Background Multimorbidity imposes a heavy burden on individuals, families, and society. There are relatively few studies exploring patterns of multimorbidity among middle-aged adults in China. Objective To explore the current status of multimorbidity, associated risk factors, and multimorbidity patterns among adults aged 45-64 years in China, so as to provide a scientific basis to prevent and control multimorbidity in China. Methods A total of 5494 adults aged 45-64 years from the Chinese Health and Nutrition Survey (CHNS) in 2018 were selected. Of these, 2494 (45.39%) were men and 3000 (54.61%) were women. The nine diseases included were hypertension, diabetes, dyslipidaemia, obesity, mild cognitive impairment (MCI), myocardial infarction, stroke, asthma, and tumor. The prevalence of each disease or multimorbidity was expressed as N (%). Comparisons of multimorbidity prevalence between different groups were performed using the χ² test or Cochran-Armitage trend test. Association rule with the Apriori algorithm was used to explore the pattern of multimorbidity, with parameters set at a minimum conditional support of 3.00%, a minimum rule confidence of 50.00%, and a lift of >1.20. Logistic regression was used to evaluate the associations between selected risk factors and multimorbidity. Results In 2018, 37.44% of participants reported multimorbidity in 15 provinces of China. The prevalence of diseases in descending order was dyslipidaemia (39.99%), hypertension (39.48%), obesity (16.42%), MCI (14.47%), diabetes (14.16%), tumor (1.09%), stroke (1.04%), myocardial infarction (0.71%), and asthma (0.64%). A total of seven multimorbidity patterns were identified in this group. Obesity paired with hypertension, and diabetes paired with dyslipidemia were the two major patterns of multimorbidity in the general population and age or sex subgroups. The multimorbidity patterns of different populations were concentrated in the combination of obesity, hypertension, diabetes, and dyslipidemia. The risk of multimorbidity was lower in females than in males (OR=0.85, 95%CI: 0.75, 0.97). The multimorbidity risk was 1.56 times higher in the 55-64 years group than in the 45-54 years group (OR=1.56, 95%CI: 1.40, 1.75). Drinking in the past year increased the risk of multimorbidity by 25% (OR=1.25, 95%CI: 1.08, 1.45) compared to no alcohol comsumption in the past year. High and medium levels of physical activity were associated with a decreased OR (high: OR=0.74, 95%CI: 0.65, 0.85; medium: OR=0.81, 95%CI: 0.70, 0.93) with low level of physical activity as reference. Conclusion In 2018, there was a high prevalence rate of multimorbidity among middle-aged adults in China. The main multimorbidity patterns were obesity-hypertension and diabetes-dyslipidemia. Surveillance and interventions should be strengthened particularly for men, individuals with alcohol consumption or insufficient physical activity, and those with major multimorbidity patterns.

Objective:Analyze the mediating and moderating effects of the relationship between food intake and blood glucose levels.Methods:This study uses data from the China Health and Nutrition Survey project in the survey 2018, involving 11 043 adults aged 18 years or older, who have complete dietary data, waist circumference (WC), glycated hemoglobin A1c (HbA1c) indicators, and other key variables. Food consumption data was gathered via three consecutive 24-hour dietary recalls and weighing accounting method, which included two weekdays and one weekend day. The average daily intake of various foods and total energy intake were calculated. The mediation effect and moderation effect analysis were conducted using simple mediation models, direct moderation effect models, and moderated mediation analysis theoretical models. The confidence interval method (bootstrap method) was performed for testing and analysis.Results:A total of 4 951 males and 6 092 females were included in the stratified analysis by gender. The mediating effects on the rice, wheat, and red meat→WC→HbA1c were all statistically significant in males. The standardized coefficients were -0.009 ( P<0.001), 0.013 ( P<0.001), and -0.005 ( P=0.008), respectively. In females, the mediating effect on the wheat→WC→HbA1c was statistically significant, and the standardized coefficient was 0.017 ( P<0.001); the impact of red meat intake on HbA1c is negatively regulated by the intake of dark vegetables, with a direct moderating effect; the standardized coefficient of the interaction term between red meat and dark vegetables was -0.024 ( P=0.008). Dark vegetables have a moderated mediator on the pathway from rice to WC and HbA1c ( a3b1=-0.003, P=0.041) in males. The mediating effect of WC is negatively regulated by the intake of dark vegetables (mediation effect difference U1/-1=-0.006, P=0.048). Dark vegetables showed a moderated mediator on the pathway from wheat to WC and HbA1c ( a3b1=-0.004, P=0.045) in females. The mediating effect of WC is negatively regulated by the intake of dark vegetables (mediation effect difference U1/-1=-0.009, P=0.049). Conclusions:Changes in WC indicators caused by rice, wheat, and red meat intake. WC could mediate between rice, wheat, red meat, and HbA1c. Dark vegetables directly or indirectly regulate HbA1c levels by interacting with rice, wheat, and red meat.

Background China is witnessing an accelerated aging process and an increasingly serious situation of Parkinson's disease. Research on the pre-disease stage and its related influencing factors has gained more and more attention. Objective To analyze the current situation of prodromal Parkinson's disease (pPD) of people aged 55 years and above in four provinces of China, and to explore its influencing demographic and socio-economic characteristics. Methods Using the data of Community-based Cohort Study on Nervous System Disease in 2020, a total of 10724 participants with complete data on demographic and socio-economic factors and risk factors on Parkinson's disease were selected. Based on the criteria recommended by the International Parkinson and Movement Disorder Society (MDS), we evaluated risk level (i.e., post-test probability) of pPd, prevalence of possible or probable pPD, and number of pPD-related risk/prodromal markers in the participants. Multiple linear regression and multiple logistic regression models were used to analyze the influencing socio-demographic factors of risk level of pPd and prevalence of possible or probable pPD, and Poisson regression and multinomial logit regression models were used to analyze the influencing socio-demographic factors of the number of pPD-related risk/prodromal markers in the total sample, men, and women, respectively. Results The median (P₂₅, P₇₅) of post-test probability of pPD in 2020 was 0.78% (0.42%, 1.66%), the prevalence rate of possible or probable pPD was 0.34%, and 69.03% of the participants reported 3-5 pPD-related risk/prodromal markers. The post-test probabilities of men, those with older age, lower education level, per capita monthly household income < 1000 yuan, urban residency, or without active employment were higher (P<0.05). Men and being aged ≥ 75 years had a higher prevalence of possible or probable pPD (P<0.05). The OR of possible or probable pPD was 8.404 (95%CI: 2.839−24.879) in subjects aged ≥ 75 years versus those aged 55−64 years. Males, those without active employment, being less educated, with older age, and urban residents were more likely to report pPD-related risk/prodromal markers than those of the opposite groups (P<0.05). Conclusion Men, subjects aged ≥75 years, those with lower education level, urban residents, and those without active employment have higher risk levels of pPD and are more likely to report pPD-related risk/prodromal markers among people aged 55 years and above in the four provinces of China, poor economic situation is also associated with higher risk levels of pPD.

Background Gastrointestinal microbiota plays an important role in the development of Parkinson's disease (PD), and dietary factors have a great impact on intestinal micro ecology. At present, few studies focus on red meat and PD, especially prodromal PD (pPD). Objective To understand the relationships of the intake of red meat and processed meat products with pPD and the number of risk/prodromal markers, and to explore the association of dietary factors with pPD. Methods Based on the data of Community-based Cohort Study on Nervous System Disease in 2018 and 2020, adults aged 55 years and older with complete demographic information, dietary survey information, and information on risk factors related to PD were selected from four provinces of China. After excluding those reporting abnormal total energy intake or those reporting alcohol drinking or abused drugs for a long period of time, and confirmed mental diseases with prescribed drugs, a total of 10003 subjects were included. Food frequency questionnaire was used to calculate the intake of red meat and processed meat products. The pPD-related risk/prodromal markers were selected following the International Parkinson and Movement Disorder Society criteria for pPD, and the risk level and the number of markers of pPD were then calculated. The relationship between the intake of red meat and processed meat and the risk level of pPD was analyzed by multiple linear regression. The relationship between the intake of red meat and processed meat and the pPD marker number groups was analyzed by multinomial logit regression model. Results In 2018, the intake of red meat and processed meat was 28.57 g·d⁻¹ in the target population. In 2020, the median of the number of risk/prodromal markers was 3, and the median M (P₂₅, P₇₅) of the posterior probability of pPD was 0.74% (0.42%, 1.49%). The multiple linear regression analysis showed that the higher the intake of red meat and processed meat, the higher the risk level of pPD in follow-up (b=0.021, P<0.05). The multiple logit regression model showed that compared with the lowest quartile (Q1), the highest quartile (Q4) group of red meat and processed meat intake were more likely reporting 3−5 risk/prodromal markers than ≤ 2 risk/prodromal markers (OR=1.185, 95%CI: 1.015−1.382). Conclusion The intake level of red meat and processed meat is related to the risk level of pPD, and a higher intake of red meat and processed meat may be a potential risk factor of pPD.

Background It has been reported that a high intake of dairy products might be associated with an increased risk of Parkinson's disease (PD) in foreign studies, but no such study has yet been conducted on prodromal Parkinson's disease (pPD) and the Chinese population. Objective To investigate the prospective relationship between the intake of dairy products and pPD among people aged 55 and above in four provinces of China. Methods The research data were obtained from the baseline 2018 and follow-up 2020 surveys of Community-based Cohort Study on Nervous System Disease. A total of 9984 residents were selected who participated in both waves of surveys and had complete data on demographics, dietary products intake, and risk factors for PD. We evaluated the risk level and the numbers of related risk/prodromal markers of pPD in the participants based on a criteria recommended by the International Parkinson and Movement Disorder Society (MDS). Food Frequency Questionnaire was used to obtain food consumption data in the past 12 months, and the intake of dairy products was calculated and divided into non-consumption and tertiles of consumption (T1, T2, and T3 from low to high). Multiple linear regression was used to analyze the association between baseline dairy intake and risk level of follow-up pPD. Poisson regression and multinomial logit regression models were used to analyze the relationship of baseline dairy products and the number of risk/prodromal markers of follow-up pPD in the population, and multiple logistic regression was used to analyze each risk/prodromal marker of follow-up pPD according to baseline levels of dairy products intake. Results The percentage of residents without dairy products consumption was 58.02% in 2018, and the dairy products intakes were relatively high among residents being female, aged 55 to 74 years, with an education level of middle school and above, with a per capita monthly household income ≥ 1000 yuan, living in urban areas, and without active employment (P<0.05). The median risk level of pPD was 0.74% in 2020, and the proportion of residents with 3 to 5 markers was 66.74%. The multiple linear regression analysis results suggested no association between baseline dairy intake and follow-up risk level of pPD. The Poisson regression model showed that the high dairy products intake group at baseline (T3, median=250.00 g·d⁻¹) was found to be 1.159 (95%CI: 1.065~1.261, P_trend<0.001) times more likely to have the risk/prodromal markers of pPD at follow-up than non-consumers. When the number of markers was grouped, no statistically significant association was found by multiple logistic regression analysis. Conclusion Although high dairy products intake levels might be associated with pPD risk/prodromal markers among people aged 55 and above in four provinces of China, no direct association is found between dairy products intake and pPD risk levels in this study.

Background Changes in cognitive function exist before the onset of clinical Parkinson's disease. However, studies on association between cognitive function and prodromal Parkinson's disease (pPD) are limited. Objective To estimate probability of pPD and assess its association with global and domain cognitive function in Chinese elders. Methods Data were drawn from the Community-based Cohort Study on Nervous System Disease 2018 (baseline) and 2020 (follow-up). We selected 3911 residents aged 55 and above who participated the two waves, without Alzheimer's disease and Parkinson's disease, and with completed information on demographics, disease history, cognitive function test, and risk factors of Parkinson's disease. Cognitive function was assessed using the Chinese version of Montreal Cognitive Assessment Scale. Calculation of probability of pPD and assessment of possible (probability between 30% and <80%) or probable (probability ≥80%) pPD were performed according to the criteria published by the International Parkinson and Movement Disorder Society. Multiple linear regression model was employed to analyze the association between baseline cognitive function and follow-up probability of pPD. Results The medians of scores of baseline global cognitive function and cognitive domains in terms of memory, execution, visuospatial function, language, attention, and orientation were 23, 12, 9, 6, 5, 14, and 6, respectively. The median of follow-up probability of pPD was 0.87%, and the proportion of participants with possible or probable pPD was 0.4%. The differences in the distribution of follow-up probability of pPD were significant in groups by baseline global cognitive score quartiles (χ²=21.68, P<0.001). A higher baseline global cognitive score was considerably related to a lower follow-up probability of pPD, b(95%CI)=0.994(0.988~0.999), P=0.040. After adjusting for selected confounders, the results of multiple linear regression analyses showed that the probability of pPD in the highest quartile group was decreased by 10.7% (b=0.893, 95%CI: 0.794-0.992, P=0.034) relative to the lowest quartile group, and the trend was significant (trend P=0.031). Higher baseline index scores of execution, attention, and orientation were highly related to a lower follow-up probability of pPD (all P<0.05). Conclusion Declines in global cognitive function and cognitive domains of execution, attention, and orientation may associate with a higher probability of pPD in middle-aged and elderly population, which suggests the significance of cognitive intervention in early stage for pPD prevention.

Objective:To analyze probability of prodromal Parkinson's disease (pPD) and assess the association between global cognitive function and cognitive domain function and probability of pPD in ≥55 years old middle-aged and elderly people in Hebei, Zhejiang, Shaanxi and Hunan Provinces in China.Methods:Data were collected from dataset of the Community-based Cohort Study on Nervous System Disease 2020. We selected 4 634 Alzheimer disease and Parkinson's disease free persons aged ≥55 years with completed information on demographics, disease history, cognitive test, and risk factors of Parkinson's disease for this study. Cognitive function was assessed using Montreal Cognitive Assessment Scale (Chinese version). Calculation of probability of pPD and assessment of possible/probable pPD were performed according to the criteria published by the International Parkinson and Movement Disorder Society. Multivariate linear regression model was used to analyze the association between cognitive function and probability of pPD.Results:The M ( Q1, Q3) of global cognitive function and cognitive domains in terms of memory, execution, visuospatial function, language, attention and orientation were 25 (20, 30), 13 (11, 15), 10 (7, 12), 6 (4, 7), 5 (4, 6), 15 (12, 18) and 6 (6, 6) points, respectively. The M( Q1, Q3) of probability of pPD was 0.42% (0.80%, 1.73%), and the proportion of the study subjects with possible/probable pPD was 0.4%. Differences in the distribution of probability of pPD were significant among groups by total cognitive score quartiles ( P<0.001), and the difference in proportions of study subjects with possible/probable pPD was significant and showed decline trend ( P=0.001). After adjusted for confounders, the results of multivariate linear regression analyses showed that probability of pPD in the Q2, Q3 and Q4 group decreased by 23.4%, 31.2% and 20.1% compared with Q1 group, and corresponding β values were 0.766 (95% CI: 0.702-0.836), 0.688 (95% CI: 0.631-0.751) and 0.799 (95% CI: 0.730-0.875), respectively, the trend was significant ( P<0.001). Higher index scores of execution, visuospatial function, language, attention and orientation were highly related to lower probability of pPD ( P<0.001). Conclusion:Declines in global cognitive function and cognitive domains of execution, visuospatial function, language, attention and orientation might increase the probability of pPD in middle-aged and elderly people, suggesting the importance of cognitive intervention in early stage for pPD prevention.

Glycolytic metabolism enzymes have been implicated in the immunometabolism field through changes in metabolic status. PGK1 is a catalytic enzyme in the glycolytic pathway. Here, we set up a high-throughput screen platform to identify PGK1 inhibitors. DC-PGKI is an ATP-competitive inhibitor of PGK1 with an affinity of K _d = 99.08 nmol/L. DC-PGKI stabilizes PGK1 in vitro and in vivo, and suppresses both glycolytic activity and the kinase function of PGK1. In addition, DC-PGKI unveils that PGK1 regulates production of IL-1β and IL-6 in LPS-stimulated macrophages. Mechanistically, inhibition of PGK1 with DC-PGKI results in NRF2 (nuclear factor-erythroid factor 2-related factor 2, NFE2L2) accumulation, then NRF2 translocates to the nucleus and binds to the proximity region of Il-1β and Il-6 genes, and inhibits LPS-induced expression of these genes. DC-PGKI ameliorates colitis in the dextran sulfate sodium (DSS)-induced colitis mouse model. These data support PGK1 as a regulator of macrophages and suggest potential utility of PGK1 inhibitors in the treatment of inflammatory bowel disease.

Background In recent years, Chinese residents have undergone profound changes in dietary habits and lifestyle, and the increasing prevalence rate of central obesity has become one of the major public health problems. Objective To analyze the changes in waist circumference distribution and central obesity prevalence, and the differences by demographic and socioeconomic factors among Chinese adults aged 18-35 in 15 provinces (autonomous regions and municipalities) from 1993 to 2018, and to provide evidence for further exploration of etiology and control measures. Methods Based on the data of nine follow-up rounds of the China Health and Nutrition Survey from 1993 to 2018, adults aged 18 to 35 were selected as study subjects. After excluding the records of missing demographic information or abnormal physical measurement data, a total of 16008 subjects were included in this study. Central obesity was diagnosed by WS/T 428—2013 Criteria of weight for adults. Spearman rank test was used to analyze the changes of waist circumference; Cochran-Armitage trend test was used to analyze the trends of central obesity prevalence rate; multiple logistic regression analysis was used to analyze the influencing factors of central obesity in the whole population; subgroup analysis on waist circumference and central obesity prevalence rate was also conducted among participants from the 2018 follow-up survey. survey. Results From 1993 to 2018, the waist circumference and prevalence rate of central obesity of adults aged 18-35 in 15 provinces (autonomous regions and municipalities) significantly increased by year (P<0.05). In males, the prevalence rate increased from 4.40% to 35.49% (P_trend<0.05), while in females, it increased from 6.33% to 18.31% (P_trend<0.05), and the average growth rates were 8.14% and 2.58% per annum, respectively. The results of multiple model analysis showed that subjects aged 25 to 35 years were more likely to have central obesity than the control group with age 18 to 24 years in both males (OR=1.285, 95%CI: 1.066-1.550) and females (OR=1.558, 95%CI: 1.234-1.967). There were significant associations of central obesity in males with residence, geographical location, and economic zones: urban males were 39.5% (OR=1.395, 95%CI: 1.169-1.165) more likely to suffer from central obesity than rural males; males living in southern China were 37.9% (OR=0.621, 95%CI: 0.519-0.744) less likely to suffer from central obesity than those living in northern China; compared with males living in central economic zone, males living in western economic zone were 27.1% (OR=0.729, 95%CI: 0.567-0.937) less likely and males living in eastern economic zone were 21.8% (OR=1.218, 95%CI: 1.017-1.459) more likely to suffer from central obesity. No significant correlation was found of residence and geographical location with central obesity in females, only in the western economic zone, females were 32.4% (OR=0.676, 95%CI: 0.515-0.886) less likely to suffer from central obesity than those in the central economic zone. With increase of income levels, females were less likely to be central obese, and females of middle income level (OR=0.749, 95%CI: 0.600-0.934) and high income level (OR=0.684, 95%CI: 0.542-0.864) were less likely to suffer from central obesity than those of low income level. In the total population, a higher body mass index (BMI) level was significantly associated with having central obesity; overweight and obese males were found to be 12.207 (95%CI: 10.228-14.568) and 150.418 (95%CI: 111.186-203.492) times more likely to have central obesity, respectively, and the odds ratios for females were 9.014 (95%CI: 7.446-10.912) and 88.215 (95%CI: 61.411-126.717), respectively. Conclusion From 1993 to 2018, waist circumference and the prevalence rate of central obesity in adults aged 18-35 in selected 15 provinces (autonomous regions and municipalities) of China have been increased year by year, the condition of central obesity is more severe in males. Gender, age, economic zones, and BMI are the major influencing factors. It is necessary to take effective early screening and intervention measures targeting central obesity in youth population to reduce health risks.

Background Overweight and obesity are on the rise all over the world and are related to a variety of chronic diseases. There is a lack of such research on the population aged 18-35. Objective To explore the trends of overweight and obesity in adults aged 18-35 from 1989 to 2018 and the epidemiological characteristics in 2018. Methods A total of 22425 adults aged 18-35 enrolled in the China Health and Nutrition Survey in 1989, 1991, 1993, 1997, 2000, 2004, 2006, 2009, 2011, 2015, and 2018 were selected as study subjects. Overweight and obesity were judged in accordance with WST 428-2013 Determination of adult weight. The trend analysis of body mass index (BMI) level adopted a general linear model, and the trend analysis of overweight and obesity rate adopted a chi-square test for trend. A joinpoint regression model was used to calculate the average annual percentage change (AAPC) and annual percentage change (APC). A log-binomial regression model was used to analyze the relationship between socioeconomic factors and overweight/obesity, and a model with sex stratification was also constructed. Results In the period of 1989–2018, the BMI, overweight rate, and obesity rate of adults aged 18-35 all showed an upward trend. The BMI increased from (21.3±2.3) kg·m⁻² to (23.3±4.0) kg·m⁻², and the rate of overweight and obesity increased from 12.1% to 36.8%. The results of joinpoint regression model showed that 2000 was a joinpoint, and the APCs of overweight rates of 1989–2000 and 2000–2018 were 4.1% and 2.4% respectively (P < 0.05), and the APCs of obesity rates were 15.2% and 7.5% respectively (P < 0.05). From 1989 to 2018, the overweight rate increased at an average annual rate of 3.1% (AAPC=3.1%, 95%CI: 2.4%-3.7%, P<0.05), and the obesity rate increased at an average annual rate of 10.3% (AAPC=10.3%, 95%CI: 7.6%-13.2%, P<0.05). The overweight and obesity rates of men, the 25-35 age group, and northerners were 49.5%, 38.7%, and 45.4% respectively. About 52.6% of men aged 25-35 were overweight and obese. The results of log-binomial regression analysis showed that the risks of overweight and obesity were lower in women (with men as reference, RR=0.54, 95%CI: 0.44-0.65) and in southerners (with northerners as reference, RR=0.74, 95%CI: 0.61-0.91), but was higher in the 25-35 year old group (with the 18-24 year old group as reference, RR=1.41, 95%CI: 1.07-1.87). After stratification by sex, the results of log-binomial regression analysis showed that compared with men aged 18-34, men aged 25-35 had an increased risk of overweight and obesity (RR=1.50, 95%CI: 1.04-2.14), and compared with women in the north, women in the south had a lower risk of overweight and obesity (RR=0.63, 95%CI: 0.46-0.87). Conclusion The problem of overweight and obesity of Chinese adults aged 18-35 is serious. We should give priority to intervene and prevent the overweight and obesity of men, people aged 25-35, and northerners, especially men aged 25-35.