OBJECTIVE: To investigate the clinical characteristics of overlapping syndromes of low muscle mass in Chinese patients with rheumatoid arthritis (RA) and their impact on physical function. METHODS: Consecutive patients with RA were recruited from September 2019 to April 2024 at Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital. Clinical data including disease acti-vity, physical function and radiographic assessment were collected. All patients also finished measurement of body composition, grip strength, and gait speed, and overlapping syndromes of low muscle mass as well as malnutrition, sarcopenia, sarcopenic obesity, and cachexia were evaluated. The Stanford health assessment questionnaire- disability index (HAQ-DI) was used to evaluate physical function. Logistic regression was used to analyze the related factors of physical dysfunction. RESULTS: A total of 1 016 RA patients were recruited. Their mean age was (52.4±12.5) years, and 82.5% were female. There were 557 cases (54.8%) with overlapping syndromes of low muscle mass and all of them were malnutrition. On this basis, 326 cases (32.1%) exhibited sarcopenia, 124 (12.2%) sarcopenic obesity, and 33 (3.2%) cachexia. There were 584 (57.4%) of RA patients having physical dysfunction, with varying degrees of severity 421 (41.4%) mild, 124 (12.2%) moderate, and 39 (3.8%) severe. Compared with patients without overlapping syndromes of low muscle mass (n=459) or with malnutrition only (n=231), RA patients with both malnutrition and sarcopenia (n=326) had significantly higher core disease activity indicators and higher rate of physical dysfunction (69.6% vs. 42.0% vs. 56.6%). However, compared with patients without overlapping syndromes of low muscle mass, patients with malnutrition only had lower HAQ-DI score (median 0.0 vs. 0.1) and lower rate of physical dysfunction (42.0% vs. 56.6%). Multivariate Logistic regression analysis showed that simultaneously overlapping malnutrition and sarcopenia were associated factors of physical dysfunction (OR=2.021, 95%CI: 1.067-3.828), but malnutrition only was not. CONCLUSION Simultaneously overlapping malnutrition and sarcopenia can deteriorate disease activity and physical dysfunction in RA patients. The screening and evaluation of overlapping syndromes of low muscle mass, especially sarcopenia should be emphasized in patients with RA.
Humans ; Arthritis, Rheumatoid/physiopathology* ; Female ; Male ; Sarcopenia/complications* ; Middle Aged ; Cachexia/diagnosis* ; Malnutrition/etiology* ; Obesity/physiopathology* ; Body Composition ; Syndrome ; Hand Strength ; Adult ; Muscle, Skeletal/physiopathology* ; Surveys and Questionnaires

Malnutrition is common in patients with end-stage liver disease (ESLD) and is an independent risk factor for survival, therefore it should be treated as the same important guideline as ascites and hepatic encephalopathy. However, up to now, there is no clinical nutrition guideline for patients with ESLD in China. In order to standardize the nutrition treatment, Chinese Society of Hepatology (CSH) and Chinese Society of Gastroenterology (CSGE), Chinese Medical Association(CMA) co-organized and co-developed this guideline. Recommendations on nutritional screening and assessment as well as principles of intervention and management in patients with ESLD were provided to help clinicians make rational decisions on clinical malnutrition.
Ascites ; China ; End Stage Liver Disease/physiopathology* ; Enteral Nutrition/standards* ; Gastroenterology/standards* ; Hepatic Encephalopathy ; Humans ; Liver Cirrhosis/complications* ; Malnutrition/physiopathology* ; Nutrition Assessment ; Nutritional Status ; Practice Guidelines as Topic

BACKGROUND/AIMS: Malnutrition and growth retardation are important issues in treating pediatric Crohn's disease (CD). Thus, we aimed to investigate the prevalence of various nutritional and growth parameters at the time of diagnosis in Korean children with CD. METHODS: Seventy-one children (<18 years) were enrolled. We analyzed the Z-scores of height-for-age (HAZ), weight-for-height (WHZ), body mass index for age (BMIZ), bone mineral density for age (BMDZ), and the biochemical markers measured at the time of diagnosis. RESULTS: At diagnosis, HAZ <-2 was observed in three patients (4%), WHZ <-2 in 20 patients (28%), BMIZ <-2 in 19 patients (27%), and BMDZ <-2 in 11 patients (18%). The HAZ was significantly lower in females and patients with extraintestinal manifestations, and the WHZ and BMIZ were significantly lower in patients with stricturing and penetrating disease. Subnormal serum levels were highly prevalent for hemoglobin, albumin, iron, ferritin, calcium, magnesium, folate, vitamin B12, and zinc. There was a significant correlation between nutritional status, growth retardation, and disease activity. CONCLUSIONS: Abnormal nutritional status was highly prevalent in Korean children with CD at the time of diagnosis and was associated with the extent, behavior, and activity of the disease.
Adolescent ; Age Factors ; Body Mass Index ; Body Size ; Body Weight ; Bone Density ; Child ; Crohn Disease/blood/*complications/diagnosis/physiopathology ; Female ; Growth Disorders/complications ; Humans ; Male ; Malnutrition/complications ; Nutritional Status ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies

Ascorbic Acid ; administration & dosage ; Child ; Child Nutrition Disorders ; complications ; diet therapy ; Diagnosis, Differential ; Femoral Neoplasms ; diagnosis ; Femur ; diagnostic imaging ; Humans ; Male ; Protein-Energy Malnutrition ; complications ; diet therapy ; Radiography ; Scurvy ; diagnosis ; diet therapy ; etiology ; physiopathology ; Treatment Outcome

OBJECTIVETo investigate the effect of Shenshuai Yangzhen Capsule (SYC) on hypothalamic leptin-neuropeptide Y (NPY) and proopiomelanocortin (POMC) axes in chronic renal failure (CRF) rats with malnutrition (MN).

METHODSForty-two male SD rats of SPF grade were established into CRF-MN model by 5/6 nephrectomy and 4% casein diet, the happening time of MN in them was recorded. Rats successfully modeled were randomized into three groups, 11 rats in Group A treated with SYC, 11 in group B treated with composite alpha-keto acid and 12 in Group C was untreated. Besides, a normal control group was set up with 8 healthy rats. After being treated for 4 weeks, the renal function related indices, including serum creatinine (Scr), blood urea nitrogen (BUN), 24 hour urine protein (24 h Upro), albumin (ALB), haemoglobin (Hb) insulin like growth factor-1 (IGF-1), total cholesterol (TC) and triglyeride (TG) were measured, and body weight, food intake in rats were observed dynamically, blood leptin and NPY level in rats were determined by radioimmunoassay; mRNA expressions of OB-Rb, NPY and POMC in hypothalamus were detected with RT-PCR.

RESULTSCRF rats revealed MN at the end of 10th week after modeling. Compared with Group C, the condition of MN in Group A was significantly improved, showing increase of food intake and body weight (P < 0.05), marked improvement of renal function (P < 0.05), decrease of LP and NPY levels in plasma (P < 0.05), as well as up-regulated NPY mRNA expression and down-regulated mRNA expressions of OB-Rb and POMC in hypothalamus (P < 0.01).

CONCLUSIONSYC can improve the malnutrition condition in rats with CRF, which is possibly by way of depressing OB-Rb and POMC mRNA expression and upgrading NPY mRNA expression in hypothalamus.

Animals ; Drugs, Chinese Herbal ; pharmacology ; Hypothalamus ; metabolism ; Kidney Failure, Chronic ; complications ; metabolism ; physiopathology ; Leptin ; genetics ; metabolism ; Male ; Malnutrition ; etiology ; metabolism ; physiopathology ; Neuropeptide Y ; genetics ; metabolism ; Pro-Opiomelanocortin ; genetics ; metabolism ; RNA, Messenger ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley

Acute pancreatitis (AP) is a common acute abdomen in clinic with a rapid onset and dangerous pathogenetic condition. AP can cause an injury of intestinal mucosa barrier, leading to translocation of bacteria or endotoxin through multiple routes, bacterial translocation (BT), gut-origin endotoxaemia, and secondary infection of pancreatic tissue, and then cause systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS), which are important factors influencing AP's severity and mortality. Meanwhile, the injury of intestinal mucosa barrier plays a key role in AP's process. Therefore, it is clinically important to study the relationship between the injury of intestinal mucosa barrier and AP. In addition, many factors such as microcirculation disturbance, ischemic reperfusion injury, excessive release of inflammatory mediators and apoptosis may also play important roles in the damage of intestinal mucosa barrier. In this review, we summarize studies on mechanisms of AP.
Acute Disease ; Animals ; Humans ; Intestinal Mucosa ; blood supply ; injuries ; metabolism ; Malnutrition ; pathology ; Microcirculation ; metabolism ; Pancreatitis ; complications ; metabolism ; pathology ; physiopathology ; Reperfusion Injury ; pathology

OBJECTIVETo explore the factors influencing insulin resistance in children with different nutritional status during pubertal development.

METHODSThree hundred children with simple obese aged 7 to 17 years, and 300 normal healthy children and 300 children with malnutrition, matched for age (+/- 3 months) and height (+/- 2 cm), were selected. Fasting serum levels of leptin, insulin, glucose, total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C) and high density lipoprotein-cholesterol (HDL-C) were measured for them.

RESULTSLevels of fasting serum insulin in obese children, except for boys at Tanner stage I and girls at Tanner stage II, were higher than those in normal and malnutrition children (P < 0.01). Average serum level of leptin in obese boys and girls at varied Tanner stages was higher than that in normal children, and higher in normal children than that in children with malnutrition (P<0.01). Serum level of TG in obese children [(1.53 +/- 0.13) mmol/L] was higher than that in normal ones [(1.12 +/- 0.10) mmol/L] and in children with malnutrition [(1.03 +/- 0.09) mmol/L]. There was no significant difference in levels of fasting blood glucose and other blood lipids between the three groups of children. Insulin sensitivity decreased with pubertal development and its index reversely correlated with Tanner stage and serum level of leptin (r=-0.27 and -0.36, respectively, P<0.01).

CONCLUSIONObesity (BMI), serum level of leptin and pubertal development were independent risk factors for insulin resistance in children aged 7 to 17 years.

Adolescent ; Body Mass Index ; Child ; Estradiol ; blood ; Growth Hormone ; metabolism ; Humans ; Insulin ; blood ; Insulin Resistance ; Leptin ; blood ; physiology ; Male ; Malnutrition ; blood ; Obesity ; blood ; physiopathology ; Puberty ; physiology ; Testosterone ; blood

OBJECTIVETo investigate the effects of pregnancy malnutrition on the occurrence of insulin resistance (IR) in rat offspring during adult stage and to find out the relationship between TNF-alpha and IR; and to find out a reasonable early nutritional intervention measure for the prevention of IR, through giving different diets to offspring.

METHODSAn IUGR model was built by maternal nutrition restriction. 80 newborn IUGR female pups were randomly divided into 4 groups, the mother rats were given the following diet respectively for 3 weeks after delivery, pups were fed by mother milk: (1) The IUGR (intrauterine growth retardation) rat model was used and the animals were divided into: IUGR control group (group S/N) fed with normal diet, (2) IUGR high-caloric diet group (group A), (3) IUGR high-protein and high-caloric diet group (group B) and (4) IUGR high-protein isocaloric diet group (group C). Each group had 20 pups and another 20 normal female pups were fed with normal diet as the normal control group (group C/N). All pups were weaned at the 4th week of age and fed with normal diet till the end of the experiment. At the 12th week (adulthood) and 48th week (senility) of life, body weight and length, the fasting blood glucose, insulin concentration, TNF-alpha of adipose tissue and body weight were measured. Body mass index (BMI), ISI (insulin sensitive index), IRI (insulin resistant index) and HBCI (beta cell insulin excretion index) and their correlation to TNF-alpha were calculated.

RESULTSAt 12th week and 48th week of life, the insulin sensitivity of IUGR model group was significantly lower than group C/N, although there was no significant difference of body weight between these two groups. TNF-alpha was negatively correlated with ISI, positively correlated with IRI and no relation to HBCI. Group A and B was fatter and developed more severe IR. There were no significant differences in ISI, IRI, HBCI and TNF-alpha between group C and group C/N.

CONCLUSIONSIUGR offspring of pregnancy malnutrition mother rats showed IR at the age of 12th week. TNF-alpha was closely related to the occurrence of IR in IUGR pups. IUGR pups fed with high caloric diet or high protein and caloric diet at the early postnatal period amplified the metabolic abnormality. The high protein isocaloric diet is effective early nutritional intervention measure for the prevention of occurrence of IR at adulthood.

Animals ; Animals, Newborn ; growth & development ; Body Weight ; drug effects ; Dietary Proteins ; pharmacology ; Female ; Fetal Growth Retardation ; blood ; etiology ; Insulin Resistance ; physiology ; Malnutrition ; physiopathology ; Pregnancy ; Pregnancy Complications ; Prenatal Exposure Delayed Effects ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; metabolism