Background: The incidence density of metabolic dysfunction-associated fatty liver disease (MAFLD) and the effect of a healthy lifestyle on the risk of MAFLD remain unknown. We evaluated the prevalence and incidence density of MAFLD and investigated the association between healthy lifestyle and the risk of MAFLD. Methods: A cross-sectional analysis was conducted on 37,422 participants to explore the prevalence of MAFLD. A cohort analysis of 18,964 individuals was conducted to identify the incidence of MAFLD, as well as the association between healthy lifestyle and MAFLD. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) with adjustments for confounding factors. Results: The prevalence of MAFLD, non-alcoholic fatty liver disease, and their comorbidities were 30.38%, 28.09%, and 26.13%, respectively. After approximately 70 thousand person-years of follow-up, the incidence densities of the three conditions were 61.03, 55.49, and 51.64 per 1,000 person-years, respectively. Adherence to an overall healthy lifestyle was associated with a 19% decreased risk of MAFLD (HR, 0.81; 95% CI, 0.72 to 0.92), and the effects were modified by baseline age, sex, and body mass index (BMI). Subgroup analyses revealed that younger participants, men, and those with a lower BMI experienced more significant beneficial effects from healthy lifestyle. Conclusion Our results highlight the beneficial effect of adherence to a healthy lifestyle on the prevention of MAFLD. Health management for improving dietary intake, physical activity, and smoking and drinking habits are critical to improving MAFLD.

Objective:To explore the association between dietary patterns and the incidence of type 2 diabetes mellitus(T2DM), so as to provide insights for the prevention and management of T2DM.Methods:Participants were recruited from the " The Tianjin Chronic Inflammation and Health Cohort Study(TCLSIH)" cohort study from 2013 to 2018, who had completed the modified semiquantitative food frequency questionnaire(FFQ) and blood glucose testing( n=26 425), free of cardiovascular disease, cancer, or diabetes at baseline. The relevant information collected includes food frequency, blood glucose concentration, and other confounding factors. In this study, the correlation between dietary patterns and T2DM was tested using Cox proportional risk regression model, and the gender stratification analysis and body mass index stratification analysis of different gender groups were carried out. All statistical analysis was performed using SAS 9.3 software. Results:The age of all participants was (41.0±11.5)years, and the cumulative incidence was 3.84% for T2DM. The cumulative incidence of T2DM in male population was 5.29%, while that in female population was 2.16%. There were significant differences in the incidence of T2DM among different genders( P <0.001). The multivariable-adjusted hazard ratios( HR) and corresponding 95% CI of T2DM across the plant-based dietary pattern score were 1.09(95% CI 0.91-1.31), 0.80(95% CI 0.66-0.97), and 0.76(95% CI 0.62-0.94; Ptrend =0.010). Moreover, no statistically significant differences were observed between animal and traditional northern Chinese diets with the incidence of T2DM. Conclusions:The plant-based dietary patterns were associated with substantially lower risk of developing T2DM, and there were no significant association between animal and traditional northern Chinese dietary patterns with T2DM. Plant-based dietary patterns characterized by a variety of fruit, leeks, onions, seaweed may be beneficial to the prevention and control of T2DM.

Objective:Investigate the relationship between dietary patterns and sarcopenia in a Chinese elderly population.Methods:Participants in this cross-sectional study were recruited from the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. The study population comprised 2 423 participants, with mean age of (67.6±5.2) years. Sarcopenia was defined based on the guidelines of the Asian Working Group for Sarcopenia. Three dietary patterns were derived by factor analysis: fruit and sweet pattern, traditional oriental pattern, and animal food pattern. The association between quartile categories of dietary pattern scores and the presence of sarcopenia was analyzed using multiple logistic regression models. Odds ratios ( OR) and 95% confidence interval ( CI) were calculated. Results:The prevalence of sarcopenia was 16.1%. After adjusting for confounding factors, compared with the lowest quartile, the adjusted OR ( 95%CI) of sarcopenia for the highest quintile of Fruit and sweet pattern score, Traditional oriental pattern score and Animal food pattern score were 1.06 (0.74, 1.50), 0.54 (0.34, 0.86), and 0.50 (0.33, 0.74), ( P for trend were 0.87,<0.01, and<0.001), respectively. Conclusions:The current study found that the traditional oriental pattern and animal food pattern has a protective relation for sarcopenia in elderly adults, which suggests its potential to attenuate or prevent the progression of sarcopenia.

Objective:To access the independent associations between serum ferritin quintile levels and metabolic syndrome (MS) in adults of different genders.Methods:19 563 participants over the age of 18 years were recruited from "TCLSIH Cohort Study" from 2007 to 2015. Serum ferritin concentration was measured by Enzyme-linked immunoassay, while metabolic syndrome was diagnosed according to MS diagnostic criteria formulated by Chinese Diabetes Society in 2013. Multiple logistic regression analysis was used to assess the association between serum ferritin quintile levels and the prevalence of MS in males and females. Results:After adjusting the confounding factors, the overall prevalence of MS gradually increased with the increasing of serum ferritin levels, similar results were observed in males and females. Subjects were divided into 5 subgroups according to serum ferritin levels. Compared with level 1 group, logistic regression showed that the serum ferritin quintiles of males and females ranged from low to high, the OR (95% confidence interval) for metabolic syndrome were 1.142 (0.998, 1.307), 1.382 (1.210, 1.579), 1.680 (1.472, 1.917), 2.085 (1.827, 2.380), respectively ( Ptrend<0.01), and 1.147 (0.911, 1.444), 1.346 (1.075, 1.687), 1.567 (1.268, 1.941), 2.444 (1.981, 3.023), respectively ( Ptrend<0.01). Conclusion:The elevated ferritin levels were positively related to the prevalence of metabolic syndrome in adults of different genders.

Objective:To evaluate the association between the number of teeth missed and the prevalence of non-alcoholic fatty liver disease (NAFLD) in adults.Methods:A cross-sectional study was carried out in 26 983 adults from Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. The number of teeth missed (excluding third molars) was recorded and classified into four categories: 0, 1-, 3- and ≥6. NAFLD was diagnosed by at least two liver ultrasonography examinations. Adjusted multivariable logistic regression analysis was used to access the association between the number of missed teeth and NAFLD in adults.Results:The overall prevalence of NAFLD was 7 270 and the number of the subjects with at least one tooth missed was 9 667. The multivariable-adjusted ORs (95% CI) of NAFLD across the categories of tooth missing (0, 1-, 3- and ≥6) were as follows: 1.00, 1.04 (0.93-1.15), 1.08 (0.93-1.26) and 1.38 (1.09-1.76) (trend test P=0.030) in males; 1.00, 0.96 (0.82-1.12), 1.11 (0.91-1.35) and 1.22 (0.90-1.64) (trend test P=0.450) in females. Conclusion:The number of missed teeth was positively associated with a higher prevalence rate of NAFLD in males with over 6 teeth missed, but not in females.

Minimizing the burden on study subjects and assessing the general dietary nutritional status as accurately as possible are the basis of a nutritional epidemiological cohort study in the general population. While introducing the main dietary nutrition assessment methods, this paper manly describes the basic contents and principles for the development of food frequency questionnaire, and briefly illustrates the problems and solutions for the development of area specific food frequency questionnaires by taking the example of Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) cohort study. Finally, discusses preliminarily the necessity and possibility of developing a national food frequency questionnaire.

Objective:To evaluate the relationship between lifestyle factors and depressive symptoms based on the TCLSIH cohort of 2013-2016 and provide evidence for the intervention on lifestyle in the prevention and treatment of depression in the future.Methods:A cross-sectional study was conducted in 24 256 persons by using a self-rating depression scale (SDS) to assess the depressive symptoms, and lifestyle questionnaire survey and physical examination were carried out. By using software SAS 9.3. The study subjects were divided into two groups: non-depression group (SDS score <45) and depression group (SDS score≥45), and the relationship between lifestyle factors and depressive symptoms was analyzed.Results:The study subjects in depression group accounted for 16.59 %; the baseline survey showed that compared with non-depression group, the subjects in depression group had higher neutrophil count and lymphocyte count ratio (NLR), lower BMI, lower total energy intake, and lower physical activity level, and tended to take less plant food diet, more animal food diet and sweet food diet ( P<0.000 1). In the depressive group, there were more smokers and less occasional drinkers ( P<0.01), and there were more women, home-aloners, people with lower education levels, people with lower total household income, and less staff members, married and those who liked to contact relatives and friends, but the proportion of people who spent more than 5 hours daily for outdoor activities was higher. Multiple linear regression analysis results showed that being male, aged, NLR, smoking ( OR=1.14, 95 %CI: 1.03-1.26), quitting alcohol, being home-aloners, animal food diet ( OR=1.41, 95 %CI:1.35-1.46), sweet food diet ( OR=1.17, 95 %CI: 1.13-1.22), sleep time >7.5 h/d, outdoor activity time 3-5 h/d, outdoor activity time >5 h/d were positively correlated with depression ( P<0.05). BMI( OR=0.98, 95 %CI: 0.97-0.99), education level ( OR=0.76, 95 %CI: 0.70-0.82), being staff member, total household income ( OR=0.63, 95 %CI: 0.58-0.68), total energy intake, physical activity ( OR=0.86, 95 %CI: 0.84-0.89), married status, move contacts with relatives or friends were negatively related with depression ( P<0.05). Conclusion:Lifestyle is closely related to the occurrence of depressive symptoms, and lifestyle intervention seems be a new way to prevent and treat depression.

Objective To evaluate the prediction value of serum uric acid level in the occurrence of multiple metabolic disorders.Methods The subjects are from the Health Management Centre,Tianjin Medical University General Hospital.Four kinds of metabolic diseases,namely type 2 diabetes mellitus,hypertension,hyperlipidemia,and nonalcoholic fatty liver disease (NAFLD),were analyzed by four-cohort analysis.Sample sizes were 56 915,47 387,31 431,and 35 203.The average follow-up time for each cohort was (3.56±2.32),(3.31±2.24),(2.70±1.95),(2.90± 1.76) years,respectively.In each cohort,the population was divided into two groups,depending on the occurrence of type 2 diabetes,hypertension,hyperlipidemia,and NAFLD during follow-up.All relevant variables were tested for baseline and follow-up,including laboratory tests,lifestyle questionnaire,and physical examination.Statistical analysis by Cox proportional hazard regression model was performed for the relationships between the fifth percentile of the distribution of serum uric acid levels and incidence of type 2 diabetes,hypertension,hyperlipidemia,and NAFLD.Results During the follow-up period,the incidence of type 2 diabetes,hypertension,hyperlipidemia,and NAFLD were 3.5％,17.6％,33.4％,and 15.7％,respectively.After adjustment for confounding factors,with the increase in serum uric acid level,the hazard ratios (95％CI) of type 2 diabetes were 1.00,0.82 (0.70,0.95),0.80 (0.69,0.92),0.77 (0.67,0.88),and 0.83 (0.72,0.95) (P=0.02).Meanwhile,higher risk of hypertension,hyperlipidemia,and NAFLD were associated with elevated serum uric acid level.In the group with the highest serum uric acid level in each cohort,the hazard ratio (95％CI) of hypertension,hyperlipidemia,and NAFLD were 1.17 (1.09,1.25),1.20 (1.13,1.28),and 1.56 (1.43,1.70),respectively (P＜ 0.01),as compared to the group with the lowest level.Conclusion Serum uric acid levels have a positive predictive value for the occurrence of hypertension,hyperlipidemia,and NAFLD,but have a negative predictive value for type 2 diabetes.

Objective To investigate the relationship between white blood cell count (WBC) and the prevalence of simple fatty liver disease (SFL) and nonalcoholic steatohepatitis (NASH). Methods We designed a large scale cross-sectional study in an adult population. Participants were selected from Tianjin Medical University's General Hospital-Health Management Centre. The diagnoses of simple fatty liver disease and nonalcoholic steatohepatitis were based on liver ultrasonography and serum alanine aminotransferase concentration. A total of 37507 subjects (8644 SFL and 2557 NASH) were included in this study. Multiple logistic regression analysis was used to assess whether the quartiles of WBC were associated with the prevalence of simple fatty liver disease and nonalcoholic steatohepatitis. Results After adjusting for potential confounders, the odds ratios (95% confidence interval) of simple fatty liver disease and nonalcoholic steatohepatitis for increasing quartiles of WBC were: simple fatty liver disease, 1.00 (reference), 1.37 (1.24, 1.50), 1.70 (1.55, 1.86) and 2.09 (1.90, 2.29) (P for trend<0.0001);nonalcoholic steatohepatitis, 1.00 (reference), 1.39 (1.16, 1.66), 1.69 (1.43, 1.99) and 2.13 (1.81, 2.50) (P for trend<0.0001). Conclusions This study proves the correlation between WBC and the prevalence of simple fatty liver disease and nonalcoholic steatohepatitis. Further study is needed to clarify whether WBC has a predictive value for the occurrence of nonalcoholic fatty liver disease.

Objective To explore the association between the infection rate of Helicobacter pylori (Hp) and intake frequency of capsicum in dietary pattern. Methods A total of 914 health check-up participants were recruited from Tianjin Medical University General Hospital (male: 510,female:404). All participants were asked about the intake frequency of capsicum. Diagnostic criteria of the Hp infection included positive C13 breath test. Results The intake frequency of capsicum was ≥2 times/week, 1 time/week and <1 time/week. The infection rate of Hp was 56.08%, 49.04% and 48.29%. After adjusting for covariates, compared with the≥2 times/week, the odds ratios(95%confidence interval)of intake frequency of capsicum 1 time/week and <1 time/week: the frequency of capsicum intake ≥2 times/week was 1.00 (reference), the frequency of capsicum intake 1 time/week was 0.57(0.33-0.97) and the frequency of capsicum intake<1 time/week was 0.69(0.42-1.14) in men;the frequency of capsicum intake≥2 times/week was 1.00 (reference), the frequency of capsicum intake 1 time/week was 1.01(0.54-1.88), and the frequency of capsicum intake<1 time/week was 0.71(0.41-1.23) in women. Conclusions This study found that food intake frequency of capsicum≥2 times/week was associated with the infection rate of Hp in men. But similar relationship was not observed in women.