Publications by authors named "Guo Zeng"

72 Publications

Starchy vegetable intake in the first trimester is associated with a higher risk of gestational diabetes mellitus: a prospective population-based study.

J Matern Fetal Neonatal Med 2021 Jun 6:1-8. Epub 2021 Jun 6.

Department of Nutrition and Food Safety, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.

Objective: The purpose of this study was to evaluate the association between starchy vegetable consumption and subgroup consumption in the first trimester and the risk of gestational diabetes mellitus (GDM).

Methods: A prospective study ( = 1444) was conducted in China. Dietary information was assessed by 24-hour dietary recalls for three days and then we calculated the consumption of total starchy vegetable and its subgroups, including (1) potato and (2) other starchy vegetable (pumpkin, lotus root, yam, taro, water chestnut, pea, and cowpea). GDM was diagnosed according to the results of 75-g two-hour oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. A modified log-binomial regression was used to estimate RRs and 95% CIs of GDM risk.

Results: Among the 1444 participants in our study, 520 were diagnosed with GDM. The adjusted RRs (95% CIs) for GDM from the lowest to the highest quartiles of total starchy vegetable consumption were 1.00 (reference), 1.29 (1.06, 1.57), 1.13 (0.93, 1.40), and 1.26 (1.02, 1.56), respectively; for trend = .032. For potato, the RR of GDM risk was 1.32 for the highest potato intake quartile compared with the lowest quartile (95% CI 1.07-1.64, for trend = .003). In addition, we did not observe an association between other starchy vegetable intakes and GDM risk.

Conclusions: A higher consumption of total starchy vegetables and potatoes in the first trimester is associated with a greater risk of GDM.
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http://dx.doi.org/10.1080/14767058.2021.1924144DOI Listing
June 2021

Specific fruit but not total fruit intake during early pregnancy is inversely associated with gestational diabetes mellitus risk: a prospective cohort study.

Public Health Nutr 2021 May 5:1-10. Epub 2021 May 5.

Department of Nutrition and Food Safety, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin Nan Road, Chengdu, SC610041, People's Republic of China.

Objectives: Fruit intake may influence gestational diabetes mellitus (GDM) risk. However, prospective evidence remains controversial and limited. The current study aimed to investigate whether total fruit and specific fruit intake influence GDM risk.

Design: A prospective cohort study was conducted. Dietary information was collected by a 3-d 24-h dietary recall. All participants underwent a standard 75-g oral glucose tolerance test at 24-28 gestational weeks. Log-binomial models were used to estimate the association between fruit intake and GDM risk, and the results are presented as relative risks (RR) and 95 % CI.

Setting: Southwest China.

Participants: Totally, 1453 healthy pregnant women in 2017.

Results: Total fruit intake was not associated with lower GDM risk (RR of 1·03 (95 % CI 0·83, 1·27) (Ptrend = 0·789)). The RR of GDM risk was 0·73 for the highest anthocyanin-rich fruit intake quartile compared with the lowest quartile (95 % CI 0·56, 0·93; Ptrend = 0·015). A higher grape intake had a linear inverse association with GDM risk (Q4 v. Q1: RR = 0·65; 95 % CI 0·43, 0·98; Ptrend = 0·044), and after further adjustment for anthocyanin intake, the inverse association tended to be non-linear (Q4 v. Q1: RR = 0·65; 95 % CI 0·44, 0·98; Ptrend = 0·079). However, we did not find an association between glycaemic index-grouped fruit, glycaemic load-grouped fruit or other fruit subtype intake and GDM risk.

Conclusions: In conclusion, specific fruit intake (particularly anthocyanin-rich fruit and grapes) but not total fruit intake was inversely associated with GDM risk.
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http://dx.doi.org/10.1017/S1368980021001920DOI Listing
May 2021

Optimal gestational weight gain in Chinese pregnant women by Chinese-specific BMI categories: a multicentre prospective cohort study.

Public Health Nutr 2021 Apr 12:1-11. Epub 2021 Apr 12.

Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou510080, People's Republic of China.

Objective: To establish optimal gestational weight gain (GWG) in Chinese pregnant women by Chinese-specific BMI categories and compare the new recommendations with the Institute of Medicine (IOM) 2009 guidelines.

Design: Multicentre, prospective cohort study. Unconditional logistic regression analysis was used to evaluate the OR, 95 % CI and the predicted probabilities of adverse pregnancy outcomes. The optimal GWG range was defined as the range that did not exceed a 1 % increase from the lowest predicted probability in each pre-pregnancy BMI group.

Setting: From nine cities in mainland China.

Participants: A total of 3731 women with singleton pregnancy were recruited from April 2013 to December 2014.

Results: The optimal GWG (ranges) by Chinese-specific BMI was 15·0 (12·8-17·1), 14·2 (12·1-16·4) and 12·6 (10·4-14·9) kg for underweight, normal weight and overweight pregnant women, respectively. Inappropriate GWG was associated with several adverse pregnancy outcomes. Compared with women gaining weight within our proposed recommendations, women with excessive GWG had higher risk for macrosomia, large for gestational age and caesarean section, whereas those with inadequate GWG had higher risk for low birth weight, small for gestational age and preterm delivery. The comparison between our proposed recommendations and IOM 2009 guidelines showed that our recommendations were comparable with the IOM 2009 guidelines and could well predict the risk of several adverse pregnancy outcomes.

Conclusions: Inappropriate GWG was associated with higher risk of several adverse pregnancy outcomes. Optimal GWG recommendations proposed in the present study could be applied to Chinese pregnant women.
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http://dx.doi.org/10.1017/S1368980021001622DOI Listing
April 2021

A low-carbohydrate dietary pattern characterised by high animal fat and protein during the first trimester is associated with an increased risk of gestational diabetes mellitus in Chinese women: A prospective cohort study.

Br J Nutr 2021 Feb 18:1-22. Epub 2021 Feb 18.

Department of Nutrition and Food Safety, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.

We aimed to examine the association between low-carbohydrate diet (LCD) scores during the first trimester and gestational diabetes mellitus (GDM) risk in a Chinese population. A total of 1455 women were included in 2017. Dietary information during the first trimester was collected by 24-hour dietary recalls for 3 days. The overall, animal and plant LCD scores, which indicated adherence to different low-carbohydrate dietary patterns, were calculated. GDM was diagnosed based on the results of a 75-g, 2-h oral glucose tolerance test at 24-28 weeks gestation. Log-binomial models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). The results showed that the multivariable-adjusted RRs (95% CIs) of GDM from the lowest to the highest quartiles of the overall LCD score were 1.00 (reference), 1.15 (0.92, 1.42), 1.30 (1.06, 1.60), and 1.24 (1.01, 1.52) (P=0.026 for trend). Multivariable-adjusted RRs (95% CIs) of GDM from the lowest to the highest quartiles of the animal LCD score were 1.00 (reference), 1.20 (0.96, 1.50), 1.41 (1.14, 1.73), and 1.29 (1.04, 1.59) (P=0.002 for trend). After additional adjustment for gestational weight gain before GDM diagnosis, the association of the overall LCD score with GDM risk was non-significant, while the association of animal LCD score with GDM risk remained significant. There was no statistically significant association between the plant LCD score and the risk of GDM. In conclusion, a low-carbohydrate dietary pattern characterised by high animal fat and protein during the first trimester is associated with an increased risk of GDM in Chinese women.
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http://dx.doi.org/10.1017/S0007114521000611DOI Listing
February 2021

[Prospective study of red meat intake in the first and second trimesters and the risk of gestational diabetes mellitus in Chengdu in 2017].

Wei Sheng Yan Jiu 2021 Jan;50(1):63-68

Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.

Objective: To evaluate the red meat intake of pregnant women in Chengdu area and explore the effect of red meat intake in the first and second trimesters on gestational diabetes mellitus(GDM).

Methods: From February to July 2017, a prospective study was conducted among healthy singleton pregnant women within 8-14 weeks of gestation in a prenatal clinic of maternal-and-child medical institution in Chengdu City through purposive sampling. Data on maternal demographic characteristics was collected through questionnaire in early pregnancy. 3-day 24 hour dietary recall was used to collect dietary intake information in the first and second trimesters. The 75 g oral glucose tolerance test(OGTT)was conducted at 24 to 28 weeks of gestation, and GDM was diagnosed according to the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China(2014). Multivariate unconditional Logistic regression model was used to explore the association between tertiles of red meat intake and the risk of GDM in the first and second trimesters.

Results: A total of 985 valid samples were followed up. The mean intake of total meat and red meat in middle pregnancy(102. 9 g/d and 74. 6 g/d) was higher than that in early pregnancy(70. 7 g/d and 52. 0 g/d). The difference was statistically significant(P<0. 05). Red meat accounted for 73. 6% and 72. 5% of total meat intake in early and middle pregnancy, respectively. After adjusting the confounding factors, multivariate unconditional Logistic regression analysis showed the risk of GDM was 1. 499 times(95%CI 1. 028-2. 185) in the highest red meat intake(>86 g/d)women compared with the lowest red meat intake(<44 g/d) women in the second trimester. No association was found between red meat intake in the first trimester and the occurrence of GDM(OR=1. 029, 95%CI 0. 716-1. 481).

Conclusion: Pregnant women in Chengdu area have excessive intake of red meat in the second trimester. Higher intake of red meat in the second trimester(>86 g/d) may increase the risk of gestational diabetes.
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http://dx.doi.org/10.19813/j.cnki.weishengyanjiu.2021.01.011DOI Listing
January 2021

Association of gestational weight gain with cesarean section: a prospective birth cohort study in Southwest China.

BMC Pregnancy Childbirth 2021 Jan 14;21(1):57. Epub 2021 Jan 14.

West China School of Public Health and West China Fourth Hospital, Chengdu, China.

Background: Cesarean section (CS) is a rising public health issue globally, and is particularly serious in China. Numerous studies have suggested that gestational weight gain (GWG) control may be an effective way to reduce the rate of CS. However, rare study has examined the association between GWG and CS among women in Southwest China. We proposed to examine their association based on a prospective birth cohort, and further to explore the optimal GWG range.

Methods: We retrieved data from a prospective birth cohort from Sichuan Provincial Hospital for Women and Children, Southwest China. Unconditional multivariable logistic regression was used to examine the association between GWG and CS by adjusting for potential confounders. In one analysis, we incorporated the GWG as a categorical variable according to the Institute of Medicine (IOM) recommendation, similar to the method used in the majority of previous studies. In the other analysis, we directly incorporated GWG as a continuous variable and natural cubic splines were used to characterize the potential nonlinear exposure-response relationship, aiming to identify the optimal GWG. We further stratified the above analysis by pre-pregnancy BMI and GDM, and then a heterogeneity test based on a multivariate meta-analysis was conducted to examine whether the stratum specific estimations agreed with each other.

Results: A total of 1363 participants were included. By adopting the IOM recommendation, the adjusted OR of CS was 0.63 (0.47, 0.84) for insufficient GWG and 1.42 (1.06, 1.88) for excessive GWG. After stratification by pre-pregnancy BMI, we found a higher risk of CS in associated with excessive GWG in the stratum of underweight compared with the other strata, which implied that pre-pregnancy BMI may be an effect modifier. By applying a flexible spline regression, the optimal GWG levels in terms of reducing the CS rate based on our data were more stringent than those of IOM recommendation, which were 9-12 kg for underweight women, < 19 kg for normal weight women and < 10 kg for overweight/obese women.

Conclusions: These results suggested that a more stringent recommendation should be applied in Southwest China, and that more attention should be given to underweight women.
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http://dx.doi.org/10.1186/s12884-020-03527-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807892PMC
January 2021

Duration and quality of sleep during pregnancy are associated with preterm birth and small for gestational age: A prospective study.

Int J Gynaecol Obstet 2021 Jan 9. Epub 2021 Jan 9.

Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.

Objective: To explore the associations of duration and quality of sleep during pregnancy with preterm birth and small for gestational age (SGA).

Methods: A prospective study was carried out on 1082 healthy women with singleton pregnancies from Chengdu, China. Self-report questionnaires, including duration and quality of sleep and other information, were administered at 8-12, 24-28, and 32-36 weeks of pregnancy. Data on gestational age and weight and length of the neonates were recorded after delivery. After controlling the potential confounders, a multivariable logistic regression model was performed to evaluate whether duration and quality of sleep were associated with preterm birth and SGA.

Results: Participants with short duration of sleep during the third trimester were more likely to report preterm birth (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.26-4.81) and SGA (OR 2.67, 95% CI 1.18-6.54). Participants with poor quality of sleep during the third trimester were at high risk for preterm birth (OR 2.26, 95% CI 1.29-5.84) and SGA (OR 2.08, 95% CI 1.19-5.38).

Conclusion: Short duration and poor quality of sleep during pregnancy are associated with an increased risk of preterm birth and SGA. Sleep characteristics should be assessed during prenatal evaluations to decrease adverse maternal and fetal outcomes.
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http://dx.doi.org/10.1002/ijgo.13584DOI Listing
January 2021

Clinical Characteristics and Prognostic Analysis of Patients With Signet Ring Cell Gastric Carcinoma.

Technol Cancer Res Treat 2020 Jan-Dec;19:1533033820983812

Department of Medical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China.

We do not know the clinical and prognostic factors that influence the survival of patients with gastric signet ring cell carcinoma (SRC). Therefore, a retrospective review was undertaken of 219 patients with SRC who had undergone gastrectomy between January 2009 and December 2012 in our hospital. Patient age, sex, TNM stage, vessel carcinoma embolus, perineural invasion, tumor site and operation type, postoperative chemotherapy, and five-year overall survival were recorded and evaluated. In our study, 93 cases (42.5%) were signet ring cell carcinoma only, and 126 cases (57.5%) were signet ring cell carcinoma coexisting with other components (such as adenocarcinoma or mucus adenocarcinoma). Eighty-three patients were female, 136 were male, 46 occurred at the gastroesophageal junction (21.0%), 63 at the fundus/body (28.8%), 80 were antrum/pylorus (36.5%), and 30 were whole stomach (13.7%). The prognosis of gastric antrum/ pylorus cancer was the best (P < 0.05). There were 133 patients (60.7%) with stage III, and the single factor analysis showed that the earlier the stage, the better the prognosis. The overall five-year survival rate was 30.1% in all patients. One-hundred and 41 patients (64.4%) received D2 radical surgery, 64 (29.2%) received D1 radical operation, and 14 (6.4%) received palliative resection, and the patients who received D2 had the best overall survival (P < 0.05). The survival time of the paclitaxel-based regimen in postoperative adjuvant chemotherapy tended to be prolonged. There was no statistical difference in overall survival between the percentage of signet-ring cells and sex. In summary, age, tumor stage, and surgical resection combined with D2 lymphadenectomy were independent prognostic factors for SRC. Adjuvant chemotherapy with a paclitaxel-based regimen may improve the survival of patients with SRC.
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http://dx.doi.org/10.1177/1533033820983812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780316PMC
December 2020

[A Prospective Study of the Relationship Between Dietary Patterns during the Second Trimester of Pregnancy and Gestational Weight Gain].

Sichuan Da Xue Xue Bao Yi Xue Ban 2020 Nov;51(6):822-827

Department of Nutrition and Food Safety, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.

Objective: To study dietary patterns during the second trimester of pregnancy and to investigate the relationship between dietary patterns and gestational weight gain (GWG).

Methods: A prospective cohort study was conducted to select healthy singleton pregnant women at 8-14 weeks of gestation in a maternal and child health care institution in Chengdu city. Food items and quantities were collected at 8-14, 24-28, 32-36 weeks of gestation by using the 3-day 24-hour dietary recall and energy intakes were calculated. Dietary patterns during the second trimester were established by factor analysis and factor scores were calculated. The weight of pregnant women was measured at 8-14, 24-28 weeks of gestation and 1 week before delivery, and the total GWG and the GWG rates in the second and third trimesters were calculated. Multiple linear regression analyses were used to analyze the association between dietary patterns and GWG.

Results: A total of 1 004 samples were included. Three dietary patterns were identified: Milk-egg-whole grain pattern, Beverage-dessert pattern and Traditional pattern. The average total GWG was (13.2±4.5) kg. The average weight gain rate was (0.4±0.2) kg/week in the second trimester. The average weight gain rate was (0.5±0.3) kg/week in the third trimester. After adjusting for confounding factors including maternal age, body mass index before pregnancy, dietary energy intake, physical activity, multiple linear regression analysis showed that the factor score of Beverage-dessert pattern was positively associated with the total GWG and the weight gain rate in the third trimester ( =0.370, 95% confidence interval ( ): (0.103, 0.636), =0.007; =0.014, 95% : (0.000, 0.027), =0.049, respectively), and the factor score of Traditional pattern was negatively associated with the total GWG ( =-0.285, 95% : (-0.555, -0.015), =0.039). There was no association between the Milk-egg-whole grain pattern and GWG.

Conclusion: Dietary patterns during the second trimester of pregnancy are associated with GWG. The Beverage-dessert pattern may increase the total GWG and weight gain rate in the third trimester. The traditional pattern may help control the total GWG.
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http://dx.doi.org/10.12182/20201160105DOI Listing
November 2020

[Associations of Dairy Consumption during Pregnancy and Neonatal Birth Body Mass: a Prospective Study].

Sichuan Da Xue Xue Bao Yi Xue Ban 2020 Sep;51(5):680-684

Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China.

Objective: To investigate the dairy product intake during pregnancy in Southwest China and to explore its relationship with neonatal birth body mass.

Methods: A prospective study was conducted to select healthy singleton pregnant women at 8-14 weeks of gestation in a maternal and fetal health care institution in Chengdu City. Dairy product consumption during the first, second, third trimester of pregnancy were collected by 24-hour dietary recalls at 8-14 weeks, 24-28 weeks and 32-36 weeks of pregnancy, respectively, and the total milk intake and milk consumption rate were calculated. According to the dietary guidelines for Chinese pregnant women (2016), the recommended amount of milk (300 g/d) was used as the standard to calculate the compliance rate. The respondents were divided into three groups: no dairy consumption group, insufficient dairy consumption group and suitable dairy consumption group. The gestational age at delivery and neonatal birth body mass were collected by the hospital information system. Logistic regression model was used to analyze the association between milk intake during pregnancy and neonatal birth body mass.

Results: A total of 962 pregnant women were included. The average milk intake in the first, second and third trimester of pregnancy were 125.0 (0, 236.1) g/d, 208.3 (0, 284.7) g/d and 250.0 (150.0, 416.7) g/d, respectively, with the compliance rates of 12.6%, 33.2% and 48.4%, respectively. The average neonatal birth body mass was (3 225.0±399.8) g. The incidence of small for gestational age (SGA) and large for gestational age (LGA) was 8.3% and 3.9%, respectively. Compared with no dairy consumption group in the second trimester of pregnancy, the risk of SGA was lower in suitable dairy consumption group (odds ratio ()=0.786, 95% confidence interval (): 0.385-0.976). Compared with no dairy consumption group in the third trimester of pregnancy, the risk of SGA was lower in insufficient dairy consumption group and suitable dairy consumption group (=0.672, 95%: 0.477-0.821 and =0.497, 95%: 0.116-0.807, respectively). No association was observed between milk intake in the first trimester and neonatal birth body mass, and milk intake in the second and third trimester of pregnancy was not associated with the risk of LGA.

Conclusion: Insufficient milk intake of pregnant women is a significant problem in southwest China and needs to be improved. Milk intake during pregnancy is associated with neonatal birth body mass, and increased milk intake in the second and third trimester of pregnancy may reduce the risk of SGA.
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http://dx.doi.org/10.12182/20200960105DOI Listing
September 2020

Protocol of a multicenter, single-blind, randomised, parallel controlled feeding trial evaluating the effect of a Chinese Healthy Heart (CHH) diet in lowering blood pressure and other cardiovascular risk factors.

BMJ Open 2020 08 20;10(8):e036394. Epub 2020 Aug 20.

Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.

Introduction: Unhealthy diet has been identified as the number one attributor of total mortality in China, accounting for more than 20% of total deaths. Although the Dietary Approach to Stop Hypertension (DASH) and Mediterranean diets have been proven beneficial in managing cardiovascular risk factors in Western countries, whether healthy diets with similar cardiovascular benefits can be developed that are consistent with Chinese food culture remains unknown.

Methods/design: The Diet, ExerCIse and CarDiovascular hEalth (DECIDE)-Diet trial is a multicentre, single-blind, randomised controlled feeding trial to evaluate the effect of the Chinese Healthy Heart (CHH) diet, in comparison with the Chinese usual diet, in lowering cardiovascular risk factors among community residents with the increased cardiovascular risk. A total of 360 adults aged between 25 and 75 years old and with systolic blood pressure between 130 and 159 mm Hg will be recruited from four centres located in four areas representing four major Chinese cuisines: Beijing, Shanghai, Guangzhou and Chengdu. After 1 week of run-in period with local usual diet, the compliant participants will be randomised to the intervention group with the CHH diet or the control group with the usual local diet, on a 1:1 ratio, for 4 weeks. Body weight of study participants will be maintained during the entire study period. The primary outcome is the change in SBP from the baseline to the end of the study. DECIDE-Diet trial will be the first randomised controlled feeding trial to evaluate the effect of a CHH diet in lowering cardiovascular risk factors. This trial will provide compelling evidence on the CHH diet in effect of improving cardiovascular health among Chinese food consumers all around the world.

Ethics And Dissemination: This trial adheres to the Declaration of Helsinki and guidelines of Good Clinical Practice. Signed informed consent will be obtained from all participants. The trial has been approved by the Peking University Institutional Review Board (approval number: IRB00001052-18094). The results will be disseminated through academic conferences and publications in international peer-reviewed journals.

Trail Registration Number: ClinicalTrials.gov Registry (NCT03882645); Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2019-036394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440703PMC
August 2020

Platinum (II)-doped graphitic carbon nitride with enhanced peroxidase-like activity for detection of glucose and HO.

Spectrochim Acta A Mol Biomol Spectrosc 2020 Nov 26;241:118649. Epub 2020 Jun 26.

Institute of Pharmacy and Pharmacology, University of South China, HengYang 421000, Hunan, China. Electronic address:

A platinum (II)-doped graphitic carbon nitride ([email protected]) nanozyme was prepared in this work. Compared to g-CN, [email protected] shows enhanced peroxidase-like activity. According to DFT calculations and ESR measurements, the Pt on the surface of g-CN accelerates the decomposition of HO into OH and consequently accelerates TMB oxidation. Furthermore, as a proof of concept, the obtained [email protected] was applied in the detection of glucose with an LOD of 0.01 mM. The reproducibility and precision tests of the glucose detection method based on [email protected] show that this method is reliable and feasible for the detection of glucose.
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http://dx.doi.org/10.1016/j.saa.2020.118649DOI Listing
November 2020

Biochemical, Histopathological, and Genetic Characterization of Posture-Responsive and Unresponsive APAs.

J Clin Endocrinol Metab 2020 09;105(9)

Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia.

Context And Objective: Posture-responsive and posture-unresponsive aldosterone-producing adenomas (APAs) account for approximately 40% and 60% of APAs, respectively. Somatic gene mutations have been recently reported to exist in approximately 90% of APAs. This study was designed to characterize the biochemical, histopathologic, and genetic properties of these 2 types of APA.

Methods: Plasma levels of aldosterone and hybrid steroids (18-oxocortisol and 18-hydroxycortisol) were measured by liquid chromatography-tandem mass spectrometry. Immunohistochemistry for CYP11B2 (aldosterone synthase) and CYP17A1 (17α-hydroxylase) and deoxyribonucleic acid sequencing (Sanger and next-generation sequencing) were performed on APA tissue collected from 23 posture-unresponsive and 17 posture-responsive APA patients.

Results: Patients with posture-unresponsive APA displayed higher (P < 0.01) levels of hybrid steroids, recumbent aldosterone and cortisol, larger (P < 0.01) zona fasciculata (ZF)-like tumors with higher (P < 0.01) expression of CYP17A1 (but not of CYP11B2) than patients with posture-responsive APA (most of which were not ZF-like). Of 40 studied APAs, 37 (92.5%) were found to harbor aldosterone-driving somatic mutations (KCNJ5 = 14 [35.0%], CACNA1D = 13 [32.5%], ATP1A1 = 8 [20.0%], and ATP2B3 = 2 [5.0%]), including 5 previously unreported mutations (3 in CACNA1D and 2 in ATP1A1). Notably, 64.7% (11/17) of posture-responsive APAs carried CACNA1D mutations, whereas 56.5% (13/23) of posture-unresponsive APAs harbored KCNJ5 mutations.

Conclusions: The elevated production of hybrid steroids by posture-unresponsive APAs may relate to their ZF-like tumor cell composition, resulting in expression of CYP17A1 (in addition to somatic gene mutation-driven CYP11B2 expression), thereby allowing production of cortisol, which acts as the substrate for CYP11B2-generated hybrid steroids.
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http://dx.doi.org/10.1210/clinem/dgaa367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426003PMC
September 2020

Effects of Ramipril on the Aldosterone/Renin Ratio and the Aldosterone/Angiotensin II Ratio in Patients With Primary Aldosteronism.

Hypertension 2020 08 8;76(2):488-496. Epub 2020 Jun 8.

From the Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia (Z.G., D.C., M.W., M.S.).

The aldosterone/renin ratio (ARR) is currently considered the most reliable approach for case detection of primary aldosteronism (PA). ACE (Angiotensin-converting enzyme) inhibitors are known to raise renin and lower aldosterone levels, thereby causing false-negative ARR results. Because ACE inhibitors lower angiotensin II levels, we hypothesized that the aldosterone/equilibrium angiotensin II (eqAngII) ratio (AA2R) would remain elevated in PA. Receiver operating characteristic curve analysis involving 60 patients with PA and 40 patients without PA revealed that the AA2R was not inferior to the ARR in screening for PA. When using liquid chromatography-tandem mass spectrometry to measure plasma aldosterone concentration, the predicted optimal AA2R cutoff for PA screening was 8.3 (pmol/L)/(pmol/L). We then compared the diagnostic performance of the AA2R with the ARR among 25 patients with PA administered ramipril (5 mg/day) for 2 weeks. Compared with basally, plasma levels of equilibrium angiotensin I (eqAngI) and direct renin concentration increased significantly (<0.01 or <0.05) after ramipril treatment, whereas eqAngII and ACE activity (eqAngII/eqAngI) decreased significantly (<0.01). The changes of plasma renin activity and plasma aldosterone concentration in the current study were not significant. On day 14, 4 patients displayed false-negative results using ARR_direct renin concentration (plasma aldosterone concentration/direct renin concentration), 3 of whom also showed false-negative ARR_plasma renin activity (plasma aldosterone concentration/plasma renin activity). On day 15, 2 patients still demonstrated false-negative ARR_plasma renin activity, one of whom also showed a false-negative ARR_direct renin concentration. No false-negative AA2R results were observed on either day 14 or 15. In conclusion, compared with ARR which can be affected by ACE inhibitors causing false-negative screening results, the AA2R seems to be superior in detecting PA among subjects receiving ACE inhibitors.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.14871DOI Listing
August 2020

[Effects of iron supplement intake on gestational diabetes mellitus in early and middle pregnancy in Chengdu City in 2017].

Wei Sheng Yan Jiu 2020 Mar;49(2):227-232

Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China.

Objective: To explore the effect of iron supplement intake on gestational diabetes mellitus(GDM) in early and middle pregnancy.

Methods: From February to April 2017, a prospective study was conducted among 807 early pregnant women in a prenatal clinic of a maternal and child medical institution in Chengdu City through purposive sampling. Data on maternal demographic characteristics was collected through questionnaire in early pregnancy. In early and middle pregnancy, the information of iron supplement intake were collected with questionnaire, 3-day 24 hour dietary recall method was used to assess maternal diet. According to the WHO recommendation, 60 mg/d iron supplementation during pregnancy was used as the dividing point, <60 mg/d iron supplementation was used as the low level group, and ≥60 mg/d iron supplementation was used as the high level group. At the 24 th to 28 th pregnant week, the oral glucose tolerance test(OGTT) was conducted, and GDM was diagnosed according to the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China(2014). Multivariate unconditional Logistic regression model was used to analyze the effect of iron supplement intake on gestational diabetes mellitus(GDM) in early and middle pregnancy.

Results: A total of 739 valid samples were followed up, the age was(28. 22±3. 75) years old. In early and middle pregnancy, the rate of taking iron supplementation was 5. 0% and 67. 9%, 3. 8% and 47. 1% of them iron supplement intake was more than 60 mg/d. After adjustmenting for body mass index, age, dietary iron, etc. Multivariate unconditional Logistic regression analysis showed that there was a positive correlation between the average intake of iron supplement and the occurrence of GDM in women during the second trimester of pregnancy(OR=1. 059, 95%CI 1. 016-1. 104). Compared with the lower iron supplement intake(<60 mg/d) women in midpregnancy, the risk of GDM was 1. 406 times(95%CI 1. 019-1. 939)in the higher iron supplement intake(≥60 mg/d) women. No correlation was found between iron intake in early pregnancy and the occurrence of GDM.

Conclusion: Iron supplement intake during pregnancy may increase the risk of GDM. Appropriate intake of iron supplement for pregnant women is worth discussing.
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http://dx.doi.org/10.19813/j.cnki.weishengyanjiu.2020.02.010DOI Listing
March 2020

[Anxiety and depression on gestational diabetes mellitus in early pregnancy].

Wei Sheng Yan Jiu 2020 Mar;49(2):179-184

Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China.

Objective: To investigate the effects of anxiety and depression on gestational diabetes mellitus(GDM) in early pregnancy.

Methods: A prospective study was conducted in 2017 to select 1426 single-child healthy pregnant women of 8-14 weeks from the Sichuan Provincial Hospital for Women and Children through a deliberate sampling method. The age was(28. 6±4. 0) years old. Basic information such as age, pre-pregnancy weight, parity, and gravidity of pregnant women was collected through questionnaire survey. The anxiety self-rating scale(SAS) and depression self-rating scale(SDS) were used to collect information of anxiety and depression in pregnant women, and their anxiety and depressive symptoms were evaluated according to the result of Chinese norm. At 24 to 28 weeks of gestation, the oral glucose tolerance test(OGTT) was conducted. GDM was diagnosed according to the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China(2014). Multivariate unconditional Logistic regression was adopted to analyze the effects of anxiety and depression on GDM in pregnant women.

Results: The incidence of GDM in early pregnancy anxiety group and depression group was 41. 8% and 33. 6%, respectively. The incidence of anxiety, depression, and anxiety combined with depression were 7. 7%, 10. 5% and 4. 8%, respectively. The incidence of anxiety and depression in the group of pregnant women younger than 30 years old(9. 0% and 11. 7%) was higher than that in the group of pregnant women older than 30 years old(5. 3% and 8. 1%). The prevalence of anxiety and depression in the group of nulliparous women(8. 8% and 11. 9%) was higher than that in the group of multiparous women(5. 4% and 6. 4%). The difference was statistically significant(P<0. 05). After adjusting the confounding factors such as age, pre-pregnancy body mass index, family history of diabetes, gravidity, parity, energy intake, conception, education, occupation, smoking and drinking, the result showed that the risk of GDM in anxious pregnant women was increased, compared with that in non-anxious pregnant women in early pregnancy(OR=1. 556, 95% CI 1. 014-2. 387). However, the association between early pregnancy depression and the occurrence of GDM was not found(P>0. 05). Compared with the non-anxiety group in the early pregnancy, the risk of GDM in the anxiety group was increased both in pregnant women under 30 years old(OR=1. 654, 95% CI 1. 004-2. 726) and nulliparous women(OR=1. 633, 95% CI 1. 013-2. 634). No correlation between anxiety and risk of GDM was observed in pregnant women over 30 years old and multiparous women(P>0. 05).

Conclusion: Anxiety in early pregnancy increases the risk of GDM. Pregnant women under 30 years old and and nulliparous women are at high risk of anxiety.
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http://dx.doi.org/10.19813/j.cnki.weishengyanjiu.2020.02.002DOI Listing
March 2020

Measurement of Equilibrium Angiotensin II in the Diagnosis of Primary Aldosteronism.

Clin Chem 2020 03;66(3):483-492

Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia.

Background: Many medications (including most antihypertensives) and physiological factors affect the aldosterone/renin ratio (ARR) when screening for primary aldosteronism (PA). We sought to validate a novel equilibrium angiotensin II (eqAngII) assay and compare correlations between the aldosterone/angiotensin II ratio (AA2R) and the current ARR under conditions affecting the renin-angiotensin system.

Methods: Among 78 patients recruited, PA was excluded in 22 and confirmed in 56 by fludrocortisone suppression testing (FST). Peripheral levels of eqAngII, plasma renin activity (PRA) and direct renin concentration (DRC) were measured.

Results: EqAngII showed good consistency with DRC and PRA independent of PA diagnosis, posture, and fludrocortisone administration. EqAngII showed close (P < 0.01) correlations with DRC (r = 0.691) and PRA (r = 0.754) during FST. DRC and PRA were below their assays' functional sensitivity in 43.9% and 15.1%, respectively, of the total 312 samples compared with only 7.4% for eqAngII (P < 0.01). Bland-Altman analysis revealed an overestimation of PRA and DRC compared with eqAngII in a subset of samples with low renin levels. The AA2R showed not only consistent changes with the ARR but also close (P < 0.01) correlations with the ARR, whether renin was measured by DRC (r = 0.878) or PRA (r = 0.880).

Conclusions: Dynamic changes of eqAngII and the AA2R show good consistency and close correlations with renin and the ARR. The eqAngII assay shows better sensitivity than DRC and PRA assays, especially at low concentrations. Whether the AA2R can reduce the impact of some factors that influence the diagnostic power of the ARR warrants further study.
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http://dx.doi.org/10.1093/clinchem/hvaa001DOI Listing
March 2020

Associations between Maternal Lipid Profiles and Pregnancy Complications: A Prospective Population-Based Study.

Am J Perinatol 2019 Dec 31. Epub 2019 Dec 31.

Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.

Objective:  To investigate whether plasma lipid profiles are independently associated with pregnancy complications including gestational diabetes mellitus (GDM), hypertensive disorder complicating pregnancy (HDCP), and intrahepatic cholestasis of pregnancy (ICP).

Study Design:  A prospective study was conducted among 1,704 pregnant women at three medical institutions in Chengdu, China. The concentrations of triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured at gestational weeks 12 ± 1, 24 ± 1, and 34 ± 1. Logistic regression models were used to estimate the association between lipid profiles and pregnancy complications. Receiver operating characteristic analysis was performed to determine the value of lipid profiles to predict GDM and HDCP.

Results:  After adjusting for potential confounders, TG, TC, and LDL-C in the first trimester were independently associated with GDM (TG: odds ratio [OR] =2.00, 95% confidence interval [CI]: 1.57-2.56; TC: OR = 1.38, 95% CI: 1.16-1.64; LDL-C: OR = 1.43, 95% CI: 1.14-1.79) and HDCP (TG: OR = 2.42, 95% CI: 1.56-3.78, TC: OR = 1.64, 95% CI: 1.04-2.57; LDL-C: OR = 1.87, 95% CI: 1.07-3.25). The TC concentration during the whole pregnancy (first trimester: OR = 1.53, 95% CI: 1.13-2.08; second trimester: OR = 1.31, 95% CI: 1.06-1.61; third trimester: OR = 1.39, 95% CI: 1.17-2.04) and LDL-C in the last two trimesters (second trimester: OR = 1.62, 95% CI: 1.30-2.04; third trimester: OR = 1.56, 95% CI: 1.29-1.88) were positively associated with ICP. HDL-C in the third trimester was negatively associated with the risk of ICP (OR = 0.46, 95% CI: 0.22-0.98). Combining lipid profiles in the first trimester with the other common predictors to predict GDM or HDCP owned stronger predictive power with the largest area under the curve (GDM: 0.643 [95% CI: 0.613-0.673], HDCP: 0.707 [95% CI: 0.610-0.804]) than either indicator alone.

Conclusion:  Maternal lipid profiles during the whole pregnancy are significantly associated with GDM, HDCP, and ICP. Combining lipid profiles in the first trimester with the other common predictors could effectively improve the power of predicting GDM and HDCP.
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http://dx.doi.org/10.1055/s-0039-3402724DOI Listing
December 2019

Excessive gestational weight gain in the first trimester is associated with risk of gestational diabetes mellitus: a prospective study from Southwest China.

Public Health Nutr 2020 02 20;23(3):394-401. Epub 2019 Dec 20.

Department of Nutrition, Food Safety and Toxicology, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Renmin Nan Road, 610041 Chengdu, Sichuan, People's Republic of China.

Objective: To evaluate the effects of gestational weight gain (GWG) in the first trimester (GWG-F) and the rate of gestational weight gain in the second trimester (RGWG-S) on gestational diabetes mellitus (GDM), exploring the optimal GWG ranges for the avoidance of GDM in Chinese women.

Design: A population-based prospective study was conducted. Gestational weight was measured regularly in every antenatal visit and assessed by the Institute of Medicine (IOM) criteria (2009). GDM was assessed with the 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. Multivariable logistic regression was performed to assess the effects of GWG-F and RGWG-S on GDM, stratified by pre-pregnancy BMI. In each BMI category, the GWG values corresponding to the lowest prevalence of GDM were defined as the optimal GWG range.

Setting: Southwest China.

Participants: Pregnant women (n 1910) in 2017.

Results: After adjusting for confounders, GWG-F above IOM recommendations increased the risk of GDM (OR; 95 % CI) among underweight (2·500; 1·106, 5·655), normal-weight (1·396; 1·023, 1·906) and overweight/obese women (3·017; 1·118, 8·138) compared with women within IOM recommendations. No significant difference was observed between RGWG-S and GDM (P > 0·05) after adjusting for GWG-F based on the previous model. The optimal GWG-F ranges for the avoidance of GDM were 0·8-1·2, 0·8-1·2 and 0·35-0·70 kg for underweight, normal-weight and overweight/obese women, respectively.

Conclusions: Excessive GWG in the first trimester, rather than the second trimester, is associated with increased risk of GDM regardless of pre-pregnancy BMI. Obstetricians should provide more pre-emptive guidance in achieving adequate GWG-F.
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http://dx.doi.org/10.1017/S1368980019003513DOI Listing
February 2020

Diagnosis of Primary Aldosteronism by Seated Saline Suppression Test-Variability Between Immunoassay and HPLC-MS/MS.

J Clin Endocrinol Metab 2020 03;105(3)

Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia.

Background: In primary aldosteronism (PA), excessive, autonomous secretion of aldosterone is not suppressed by salt loading or fludrocortisone. For seated saline suppression testing (SSST), the recommended diagnostic cutoff 4-hour plasma aldosterone concentration (PAC) measured by high-performance liquid chromatography-mass spectrometry (HPLC-MS/MS is 162 pmol/L. Most diagnostic laboratories, however, use immunoassays to measure PAC. The cutoff for SSST using immunoassay is not known. We hypothesized that the cutoff is different between the assays.

Methods: We analyzed 80 of the 87 SSST tests that were performed during our recent study defining the HPLC-MS/MS cutoff. PA was confirmed in 65 by positive fludrocortisone suppression testing (FST) and/or lateralization on adrenal venous sampling and excluded in 15 by negative FST. PAC was measured by a chemiluminescence immunoassay (PACIA) in the SSST samples using the DiaSorin Liaison XL analyzer, and receiver operating characteristics (ROC) analysis was performed to identify the PACIA cutoff.

Results: ROC revealed good performance (area under the curve = 0.893; P < .001) of 4-hour postsaline PACIA for diagnosis of PA and an optimal diagnostic cutoff of 171 pmol/L, with sensitivity and specificity of 95.4% and 80.0%, respectively. A higher cutoff of 217 pmol/L improved specificity (86.7%) with lower sensitivity (86.2%). PACIA measurements strongly correlated with PAC measured by HPLC-MS (r = 0.94, P < .001).

Conclusions: A higher diagnostic cutoff for SSST should be employed when PAC is measured by immunoassay rather than HPLC-MS/MS. The results suggest that (i) PA can be excluded if 4-hour PACIA is less than 171 pmol/L, and (ii) PA is highly likely if the PACIA is greater than 217 pmol/L by chemiluminescence immunoassay. A gray zone exists between the cutoffs of 171 and 217 pmol/L, likely reflecting a lower specificity of immunoassay.
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http://dx.doi.org/10.1210/clinem/dgz150DOI Listing
March 2020

[Structure of preschoolers intestinal Bifidobacteria and its relationship with milk consumption].

Wei Sheng Yan Jiu 2019 May;48(3):435-439

Department of Nutrition Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China.

Objective: To determine the population structure of intestinal Bifidobacteria in preschool children, and evaluate its relationship with milk consumption.

Methods: The study was performed among 200 healthy children aged 2 to 6 in a kindergarten, Chengdu. Half of the children were female. The information of their milk consumption was collected through questionnaire finished by their parents. The levels of Bifidobacterium and 8 Bifidobacterium species in the subject feces were analyzed by real-time fluorescence quantitative PCR. The differences between the population structures of intestinal Bifidobacteria in children with different milk consumption were compared.

Results: The detection rate of Bifidobacteria in the feces of the children was 100%, and the bacterial amount was(9.33±0.54) log_(10 )CFU/g. In comparison with the group whose daily milk consumption was less than 300 mL, the detection rate of B. breve(88.9% vs. 78.4%, χ~2=4.039, P=0.044), the amount of B. breve and B. infantis [(7.35±1.25) log_(10 )CFU/g vs.(6.91±1.32) log_(10 )CFU/g, t=-2.096, P=0.038;(7.36±1.35) log_(10 )CFU/g vs.(6.68±1.45) log_(10 )CFU/g, t=-2.412, P=0.018]were higher in the group whose daily milk consumption was no less than 300 mL.

Conclusion: The detection rate of Bifidobacteria is 100% in the 200 preschool children of Chengdu. B. catenulatum, B. longum and B. breve are believed to be major bifidobacterial species in children intestinal microbiota. The study manifests the association between milk consumption and B. breve or B. infantis engraftment.
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May 2019

Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life.

Support Care Cancer 2020 Jan 3;28(1):373-380. Epub 2019 May 3.

Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.

Background/objectives: The assessment of nutritional status and the quality of life in patients with gastric cancer has become one of the important goals of current clinical treatment. The purpose of this study was to assess the nutritional status in hospitalized gastric cancer patients by using patient-generated subjective global assessment (PG-SGA) and to analyze the influence of nutritional status on the patients' quality of life (QOL).

Methods: We reviewed the pathological diagnosis of gastric cancer for 2322 hospitalized patients using PG-SGA to assess their nutritional status and collected data on clinical symptoms, the anthropometric parameters (height, weight, body mass index (BMI), mid-arm circumference (MAC), triceps skin-fold thickness (TSF), and hand-grip strength (HGS). We also collected laboratory data (prealbumin, albumin, hemoglobin) within 48 h after the patient was admitted to the hospital. The 30-item European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) was used for QOL assessment in all patients.

Results: By using PG-SGA, we found 80.4% of the patients were malnourished (score ≥ 4) and 45.1% of the patients required urgent nutritional support (score ≥ 9). In univariate analysis, old age (> 65 years, p < 0.001), female (p = 0.007), residence in a village (p = 0.004), a lower level of education (p < 0.001), and self-paying (p < 0.001) were indicated as risk factors of patients with gastric cancer to be suffering from severe malnutrition. There was a negative correlation between PG-SGA and various nutritional parameters (p < 0.05). The quality of life was significantly different in gastric cancer patients with different nutritional status (p < 0.01).

Conclusion: Malnutrition of hospitalized patients with gastric cancer in China is common and seriously affects the patients' quality of life. The nutritional status should be evaluated in a timely manner and reasonable nutritional intervention should be provided as soon as possible. The PG-SGA was fit for using as a clinical nutrition assessment method, being worthy of clinical application.
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http://dx.doi.org/10.1007/s00520-019-04803-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882767PMC
January 2020

Response to Letter to the Editor: "Comparison of Seated With Recumbent Saline Suppression Testing for the Diagnosis of Primary Aldosteronism".

J Clin Endocrinol Metab 2019 06;104(6):2344-2345

Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia.

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http://dx.doi.org/10.1210/jc.2019-00179DOI Listing
June 2019

[Effect of gestational weight gain rate on pregnancy outcomes among Chengdu City pregnant women with normal pre-pregnancy body mass index].

Wei Sheng Yan Jiu 2018 Nov;47(6):890-894

Department of Nutrition, Food Safety and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China.

Objective: To explore the association between gestational weight gain rate( GWGR) and pregnancy outcomes among pregnant women with normal pre-pregnancy body mass index( BMI).

Methods: In this prospective study, 389 healthy pregnant women at the( 12 ± 1) th with normal pre-pregnancy BMI from Chengdu City who delivered a singleton were included in 2013. The basic information such as age, pre-pregnant weight was obtained by questionnaire, height and weight was measured. Then the weight was measured at the( 28 ± 1) th and last week before delivery, respectively, the different trimester GWGR was calculated and classified by IOM criteria. Gestational age, gestational diabetes mellitus( GDM) and other pregnancy outcomes were collected by questionnaire. Multiple non-conditional Logistic regression models were used to test the association between GWGR and pregnancy outcomes.

Results: The proportion of insufficient GWGR and excessive GWGR in first trimester was 50. 7% and 31. 8%, respectively, the proportion of excessive GWGR in the second and third trimester was68. 5% and 57. 8%, respectively. After adjusting the age, education, gravidity and family disease history and other confounding factors, multiple non-conditional logistic regression showed: compared with adequate GWGR in the third trimester, insufficient and excessive GWGR were associated with increased risk of cesarean delivery( OR = 2. 48, 95% CI 1. 18-5. 23 and OR = 1. 76, 95% CI 1. 02-3. 03, respectively). Compared with adequate GWGR in the first trimester, excessive GWGR were associated with increased risk of GDM( OR = 2. 55, 95% CI 1. 03-6. 28).

Conclusion: The abnormal of GWGR would increase the risk of cesarean delivery and GDM.
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November 2018

[Effect of gestational weight gain on the neonatal birth weight among pregnancy women in Chengdu City].

Wei Sheng Yan Jiu 2018 Nov;47(6):900-905

Department of Nutrition, Food Safety and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China.

Objective: To explore the effects of total gestational weight gain( GWG)and gestational weight gain rate( GWGR) per trimester on the neonatal birth weight.

Methods: A prospective cohort study was conducted among 549 healthy pregnant women at the( 12 ± 1) th pregnant week from Chengdu City, China who delivered a singleton. Basic information about age, pre-gestational weight and so on was collected by questionnaire, while the height and weight were measured at the first time. Weight at the( 28 ± 1) th and last week before delivery was measured respectively, while the total GWG and the different trimester GWGR were calculated and assessed by Institute of Medicine( IOM) criteria( 2009). The gestational week, neonatal weight and other information were collected after delivery. Multiple non-conditional Logistic regression models were used to test the effect of the total GWG/GWGR per trimester on neonatal birth weight.

Results: The total GWG was( 16. 2 ± 4. 6) kg. The prevalence of abnormal total GWG was 59. 1%, the excessive GWG was 44. 3%. The prevalence of insufficient GWGR in the first trimester was 44. 3%. In the second, third, the second and third trimester, the prevalence of excessive GWGR were 63. 6%, 55. 7% and 65. 8%, respectively. After adjusting the age at delivery, pre-pregnancy body mass index, gestational week and other confounding factors, the result showed that compared with adequate GWG group, insufficient GWG group was increased risk of small for gestational age( SGA)( OR =2. 51, 95% CI 1. 08-5. 82), excessive total GWG group was increased risk of large for gestational age( LGA)( OR = 2. 54, 95% CI 1. 20-5. 36). Compared with adequate GWGR group in the second trimester, excessive GWGR group was decreased risk of SGA( OR = 0. 27, 95% CI 0. 13-0. 60). Compared with adequate GWGR group in the second and third trimester, excessive GWGR group was decreased risk of SGA( OR = 0. 28, 95%CI 0. 13-0. 59).

Conclusion: Abnormal total GWG among pregnant women in Chengdu City is a big problem that both excessive and insufficient GWG existed. Excessive total GWG is the independent risk factor for LGA. GWGR in the second and the second and third trimester are significantly associated with SGA.
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November 2018

[Energy intake as determinants of gestational weight gain in Chengdu].

Wei Sheng Yan Jiu 2018 Nov;47(6):895-905

Department of Nutrition, Food Safety and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China.

Objective: To examine the relation between energy intake and its sources and gestational weight gain( GWG).

Methods: In this prospective cohort study, 585 healthy women with singleton pregnancy were selected in 2013. The 24-hour recalls was used to collect food intake at the first, second and last trimesters, and energy intake and percentages of energy from macronutrient were calculated. Weight measuring were administered at( 12 ± 1) th, ( 28 ± 1) th weeks' gestation and last week before delivery, and the GWG rate was calculated. Multivariable linear regression was used to analyze therelationship between energy and GWG.

Results: The mean energy intake for the first, second and last trimesters were 1718. 6 kcal/d, 2202. 9 kcal/d and 2313. 4 kcal/d, respectively, the average percentages of energy from carbohydrate were 62. 6%, 59. 5%and 59. 1%, respectively, the average percentages of energy from fat were 21. 8% 、23. 9% and 24. 3%, respectively, the average percentages of energy from protein were15. 6% 、16. 5% and 16. 7%, respectively. Multiple linear regression analysis showed that energy intake during pregnancy was positively correlated with GWG during pregnancy( P < 0. 05). The adjusted weight gain for each trimester was 37. 3 g/week( 95% CI 22. 8 to 51. 8, P < 0. 05), 16. 8 g/week( 95% CI 4. 8 to 28. 8, P < 0. 05), and 25. 8 g/week( 95% CI 10. 6 to 41. 1, P < 0. 05) higher in the highest( Q5) versus lowest( Q1)quintile of energy intake. The adjusted weight gain in last trimester was 19. 1 g/week higher( 95% CI 3. 1 to 35. 1, P < 0. 05) in the highest( Q5) versus lowest( Q1) quintile of percentages of energy from carbohydrate. The adjusted weight gain in last trimester was16. 2 g/week lower( 95% CI-3. 1 to-0. 9, P < 0. 05) in the highest( Q5) versus lowest( Q1) quintile of percentages of energy from fat.

Conclusion: A positive correlation is found between dietary energy intake and GWG. Percentages of energy from carbohydrate and fat in the last trimester have a significant effect on GWG.
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November 2018

Association Between Serum C-Reactive Protein Concentration and Nutritional Status of Malignant Tumor Patients.

Nutr Cancer 2019 17;71(2):240-245. Epub 2018 Nov 17.

a Department of Medical Oncology , Fujian Cancer Hospital, Fujian Medical University Cancer Hospital , Fuzhou , Fujian , China.

Background: The level of the systemic inflammatory marker C-reactive protein (CRP) is elevated in many patients with malignant disease and may be related to nutritional status.

Objective: To analyze the association between serum CRP levels in patients with malignant tumors and their nutritional status.

Method: A total of 3,692 cases were analyzed and the serum CRP levels were determined using an immunometric assay. Nutritional status was assessed by using patient-generated subjective global assessment (PG-SGA). The biochemical evaluation of prealbumin (PA), albumin (ALB), cholesterol (CHOL), and triglycerides (TG) were assayed within 48 h admission to the hospital. The association between serum CRP concentration and the nutritional status, the stage of the tumor and other factors was analyzed by univariate and multivariate logistic regression analysis.

Result: Elevated serum CRP was observed in 47.6% (1,548/3,269) of patients compared with the reference value, and the median CRP concentration was 18.29 mg/l. Patient serum CRP concentrations in the malnourished group (PG-SGA B + C) were higher than in the well-nourished (PG-SGA A) patients (P < 0.05). The serum CRP level was related to the patients' age, gender, tumor stage, and was affected by hepatitis, liver cirrhosis, diabetes, but it has no effect on hypertension. The CRP high patients had lower PA and ALB levels, lower Karnofsky performance status scores, and higher PG-SGA scores (P < 0.05), and there was no relationship with CHOL and TG levels. Weight loss in the previous 1 mo was seen with CRP positive patients (P < 0.05).

Conclusion: Almost 50% of malignant tumor patients had elevated serum CRP levels indicating a systemic inflammatory state. The nutritional status was worse in cancer patients with higher concentrations of serum CRP. The level of CRP was associated with the tumor stage, and, as stage is a prognostic factor, so can CRP be used as a prognostic maker in malignant tumors patients.
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http://dx.doi.org/10.1080/01635581.2018.1524019DOI Listing
June 2020

[Moderate-to-vigorous Physical Activities and Gestational Weight Gains during the Second and Last Trimesters of Pregnancy].

Sichuan Da Xue Xue Bao Yi Xue Ban 2018 Nov;49(6):938-943

Department of Nutrition Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China.

Objective: To determine the level of moderate-to-vigorous physical activities (MVPA) and its relationship with gestational weight gains (GWG) in the second and the last trimesters of pregnancy.

Methods: A prospective study was conducted in Chengdu on 362 healthy pregnant women at the 24-28 gestation weeks who delivered a singleton. Demographic data and pre-pregnancy body mass were collected using a questionnaire. Weight gains at the gestation weeks of 24-28 and 32-36 were measured for the first two trimesters and the last trimester of pregnancy. The Denmark self-reported physical activity scale was used for measuring the duration and intensity of physical activities. Multiple linear regression models were established to determine the relationship between MVPA and GWG.

Results: The last trimester had lower average daily MVPA 〔(0.76±0.93) h〕 compared with the second trimester 〔(1.61±1.61) h, =9.056, <0.001〕. About 74.6% of the participants met the PA recommendations for the second trimester, compared with 60.5% for the last trimester (=16.387, <0.001). The participants experienced an average GWG of (7.36±3.78) kg during the first two trimesters, and (5.80±2.57) kg during the last trimester, corresponding to a growth rate of (0.30±0.15) kg/week for the first two trimesters and (0.51±0.22) kg/week for the last trimester. Compared with the most inactive group, the participants with medium PA experienced less GWG 〔(5.34±2.91) kg vs.(6.26±2.54) kg, <0.05〕 and a lower GWG rate 〔(0.48±0.26) kg/week vs.(0.56±0.20) kg/week, <0.05〕 during the last trimester. Age, gestational week, ethnicity, pre-pregnant BMI, GDM, pre-pregnant smoking and employment were associated with GWG and the GWG rates during the first two trimesters and the third trimester (<0.05). Compared with the most inactive group, low 〔-0.358(-0.691--0.026)〕 and medium 〔-0.762(-1.486- -0.037)〕 PA were associated with lower GWG during the last trimester. Moderate PA was associated with a lower GWG rate 〔-0.071(-0.133--0.008)〕 after adjustment for gestational age, energy intake, pre-pregnancy BMI and other potential confounders.

Conclusions: Insufficient physical activities are a serious problem in the pregnant women of Chengdu over the last two trimesters. Appropriate MVPA in the last trimester of pregnancy may reduce GWG and GWG rates.
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November 2018

Cellular and Genetic Causes of Idiopathic Hyperaldosteronism.

Hypertension 2018 10;72(4):874-880

Department of Molecular and Integrative Physiology (W.E.R.), and Department of Medicine (W.E.R.), University of Michigan, Ann Arbor.

Primary aldosteronism affects ≈5% to 10% of hypertensive patients and has unilateral and bilateral forms. Most unilateral primary aldosteronism is caused by computed tomography-detectable aldosterone-producing adenomas, which express CYP11B2 (aldosterone synthase) and frequently harbor somatic mutations in aldosterone-regulating genes. The cause of the most common bilateral form of primary aldosteronism, idiopathic hyperaldosteronism (IHA), is believed to be diffuse hyperplasia of aldosterone-producing cells within the adrenal cortex. Herein, a multi-institution cohort of 15 IHA adrenals was examined with CYP11B2 immunohistochemistry and next-generation sequencing. CYP11B2 immunoreactivity in adrenal glomerulosa harboring non-nodular hyperplasia was only observed in 4/15 IHA adrenals suggesting that hyperplasia of CYP11B2-expressing cells may not be the major cause of IHA. However, the adrenal cortex of all IHA adrenals harbored at least 1 CYP11B2-positive aldosterone-producing cell cluster (APCC) or micro-aldosterone-producing adenomas. The number of APCCs per case (and individual APCC area) in IHA adrenals was significantly larger than in normotensive controls. Next-generation sequencing of DNA from 99 IHA APCCs demonstrated somatic mutations in genes encoding the L-type calcium voltage-gated channel subunit α 1-D ( CACNA1D, n=57; 58%) and potassium voltage-gated channel subfamily J-5 ( KCNJ5, n=1; 1%). These data suggest that IHA may result from not only hyperplasia but also the accumulation or enlargement of computed tomography-undetectable APCC harboring somatic aldosterone-driver gene mutations. The high prevalence of mutations in the CACNA1D L-type calcium channel provides a potential actionable therapeutic target that could complement mineralocorticoid blockade and inhibit aldosterone overproduction in some IHA patients.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.118.11086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207209PMC
October 2018

Comparison of Seated With Recumbent Saline Suppression Testing for the Diagnosis of Primary Aldosteronism.

J Clin Endocrinol Metab 2018 11;103(11):4113-4124

Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia.

Context: Failure of plasma aldosterone suppression during fludrocortisone suppression testing (FST) or saline suppression testing (SST) confirms primary aldosteronism (PA). Aldosterone is often higher upright than recumbent in PA; upright levels are used during FST. In a pilot study (24 patients with PA), seated saline suppression testing (SSST) was more sensitive than recumbent saline suppression testing (RSST).

Objective, Design, And Patients: The current validation study involved 100 patients who underwent FST, RSST, and SSST, eight before and after unilateral adrenalectomy. Of the 108 FSTs, 73 confirmed and 18 excluded PA. Four patients with inconclusive FST lateralized on adrenal venous sampling, making a total of 77 with PA.

Results: The area under the receiver operating characteristic (ROC) curve was greater for SSST than RSST (0.96 vs. 0.80; P < 0.01). ROC analysis predicted optimal cutoff aldosterone levels of 162 pmol/L for SSST and 106 pmol/L for RSST. At these cutoffs, SSST showed high sensitivity for PA (87%) that markedly exceeded that for RSST (38%; P < 0.001) but similar specificity (94 vs. 94%; not significant). SSST was more sensitive than RSST in detecting both unilateral (n = 28, 93% vs. 68%, P < 0.05) and bilateral (n = 40, 85% vs. 20%, P < 0.001) forms of PA. Only three SSST (vs. 9 RSST and 17 FST) results were inconclusive.

Conclusions: SSST is highly sensitive and superior to RSST in identifying both unilateral and bilateral forms of PA and has a low rate of false positives and inconclusive results. It therefore offers a reliable and much less complicated and expensive alternative to FST for confirming PA.
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http://dx.doi.org/10.1210/jc.2018-01394DOI Listing
November 2018