroborated results with triglyceride and with uric acid, and also provided causal support for published fecal bacterial markers for cancer and cardiovascular diseases. This study illustrates the value of human genetic information to help prioritize gut microbial features for mechanistic and clinical studies.