1.Associations between parental adherence to healthy lifestyles and cognitive performance in offspring: A prospective cohort study in China
Rongxia LV ; Yuhui HUANG ; Siyi HUANG ; Shiyi WU ; Siwen WANG ; Guangyu HU ; Yanan MA ; Peige SONG ; E. Jorge CHAVARRO ; S.V. SUBRAMANIAN ; Chunling LU ; Zhihui LI ; Changzheng YUAN
Chinese Medical Journal 2024;137(6):683-693
Background::Previous studies have reported associations of specific maternal and paternal lifestyle factors with offspring’s cognitive development during early childhood. This study aimed to investigate the prospective associations between overall parental lifestyle and offspring’s cognitive performance during adolescence and young adulthood in China.Methods::We included 2531 adolescents aged 10-15 years at baseline in 2010 from the China Family Panel Studies. A healthy parental lifestyle score (ranged 0-5) was constructed based on the following five modifiable lifestyle factors: Smoking, drinking, exercise, sleep, and diet. Generalized estimating equation models were used to examine the association between baseline parental healthy lifestyle scores and offspring’s fluid and crystallized intelligence in subsequent years (2012, 2014, 2016, and 2018).Results::Offspring in the top tertile of parental healthy lifestyle scores performed better in overall fluid intelligence (multivariable-adjusted β = 0.53, 95% confidence interval [CI]: 0.29-0.77) and overall crystallized intelligence (multivariable-adjusted β = 0.35, 95% CI: 0.16-0.54) than those in the bottom tertile of parental healthy lifestyle scores. The results were similar after further adjustment for the offspring’s healthy lifestyle scores and persisted across the subgroups of parental socioeconomic status. Additionally, maternal and paternal healthy lifestyle scores were independently associated with better offspring’s cognitive performance, with significant contribution observed for paternal never-smoking, weekly exercise, and diversified diet. When both parents and offspring adhered to a healthier lifestyle, we observed the highest level of the offspring’s overall crystallized intelligence. Conclusions::Our study indicates that parental adherence to a healthier lifestyle is associated with significantly better offspring’s cognitive performance during adolescence and early adulthood, regardless of socioeconomic status. These findings highlight the potential cognitive benefits of promoting healthy lifestyles among parents of adolescents.
2.Safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy: A prospective, multi-center, single arm trial
Pengfei MA ; Sen LI ; Gengze WANG ; Xiaosong JING ; Dayong LIU ; Hao ZHENG ; Chaohui LI ; Yunshuai WANG ; Yinzhong WANG ; Yue WU ; Pengyuan ZHAN ; Wenfei DUAN ; Qingquan LIU ; Tao YANG ; Zuomin LIU ; Qiongyou JING ; Zhanwei DING ; Guangfei CUI ; Zhiqiang LIU ; Ganshu XIA ; Guoxing WANG ; Panpan WANG ; Lei GAO ; Desheng HU ; Junli ZHANG ; Yanghui CAO ; Chenyu LIU ; Zhenyu LI ; Jiachen ZHANG ; Changzheng LI ; Zhi LI ; Yuzhou ZHAO
Chinese Journal of Gastrointestinal Surgery 2023;26(10):977-985
Objective:To evaluate the safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy.Methods:This prospective, multi-center, single-arm study was initiated by the Affiliated Cancer Hospital of Zhengzhou University in June 2021 (CRAFT Study, NCT05282563). Participating institutions included Nanyang Central Hospital, Zhumadian Central Hospital, Luoyang Central Hospital, First Affiliated Hospital of Henan Polytechnic University, First Affiliated Hospital of Henan University, Luohe Central Hospital, the People's Hospital of Hebi, First People's Hospital of Shangqiu, Anyang Tumor Hospital, First People's Hospital of Pingdingshan, and Zhengzhou Central Hospital Affiliated to Zhengzhou University. Inclusion criteria were as follows: (1) gastric adenocarcinoma confirmed by preoperative gastroscopy;(2) preoperative imaging assessment indicated that R0 resection was feasible; (3) preoperative assessment showed no contraindications to surgery;(4) esophagojejunostomy planned during the procedure; (5) patients volunteered to participate in this study and gave their written informed consent; (6) ECOG score 0–1; and (7) ASA score I–III. Exclusion criteria were as follows: (1) history of upper abdominal surgery (except laparoscopic cholecystectomy);(2) history of gastric surgery (except endoscopic submucosal dissection and endoscopic mucosal resection); (3) pregnancy or lactation;(4) emergency surgery for gastric cancer-related complications (perforation, hemorrhage, obstruction); (5) other malignant tumors within 5 years or coexisting malignant tumors;(6) arterial embolism within 6 months, such as angina pectoris, myocardial infarction, and cerebrovascular accident; and (7) comorbidities or mental health abnormalities that could affect patients' participation in the study. Patients were eliminated from the study if: (1) radical gastrectomy could not be completed; (2) end-to-side esophagojejunal anastomosis was not performed during the procedure; or (3) esophagojejunal anastomosis reinforcement was not possible. Double and a half layered esophagojejunal anastomosis was performed as follows: (1) Open surgery: the full thickness of the anastomosis is continuously sutured, followed by embedding the seromuscular layer with barbed or 3-0 absorbable sutures. The anastomosis is sutured with an average of six to eight stitches. (2) Laparoscopic surgery: the anastomosis is strengthened by counterclockwise full-layer sutures. Once the anastomosis has been sutured to the right posterior aspect of the anastomosis, the jejunum stump is pulled to the right and the anastomosis turned over to continue to complete reinforcement of the posterior wall. The suture interval is approximately 5 mm. After completing the full-thickness suture, the anastomosis is embedded in the seromuscular layer. Relevant data of patients who had undergone radical gastrectomy in the above 12 centers from June 2021 were collected and analyzed. The primary outcome was safety (e.g., postoperative complications, and treatment). Other studied variables included details of surgery (e.g., surgery time, intraoperative bleeding), postoperative recovery (postoperative time to passing flatus and oral intake, length of hospital stay), and follow-up conditions (quality of life as assessed by Visick scores).Result:[1] From June 2021 to September 2022,457 patients were enrolled, including 355 men and 102 women of median age 60.8±10.1 years and BMI 23.7±3.2 kg/m2. The tumors were located in the upper stomach in 294 patients, mid stomach in 139; and lower stomach in 24. The surgical procedures comprised 48 proximal gastrectomies and 409 total gastrectomies. Neoadjuvant chemotherapy was administered to 85 patients. Other organs were resected in 85 patients. The maximum tumor diameter was 4.3±2.2 cm, number of excised lymph nodes 28.3±15.2, and number of positive lymph nodes five (range one to four. As to pathological stage,83 patients had Stage I disease, 128 Stage II, 237 Stage III, and nine Stage IV. [2] The studied surgery-related variables were as follows: The operation was successfully completed in all patients, 352 via a transabdominal approach, 25 via a transhiatus approach, and 80 via a transthoracoabdominal approach. The whole procedure was performed laparoscopically in 53 patients (11.6%), 189 (41.4%) underwent laparoscopic-assisted surgery, and 215 (47.0%) underwent open surgery. The median intraoperative blood loss was 200 (range, 10–1 350) mL, and the operating time 215.6±66.7 minutes. The anastomotic reinforcement time was 2 (7.3±3.9) minutes for laparoscopic-assisted surgery, 17.6±1.7 minutes for total laparoscopy, and 6.0±1.2 minutes for open surgery. [3] The studied postoperative variables were as follows: The median time to postoperative passage of flatus was 3.1±1.1 days and the postoperative gastrointestinal angiography time 6 (range, 4–13) days. The median time to postoperative oral intake was 7 (range, 2–14) days, and the postoperative hospitalization time 15.8±6.7 days. [4] The safety-related variables were as follows: In total, there were 184 (40.3%) postoperative complications. These comprised esophagojejunal anastomosis complications in 10 patients (2.2%), four (0.9%) being anastomotic leakage (including two cases of subclinical leakage and two of clinical leakage; all resolved with conservative treatment); and six patients (1.3%) with anastomotic stenosis (two who underwent endoscopic balloon dilation 21 and 46 days after surgery, the others improved after a change in diet). There was no anastomotic bleeding. Non-anastomotic complications occurred in 174 patients (38.1%). All patients attended for follow-up at least once, the median follow-up time being 10 (3–18) months. Visick grades were as follows: Class I, 89.1% (407/457); Class II, 7.9% (36/457); Class III, 2.6% (12/457); and Class IV 0.4% (2/457).Conclusion:Double and a half layered esophagojejunal anastomosis in radical gastrectomy is safe and feasible.
3.Safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy: A prospective, multi-center, single arm trial
Pengfei MA ; Sen LI ; Gengze WANG ; Xiaosong JING ; Dayong LIU ; Hao ZHENG ; Chaohui LI ; Yunshuai WANG ; Yinzhong WANG ; Yue WU ; Pengyuan ZHAN ; Wenfei DUAN ; Qingquan LIU ; Tao YANG ; Zuomin LIU ; Qiongyou JING ; Zhanwei DING ; Guangfei CUI ; Zhiqiang LIU ; Ganshu XIA ; Guoxing WANG ; Panpan WANG ; Lei GAO ; Desheng HU ; Junli ZHANG ; Yanghui CAO ; Chenyu LIU ; Zhenyu LI ; Jiachen ZHANG ; Changzheng LI ; Zhi LI ; Yuzhou ZHAO
Chinese Journal of Gastrointestinal Surgery 2023;26(10):977-985
Objective:To evaluate the safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy.Methods:This prospective, multi-center, single-arm study was initiated by the Affiliated Cancer Hospital of Zhengzhou University in June 2021 (CRAFT Study, NCT05282563). Participating institutions included Nanyang Central Hospital, Zhumadian Central Hospital, Luoyang Central Hospital, First Affiliated Hospital of Henan Polytechnic University, First Affiliated Hospital of Henan University, Luohe Central Hospital, the People's Hospital of Hebi, First People's Hospital of Shangqiu, Anyang Tumor Hospital, First People's Hospital of Pingdingshan, and Zhengzhou Central Hospital Affiliated to Zhengzhou University. Inclusion criteria were as follows: (1) gastric adenocarcinoma confirmed by preoperative gastroscopy;(2) preoperative imaging assessment indicated that R0 resection was feasible; (3) preoperative assessment showed no contraindications to surgery;(4) esophagojejunostomy planned during the procedure; (5) patients volunteered to participate in this study and gave their written informed consent; (6) ECOG score 0–1; and (7) ASA score I–III. Exclusion criteria were as follows: (1) history of upper abdominal surgery (except laparoscopic cholecystectomy);(2) history of gastric surgery (except endoscopic submucosal dissection and endoscopic mucosal resection); (3) pregnancy or lactation;(4) emergency surgery for gastric cancer-related complications (perforation, hemorrhage, obstruction); (5) other malignant tumors within 5 years or coexisting malignant tumors;(6) arterial embolism within 6 months, such as angina pectoris, myocardial infarction, and cerebrovascular accident; and (7) comorbidities or mental health abnormalities that could affect patients' participation in the study. Patients were eliminated from the study if: (1) radical gastrectomy could not be completed; (2) end-to-side esophagojejunal anastomosis was not performed during the procedure; or (3) esophagojejunal anastomosis reinforcement was not possible. Double and a half layered esophagojejunal anastomosis was performed as follows: (1) Open surgery: the full thickness of the anastomosis is continuously sutured, followed by embedding the seromuscular layer with barbed or 3-0 absorbable sutures. The anastomosis is sutured with an average of six to eight stitches. (2) Laparoscopic surgery: the anastomosis is strengthened by counterclockwise full-layer sutures. Once the anastomosis has been sutured to the right posterior aspect of the anastomosis, the jejunum stump is pulled to the right and the anastomosis turned over to continue to complete reinforcement of the posterior wall. The suture interval is approximately 5 mm. After completing the full-thickness suture, the anastomosis is embedded in the seromuscular layer. Relevant data of patients who had undergone radical gastrectomy in the above 12 centers from June 2021 were collected and analyzed. The primary outcome was safety (e.g., postoperative complications, and treatment). Other studied variables included details of surgery (e.g., surgery time, intraoperative bleeding), postoperative recovery (postoperative time to passing flatus and oral intake, length of hospital stay), and follow-up conditions (quality of life as assessed by Visick scores).Result:[1] From June 2021 to September 2022,457 patients were enrolled, including 355 men and 102 women of median age 60.8±10.1 years and BMI 23.7±3.2 kg/m2. The tumors were located in the upper stomach in 294 patients, mid stomach in 139; and lower stomach in 24. The surgical procedures comprised 48 proximal gastrectomies and 409 total gastrectomies. Neoadjuvant chemotherapy was administered to 85 patients. Other organs were resected in 85 patients. The maximum tumor diameter was 4.3±2.2 cm, number of excised lymph nodes 28.3±15.2, and number of positive lymph nodes five (range one to four. As to pathological stage,83 patients had Stage I disease, 128 Stage II, 237 Stage III, and nine Stage IV. [2] The studied surgery-related variables were as follows: The operation was successfully completed in all patients, 352 via a transabdominal approach, 25 via a transhiatus approach, and 80 via a transthoracoabdominal approach. The whole procedure was performed laparoscopically in 53 patients (11.6%), 189 (41.4%) underwent laparoscopic-assisted surgery, and 215 (47.0%) underwent open surgery. The median intraoperative blood loss was 200 (range, 10–1 350) mL, and the operating time 215.6±66.7 minutes. The anastomotic reinforcement time was 2 (7.3±3.9) minutes for laparoscopic-assisted surgery, 17.6±1.7 minutes for total laparoscopy, and 6.0±1.2 minutes for open surgery. [3] The studied postoperative variables were as follows: The median time to postoperative passage of flatus was 3.1±1.1 days and the postoperative gastrointestinal angiography time 6 (range, 4–13) days. The median time to postoperative oral intake was 7 (range, 2–14) days, and the postoperative hospitalization time 15.8±6.7 days. [4] The safety-related variables were as follows: In total, there were 184 (40.3%) postoperative complications. These comprised esophagojejunal anastomosis complications in 10 patients (2.2%), four (0.9%) being anastomotic leakage (including two cases of subclinical leakage and two of clinical leakage; all resolved with conservative treatment); and six patients (1.3%) with anastomotic stenosis (two who underwent endoscopic balloon dilation 21 and 46 days after surgery, the others improved after a change in diet). There was no anastomotic bleeding. Non-anastomotic complications occurred in 174 patients (38.1%). All patients attended for follow-up at least once, the median follow-up time being 10 (3–18) months. Visick grades were as follows: Class I, 89.1% (407/457); Class II, 7.9% (36/457); Class III, 2.6% (12/457); and Class IV 0.4% (2/457).Conclusion:Double and a half layered esophagojejunal anastomosis in radical gastrectomy is safe and feasible.
4.Impact of Wuhan lockdown on the spread of COVID-19 in China: a study based on the data of population mobility.
Shu LI ; Qinchuan WANG ; Sicong WANG ; Junlin JIA ; Zilong BIAN ; Changzheng YUAN ; Sisi WANG ; Xifeng WU ; Shuyin CAO ; Chen CHEN ; Xiaolin XU ; Yuanqing YE ; Hao LEI ; Wenyuan LI ; Kejia HU
Journal of Zhejiang University. Medical sciences 2021;50(1):61-67
This study aimed to quantitatively assess the effectiveness of the Wuhan lockdown measure on controlling the spread of coronavirus diesase 2019 (COVID-19). : Firstly,estimate the daily new infection rate in Wuhan before January 23,2020 when the city went into lockdown by consulting the data of Wuhan population mobility and the number of cases imported from Wuhan in 217 cities of Mainland China. Then estimate what the daily new infection rate would have been in Wuhan from January 24 to January 30th if the lockdown measure had been delayed for 7 days,assuming that the daily new infection in Wuhan after January 23 increased in a high,moderate and low trend respectively (using exponential, linear and logarithm growth models). Based on that,calculate the number of infection cases imported from Wuhan during this period. Finally,predict the possible impact of 7-day delayed lockdown in Wuhan on the epidemic situation in China using the susceptible-exposed-infectious-removed (SEIR) model. : The daily new infection rate in Wuhan was estimated to be 0.021%,0.026%,0.029%,0.033% and 0.070% respectively from January 19 to January 23. And there were at least 20 066 infection cases in Wuhan by January 23,2020. If Wuhan lockdown measure had been delayed for 7 days,the daily new infection rate on January 30 would have been 0.335% in the exponential growth model,0.129% in the linear growth model,and 0.070% in the logarithm growth model. Correspondingly,there would have been 32 075,24 819 and 20 334 infection cases travelling from Wuhan to other areas of Mainland China,and the number of cumulative confirmed cases as of March 19 in Mainland China would have been 3.3-3.9 times of the officially reported number. Conclusions: Timely taking city-level lockdown measure in Wuhan in the early stage of COVID-19 outbreak is essential in containing the spread of the disease in China.
COVID-19
;
China/epidemiology*
;
Cities
;
Communicable Disease Control
;
Humans
;
SARS-CoV-2
5.Impact of socioeconomic status,population mobility and control measures on COVID-10 development in major cities of China.
Shu LI ; Sicong WANG ; Yong ZHU ; Sisi WANG ; Changzheng YUAN ; Xifeng WU ; Shuyin CAO ; Xiaolin XU ; Chen CHEN ; Yuanqing YE ; Wenyuan LI ; Hao LEI ; Kejia HU ; Xin XU ; Hui ZHU
Journal of Zhejiang University. Medical sciences 2021;50(1):52-60
To evaluate the impact of socioeconomic status,population mobility,prevention and control measures on the early-stage coronavirus disease 2019 (COVID-19) development in major cities of China. : The rate of daily new confirmed COVID-19 cases in the 51 cities with the largest number of cumulative confirmed cases as of February 19,2020 (except those in Hubei province) were collected and analyzed using the time series cluster analysis. It was then assessed according to three aspects,that is, socioeconomic status,population mobility,and control measures for the pandemic. : According to the analysis on the 51 cities,4 development patterns of COVID-19 were obtained,including a high-incidence pattern (in Xinyu),a late high-incidence pattern (in Ganzi),a moderate incidence pattern (in Wenzhou and other 12 cities),and a low and stable incidence pattern (in Hangzhou and other 35 cities). Cities with different types and within the same type both had different scores on the three aspects. : There were relatively large difference on the COVID-19 development among different cities in China,possibly affected by socioeconomic status,population mobility and prevention and control measures that were taken. Therefore,a timely public health emergency response and travel restriction measures inside the city can interfere the development of the pandemic. Population flow from high risk area can largely affect the number of cumulative confirmed cases.
COVID-19
;
China/epidemiology*
;
Cities
;
Humans
;
SARS-CoV-2
;
Social Class
6.Predicting COVID-19 epidemiological trend by applying population mobility data in two-stage modeling.
Shu LI ; Qinchuan WANG ; Sicong WANG ; Junlin JIA ; Changzheng YUAN ; Sisi WANG ; Xifeng WU ; Shuyin CAO ; Chen CHEN ; Xiaolin XU ; Yuanqing YE ; Zhengping XU ; Hao LEI ; Zhijun YING ; Kejia HU ; Vermund STEN H
Journal of Zhejiang University. Medical sciences 2021;50(1):68-73
To predict the epidemiological trend of coronavirus disease 2019 (COVID-19) by mathematical modeling based on the population mobility and the epidemic prevention and control measures. : As of February 8,2020,the information of 151 confirmed cases in Yueqing,Zhejiang province were obtained,including patients' infection process,population mobility between Yueqing and Wuhan,etc. To simulate and predict the development trend of COVID-19 in Yueqing, the study established two-stage mathematical models,integrating the population mobility data with the date of symptom appearance of confirmed cases and the transmission dynamics of imported and local cases. : It was found that in the early stage of the pandemic,the number of daily imported cases from Wuhan (using the date of symptom appearance) was positively associated with the number of population travelling from Wuhan to Yueqing on the same day and 6 and 9 days before that. The study predicted that the final outbreak size in Yueqing would be 170 according to the number of imported cases estimated by consulting the population number travelling from Wuhan to Yueqing and the susceptible-exposed-infectious-recovered (SEIR) model; while the number would be 165 if using the reported daily number of imported cases. These estimates were close to the 170,the actual monitoring number of cases in Yueqing as of April 27,2020. : The two-stage modeling approach used in this study can accurately predict COVID-19 epidemiological trend.
COVID-19
;
China/epidemiology*
;
Disease Outbreaks
;
Humans
;
Models, Theoretical
;
Pandemics
;
SARS-CoV-2
7.Factors relating to bone mineral density in young and middle-aged patients with ankylosing spondylitis.
Xin WU ; Jia-Yun ZHONG ; Geng WANG ; Hu-Ji XU
Chinese Medical Journal 2021;134(21):2556-2563
BACKGROUND:
Ankylosing spondylitis (AS) is a common chronic progressive rheumatic disease. The aim of this study was to explore factors influencing abnormal bone mineral density (BMD) in young and middle-aged patients with AS.
METHODS:
From July 2014 to August 2018, hospitalized patients with AS and health examinees in the health examination center of our clinics, ranging in age from 20 to 50 years, were monitored. The BMD of the lumbar spine and femoral neck of AS patients and those of a healthy control group were measured using dual-energy X-ray absorption. The BMDs of AS patients were compared with respect to age, course of disease, iritis, smoking habits, sex, height, weight, body mass index (BMI), medication use, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet volume, platelet count, uric acid (UA), alkaline phosphatase (AKP), and calcium ion levels. Single-nucleotide polymorphisms (SNPs) related to BMD were screened using genome-wide association analysis.
RESULTS:
There was no statistical difference in the proportion of abnormal bone masses between the different body parts. The BMD of all bones in AS patients was lower than that in healthy controls (P < 0.05). Additionally, BMD was correlated with serum calcium and CRP in AS patients (P < 0.05), but not with age, platelet volume, platelet count, ESR, UA, AKP, height, weight, and BMI. The incidence of abnormal bone mass in AS patients was correlated with sex (P < 0.05), but not with medication use, iritis, or smoking. BMD of the lumbar spine in AS patients did not correlate linearly with the course of the disease, but BMD of the femoral neck correlated linearly with the course of the disease (P < 0.05). BMD was correlated with multiple SNPs in patients with AS. Lumbar BMD was correlated with rs7025373 and rs7848078. Femoral head BMD was correlated with 3:102157365, 3:102157417, rs1252202, rs1681355, rs3891857, rs7842614, and rs9870734, suggesting that genetic factors play a role in BMD in patients with AS.
CONCLUSIONS
The proportion of abnormal bone mass in AS patients was higher than that in healthy individuals of the same age. The factors related to BMD in patients with AS are gender, CRP, and blood calcium. The BMD of the femoral neck of AS patients decreases with the course of the disease, but BMD of the lumbar spine is not related to the course of the disease. BMD in AS patients is associated with multiple SNPs.
Absorptiometry, Photon
;
Adult
;
Bone Density
;
Femur Neck
;
Genome-Wide Association Study
;
Humans
;
Lumbar Vertebrae
;
Middle Aged
;
Spondylitis, Ankylosing/genetics*
;
Young Adult
8.Expert Consensus on Clinical Diseases Responding Specifically to Traditional Chinese Medicine:Membranous Nephropathy
Bao-li LIU ; Yi-fei ZHONG ; Wei-jing LIU ; Ming WANG ; Bo YANG ; Hong-yu CHEN ; Zhi-guo MAO ; Yi-lun ZHOU ; Fang SUN ; Hong-liang RUI ; Ya-juan DUAN ; Wen-hu LIU ; Hong-tao YANG ; Xiao-xiao ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2021;27(16):185-190
Traditional Chinese medicine (TCM) is a great treasure house, exhibiting unique advantages in the treatment of some difficult and critical diseases. The incidence rate of membranous nephropathy has increased year by year in recent years, and has become the first cause of primary glomerular diseases. However, its pathogenesis is not clear. Modern medicine often uses immunosuppressive therapy, but it often faces the problems of high side effects and high recurrence rate. The China Association of Chinese Medicine (CACM) invited clinical experts of TCM and western medicine to fully discuss membranous nephropathy, which was later confirmed to be one of the clinical diseases responding specifically to TCM. Apart from summarizing the pathogenesis and clinical diagnosis and treatment of membranous nephropathy in both TCM and western medicine, this paper also detailed TCM cognition, syndrome differentiation, and therapeutic schemes of membranous nephropathy, aiming to improve the clinical remission rate of membranous nephropathy and provide reference for its clinical treatment.
9.Association between thyroxine level and nonalcoholic fatty liver disease
Tian TIAN ; Wenwei HU ; Xue LI ; Jie WU ; Dan ZHANG ; Changzheng LI
Journal of Clinical Hepatology 2021;37(10):2357-2363
Objective To investigate the association between thyroxine level and nonalcoholic fatty liver disease (NAFLD). Methods A retrospective analysis was performed for 3289 subjects who underwent physical examination in PLA Rocket Force Characteristic Medical Center from July 2015 to April 2019, and according to medical history and thyroid function, they were divided into subclinical hypothyroidism group with 210 subjects and normal thyroid function group with 3079 subjects. According to the results of abdominal color Doppler ultrasound, the normal thyroid function group was divided into NAFLD group with 516 subjects and non-NAFLD group with 2563 subjects; according to body mass index (BMI), the normal thyroid function group was divided into non-obese group (BMI < 25 kg/m 2 ) and obese group (BMI ≥25 kg/m 2 ); according to the age, the normal thyroid function group was divided into elderly group (age ≥60 years) and young and middle-aged group (age < 60 years). The normal thyroid function group was typed based on age and body type. Related data were collected, including sex, age, BMI, blood pressure, waist circumference, fasting blood glucose, uric acid, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, free triiodothyronine, free thyroxine, triiodothyronine, thyroxine, and thyroid stimulating hormone (TSH). The two-independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test used for comparison of categorical data between two groups. A multivariate logistic regression analysis was used to investigate risk factors, and the receiver operator characteristic (ROC) curve was used to analyze the cut-off values of related indices in predicting NAFLD. Results The subclinical hypothyroidism group had a higher prevalence rate of NAFLD than the normal thyroid function group (22.38% vs 16.76%, χ 2 =4.380, P =0.036), and in the subclinical hypothyroidism group, the NAFLD patients had a higher level of TSH than the non-NAFLD patients( Z =-1.994, P =0.046). In the subclinical hypothyroidism group, there were no significant differences in thyroid parameters between the NAFLD group and the non-NAFLD group (all P > 0.05); after stratification based on age and body type, in the obese-young and middle-aged subgroup, male sex, low free thyroxine, fasting blood glucose, and triglyceride were independent risk factors for NAFLD (odds ratio=4.729, 0.067, 1.814, and 1.717, P =0.003, 0.010, 0.011, and 0.014). The cut-off values of free thyroxine, fasting blood glucose, and triglyceride were 1.123 ng/dL, 5.15 mmol/L, and 1.02 mmol/L, respectively, in predicting NAFLD, and the area under the ROC curve was 0.832 for combined prediction. Conclusion There is a high prevalence rate of NAFLD in the population with subclinical hypothyroidism, and when thyroid function is within the normal range, low free thyroxine is associated with the onset of NAFLD in the young and middle-aged obese people.
10.Metabolic characteristics of nonalcoholic fatty liver disease and related risk factors in non-obese population
Tian TIAN ; Wenwei HU ; Xue LI ; Ji LI ; Dan ZHANG ; Changzheng LI
Journal of Clinical Hepatology 2020;36(6):1310-1313
ObjectiveTo investigate the metabolic characteristics of nonalcoholic fatty liver disease (NAFLD) and related risk factors in non-obese population. MethodsA retrospective analysis were performed for 12 125 individuals who underwent physical examination in Physical Examination Center of PLA Rocket Force Characteristic Medical Center from July 2013 to April 2019. According to body mass index (BMI) <25 kg/m2, these individuals were divided into non-obese group with 8528 individuals and obese group with 3597 individuals; according to the results of abdominal ultrasound, the non-obese group was further divided into NAFLD group with 1025 individuals and non-NAFLD group with 7503 individuals. According to BMI <25 kg/m2, 3281 individuals with NAFLD were divided into non-obese NAFLD subgroup with 1025 individuals and obese NAFLD group with 2256 individuals. Related clinical data were collected, including sex, age, BMI, fasting blood glucose, uric acid, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, and hemoglobin. Non-normally distributed continuous data were expressed as M(P25-P75), and the Mann-Whitney U test was used for comparison between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed to investigate risk factors. ResultsAmong the 12 125 individuals who underwent the physical examination, the detection rate of NAFLD was 27.06%, and the detection rate of non-obese NAFLD was 8.45%, accounting for 12.02% of the non-obese population. The multivariate logistic regression analysis, based on the univariate analysis, had a diagnostic accordance rate of 89%, and the results showed that the increase in age, BMI, fasting blood glucose, uric acid, triglyceride, low-density lipoprotein, and hemoglobin were independent risk factors for non-obese NAFLD (odds ratio [OR]=1.043, 1.716, 1.161, 1.004, 1.791, 2.587, and 1.011, P<0.001, <0.001, =0.001, <0.001, <0.001, <0.001, and =0.011), suggesting that non-obese NAFLD had the strongest association with low-density lipoprotein and had no association with age, uric acid, and hemoglobin. Total cholesterol and high-density lipoprotein were non-susceptible factors for non-obese NAFLD (OR=0.521 and 0.523, P=0.007 and 0.024). ConclusionNon-obese NAFLD is closely associated with metabolic disorders, and further studies are needed to explore the association between serum cholesterol and non-obese NAFLD.

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