Background::Acute-on-chronic liver failure (ACLF) is a severe liver disease with complex pathogenesis. Clinical hypoglycemia is common in patients with ACLF and often predicts a worse prognosis. Accumulating evidence suggests that glucose metabolic disturbance, especially gluconeogenesis dysfunction, plays a critical role in the disease progression of ACLF. Lon protease-1 (LONP1) is a novel mediator of energy and glucose metabolism. However, whether gluconeogenesis is a potential mechanism through which LONP1 modulates ACLF remains unknown.Methods::In this study, we collected liver tissues from ACLF patients, established an ACLF mouse model with carbon tetrachloride (CCl 4), lipopolysaccharide (LPS), and D-galactose (D-gal), and constructed an in vitro hypoxia and hyperammonemia-triggered hepatocyte injury model. LONP1 overexpression and knockdown adenovirus were used to assess the protective effect of LONP1 on liver injury and gluconeogenesis regulation. Liver histopathology, biochemical index, mitochondrial morphology, cell viability and apoptosis, and the expression and activity of key gluconeogenic enzymes were detected to explore the underlying protective mechanisms of LONP1 in ACLF. Results::We found that LONP1 and the expressions of gluconeogenic enzymes were downregulated in clinical ACLF liver tissues. Furthermore, LONP1 overexpression remarkably attenuated liver injury, which was characterized by improved liver histopathological lesions and decreased serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in ACLF mice. Moreover, mitochondrial morphology was improved upon overexpression of LONP1. Meanwhile, the expression and activity of the key gluconeogenic enzymes were restored by LONP1 overexpression. Similarly, the hepatoprotective effect was also observed in the hepatocyte injury model, as evidenced by improved cell viability, reduced cell apoptosis, and improved gluconeogenesis level and activity, while LONP1 knockdown worsened liver injury and gluconeogenesis disorders.Conclusion::We demonstrated that gluconeogenesis dysfunction exists in ACLF, and LONP1 could ameliorate liver injury and improve gluconeogenic dysfunction, which would provide a promising therapeutic target for patients with ACLF.

Objective: To investigate the prevalence of calf muscle cramps and possible influencing factors for pregnant women in China. Methods: Using a multi-stage stratified probability proportional to size cluster randomization sampling method during 2010-2012. A total of 3 582 pregnant women were investigated at 150 counties from 31 provinces in China mainland. Information on calf muscle cramps, demographic socio-economic status, pregnancy information, and the physical activities was collected through questionnaires. The semi-quantitative food frequency questionnaire (FFQ) was used to collect food intake of pregnant women. Dynamic cluster analysis was used to assess dietary pattern. Multiple logistic regression was used to investigate the possible influencing factors for calf muscle cramps. Results: The prevalence of calf muscle cramps was 32.9% (1 180/3 582) in Chinese pregnant women, which was 11.6% (87/748), 28.2% (420/1 492), and 50.2% (673/1 342), respectively, during the first, second and third trimester. There were significant differences between them (χ²=349.16, P<0.001). Dietary patterns of the pregnant women were classified into three groups, which called relatively balanced pattern, high vegetables and fruits pattern, and high dairy pattern. Among the three groups, the prevalence of calf muscle cramps was 32.0% (952/2 971), 37.2% (186/500), and 37.8% (42/111), with significant differences (χ²=6.39, P=0.041). The OR (95%CI) values of calf muscle cramps in the second and third trimester was 2.96 (2.28-3.83), and 8.02 (6.16-10.44), respectively, comparing with the first trimester. The OR (95%CI) values of calf muscle cramps in the women taking calcium before pregnant was 1.45 (1.19-1.76), comparing with the one who was not taken. The OR (95%CI) values of calf muscle cramps in the women who had been diagnosed by pregnancy-induced hypertension was 5.76 (2.06-16.12), comparing with the one who had not been diagnosed. The OR (95%CI) values of calf muscle cramps in the high vegetables and fruits pattern and high dairy pattern was 1.13 (0.91-1.41), and 1.18 (0.76-1.81), respectively, comparing with the relatively balanced pattern. Conclusion The prevalence of calf muscle cramps was relatively high in Chinese pregnant women, which was significantly different among three trimesters. The residential areas, occupation, and pregnancy-induced hypertension might be related to the prevalence of calf muscle cramps. However, there was no significant difference among different dietary patterns.

Objective: To investigate the prevalence of anemia and related risk factors for pregnant women in China. Method: Based on Chinese National Nutrition and Health Surveillance 2010-2012, a total of 3 501 pregnant women were investigated from 150 counties of 31 provinces, municipalities and autonomous regions in China, using a multi-stage stratified cluster randomization sampling method. General information of pregnant women, health status, and food intake during the gestation, was collected through a questionnaire investigation. 6 ml fasting venous blood was collected for the determination of hemoglobin concentration. Data were analyzed using multiple logistic regression to investigate the prevalence of anemia and the related influencing factors. Results: The 605 of 3 501 pregnant women had anemia. The prevalence of anemia was 17.2%; and mild anemia accounted for about 61.0% (369/605). Compared with the pregnant women living in the large cities, the OR (95%CI) of those living in the poor rural areas was 1.46 (1.08-1.98). Compared with the pregnant women living in the south area of China, the OR (95%CI) of those living in the north area of China was 1.39 (1.15-1.68); Compared with the pregnant women in the first trimester, the OR (95%CI) of those in the second trimester and the third trimester were 1.79 (1.33-2.43) and 2.11 (1.56-2.85), respectively. The OR (95%CI) of pregnant women who had used folic acid supplementation within the 6 months prior to gestation was 0.76 (0.63-0.93) compared with those who had not used. Conclusion From 2010 to 2012, the epidemic characteristics of anemia was mild for the pregnant women in China, and pregnant women residential areas, periods of pregnancy and whether to take folic acid were related to anemia.

Objective: To examine the status and related factors for gestational weight gain of Chinese pregnant women at different trimesters in 2010-2012. Methods: Participants were from Chinese National Nutrition and Health Surveillance in 2010-2012. Using a multi-stage stratified cluster random sampling method, we recruited 2 805 singleton pregnant women with gestational age 13 weeks or more from 31 provinces of China. A standard questionnaire was used to collect general information and pre-pregnancy weight; body weight and height of pregnant women were measured using a unified weighing scale and stadiometer, dietary intake during the previous year was collected using a food frequency questionnaire. A multiple logistic regression was used to analyze potential factors associated with appropriate gestational weight gain. Results: Among 2 805 pregnant women, 1 441 were in the second (13-27 weeks) and 1 364 in the third trimesters (≥28 weeks) . In the 2^nd trimester, 229 cases (15.9%), 440 cases (30.5%) and 772 cases (53.6%) were insufficient gestational weight gain, appropriate gestational weight gain and excessive gestational weight gain respectively. So were 256 cases (18.8%), 474 cases (34.8%), 634 cases (46.5%) in the 3^rd trimester respectively. In the multivariate unconditional logistic model, less fruit intake was associated with insufficient weight gain for women in the 2^nd trimester (OR (95%CI): 1.58 (1.06-2.34)). Pregnant women with Han ethnicity who live in the small/medium city had lower risk of insufficient weight gain in the 3^rd trimester (OR (95%CI): 0.58 (0.34-0.98)). Those pregnant women with physical activity <1 hour/day had a higher risk of excessive weight gain (OR (95%CI): 1.33 (1.02-1.73)). Conclusion The prevalence of appropriate gestational weight gain was low in China. Our study suggests that pregnant weight gain is associated with fruit intake, types of residential area and physical activity.

Objective: To analyze the status of gestational weight gain (GWG) among Chinese mothers who gave singleton and full-term births, and to look at optimal GWG ranges. Methods: In 2013, using the multi-stage stratified and population proportional cluster sampling method, we investigated 8 323 mother-child pairs at their 0-24 months postpartum from 55 counties (cities/districts) of 30 provinces (except Tibet) in mainland China. Questionnaire was used to collect data on body weight before pregnancy and delivery, diseases during gestation, hemorrhage or not at postpartum, child birth weight and length, and other information about pregnant outcomes. We measured mother's body weight and height, and child's body weight and length. Based on 'Chinese Adult Body Weight Standard’, we divided mothers into four groups according to their body weight before pregnancy: low weight (BMI<18.5 kg/m²), normal weight (BMI 18.5-23.9 kg/m²), overweight (BMI 24.0-27.9 kg/m²) and obesity (BMI≥28.0 kg/m²). The status of GWG was assessed by IOM optimal GWG guidelines. Chinese optimal GWG ranges were calculated according to the association of GWG with pregnant outcomes and anthropometry of mothers and children, and according to P25-P75 of GWG among mothers who had good pregnant outcomes and good anthropometry, and whose children had good anthropometry. The status of GWG was assessed by the new optimal ranges. Results: P50 (P25-P75) of GWG among the 8 323 mothers was 15.0 (10.0-19.0) kg. According to the proposed optimal GWG ranges of IOM, the proportions of inadequate, optimal and excessive GWG accounted for 27.2% (2 263 mothers), 36.2% (3 016 mothers) and 36.6% (3 044 mothers). The optimal GWG ranges for low weight, normal weight, overweight and obesity were 11.5-18.0, 10.0-15.0, 8.0-14.0 and 5.0-11.5 kg. Based on these optimal GWG ranges established in this study, the rates of inadequate, optimal and excessive GWG were 15.7% (1 303 mothers), 45.0% (3 744 mothers) and 39.3% (3 276 mothers), and these rates were significantly different from that defined by the IOM standards (χ2=345.36, P<0.001). Conclusion The median of GWG among Chinese mothers is 15.0 kg, which is at a relatively higher level. This study suggests the optimal GWG ranges for Chinese women who give singleton and full-term babies, which appears lower than IOM's.

Objective:By analyzing the effect of deacetylase inhibitors on macrophage polarization process of histone modification,and the influence of the process of macrophage polarization ,analysis deacetylase inhibitors whether have the effect on the activity of the macrophage polarization by altered histone modification of macrophages , in order to provide a new perspective for the treatment of autoimmune diseases .Methods:Using lipopolysaccharide ( LPS) and interferon-γ( IFN-γ) to stimulate J774.1 cells for 24 h,and interleukin-4 ( IL-4 ) to stimulate J774.1 cells for 24 h.And 2 mmol/L valproic acid ( VPA ) was added in the induction process.Collecting J774.1 cells,fluorescent quantitation PCR assay and ELISA assay was used for the detection of specific markers of gene expression in macrophage polarization , flow cytometry and immunofluorescence assay for the detection of histone modifications.Results:J774.1 cells were polarized into M1 macrophages which were stimulated by LPS and IFN-γfor 24 h;and also J774.1 cells were polarized into M2 macrophages which were stimulated by IL-4 for 24 h.The degree of acetylation of H 3K9 for M1 phenotype was increased after VPA treatment , the expression of interleukin-6 (IL-6 ) , inducible nitric oxide synthase ( iNOS ) , and chemotactic factor(CCL-2) was decreased,and the expression of CD86 was increased.The degree of acetylation of H3K9 for M1 phenotype was also increased after VPA treatment ,and also the expression of Arginase,Fizz-1,mannose receptor(CD 206) and Ym1 were increased.Conclusion:The polarization state of the macrophages and histone modification had a certain relevance .VPA could induce the transformation of M1 phenotype to M2 phenotype in the induction system of the M1 macrophages,however,the expression of specific genes in M1 phenotype was inhibited in the induction system of the M 2 macrophages.

Objective To assess the dietary intake status of Chinese lactating women during the first month postpartum. Methods Data were extracted from Chinese National Nutrition and Health Surveillance, children aged 0-5 years and lactating women (2013). A total of 55 counties from 30 provinces in China (excluding the Tibet Autonomous Region) were selected using a multi-stage stratified cluster randomization sampling method. A group of 3 623 lactating women, at 1-6 months after delivery, were investigated in the study. The semi-quantitative food frequency questionnaire (FFQ) was used to collect information on frequencies and amounts of food consumed. Differences in food consumption rates and dietary intake in lactating women having different characteristics were analyzed and compared. Results To eliminate abnormal values, 3 300 lactating women were included in the study. During the first month postpartum, food types with higher consumption rates were animal products (98.2%,3 239) and vegetables (90.7%,2 987), in addition to cereals (100%) and liquids (100%). The consumption rate of fruits was 67.4%(2 222) and the lowest consumption rate was for dairy products (38.3%, 1 262). The median intake of cereals, vegetables, fruits and animal products were 247.8, 150.0, 40.0 and 178.6 g/d, respectively. The daily median intake of dairy products and soybean/nut products was 0.0 g/d. Overall, the lactating women consumed 895.7 ml/d liquids. About 49.3% (1 627) of the subjects consumed less than the recommended intake for animal products in Chinese Dietary Guideline (2016). More than 50% of the lactating women consumed less than the recommended intakes for the other types of food, especially dairy, soybean/nut and liquids. The consumption rates for dairy products were 26.9%, 29.4%, 31.8% and 33.8% and those for soybean/nut products were 33.9% , 35.8% , 37.5% and 41.7% for the lactating women living in rural areas, with educations at junior high school level and below, with average family incomes under 15 000 yuan per capita in 2012 and who work as household mothers, respectively. These consumption rates for dairy and soybean/ nuts were significantly lower than those in women living in cities (48.4%, 55.0%), with an education level of senior high school or above (48.8%, 55.7%), with average family income over 15 000 yuan per capita in 2012 (45.5% , 52.8% ) and who work outside the home (43.7% , 49.4% ). P values were <0.05 for all comparisons. Conclusion The daily intake of all foods by lactating women during the first month postpartum was lower than the levels recommended in Chinese Dietary Guideline (2016). The consumption rate of dairy and soybean/nut products during this time period was low, especially for those living in rural areas, with education levels of junior high school and below, with average family incomes less than 15 000 yuan per capita in 2012 and who are housemothers.

Objective To analyze serum vitamin D levels in Chinese lactating women, in 2013, and to evaluate their vitamin D nutritional status and influencing factors. Methods Data were from the Chinese National Nutrition and Health Surveillance in 2013. Using the multistage stratified cluster sampling method, serum samples from lactating women, at 0-24 months postpartum, were obtained from 55 sites in 30 provinces of China, excluding the Tibet Autonomous Region. The concentration of serum vitamin D was determined by mass spectroscopy. A standard questionnaire was used to obtain basic information and the season of blood collection. Dietary information for one recent month was collected using a food frequency questionnaire. A total of 1 981 lactating women were included in the study. A multiple logistic regression model was used to analyze the factors related to vitamin D levels among lactating women. Results The mean vitamin D level was (16.6±6.5) ng/ml, the prevalence of vitamin D deficiency (VDD) (vitamin D<12 ng/ml) was 25.2% (499 cases) and the prevalence of vitamin D inadequacy (12 ng/ml≤vitamin D<20 ng/ml) was 45.4% (900 cases). Compared with in the Han ethnic group, the OR value of VDD was 13.37 for Muslim ethnic women. Compared with women having a junior high school education or below, the OR value of VDD was 1.40 for those women with an educational level of senior high, middle school or above. Compared with housewives or nonworking women, the OR value of VDD was 1.62 for professional women. Compared with women living in general rural settings, the OR values of VDD for women living in large cities, medium and small cities or poor rural settings were 1.99, 1.46 and 2.66 respectively. Compared with the women surveyed in the fall, the OR value of VDD was 2.19 for the women surveyed in winter or spring. The VDD prevalence increased with higher latitude (OR=1.12) and decreased with increased meat consumption per day (OR= 0.73). (P<0.05 for all comparisons). Conclusion Vitamin D deficiency and vitamin D inadequacy were common in lactating women in China. Those with increased risk of VDD included lactating women who were ethnic Muslims, with higher education levels, engaged in a professional occupation, living in higher latitude region and were surveyed in winter and spring.

Objective To study the prevalence of delayed onset of lactation (later than 3 days) in lactating women in China and to analyze its influencing factors. Methods Data were extracted from Chinese National Nutrition and Health Surveillance-Mothers, from mothers with children under 2 years of age (in 2013). A total of 11 178 women who were lactating or had lactated were selected from 55 counties of 30 provinces (excluding the Tibet Autonomous Region) in China, using the multi-stage stratified cluster randomization sampling method. Basic information, including onset of lactation, initiation of breastfeeding, breastfeeding difficulties and breastfeeding knowledge were collected using a questionnaire investigation. The prevalence of delayed onset of lactation were analyzed by the weighted processing of complex sampling from the 6th national population census data. A multiple logistic regression was used to analyze the factors associated with delaged onset of lactation. Results Among 11 178 lactating women, 3 388 had an onset of lactation later than 3 d. The prevalence of delayed onset of lactation was 30.3%. After complex weighting, the prevalence of delayed onset of lactation was 31.2% (95%CI: 25.7%-36.8%) for lactating women in China. Delivery by Caesarean section (OR=1.28, 95%CI:1.06-1.53) and initiating breastfeeding≥4 h (OR=
2.34, 95%CI:1.76-3.11) were the negative factors for delayed onset of lactation. Compared with those living in large cities, lactating women living in medium or small cities (OR=1.39, 95%CI:1.05-1.84) had a higher risk of delayed onset of lactation. Compared with the lactating women doing housework, the risk of delayed onset of lactation was lower (P<0.05) among those whose occupations were as leaders of Enterprises/Institutions (OR=0.68, 95%CI:0.47-0.99), in catering and service trades (OR=0.61, 95%CI:0.43-0.86), in agriculture/forestry/fishery/herdsmen fields (OR=0.65, 95%CI:0.44-0.96) and who were unemployed (OR=0.64, 95%CI:0.46-0.90). Breastfeeding education during pregnancy might lower the risk of delayed onset of lactation (OR=0.78, 95%CI: 0.62-0.98). Conclusion The prevalence of delayed onset of lactation was relatively high for Chinese lactating mothers. Caesarean section and late initiation of breastfeeding were the primary risk factors. Lactating mothers living in medium or small cities and those doing housework appear to be high-priority groups for intervention. Based on our findings, breastfeeding education during pregnancy is recommended to lower the risk of delayed onset of lactation.

Objective To analyze the status of postpartum weight retention and its associated factors among Chinese lactating women in 2013. Methods This study was based on the databank of Chinese National Nutrition and Health Surveillance in 2013. Using the multi-stage stratified cluster sampling method, we enrolled 12 514 women, at 0-24 months postpartum, from 55 sites in 30 provinces of China (excluding the Tibet Autonomous Region). Questionnaires were used to collect data on basic characteristics, physical activity, lifestyle, food intake, pre-pregnancy weight, weight before delivery, disease history during pregnancy, delivery date, delivery mode, parity and breastfeeding information. Current body weight and height of each subject were measured. Postpartum weight retention in each subject was calculated as the difference between pre-pregnancy and current weights. High postpartum weight retention was defined as≥5 kg.