Objective·To evaluate the relationship between body mass index(BMI)and chronic metabolic diseases.Methods·The elderly(≥60 years old)who were underwent physical examination in the Physical Examination Center of Renji Hospital,Shanghai Jiao Tong University School of Medicine from 2014 to 2021 were studied.Their results of biochemical indicators were collected.Their height,body weight,and blood pressure were measured by trained nurses.The history of chronic metabolic diseases was collected by self-reported questionnaire.Systolic blood pressure≥140 mmHg(1 mmHg=0.133 kPa),diastolic blood pressure≥90 mmHg,or self-reported hypertension history was defined as hypertension.Fasting blood glucose≥7.0 mmol/L or self-reported history of diabetes was defined as diabetes.Total cholesterol≥6.2 mmol/L,triglyceride≥2.3 mmol/L,or self-reported history of dyslipidemia was defined as dyslipidemia.The relationship between BMI and hypertension,diabetes,and dyslipidemia was evaluated by using receiver operator characteristic(ROC)curve analysis and binary logistic regression.Results·Data of 59 083 subjects were collected[30 807 men and 28 276 women,average age:(67.9±6.3)years old].The prevalence of hypertension,diabetes and dyslipidemia was 76.5%(45 219/59 083),24.1%(14 225/59 083)and 50.0%(29 544/59 083),respectively.Compared to the elderly people aged 60?74 years,those aged 75 years and above had a higher proportion of hypertension and diabetes,and a lower proportion of dyslipidemia and no metabolic abnormalities.With ROC analysis,the BMI cut-off values for hypertension,diabetes,and dyslipidemia were 24.3,23.9,and 23.9 kg/m2.The BMI cut-off values for hypertension and diabetes in elderly men were similar to those in elderly women(for hypertension:24.3 kg/m2 in elderly men vs 24.2 kg/m2 in elderly women;for diabetes:24.0 kg/m2 in elderly men vs 23.7 kg/m2 in elderly women);however,BMI cut-off value for dyslipidemia was obviously higher in elderly men than that in elderly women(24.0 kg/m2 in elderly men vs 22.5 kg/m2 in elderly women).The BMI cut-off value for chronic metabolic diseases was higher in the elderly people aged 60?74 years than that in the elderly people aged 75 years and above(24.2?24.7 kg/m2 vs 22.9?23.8 kg/m2).Conclusion·Elderly people aged 60?74 years should maintain the BMI below 24.0 kg/m2,while those aged 75 years and above should aim for the BMI below 23.0 kg/m2,so as to reduce the risk of chronic metabolic diseases.

Objective To investigate the effects and mechanism of (-)-epigallocatechin-3-gallate (EGCG) on white adipose tissue angiogenesis in high fat diet rats.Methods Twenty-four male weaning SD rats were randomly divided into normal control group,high fat diet group and EGCG intervention group,8 rats in each group.Normal control group were fed with normal diet,high-fat diet group were fed with high-fat diet,EGCG intervention group were fed with high-fat diet along with intragastric administration of 200 mg/ (kg · d) EGCG.After 8 weeks,the rats were sacrificed.The adipocyte size and vascular density of the abdominal adipose tissue in rats in each group were observed under the microscope.The serum vascular endothelial growth factor (VEGF) concentration was detected by Elisa Kit.RT-PCR was used to detect the expression of VEGF,nuclear factor E2 (Nrf2),heme oxygenase-1 (HO-1),catalase (CAT),SOD,GPx,interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1) mRNA.Results The adipocyte size,number of vascular/each adipocyte,serum VEGF concentration and VEGF mRNA expression in adipose tissue of high fat diet group were significantly higher than those of normal control group (all P＜0.05).EGCG can significantly reduce the above indicators of high fat diet group (all P＜0.05).The expression of Nrf2,HO-1,SOD,GPx and CAT mRNA in adipose tissue of EGCG group was significantly higher than those in high fat diet group and normal control group (all P＜0.05).The expression of MCP-1 and IL-6 mRNA in adipose tissue of EGCG group was significantly lower than that in high fat diet group (all P＜0.05).Conclusion EGCG can decrease the production of serum VEGF,vascular density and the expression of VEGF mRNA in white adipose tissue of high fat diet rats,and inhibit the angiogenesis in white adipose tissue possibly due to its up-regulation of Nrf2/HO-1 pathway to increase the expression of antioxidant enzymes (SOD,CAT,GPx),reduce ROS production and decrease the inflammatory response.

Objective To evaluate the impact of total parenteral nutrition(TPN)on nutrition status and inflammatory markers in hospitalized fasted patients with inflammatory bowel disease(IBD).Methods A retrospective study was performed and 82 hospitalized fasted IBD patients [male/female=58/24,(39.4±14.5)years] who received TPN entered the study.Among them,38 patients had ulcerative colitis(UC)and 44 patients suffered from Crohn`s disease(CD).Clinical data(gender,age,duration of disease,history of disease,prednisone,immuno-suppressor,and antibiotics)were obtained from medical records.Nutritional parameters,C-creative protein(CRP),and erythrocyte sedimentation rate(ESR)before and after TPN were also obtained.Average caloric supplementation by TPN was(4 437.3±1 199.1)kJ/d and the nitrogen amount was(9.9±1.7)g/d.Median PN length was 15 days(7-54 days).67 IBD patients received a TPN formula with glutamine(≥14 d,25 patients vs.0-14 d,42 patients)and 15 IBD subjects received TPN without glutamine.Malnutrition was diagnosed by body mass index(BMI)and serum albumin level.Results The prevalence of undernutrition was 90.2％(74/82)in the study population.CD patients had a significantly longer history of disease [84(3-288)months vs.24(1-324)months,P<0.001] and a significantly lower BMI [(15.6±1.8)kg/m2 vs.(19.1±3.5)kg/m2,P<0.001] compared with those in UC patients.TPN improved nutritional parameters [serum albumin:(28.7±6.6)g/L before TPN vs.(31.7±5.8)g/L after TPN,P<0.001;pre-albumin:(174.1±85.5)mg/L before TPN vs.(227.2±82.8)mg/L after TPN,P<0.001].Conclusions TPN improves nutritional status in hospitalized fasted IBD patients.However,prospective randomized controlled trials are required to estimate the role of low-to-middle dosage of glutamine in IBD patients.

Objective To evaluate the effects of assisted reproduction technology ( ART) on gestational weight gain ( GWG) and glucose metabolism .Methods The study was performed in ART women with single-ton and full-term delivery .Age-and pre-pregnancy body mass index matched healthy women with spontaneous pregnancy, singleton, and full-term delivery were recruited as controls .Maternal characteristics (height, age, education level , pre-pregnancy body mass , pre-delivery body mass , medical history , history of abortion , fasting plasma glucose , triglyceride , total cholesterol , and glucose tolerance ) and fetal data ( delivery mode , gender , birth body mass , birth body length ) were collected by a trained nutritionist .Results A total of 200 women were recruited into this study (53 ART women and 147 controls).There was no significant difference in number of previous abortion ( the ratio between the women who had ≥3 abortions to those who had <3 abortions was 6∶47 in the ART group , and 10∶137 in the control group , χ2 =1.080 , P=0.299 ) .Compared with the control group, the ART group had higher education level (33 in the ART and 85 in the control group with un-dergraduate or higher education , 20 in the ART group and 62 in the control group with a college degree or lower education ,χ2 =6.303 , P=0.012 ) .There were no statistically significantly differences between the ART and the control groups in pre-pregnancy body mass index [ (22.00 ±3.05 ) kg/m2 vs.(21.81 ±2.62 ) kg/m2 , P=0.661] and average GWG [ (13.89 ±5.33) kg vs.(14.78 ±4.60) kg, P=0.247].GWG was appro-priate in 22 ART women, excess in 18, and inadequate in 13;in the control group, GWG was appropriate in 66 women, excess in 54, and inadequate in 27.The distribution of GWG showed no significant difference be-tween the two groups (χ2 =1.162 , P=0.247 ) .Oral glucose tolerance test in 24-28 gestational weeks showed no significant difference in fasting blood glucose between the ART and the control groups [ (4.66 ±0.39) mmol/L vs.(4.66 ±0.52) mmol/L, P=0.996], but 1-hour and 2-hour blood glucose levels were significantly in-creased in the ART women [ ( 7.87 ±1.83 ) mmol/L vs.( 7.31 ±1.51 ) mmol/L, P=0.034; ( 7.49 ± 1.29) mmol/L vs.(6.69 ±1.30) mmol/L, P=0.029].The overall prevalence of gestational diabetes melli-tus was 13.5%(27/200), with no significant difference between the ART and the control groups (18.9%vs. 11.6%, P=0.182 ) .Conclusion ART may not affect GWG , but it may cause changes of glucose metabo-lism during pregnancy .

Objective To investigate the relationship between serum ferritin and nonalcoholic fatty liver diseases in obese children.Methods Obese children aged 6 to 14 years old were enrolled.Duration of obesity, anthropometric parameters (height, body weight, waist circumference, hip circumference), bioelectrical impedance analysis (body fat), serological parameters (liver transaminases, lipid metabolism, fasting blood glucose, fasting insulin, serum ferritin) and liver ultrasonography were recorded.Insulin resistance (IR) index was calculated by homeostasis model assessment (HOMA).All subjects were divided into 3 groups according to liver ultrasound and liver transaminases : simple obese children (SOC) group, obese children with nonalcoholic simple fatty liver (NAFL) group and obese children with nonalcoholic steatohepatitis (NASH) group.Results 86 obese children entered the study, with a mean age of (10.4 ± 1.9) years, including 26 in the SOC group, 28 in the NAFL group and 32 in the NASH group.Waist circumference standard deviation score (SDS or Z-score), waist-to-hip ratio, HOMA-IR index and serum ferritin in the NASH group were obviously higher than those in the NAFL group [2.3 ± 0.3 vs.2.1 ± 0.3, P =0.020;1.0 ± 0.0 vs.0.9 ± 0.1,P=0.014;4.0±1.7 vs.2.9±1.8, P=0.006;(104.1 ±49.6) μg/Lvs.(68.4 ±22.7) μg/L, P=0.004] and the SOC group [2.3 ±0.3 vs.1.9 ±0.3, P=0.000;1.0±0.0vs.0.9 ±0.1, P=0.012;4.0 ±1.7 vs.2.5 ±1.6, P=0.001;(104.1 ±49.6) μg/Lvs.(59.2 ±28.9) μg/L, P=0.001], while there was no significant difference in body mass index Z-score [2.8 ± 0.5 vs.2.7 ± 0.6, P =0.524;2.8 ± 0.5 vs.2.7 ± 0.6, P =0.662].There were no significant differences between the NAFL group and the SOC group in the above indicators [2.1 ±0.3 vs.1.9 ±0.3, P =0.260;0.9 ±0.1 vs.0.9 ±0.1, P =0.952;2.9 ± 1.8vs.2.5±1.6, P=0.283;(68.4±22.7) μg/Lvs.(59.2±28.9) μg/L, P=0.161].Mter controlling age, body mass index, waist circumference, waist-to-hip ratio, triglyceride, and HOMA-IR index, serum ferritin was still positively correlated with the magnitude of nonalcoholic fatty liver diseases in obese children (r =0.335, P =0.002).Conclusion Serum ferritin is probably an independent risk factor for NASH in obese children.

Objective To evaluate the relationship between birth weight and nonalcoholic fatty liver diseases (NAFLD) in Chinese primary school students. Methods A cross-section study was conducted in ifve elementary schools in Gao Hang Town, Shanghai and 2163 students were enrolled in the study (1120 boys/1043 girls). Height, body weight, waist circumference and per-cent of body fat (bioelectrical impedance analysis) were measured by professional nutritionist after training. Birth weight, feeding pattern, height and body weight of parents were obtained by a self-completed questionnaire. NAFLD was diagnosed by ultra-sound. The risk factors of NAFLD were analyzed. Results The prevalence of NAFLD in the study population was 8.9%. The prevalence of NAFLD was signiifcantly higher in boys than that in girls (12.5%vs 5.0%, P<0.01). Logistic regression showed that sex (OR=1.97, 95%CI:1.21-3.21) and percent of body fat (OR=1.12, 95%CI:1.07-1.17) were the risk factors of NAFLD, and normal BMI was the protective factor of NAFLD (OR=0.09, 95%CI:0.04-0.19) in the study population. Conclusions The pre-valence of NAFLD is higher in boys than that in girls. Also overweight, and high percent of body fat are risk factors of NAFLD in children.

Objective To investigate the risk factors of central venous catheters (CVC) colonization.Methods A retrospective study was performed on adult patients with CVCs placement in Renji Hospital,Shanghai Jiaotong University from January 2006 to March 2010.Clinical data,catheter-related information (including duration of catheter placement,position and purpose of catheterization,and whether or not out-of-ward catheterization),catheter culture results,and prevalence of catheter-related blood stream infection (CRBSI)was collected.Results A total of 651 patients aged 18 to 97 years (median:63 years) were enrolled in the study,in whom 762 CVC were placed.The median duration of catheter placement was 1 1 days (2 to 122 days)and the total duration of CVC placement was 10 725 days.The prevalence of catheter colonization was 16％(122/762),and 134 germs were cultured.Gram-positive cocci was the most common colonized bactera (52.2％,70/122),followed by gram-negative bacilli (33.6％,45/122) and fungi (14.2％,19/122).Overall 13 CRBSI were confirmed and the rate of CRBSI was 1.21/1000 catheter-days.Logistic regression analysis demonstrated that the risk factors for CVC colonization included mechanical ventilation [odds ratio (OR) =1.783,95％ confidence interval (Cl) =1.108 ～2.870],serum albumin concentration less than 25 g/L before catheterization (OR =1.783,95％ Cl =1.357 ～ 6.757),prolonged duration of catheter placement (OR =1.105,95％ Cl =1.009 ～ 1.111),and out-of-ward catheterization (OR =2.837,95％ Cl =1.010 ～7.969).Conclusion Patients with prolonged duration of catheter placement and out-of-ward catheterization are inclined to CVC colonization.

Objective To investigate the incidence of metabolic syndrome among obese children in clinics. Methods One hundred and thirteen obese children aged 7 to 14 years were selected from clinics of nutrition(case group),and another 366 healthy students aged 7 to 14 years were served as controls.Height,body weight,waist circumference,hip circumference,blood pressure and liver ultrasound were measured,related biochemical parameters such as fasting blood glucose,fasting insulin,serum total cholesterol,triglyceride(TG),hiSh density lipoprotein and low density lipoprotein were detected,and the incidences of metabolic syndrome were obtained in two groups.Insulin resistance(IR)was evaluated by homeostasis model assessment(HOMA). Results There was no significant difference in age and gender between case group and control group(P>0.05).Body weight,body mass index(BMI),waist circumference,hip circumference,waist to hip ratio,systolic blood pressure,diastolic blood pressure,fasting blood glucose,fasting insulin,HOMA index and TG in case group were significantly higher than those in control group(P<0.01).The 75th percentile of HOMA index in control group was 3.28,and IR subgroup and non-IR subgroup were divided according to this cutpoint.In case group,body weight,BMI,waist circumference and TG in non-IR subgroup were significantly higher than those in IR subgroup (P< 0.05).Metabolic syndrome occurred in 51 cases(45.1%) in case group.The incidence of metabolic syndrome was higher in IR subgroup than that in non-IR group(50.0% vs 21.1%)(P<0.05). Conclusion The prevalence of metabolic syndrome is higher in overweight and obese children.IR has a close relationship with metabolic syndrome.

Objective To investigate the prevalence of parenteral nutrition related central venous catheter infection in elder patients with malignant tumors,and explore the risk factors. Methods The clinical data of 366 patients with malignant tumors who were managed with parenteral nutrition after operation were retrospectively analysed.The data of age,gender, body weight,diagnosis of primary disease,surgical approach,past history,volume of blood and albumin transfusion and time of fever(body temperature ≥38℃) were collected.Parenteral nutrition related parameters such as time of parenteral nutrition,total calorie,non-protein cMorie,amount of fat,protein and glucose,calorie to nitrogen ratio and carbohydrate to fat ratio were also recorded. Results The mean age of 366 patients was (71.8±6.9)years,mean time of parenteralnutrition was (10.6±6.3)d,and total time of catheterization was 3 336 days.The prevalence of parenteral nutrition related central venous catheter infection was 2.5%(9/366).Logistic regression analysis demonstrated that the relative risks of plasma albumin level before parenteral nutrition and time of high fever to catheter infection were 1.257 and 2.518,respectively(P<0.01 for both). Conclusion Plasma albumin level before parenteral nutrition and time of fever were two risk factors for parenteral nutrition related catheter infection in elder patients with malignant tumors.

Objective To investigate the distribution of homeostasis model assessment-insulin resistance(HOMA-IR)index and its relationship with metabolic syndrome and inflammatory cytokines in students aged 7 to 14 years. Methods The data of 366 students(n=163 for boys and n=203 for girls) aged 7 to 14 years were collected,including anthropometric parameters (height,body weight,body mass index,waist circumference,hip circumference and waist-hip ratio),blood pressure,total fat mass,fat proportion,fasting blood lipid,fasting blood glucose,fasting insulin and serum levels of inflammatory cytokines such as tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and interleukin-6(IL-6),and insulin resistance was evaluated by HOMA-IR index. Results The 75 th percentile of HOMA-IR index for boys and girls was 3.62 and 2.88,respectively.Body weight,height,body mass index,waist circumference,hip circumference,total fat mass and fat proportion were positively related to HOMA-IR index(P<0.01).When HOMA-IR index surpassed 75th percentile,age,anthropometric parameters,total fat mass,fat proportion and systolic blood pressure significantly increased in boy and girl students(P<0.05),no significant change occurred in diastolic blood pressure in boy and girl students,the levels of serum TNF-α and IL-6 significantly increased in boy students(P<0.05),while there was no significant change in level of CRP in boy students and levels of CRP.TNF-α and IL-6 in girl students. Conclusion The increase of HOMA-IR index leads to a dramatic increase of anthropometrie parameters,total fat mass,fat proportion and serum TNF-α and IL-6 in boy students,while that results in the increase of anthropometric parameters,total fat mass and fat proportion in sid students,with no significant change in serum inflammatory cytokines.