Analysis of influencing factors and interaction of body weight and disease outcome in patients with prediabetes

BACKGROUND The trend of prediabetes progressing to type 2 diabetes mellitus(T2DM)is prominent,and effective intervention can lead to a return to prediabetes.Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention.The weight change in patients with prediabetes has not attracted much attention.AIM To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM.METHODS We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance(NGT),and collected clinical data and follow-up results of all patients.Based on natural blood glucose outcomes,we classified 66 patients with progression to T2DM into the disease progression(DP)group,and 170 patients without progression to T2DM into the disease outcome(DO)group.We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression.A general linear model(univariate)was used to analyze the interaction between body weight and independent influencing factors.RESULTS There were 98 cases of impaired fasting glucose(IFG),90 cases of impaired glucose tolerance(IGT),and 48 cases of coexistent IFG and IGT.The body weight,waist circumference,body mass index,fasting blood glucose,and 2 h plasma glucose of patients with IFG,IGT,and coexistent IFG and IGT were higher than those in patients with NGT(P<0.05).Logistic regression analysis showed that body weight,glycosylated hemoglobin,uric acid,fasting insulin,and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM(P<0.05).Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905[95%confidence interval(CI):0.863-0.948],which was greater than that predicted by each indicator alone.Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1,the odds ratio(95%CI)of body weight 3 was 1.399(1.142-2.126)(P=0.033).There was a multiplicative interaction between body weight and uric acid(β=1.953,P=0.005).CONCLUSION High body weight in patients with prediabetes is an independent risk factor for progression to T2DM,and the risk of progression is increased when coexisting with high uric acid level.

The Relation of Standard Metabolic Rate to Water Temperature and Body Weight of Schlegels Black Rockfish(Sebastodes Fuscescens)

Standard metabolic rates of Schlegels black rockfish with different body weights are determined in laboratory by using the flow-through respirometer at 11.2 ℃, 14.7℃ , 18.0 ℃ and 23.6 ℃ . The results indicate that the standard metabolic rates increase with the increase of body weight at different temperatures. Relationship between them could be described as Rs = a ln W b. The mean of standard metabolic rate is significantly different among groups, but the b values are not. The standard metabolic rates of amended standard body weights decrease with the increase of temperature, and the mean of standard metabolic rate is also significantly different among groups when the standard body weights are 48.6 g, 147.9 g, and 243.1 g. Relationship between them could be described as Rsw = m e-b/T. The relations of standard metabolic rate ( Rs ) or relative metabolic rate ( Rs ) to body weight and temperature yield the following equations: Rs = 1.160 W 0.752 e -9.494/ T and Rs’= 1.160 W 0.254 e -9.494/ T.

EFFECTS OF RATION, TEMPERATURE AND BODY WEIGHT ON METABOLISM IN YOUNG BLACK PORGY

Feeding growth experiments on black porgy, Sparus macrocephalus , were carried out at four ration levels from starvation to satiation and four temperatures ranging from 14.8° to 26.8℃. The energy budget was used to calculate the metabolism in black porgy. Resting metabolism correlated significantly with body weight in power function at 24.4°, 20.1° and 14.8℃ ( R S=aW b ). The model predicting resting metabolism was obtained as: R S=0.0834W 0.8763 ·e 0.0319T . The feeding metabolism correlated linearly with ration level and food consumption. The predicting model of feeding metabolism is: R F=0.5631+0.0341·T-0.0013C·W·T+0.0010W ·T+0.0219C ·W-0.3335C. Using ln( RL+1 ), ln W , ln T and their interaction terms as independent variables, the prediction model of total daily metabolism was obtained by stepwise regression as: ln R T =-1.7328+0.3936ln W +1.1882ln( RL +1)-0.2823ln( RL +1)ln T +0.1555ln W ln T .

Risk factors related to acute renal failure after cardiac surgery for congenital heart disease in low body weight infants

Background Acute renal failure （ARF） is a common complication and a very important cause of postoperative death in children with congenital heart disease. Large cohort investigation of the morbidity and related risk factors for ARF in very young and low-body-weight children in China is still absent. Methods Data of 518 infants after cardiac surgery were analyzed retrospectively. The correlation between multivariate risk factors and ARF after cardiac surgery was analyzed by logistic regression. Results The incidence of postoperative ARF within 30 days was 6.9% （n = 36）. High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output were independent risk factors of ARF. There were statistical significances in intensive care unit staying [（21.73 ± 7.28） days vs （7.41 ± 3.76） days], P 0. 001] and mortality （27.8% vs 7.5%, P 0. 001） between the patients with or without ARF. Conclusions Acute renal failure is a key negative factor for the survivors after cardiac surgery for congenital heart disease in very young patients with low body weight. High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output are independent risk factors for development of ARF.

The Main and Interactive Effects of Fat and Salt Contents of the Diet on Characteristics of Metabolic Syndrome in Male Wistar Rats

The current Western diet contains high amounts of salt and fat. High salt and fat diets are known to have negative impacts on food intake (FI), body weight (BW), body composition (BC), glucose metabolism, and blood pressure. These factors have been studied as separate entities, but the main and interactive effects of dietary salt and fat received little study. The objective of this study was to examine the effect of sodium and fat content of the diet on FI, BW, and BC in male Wistar rats. Male Wistar Rats (n = 48) were allocated into 4 groups (n = 12) and received the following diets: 1. Normal sodium normal fat, 2. Normal sodium high fat, 3. High sodium normal fat, and 4. High sodium high-fat diet for 12 weeks. BW and FI were measured weekly. BC and organs’ weight were recorded post-termination. Regardless of sodium content, a greater FI was observed in normal-fat diet groups compared with high-fat diet groups. However, higher BW and fat (%) were observed in high-fat diet groups. Fasting blood glucose was higher in rats fed normal fat diets compared with those fed high-fat diets. Systolic and diastolic blood pressure was lower in rats fed either high fat, high salt, or normal fat, normal salt diet. In conclusion, fat but not salt content in the diet is a determining factor in the regulation of FI and body weight. Moreover, glucose metabolism can be influenced by both the fat and salt content of the diet.

Body Composition and Energy Expenditure Changes during Weight Loss: An Exploratory Study

The objective of this exploratory study was to describe changes in body composition and resting energy expenditure (REE) in adult women during weight reduction. A total of 69 client records were collected retrospectively from a 25 week commercial weight loss program that restricted calories to 90% of measured REE. Data analyzed included total body mass (TBM), fat mass (FM) and fat-free mass (FFM) from air displacement plethysmography;measured REE from indirect calorimetry;and predicted REE from linear regression. From baseline to week 25, there were significant declines in TBM (95.0 ± 24.1 kg to 87.2 ± 22.9 kg;P < 0.001) and FM (47.5 ± 18.5 kg to 39.9 ± 17.6 kg;P < 0.001). During the same time period, FFM remained unchanged (47.5 ± 7.3 kg to 47.2 ± 7.0 kg;P ≥ 0.05). REE was signify- cantly lower at weeks 13 (6595.2 ± 1312.1 kJ) and 25 (6608.2 ± 1404.6 kJ) compared to baseline (7117.4 ± 1471.5 kJ) (P < 0.001);however, REE at weeks 13 and 25 were similar (P ≥ 0.05). At weeks 13 and 25, predicted REE (6992.7 ± 1065.7 and 6939.2 ± 1056.0 kJ, respectively) was significantly higher than measured REE (6595.2 ± 1312.1 and 6608.2 ± 1404.6 kJ, respectively) (P < 0.001). The results of this study suggest that significant reduction in TBM is possible without the loss of FFM and that metabolic adaptation may occur during the process.

Prevalence and Incidence of Metabolic Syndrome in a Cohort of Patients with Rheumatoid Arthritis: A Correlation between Body Mass Index and Disease Activity

Rheumatoid Arthritis (RA) is an inflammatory disease associated with high morbidity and increased cardiovascular disease, and Metabolic Syndrome (MS) is understood as a set of metabolic disorders that correlates with obesity and sedentary lifestyle. The aim of this study is to evaluate the prevalence of MS in a cohort of patients with RA and its correlation to specific factors of the disease. A retrospective cohort study was conducted with 283 patients with RA, followed at the Rheumatology Outpatient Clinic of the Hospital de Clínicas de Porto Alegre (HCPA) between 2008 and 2016;187 continued to be followed and agreed to be reevaluated between January and November 2016. MS was defined according to the National Cholesterol Education Program and disease activity was assessed using the Disease Activity Score (DAS28). Clinical, biochemical, and anthropometric evaluations were conducted. The prevalence of MS in the first evaluation was 43.9% and, after 8 years, 59.4%. Increased waist circumference and blood pressures, elevated triglycerides and low High-Density Lipoprotein were the most frequent features of MS. The DAS28 was significantly lower in the reevaluation (p = 0.006). The prevalence of MS was higher at the end of 8 years;disease activity, as well as blood pressure, decreased during this period. Steroid use had also decreased at the end of follow-up. There was an increase of 15% of cases with MS in an 8-year follow-up cohort of patients, which was in agreement with the current literature and showed how the inflammatory process in RA is correlated to MS. The parameters of MS that varied the most were blood pressure, cholesterol and triglycerides. Ultimately, these parameters and disease activity must be observed closely in order to improve the prognosis of patients with RA.

New Mathematical Modelling on BMR and Weight Prediction for Ghanaians

Background: Basal Metabolic Rate (BMR) is the quantum of calories needed for optimum body function when at rest. This has long been an indicator of one’s health and the basis for determining the metabolic age of individuals. Many scholastic projects have led to the establishment of mathematical models and inventions that measure the BMR and other body composition parameters. However, existing computations have limitations as they do not offer accurate results for Ghanaians. Aim: The purpose of the study was to model BMR metrics that are most suitable for Ghanaians and to investigate the effect of caloric difference on weight, Lean Body Mass (LBM) and % fat composition that can be implemented with Information Technology. Research Methods and Procedures: This was an experimental study that adopted a quantitative approach. BMR and body composition were measured in a sample of 242 Ghanaian adults (141 males and 101 females) from 19 to 30 years of age. Body composition was measured using bioelectrical impendence analysis (BIA) in all participants. Each participant was under study for 7 days. A simple linear regression model was used to examine associations between BMR/calorie intake and total body weight and LBM. Results: There was a significant statistical relation between BMR and LBM and between BMR and weight of both men and women. Equations for BMR and weight were established for males and females. Furthermore, caloric intake differences affected changes in total weight as well as differences in % fat composition. Caloric intake however did not affect the difference in LBM. Conclusion: Caloric difference had an impact on total body weight and Lean Body Mass. The model derived from the study predicts weight change and BMR of Ghanaians from 19 to 30 years of age. It is termed the Health and Age Monitoring System (HAMS).

Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study

Objective: The pilot study was intended to test the feasibility of a multiple-component lifestyle intervention targeting African American adults in a weight control and cardiometabolic risk reduction program on diet, activity, and stress, using community-engagement principles. Methods: Applying mixed qualitative and quantitative measures, the intervention had a two-part sequential study design consisting of 12 weekly small group sessions that provided individual and group counseling in nutrition, exercise, and mindfulness, while incorporating focus group and interactive techniques to learn about barriers and acceptable practices for this population. The program was implemented at an African-American church in Nashville, Tennessee. Results: Thirty-four participants (aged 56.1 ± 11 years, body mass index (BMI) 36.7 ± 6.6 kg/m2) completed the intervention. Lifestyle changes after the 12 weekly sessions showed some positive trends including reduced sodium intake (from 2725.3 ± 326.5 to 2132 ± 330, mg/day, P = 0.008), increased walking steps (from 4392.1 ± 497.2 to 4895.3 ± 497.9, steps/day, not significant), and slightly decreased Perceived Stress Scale (PSS) scores (from 13.7 ± 1.4 to 12.4 ± 1.5, not significant). Body fat % among male participants decreased significantly (from 33.8 ± 2.6 to 28 ± 2.6, %, P = 0.043). Among cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) decreased significantly (from 6.6 ± 0.2 to 6.1 ± 0.2, %, P β = 2.4, P = 0.006). Twenty-one participants took part in focus groups during the program to identify barriers to healthy lifestyle changes. Primary barriers reported were price, time for preparing healthy meals, unfamiliarity with mindfulness activities, their health condition, and daily schedule available for physical activities. Conclusions: This church-based pilot intervention was proven feasible by showing modest progress in reducing adiposity and decreasing HbA1c levels. The focus group and interactive methods facilitated program direction. Future full-scale studies are warranted to identify key strategies that provide more personalized approaches and supportive environments to sustain a healthy lifestyle among these at risk minorities with limited resources.

老年人群体质量指数与慢性代谢性疾病的关系

目的·评估老年人群体质量指数(body mass index,BMI)与慢性代谢性疾病发生风险的关系。方法·以2014—2021年在上海交通大学医学院附属仁济医院体检中心进行体检的老年人(≥60岁)为研究对象。收集其各项生化指标。由经过培训的护士测量其身高、体质量和血压。采用问卷法收集研究对象既往慢性代谢性疾病史。收缩压≥140 mmHg(1 mmHg=0.133 kPa)、舒张压≥90 mmHg或既往有高血压病史,定义为高血压。空腹血糖≥7.0 mmol/L或既往有糖尿病病史,定义为糖尿病。总胆固醇≥6.2 mmol/L、三酰甘油≥2.3 mmol/L或既往有脂代谢异常病史,定义为脂质代谢紊乱。BMI与高血压、糖尿病和脂质代谢紊乱之间的关系采用受试者操作特征(receiver operator characteristic,ROC)曲线和二元Logistic回归进行分析评估。结果·共收集59083例研究对象的资料,其中男性30807例,女性28276例,平均年龄(67.9±6.3)岁。高血压、糖尿病和脂质代谢紊乱的发生率分别为76.5%(45219/59083)、24.1%(14225/59083)和50.0%(29544/59083)。与60~74岁的老年人群相比,75岁及以上的老年人患高血压和糖尿病的比例更高,患脂质代谢紊乱和无代谢异常的比例更低。通过ROC曲线分析,BMI对于高血压、糖尿病和脂质代谢紊乱的切点值分别为24.3、23.9和23.9 kg/m^(2)。老年男性高血压和糖尿病的BMI切点值和老年女性十分接近(高血压BMI切点值:老年男性24.3 kg/m^(2)vs老年女性24.2 kg/m^(2);糖尿病BMI切点值:老年男性24.0 kg/m^(2)vs老年女性23.7 kg/m^(2)),但老年男性脂质代谢紊乱的BMI切点值明显高于老年女性(老年男性24.0 kg/m^(2)vs老年女性22.5 kg/m^(2))。60~74岁老年人的BMI对慢性代谢性疾病的切点值(24.2~24.7 kg/m^(2))高于75岁及以上的老年人(22.9~23.8 kg/m^(2))。结论·60~74岁老年人群应将BMI控制在24.0 kg/m^(2)以下,而75岁及以上老年人群应将BMI控制在23.0 kg/m^(2)以下,则有利于降低其慢性代谢性疾病的风险。

不同体质指数的非酒精性脂肪性肝病患者的心功能及三大底物消耗特点

目的分析不同体质指数的非酒精性脂肪性肝病(NAFLD)患者的心功能及三大底物消耗特点。方法选取45例NAFLD患者,根据体质指数将其分为正常组(15例)、超重组(13例)和肥胖组(17例)。采用心肺运动试验(CPET)测定3组患者在运动达无氧阈时及达最大运动时的摄氧量、碳水化合物能量消耗、脂肪能量消耗、蛋白质能量消耗。采用Weber心功能评级标准评估3组患者的心功能进行评定。结果3组患者Weber心功能分级均为B级。达最大运动时,正常组、超重组、肥胖组患者的摄氧量依次降低(P<0.05);运动达无氧阈时,肥胖组患者的碳水化合物能量消耗高于超重组和正常组(P<0.05),但超重组和正常组之间差异无统计学意义(P?0.05);运动达无氧阈时,正常组、超重组、肥胖组患者的蛋白质能量消耗依次增加(P<0.05)。但运动达无氧阈和最大运动时,3组患者的脂肪能量消耗差异无统计学意义(P?0.05)。结论NAFLD患者均存在轻度至中度心功能损害。在进行较高强度运动时,体质指数越大的NAFLD患者的摄氧能力越低,心脏运动耐力越差;在进行中低强度运动时,高体质指数的NAFLD患者所需能量倾向于由碳水化合物代谢和蛋白质代谢提供;无论运动强度高低,NAFLD患者的脂肪氧化代谢能量消耗基本不受体质指数影响。

代谢健康状态转变及其与BMI的交互作用对心血管疾病发生的影响

目的探讨代谢健康状态转变与体质指数(BMI)交互作用及与心血管疾病(CVD)的关联。方法基于“新疆多民族自然人群队列建设及健康随访研究”和田调查现场,进行前瞻性队列研究。经过3年随访,根据代谢状态转变将研究对象分为保持代谢健康(MH)、代谢健康转为代谢不健康(MH-MU)、保持代谢不健康(MU)、代谢不健康转为代谢健康(MU-MH)4组,多因素Logistic回归分析不同组代谢状态对CVD发生的影响。应用限制性立方样条探讨BMI为连续变量与CVD风险的关联,分析代谢状态转变和BMI交互作用与CVD的关联。结果共10232人纳入本研究,平均年龄为(52.43±10.29)岁。在随访3年期间新发心血管疾病349例(3.41%);其中MH、MH-MU、MU和MU-MH 4组心血管疾病发生率分别为2.48%、4.21%、5.13%、3.30%。与MH组相比,MH-MU、MU组心血管疾病发生风险分别为OR=1.42(95%CI:1.05~1.93)和OR=1.41(95%CI:1.03~1.92)。限制性立方样条分析表明,基线BMI与心血管疾病发生为非线性关联(P=0.023)。BMI分组与代谢状态转变存在交互作用(χ2=26.025,P=0.001),其归因于交互效应比例为3%[RERI=0.032(95%CI:0.005~0.06)、AP=0.031(95%CI:0.007~0.05)、S=2.157(95%CI:1.194~3.897)]。结论保持或转变为代谢不健康状态均可增加心血管疾病的风险。保持或转为代谢不健康状态与超重、肥胖交互作用能够增加心血管疾病的风险。

甘油三酯葡萄糖指数及其衍生指标对瘦型代谢相关脂肪性肝病的预测价值

目的探讨甘油三酯葡萄糖指数(TyG)及其衍生指标TyG-BMI、TyG-丙氨酸转氨酶(ALT)与瘦型代谢相关脂肪性肝病(MAFLD)患病风险的相关性。方法选择2023年7-12月在我院健康管理中心进行年度健康体检并诊断为瘦型MAFLD的207例患者及100名瘦型健康对照为研究对象,比较两组血脂、血糖、肝功能、TyG、TyG-BMI、TyG-ALT等,采用单因素和多因素logistic回归模型分析影响瘦型MAFLD的因素。将所有研究对象按照TyG及其衍生指标四分位数分为4个亚组(Q1~Q4),观察各亚组瘦型MAFLD的患病率。绘制TyG、TyG-BMI、TyG-ALT预测瘦型MAFLD的ROC曲线,评估各指标的预测效能。结果纳入的8764例体检者中MAFLD患者2350例(26.8%),其中瘦型207例(8.8%,207/2350)。与瘦型健康对照组相比,瘦型MAFLD组患者的年龄大、男性多见、BMI高,空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、ALT、天冬氨酸转氨酶、γ-谷氨酰转肽酶、碱性磷酸酶、总胆红素、TyG、TyG-BMI与TyG-ALT均升高,高密度脂蛋白胆固醇降低(均P<0.01)。logistic回归分析显示,年龄、男性、ALT水平升高是瘦型MAFLD患病的独立危险因素。TyG的Q4亚组瘦型MAFLD的患病率为34.3%(71/207),高于Q1亚组(10.6%,22/207)及Q2亚组(24.2%,50/207),差异均有统计学意义(均P<0.05);TyG-BMI的Q4亚组和TyG-ALT的Q4亚组瘦型MAFLD的患病率均高于其Q1、Q2、Q3亚组[35.3%(73/207)vs 8.2%(17/207)、24.6%(51/207)、31.9%(66/207),33.8%(70/207)vs 14.0%(29/207)、23.2%(48/207)、29.0%(60/207)],差异均有统计学意义(均P<0.05)。TyG-BMI预测瘦型MAFLD的AUC值为0.8690(95%CI 0.8255~0.9126,P<0.001),高于TyG[AUC=0.8188(95%CI 0.7680~0.8696,P<0.001)]和TyG-ALT[AUC=0.7725(95%CI 0.7187~0.8262,P<0.001)]。结论TyG、TyG-BMI与TyG-ALT均与瘦型MAFLD相关,三者对瘦型MAFLD具有一定的预测价值;TyG及其衍生指标计算简易且价格低廉,可用于对瘦型MAFLD的临床初步评估。

益智清心方单次给药毒性试验研究

目的:观察24 h内益智清心方经口灌胃后的急性毒性反应和死亡情况,评价益智清心方的安全性,为进一步的重复给药毒性试验以及临床用药提供参考。方法:选取24~33 g ICR小鼠,雌雄各半,随机分为益智清心方组和空白对照组,采用最大给药量法,以最大灌胃体积40 mL/kg计,分别给予等体积的益智清心方药液和纯水,2次/d,给药期间定期监测小鼠一般状况和体质量,14 d后,收集血、尿样本,并进行大体解剖,评价益智清心方对脏器系数、血常规、尿常规等安全性指标的影响。结果:ICR小鼠按40 mL/kg经口灌胃给予最大可配制浓度为0.36 g干浸膏/mL的益智清心方药液,当日2次,累积剂量为98.6 g生药/kg体质量,约相当于成人临床拟用剂量的298倍(按公斤体质量计算)和38倍(按体表面积计算)。各组小鼠均未发现毒性相关的症状和死亡,益智清心方组小鼠在体质量、脏器系数、血常规、尿常规指标方面与对照组小鼠比较差异均无统计学意义(均P>0.05)。结论:本试验条件下,益智清心方的单次给药毒性试验中未见明显的急性毒性反应及死亡,提示其最大耐受量(MTD)>98.6 g生药/kg体质量。

不同性别老年人群身体圆度指数与体质量正常代谢异常表型的相关性研究:以三酰甘油葡萄糖乘积指数为潜在影响因素

背景身体圆度指数(BRI)是一种衡量中心性肥胖的简易指标,与心血管疾病密切相关。体质量正常代谢异常(MONW)人群患心血管疾病的风险较高,且与中心性肥胖显著相关。三酰甘油葡萄糖乘积(TyG)指数是反映胰岛素抵抗的指标。目前在不同性别老年人群中BRI、TyG指数和MONW表型的关系研究较为有限。目的探讨老年人群BRI与MONW表型患病风险在不同性别中的差异,探究TyG指数作为其不同性别中差异的潜在因素。方法选取2017-07-01—2021-06-30在安徽省10个市县区体检的≥60岁的常住居民为研究对象。采用统一的调查表收集研究对象的性别、年龄、疾病史等资料,收集体格检查和实验室检查资料,并计算BRI、TyG指数。将根据代谢状态和BMI水平分别将男性和女性分为体质量正常代谢正常(MHNW)表型和MONW表型:男性MHNW表型(n=5384)、男性MONW表型(n=6251);女性MHNW表型(n=4498)、女性MONW表型(n=8264)。根据BRI四分位数分别将男性和女性分为4个水平,即男性:M1、M2、M3、M4,女性:F1、F2、F3、F4。采用Logistic回归分析分别探讨BRI四分位水平与TyG指数升高风险以及MONW表型患病风险的关系,采用R(version 4.1.1)软件中的Z检验比较男性和女性OR值之间的差异。结果本研究共纳入24397例调查对象,其中男11635例(47.7%)、女12762例(52.3%),中位年龄67(64,70)岁,MHNW表型9882例(40.5%)、MONW表型14515例(59.5%)。不同性别MONW表型老年人群高血压比例、糖尿病比例、血脂异常比例、收缩压、舒张压、TyG指数、BRI、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)高于MHNW表型,吸烟比例、高密度脂蛋白胆固醇(HDL-C)低于MHNW表型(P<0.05);不同性别高水平BRI老年人群MONW表型患病、高血压比例、糖尿病比例、血脂异常比例、TyG指数、FPG、TG高于低水平BRI,HDL-C低于低水平BRI(P<0.05)。单因素Logistic回归分析结果显示,与BRI M1/F1水平相比,不同性别老年人群BRI M2/F2、M3/F3、M4/F4水平TyG指数升高风险均增加(P<0.05);且TyG指数升高风险随着BRI水平升高而增加(男性P_(趋势)<0.001,女性P_(趋势)<0.001);老年男性BRI M2、M3、M4水平TyG指数升高风险高于老年女性BRI F2、F3、F4水平(P<0.05)。校正混杂因素后进行多因素Logistic回归分析结果显示,与BRI M1/F1水平相比,不同性别老年人群BRI M2/F2、M3/F3、M4/F4水平MONW表型患病风险均增加(P<0.05);且MONW表型患病风险随着BRI水平升高而增加(男性P_(趋势)<0.001,女性P_(趋势)<0.001);老年男性BRI M2、M4水平MONW表型患病风险高于老年女性BRI F2、F4水平(P<0.05)。结论在不同性别老年人群中,BRI水平与MONW表型患病风险呈正相关,其中老年男性高水平BRI与MONW表型患病风险关联更为密切,TyG指数是引起其性别差异的潜在因素。

β羟丁酸在心血管疾病中的作用及意义

羟丁酸是酮体的主要成分,在肝脏生成,肝外组织代谢。心脏是重要的酮体消耗器官,病理条件下酮体氧化贡献着超过心脏所需20%的能量。近年来β羟丁酸在心血管疾病中的作用成为研究热点,由于其不仅是能量底物,还作为信号分子调节细胞代谢、炎症、细胞间相互作用和生物能量,这些功能使其在不同心血管疾病中发挥复杂多样的作用。本文对近几年β羟丁酸在心力衰竭、病理性心肌肥大、糖尿病心肌损伤、心肌缺血与再灌注损伤、心房颤动、高血压、动脉粥样硬化及钙化等疾病中的研究成果进行综述,为β羟丁酸成为心血管疾病新的干预靶点提供依据。

甘油三酯葡萄糖-体重指数与心血管及代谢性疾病相关性研究进展

甘油三酯葡萄糖指数已被认为是一种简便特异的衡量胰岛素抵抗的可靠指标,而甘油三酯葡萄糖-体重指数(TyG-BMI)则是甘油三酯葡萄糖指数与肥胖相结合所产生的更强有力的胰岛素抵抗替代标志物。TyG-BMI与心血管及代谢性疾病的严重程度和不良预后之间的相关性日益引起人们的重视。现阐述TyG-BMI在高血压、冠状动脉粥样硬化性心脏病、糖尿病、高尿酸血症和非酒精性脂肪性肝病中的临床应用价值和最新研究进展。

Long-term treatment with proton pump inhibitor is associated with undesired weight gain

AIM:To examine the effects of long-term proton pump inhibitor (PPI) therapy on body weight (BW) and body mass index (BMI) in patients with gastroesophageal reflux disease (GERD).METHODS: The subjects were 52 patients with GERD and 58 sex-and age-matched healthy controls. GERD patients were treated with PPI for a mean of 2.2 years (range, 0.8-5.7 years), and also advised on lifestyle modifications (e.g. selective diet, weight management). BW, BMI and other parameters were measured at baseline and end of study.RESULTS: Twenty-four GERD patients were treated daily with 10 mg omeprazole, 12 with 20 mg omeprazole, 8 with 10 mg rabeprazole, 5 with 15 mg lansoprazole, and 3 patients with 30 mg lansoprazole. At baseline, there were no differences in BW and BMI between reflux patients and controls. Patients with GERD showed increases in BW (baseline: 56.4±10.4 kg, end: 58.6±10.8 kg, mean±SD, P<0.0001) and BMI (baseline: 23.1±3.1 kg/m2, end: 24.0±3.1 kg/m2, P<0.001), but no such changes were noted in the control group. Mean BW increased by 3.5 kg (6.2% of baseline) in 37 (71%) reflux patients but decreased in only 6 (12%) patients during treatment.CONCLUSION: Long-term PPI treatment was associated with BW gain in patients with GERD. Reflux patients receiving PPI should be encouraged to manage BW through lifestyle modifi cations.

中国内脏脂肪指数在冠心病合并代谢综合征 患者中的评估价值

目的探讨中国内脏脂肪指数(CVAI)是否可以作为冠心病合并代谢综合征人群的可靠评估指标。方法回顾性研究。连续入选2022年8月至2023年3月于江南大学附属医院心血管内科完成冠状动脉造影检查的424例冠心病患者,并分为冠心病合并代谢综合征组(220例)和冠心病未合并代谢综合征组(204例)。测量患者入院时的腰围,收集患者的一般临床资料和实验室检查结果。计算CVAI,并比较其与其他内脏肥胖指标(腰围、体质指数)对冠心病合并代谢综合征患者的评估能力。对入院后行经皮冠状动脉介入术(PCI)的286例冠心病患者进行术后12个月的主要不良心血管事件随访。结果冠心病人群总体CVAI呈正态分布,平均值为122.49±40.45。冠心病合并代谢综合征患者的体质指数、三酰甘油、空腹血糖、血尿酸、估算的肾小球滤过率(eGFR)、Gensini评分、腰围、CVAI、合并脑卒中、糖尿病和高血压比例均高于冠心病未合并代谢综合征患者,而白蛋白和高密度脂蛋白胆固醇水平均低于冠心病未合并代谢综合征患者,差异均有统计学意义(均为P<0.05)。多因素logistic回归分析显示,血尿酸(OR=1.005,95%CI:1.001~1.009,P=0.009)、eGFR(OR=1.011,95%CI:1.000~1.023,P=0.045)和CVAI(OR=1.031,95%CI:1.020~1.043,P<0.001)均是冠心病患者合并代谢综合征的危险因素,而白蛋白(OR=0.890,95%CI:0.815~0.972,P=0.010)是冠心病患者合并代谢综合征的保护因素。与腰围、体质指数和Gensini评分比较,CVAI诊断冠心病合并代谢综合征的受试者工作特征(ROC)曲线下面积(AUC)最大(AUC=0.798,95%CI:0.736~0.859),最佳诊断位点109.389,敏感度为89.1%,特异度为64.7%。Kaplan-Meier生存分析显示,冠心病患者高CVAI组(CVAI>124.41,136例)PCI术后12个月内的主要不良心血管事件发生率高于低CVAI组(CVAI≤124.41,150例)[Log-rank(Mantel-Cox),χ^(2)=4.872,P=0.027]。结论CVAI对冠心病合并代谢综合征有一定诊断价值,对PCI术后预后也有一定预测价值,可作为冠心病合并代谢综合征患者的可靠评估指标。

UVC联合PICC在极低体重儿中的应用

目的:探究脐静脉置管(UVC)联合外周中心静脉置管(PICC)在极低体重儿中的应用。方法:回顾性分析2021年10月—2022年12月浙江省人民医院毕节医院收治的82例极低体重儿。根据置管方式的不同将其分为对照组和观察组,各41例。对照组给予PICC,观察组给予UVC联合PICC。比较两组体重情况及住院时间,置管前后营养状况、骨代谢指标、并发症及家属满意度。结果:置管后,观察组体重高于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。置管后,观察组白蛋白、白蛋白水平均高于对照组,差异有统计学意义(P<0.05)。置管后,观察组碱性磷酸酶(ALP)、磷(P)、钙(Ca)均高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组家属总满意度高于对照组,差异有统计学意义(P<0.05)。结论:UVC联合PICC能够有效提高极低体重儿体重增长,改善营养状况及骨代谢,降低并发症发生风险,缩短住院时间,进而提高家属满意度。