BACKGROUND AND OBJECTIVES:Behavioural strategies can promote adherence to intensive lifestyle treatments for obesity. This study aimed to explore effective behavioural strategies for weight maintenance in Chinese patients with overweight or obesity. METHODS AND STUDY DESIGN:Retrospective analysis of weight mainte-nance data was conducted. Patients with overweight or obesity, who had received a 3-month weight loss and behavioural intervention, were asked to complete questionnaires to monitor compliance with behavioural strategies after the weight loss. They continued to follow a daily calorie restriction for 12 months to maintain their weight. The primary outcome was to evaluate the association between a total weight loss (TWL) of more than 5% and compliance with behavioural strategies during the 6-month weight maintenance phase. RESULTS:A total of 131 patients completed the questionnaire. The top three easy-to-perform behaviours were eating vegetables and protein first and carbohydrates later, self-weighing each day and having regular eating times. Of 131 patients, 61 (46.5%) and 42 (32.1%) were followed up for 6 months and 12 months respectively. Reducing high-fat food intake (p = 0.002) and eating an average frequency of 5 times a day (p = 0.034) were associated with a TWL of more than 5% during 6 months weight maintenance. Reducing high-fat food intake was associated with a TWL of more than 5% during 12 months weight maintenance (p = 0.029). CONCLUSIONS:Chinese patients with overweight or obesity who experienced a TWL of more than 5% were more likely to reduce high-fat food intake during long-term weight maintenance.

Background and Objectives: Large-scale studies on the role of multivitamin-mineral (MVM) supplementation in preventing and managing acute respiratory infections (AURIs) are limited in Chinese populations. This study evaluated the impact of routine MVM use on AURI prevalence and symptom severity in a community-based Chinese cohort. Methods and Study Design: This retrospective study was conducted among community-based populations across China (n=3,415). Using a structured questionnaire, participants self-reported episodes of AURIs over three months. Based on regular use of MVM for at least 3 months, eligible participants were categorized into the MVM group and the control group. The impact of MVM on the frequency and severity of AURIs was assessed. Rigorous methodological approaches were applied to minimize potential biases. Results: The period prevalence of AURIs was significantly lower in the MVM group (29.9%) compared to controls (45.6%), odds ratio (OR) =0.508 (p<0.001). After propensity score matching, demographic and lifestyle factors were comparable between groups. The period prevalence of AURIs was 31.7% and 44.8% in the MVM and control groups (OR=0.572, p<0.001). Subgroup analysis indicated the protective effect of MVM supplementation was particularly significant among participants aged >= 45 years (OR=0.407, p<0.001). The MVM group reported lower prevalence of nasal congestion 0.026), sneezing (OR=0.651, p=0.002), and fatigue (OR=0.694, p=0.004) relative to the control group. Conclusions: Daily MVM supplementation for at least 3 months reduced the period prevalence of the common cold and influenza and may contribute to enhanced immune resilience in the Chinese population.

BackgroundUlcerative colitis (UC) patients often suffer from impaired nutritional conditions. However, there are few studies focused on muscle loss in UC patients as well as its impact on therapeutic response. This study aimed to investigate the prevalence of myopenia in hospitalized patients with active UC, analyze the relationship between body composition including both skeletal muscle and fat with clinical characteristics, and explore the association between body composition and clinical response to vedolizumab.MethodsA retrospective cohort study was conducted in hospitalized patients with active UC in Peking Union Medical College Hospital from November 2014 to October 2022. Computed tomography (CT) scans were used to measure skeletal muscle area, visceral fat area (VFA), subcutaneous fat area (SFA), and intramuscular fat infiltration at the third lumbar vertebrae (L3) level. These measurements were standardized by height (m) squared. Myopenia was defined as a skeletal muscle index (SMI) < 44.77 cm2/m2 for males and <32.50 cm2/m2 for females. The VFA/SFA ratio (VSR) served as an indicator of visceral obesity, while intramuscular fat infiltration was evaluated using the mean Hounsfield Unit (HU) value of the L3 skeletal muscle section.ResultsA total of 457 patients were enrolled. The prevalence of myopenia was 49.7% in this cohort. Female patients had significantly higher levels of subcutaneous fat and intramuscular fat but a lower level of visceral fat than male patients. SMI and mean HU showed positive correlations with serum albumin (ALB) and negative correlations with serum high-sensitivity C-reactive protein (hsCRP), whereas VSR showed the opposite trend. Among the 92 patients who received vedolizumab treatment, myopenia was significantly associated with a lower clinical response rate, and this association remained significant after adjusting for vedolizumab duration, ALB, and hsCRP (OR = 3.458, 95% CI 1.238–9.659, p = 0.018). Visceral obesity, defined as VSR ≥ 75th centile of gender-specific VSR, tended to diminish the clinical response rate but did not reach statistical significance.ConclusionThis study underscores the significance of assessing body composition in UC patients. Optimizing body composition should be considered an integral component of managing UC patients in the future.

The standardized nutrition support therapy can improve the nutritional status, immunity, quality of life, and clinical outcomes of patients with novel coronavirus disease (COVID-19) infection. The latest Chinese government policy also clearly states that nutrition support therapy should be included in the whole process of treatment and recovery of patients with COVID-19. Therefore, the Beijing Quality Control and Improvement Center for Clinical Nutrition Therapy has organized relevant experts to formulate the Recommendations of Nutritional Treatment for Patients with COVID-19 Infection (2023), following the latest clinical nutrition guidelines, research evidence and clinical practice of nutrition support of COVID-19. The recommendations suggest that individualized nutrition management be implemented by following the standardized pathway of nutrition management, which includes nutrition-risk screening, malnutrition diagnosis, nutrition treatment and nutrition monitoring, and by taking into account the clinical characteristics of patients with COVID-19.

Elderly inpatients with coronavirus disease 2019 (COVID-19) are often at nutritional risk and at higher risk of critical disease. The standardized nutrition treatment could effectively improve the nutritional status, quality of life, and clinical outcomes of COVID-19 patients, and is an important component of the comprehensive management of COVID-19. The individualized nutrition diagnosis, treatment and monitoring should be conducted in compliance to standard procedures of medical nutrition therapy, with consideration of the clinical characteristics of elderly COVID-19 inpatients. The Department of Clinical Nutrition at Peking Union Medical College Hospital has integrated the latest clinical nutrition guidelines and clinical practice of nutrition support of COVID-19, with the aim to provide evidence-based, concise and practical recommendations on nutritional management for elderly inpatients with COVID-19. The recommendations here are to inform effective and standardized nutrition support practice.

胃内球囊是一种无创的肥胖症治疗策略.通过在胃内放置球囊,限制容量和延缓胃排空可实现减重目的,临床上适用于单纯通过饮食和运动未能减重成功,或不愿意接受减重手术的肥胖症患者,也可用于减重手术术前先期减重的过渡性治疗.胃内球囊留置期内减重效果良好,严重并发症发生率低,但长期减重及改善代谢效果尚需更多临床研究加以验证.目前胃内球囊在我国尚未获批应用于临床.本文对胃内球囊的适应证、禁忌证、减重效果及相关并发症进行综述,以期指导临床实践.

Peripherally inserted central venous catheter (PICC)-related upper extremity venous thrombosis (UEVT) is defined as upper extremity venous thrombosis within the veins where PICCs were placed or adjacent to and may result in pulmonary embolism. Malignancies, previous history of venous thrombosis and malposition are common risk factors for PICC-UEVT. Once patients demonstrate clinical manifestations of phlebitis and thrombosis, such as swelling, pain and tenderness at the PICC site, venous duplex ultrasonography is the first choice for diagnosing PICC-UEVT. According to American College of Chest Physicians guidelines, it's not recommended to remove PICCs upon detection of PICC-UEVT. The first-line treatment is to administer systemic anticoagulants while keeping the catheter in place, unless any contraindications. PICCs could continue to be used during anticoagulation therapy, suppose that catheter tip remains well placed and functions as normal. With early diagnosis and standard anticoagulant treatment, a better clinical outcome could be achieved. Prophylactic anticoagulation is not routinely recommended per guidelines. Recommendation for asymptomatic PICC-related thrombosis is still absent and warrants further prospective studies with large sample size.

To retrospectively review the efficacy of intermittent fasting 5:2 plus program (30% of energy requirements on fast days and 70% of energy requirements on nonfasting days) in Chinese patients with overweight or obesity. This retrospective cohort study evaluated weight loss outcomes of patients treated with 12 weeks weight loss program in clinic. Adults with overweight or obesity participated in intermittent fasting 5:2 plus, daily calorie restriction (70% of energy requirements every day) or daily calorie restriction with meal replacement (70% of energy requirements every day, partly provided with high-protein meal replacement) programs for 12 weeks. The primary objective was to compare the weight loss of three groups. The primary outcome measure was the change in the % total weight loss. A total of 131 patients (35.3 ± 10.1 years; 81.7% female) were included, and the mean weight loss was 7.8 ± 4.4% after 12 weeks. The intermittent fasting 5:2 plus group (n = 42) achieved 9.0 ± 5.3% weight loss, compared with 5.7 ± 3.7% in the daily calorie restriction group (n = 41) (p < 0.001) and 8.6 ± 3.5% in the meal replacement group (n = 48) (p = 0.650). A total of 85.7% of patients in the intermittent fasting 5:2 plus group lost more than 5% body weight, vs. 58.5% in the daily calorie restriction group (p = 0.008), and 45.2% lost more than 10% body weight, vs. 14.6% in the daily calorie restriction group (p = 0.005). No serious adverse events were reported in the three groups. The intermittent fasting 5:2 plus program more effectively led to weight loss than daily calorie restriction in the short-term in Chinese patients with overweight or obesity. A longer-term prospective randomized controlled trial is needed.

BACKGROUND:Malnutrition is common in cancer patients. The NUTRISCORE is a newly developed cancer-specific nutritional screening tool and was validated by comparison with the Patient-Generated Subjective Global Assessment (PG-SGA) and Malnutrition Screening Tool (MST) in Spain. We aimed to evaluate the performance of the NUTRISCORE, MST, and PG-SGA in estimating the risk of malnutrition in Chinese cancer patients.METHODS:Data from an open parallel and multicenter cross-sectional study in 29 clinical teaching hospitals in 14 Chinese cities were used. Cancer patients were assessed for malnutrition using the PG-SGA, NUTRISCORE, and MST. The sensitivity, specificity, and areas under the receiver operating characteristic curve were estimated for the NUTRISCORE and MST using the PG-SGA as a reference.RESULTS:A total of 1000 cancer patients were included. The mean age was 55.9 (19 to 92 years), and 47.5% were male. Of these patients, 450 (45.0%) had PG-SGA B and C, 29 (2.9%) had a NUTRISCORE ≥5, and 367 (36.7%) had an MST ≥ 2. Using the PG-SGA as a reference, the sensitivity, specificity, and area under the curve values of the NUTRISCORE were found to be 6.2, 99.8%, and 0.53, respectively. The sensitivity, specificity, and area under the curve values of the MST were 50.9, 74.9%, and 0.63, respectively. The kappa index between the NUTRISCORE and PG-SGA was 0.066, and that between the MST and PG-SGA was 0.262 (P < 0.05).CONCLUSIONS:The NUTRISCORE had an extremely low sensitivity in cancer patients in China compared with the MST when the PG-SGA was used as a reference.

吃什么能增加免疫力?在门诊常被问到这个问题.吃什么与日常生活息息相关,而免疫力或抵抗力近来很受大家关注.在临床门诊一线工作十余年,有些经验体会与大家分享.要增加免疫力,我一般会考虑三种情况. 疾病情况 有疾病,抵抗力自然容易差.自觉免疫力低下,从经验上,要先排除疾病情况.比如,甲状腺功能亢进,有的人咋吃都不胖;甲状腺功能减退,干啥都没精神……体检一定得查一查甲状腺功能.有肿瘤病史,手术、放疗、化疗和免疫治疗等,都有可能导致疲劳、抵抗力差.有糖尿病、高血压、肥胖等情况,也相对容易免疫力低下.

Background: The Michigan Risk Score (MRS) was the only predicted score for peripherally inserted central venous catheters (PICC) associated upper extremity venous thrombosis (UEVT). Age-adjusted D-dimer increased the efficiency for UEVT. There were no external validations in an independent cohort. Method: A retrospective study of adult patients with PICC insertion was performed. The primary objective was to evaluate the performance of the MRS and age-adjusted D-dimer in estimating risk of PICC-related symptomatic UEVT. The sensitivity, specificity and areas under the receiver operating characteristics (ROC) of MRS and age-adjusted D-dimer were calculated. Results: Two thousand one hundred sixty-three patients were included for a total of 206,132 catheter days. Fifty-six (2.6%) developed PICC-UEVT. The incidences of PICC-UEVT were 4.9% for class I, 7.5% for class II, 2.2% for class III, 0% for class IV of MRS (p = 0.011). The incidences of PICC-UEVT were 4.5% for D-dimer above the age-adjusted threshold and 1.5% for below the threshold (p = 0.001). The areas under ROC of MRS and age-adjusted D-dimer were 0.405 (95% confidence interval (CI) 0.303-0.508) and 0.639 (95% CI 0.547-0.731). The sensitivity and specificity of MRS were 0.82 (95% CI, 0.69-0.91), 0.09 (95% CI, 0.08-0.11), respectively. The sensitivity and specificity of age-adjusted D-dimer were 0.64 (95% CI, 0.46-0.79) and 0.64 (95% CI, 0.61-0.66), respectively. Conclusions: MRS and age-adjusted D-dimer have low accuracy to predict PICC-UEVT. Further studies are needed.

We read with great interest the recently published guideline by Pironi L et al. [ [1] Pironi L. Boeykens K. Bozzetti F. Joly F. Klek S. Lal S. et al. ESPEN guideline on home parenteral nutrition. Clin Nutr. 2020; 39: 1645-1666 Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar ], entitled, ‘ESPEN Guideline on Home Parenteral Nutrition’. In the recommendation 13, right-sided central venous access devices were recommended for lower risk of thrombosis compared with left-sided approaches. This issue described in this article warrant further discussion. Reply to the comment by CHEN W et al. on the ESPEN HPN guidelinesClinical NutritionVol. 40Issue 2PreviewWe thank Dr. Chen et al. very much for their comments [1] on recommendation #13 of the ESPEN guidelines on home parenteral nutrition (HPN) [2], which suggest a preference for right-sided central venous access devices (CVAD) since these are associated with a lower risk of CVAD-related vein thrombosis (CVAD-VT). Full-Text PDF

目的 探讨衰弱对住院老年冠心病患者短期预后的影响.方法 前瞻性收集并分析2017年12月至2018年11月在北京协和医院住院治疗的老年冠心病患者临床资料.根据是否合并衰弱,将患者分为衰弱组和非衰弱组.对两组患者随访,终点事件包括非常规就诊、主要不良心脑血管事件(major adverse cardiac and cerebral events,MACCE)、全因死亡.采用多因素Cox回归分析衰弱与冠心病患者预后的关系.绘制两组无MACCE的Kaplan-Meier生存曲线,并采用Log-Rank检验进行比较.结果 共345例符合纳入和排除标准的老年冠心病患者入选本研究,包括稳定性冠心病250例,急性冠状动脉综合征95例.衰弱组74例(21.4％),其中轻度衰弱38例、中度衰弱36例,非衰弱组271例(78.6％).中位随访时间351(300,394)d,失访3例.与非衰弱组比较,衰弱组非常规就诊发生率(36.1％比21.5％)、全因死亡率(11.1％比4.1％)均升高(P均<0.05),MACCE发生率(9.7％比4.8％)无显著差异(P>0.05).多因素Cox回归分析结果显示,轻度和中度衰弱是稳定性冠心病患者全因死亡的危险因素(HR=4.169,95％CI:1.055～16.474,P=0.042),对其非常规就诊(HR=1.704,95％CI:0.947～3.066,P=0.075)、MACCE(HR=1.268,95％CI:0.331～4.863,P=0.729)无显著影响.在急性冠状动脉综合征患者中,轻度和中度衰弱对其非常规就诊(HR=1.159,95％CI:0.342～3.924,P=0.812)、MACCE(HR=0.822,95％CI:0.092～7.369,P=0.861)及全因死亡(HR=1.445,95％CI:0.210～9.964,P=0.708)均无显著影响.Kaplan-Meier生存曲线显示,衰弱组和非衰弱组患者的无MACCE生存曲线无显著差异(P>0.05).结论 住院老年冠心病患者合并轻中度衰弱的比率较高,其可能增加稳定性冠心病患者近期死亡风险.

BACKGROUND AND OBJECTIVESMalnutrition in elderly individuals is extremely common. In China, Nutritional Risk Screening 2002 (NRS-2002) is often used to assess malnutrition in hospitalized elderly patients, although a gold standard for elderly outpatients is lacking. The Nutrition Screening Initiative Checklist (NSI) and Malnutrition Screening Tool (MST) have seldom been validated in elderly outpatients. This open, parallel, multi-center, cross-sectional study evaluated the performance of NRS-2002, the NSI, and the MST in estimating malnutrition risk in elderly outpatients.METHODS AND STUDY DESIGNThis study included 986 elderly outpatients, with 53.2% being women, from five clinical teaching hospitals in Beijing. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the tools were estimated using a body mass index (BMI) of <18.5 kg/m2 as a reference.RESULTSThe mean (range) age of the patients was 69.6±6.8 (60-100) years. Overall, 4.3% had BMI <18.5 kg/m2, 16.8% scored ≥3 points in NRS-2002, 9.8% scored ≥2 points in the MST, and 37.0% scored ≥3 points in the NSI. NRS-2002 had the highest sensitivity and the best AUC (0.934 vs. 0.642 for the NSI and 0.660 for the MST, p<0.05), and the MST had the highest specificity. The sensitivity and specificity of the NSI were 0.64 and 0.64, respectively.CONCLUSIONSNRS-2002 had the highest validity, and the MST had the highest specificity in estimating the risk of malnutrition in elderly outpatients. However, the accuracy of the NSI should be further verified with large samples.

目的 分析老年住院2型糖尿病患者合并肌少症的患病情况及其影响因素.方法 按照纳入与排除标准,连续入选2018年1月至2019年12月于北京协和医院老年医学科住院治疗且年龄≥65岁的2型糖尿病患者为研究对象.运用老年综合评估,评价患者的共存疾病及老年综合征情况.采用SPSS 24.0统计软件进行数据分析.根据数据类型,分别采用t检验、Wilcoxon秩和检验、 χ2检验或Fisher精确概率法进行组间比较.采用多因素logistic回归模型分析老年2型糖尿病患者合并肌少症的影响因素.结果 最终入选225例患者,其中59例合并肌少症(肌少症组),166例未合并肌少症(非肌少症组).与无肌少症组比较,肌少症组患者的年龄更大,住院时间更长,有跌倒史、需要辅助行走、合并糖尿病靶器官病变及尿失禁的比例更高,5次起坐时间明显延长,不能完成全足距测试的比例更高,血肌酐水平更高,差异均有统计学意义(均P<0.05);男性比例较低,体质量指数(BMI)水平较低,微营养评估简表、 基本日常生活活动、工具性日常生活活动分值较低,差异均有统计学意义(均P<0.05);空腹血糖、糖化血红蛋白、血清白蛋白及前白蛋白等其他血液学指标差异无统计学意义(均P>0.05).多因素logistic回归分析显示,低BMI(OR=0.716,95％CI 0.609～0.842,P<0.001)和需要辅助行走(OR=4.391,95％CI 1.167～16.512,P=0.029)是老年2型糖尿病患者合并肌少症的影响因素.结论 老年住院2型糖尿病患者合并肌少症的患病率高,且患病率随增龄而进一步升高.对于低BMI、躯体功能下降的老年糖尿病患者,应注意肌少症的筛查并进行相应干预.

一例高龄老年患者,多器官功能储备差,嗜酸性粒细胞增多致心、 肾慢性功能不全且急性加重,经激素及免疫抑制剂治疗后嗜酸性粒细胞恢复正常、 皮疹消退,但后期出现卡氏肺孢子菌肺炎,抗感染治疗疗效不理想,最终患者因感染性休克死亡.本例患者基础情况复杂,诊治过程一波三折,经多学科团队共同参与讨论,一步步解决患者诊疗决策中的难题,体现了多学科协作在疑难病诊疗中的意义.临床上应认识到,衰弱、 谵妄亦是老年患者不良预后的危险因素,老年人机体代偿能力弱,不良反应耐受性差,易出现不良结局.在临床诊疗工作中,需权衡治疗并发症、 远期收益、 预期生存时间等多方面因素,作出正确的治疗决策.

Background This research aimed at exploring the mechanisms of alterations of metabolites and pathways in T2D from the perspective of metabolomics and transcriptomics, as well as uncovering novel drug candidate for T2D treatment. Methods Metabolites in human plasma from 42 T2D patients and 45 non-diabetic volunteers were detected by liquid chromatography-mass spectrometer (LC-MS). Microarray dataset of the transcriptome was obtained from Gene Expression Omnibus (GEO) database. Kyoto Encyclopedia of Genes and Genomes (KEGG) database was used to conduct pathway enrichment analysis. Connectivity Map (CMap) was employed to select potential drugs for T2D therapy. In vivo assay was performed to verify above findings. The protein expression levels of ME1, ME2 and MDH1 were detected by Western blot to determine the status of NAD/NADH cofactor system. Results In our study, differentially expressed metabolites were selected out between healthy samples and T2D samples with selection criteria P value < .05, |Fold Change| > 2, including N-acetylglutamate and Malate. Genes set enrichment analysis (GSEA) revealed that 34 pathways were significantly enriched in T2D. Based on CMap analysis and animal experiments, Atractyloside was identified as a potential novel drug for T2D treatment via targeting ME1, ME2 and MDH1 and regulating the NAD/NADH cofactor system. Conclusion The present research revealed differentially expressed metabolites and genes, as well as significantly altered pathways in T2D via an integration of metabolomics, transcriptomics and CMap analysis. It was also demonstrated that comprehensive analysis based on metabolomics and transcriptomics was an effective approach for identification and verification of metabolic biomarkers and alternated pathways.