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Ultra-processed foods make up more than 50% of daily energy consumed in Western countries and are rapidly increasing in China. However, little is known about the association between ultra-processed food intake and muscle strength, a predictor for physical disability in senior years. We aimed to investigate the association of ultra-processed food intake with longitudinal changes in grip strength among middle-aged and older Chinese adults. This prospective cohort study included a total of 5409 adults aged 40 years and over (61.3% men). Ultra-processed food intake was obtained by means of a validated food frequency questionnaire and classified according to the NOVA classification system. Grip strength was measured annually using a handheld digital dynamometer. Multivariable linear regression models were used to examine the association between ultra-processed food intake and annualized change in grip strength and weight-adjusted grip strength. In the fully adjusted models, annualized changes in grip strength and weight-adjusted grip strength per 10% increment in the proportion of ultra-processed foods in the diet were − 0.3708 kg (95% confidence interval − 0.5687, − 0.1730; P 0.05). Our data indicate that higher ultra-processed food intake was associated with faster grip strength decline in middle-aged and older Chinese adults.

Summary Background and aims Prospective cohort studies linking dietary patterns and non-alcoholic fatty liver disease (NAFLD) are limited, especially in Asian populations. This study aimed to prospectively investigate the association between dietary patterns and risk of NAFLD in a general Chinese adult population. Methods This study included a total of 17,360 participants free from NAFLD at baseline. Dietary patterns at baseline were identified with factor analysis based on responses to a validated 100-item food frequency questionnaire. NAFLD was diagnosed by abdominal ultrasound after excluding other causes related to chronic liver disease. Cox proportional regression models were used to assess the association between dietary patterns and risk of NAFLD. Results During a median follow-up of 4.2 years, 4034 NAFLD cases were documented. Three main dietary patterns were extracted: sugar rich dietary pattern, vegetable rich dietary pattern, and animal food dietary pattern. After adjusting for age, sex, body mass index, smoking, alcohol, education, occupation, income, physical activity, total energy intake, personal and family history of disease, depressive symptoms, dietary supplement use, inflammation markers, and each other dietary pattern score, comparing the highest with the lowest quartiles of dietary pattern scores, the multivariable hazard ratios (95% confidence interval) of NAFLD were 1.11 (1.01, 1.23) for sugar rich dietary pattern, 0.96 (0.86, 1.07) for vegetable rich dietary pattern, and 1.22 (1.10, 1.36) for animal food dietary pattern. Further adjustment for waist circumference instead of body mass index provided similar results. Conclusion Dietary patterns rich in animal foods or sugar were associated with a higher risk of NAFLD among Chinese adults, whereas a vegetable rich dietary pattern was not associated.

BACKGROUND Although preserved egg is a traditional Chinese delicacy widely consumed in China and Southeast Asian countries, whether habitual preserved egg consumption is associated with nonalcoholic fatty liver disease (NAFLD) remains unknown. OBJECTIVES This study aimed to examine the association between preserved egg consumption and risk of NAFLD in a cohort of Chinese adults. METHODS This prospective cohort study included 15,883 participants aged 19-88 y (58% women) from the TCLSIH (Tianjin Chronic Low-grade Systemic Inflammation and Health) cohort study who were free of liver diseases, cancer, and cardiovascular disease at baseline. Preserved egg consumption was assessed using an FFQ at baseline. NAFLD was diagnosed by transabdominal sonography during an annual health examination. Multivariable Cox proportional hazards regression models were used to calculate HRs and 95% CIs across categories of preserved egg consumption. RESULTS During 56,002 person-years of follow-up, 3683 first incident cases of NAFLD were recorded. After adjustment for sociodemographic characteristics, lifestyle risk factors, total energy intake, egg intake, and eating patterns, the multivariable HRs (95% CIs) of incident NAFLD according to categories of preserved egg consumption were 1.00 (reference) for never, 1.05 (0.98, 1.14) for

The independent role of muscular strength in the prevention of chronic disease is increasingly being recognized. However, no cohort study has assessed the relationship between handgrip strength and the incidence of hypertension among the middle-aged and older population. The aim of this prospective cohort study was to investigate whether handgrip strength is related to incident hypertension among people aged 40 years and over.This prospective cohort study (n = 8,480) was performed between 2013 and 2019 as part of the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study, Tianjin, China.Participants without baseline hypertension were followed up for ~6 years (median 4.0 years). Hypertension was defined according to the JNC7 criteria. Handgrip strength was measured using a hydraulic handheld dynamometer. Adjusted Cox proportional hazards regression models were used to assess the relationships between weight-adjusted handgrip strength and the risk of incident hypertension.The incidence rate of hypertension per 1000 person-years was 70. The fully adjusted hazards ratios (95% confidence interval) of the incidence of hypertension for increasing quartiles of weight-adjusted handgrip strength were: 1.00(reference), 0.84 (0.75-0.95), 0.78 (0.69-0.88), and 0.66 (0.58-0.75) (P for trend0.0001). Moreover, the adjusted hazards ratio (95% confidence interval) of incident hypertension for per unit increase in weight-adjusted handgrip strength was 0.17 (0.10-0.27) (P0.0001). Similar results were observed in males and females.The present cohort study is the first to find that high weight-adjusted handgrip strength, but not absolute handgrip strength, is significantly and independently related to low risk of incident hypertension among the middle-aged and older population.

Introduction: Mounting evidence has demonstrated that skeletal muscle and visceral adiposity play crucial roles in glucose metabolism. The purpose of this study was to investigate whether the appendicular skeletal muscle mass index (ASMI) to trunk fat mass (TFM) ratio (ASMI/TFM) is a more specific and identifiable factor for type 2 diabetes mellitus (T2DM) in older adults than conventional anthropometric measures. Methods: This cross-sectional study included 1,370 older adults from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort. ASMI and TFM were measured by using a bioelectrical impedance analyzer, and T2DM was defined with the criteria of the American Diabetes Association. Odds ratios (ORs) were evaluated using multivariable logistic analysis. Results: The prevalence of T2DM is 20.0% in this study. The multivariable-adjusted ORs (95% confidence interval) of T2DM for increasing categories of ASMI/TFM, BMI, and waist circumference (WC) were 1.00 (reference), 0.70 (0.49, 1.02), 0.61 (0.42, 0.89), and 0.45 (0.30, 0.67; p for trend p for trend = 0.10); and 1.00 (reference) and 1.78 (1.19, 2.74; p < 0.01), respectively. Conclusions: Higher ASMI/TFM was associated with a lower prevalence of T2DM in this study of older adults. The T2DM predictive value of ASMI/TFM may be stronger than BMI and WC in this population.

Results of in vitro and in vivo studies showed that green leafy vegetables (GLV) could attenuate liver steatosis. However, little is known regarding the association between GLV intake and nonalcoholic fatty liver disease (NAFLD) in human. We examined the association of GLV intake with NAFLD in a large-scale adult population.This cross-sectional study investigated 26,891 adults in China who participated in health examinations from 2013 to 2017. Newly diagnosed NAFLD was detected by liver ultrasonography. Dietary intake was assessed by using a validated and standardized food frequency questionnaire. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) across categories of GLV intake. After adjustment for sociodemographic characteristics, lifestyle factors, and other dietary intakes, the OR (95% CI) for comparing the highest vs. lowest GLV intake categories (≥7 times/week vs. almost never) was 0.72 (0.59, 0.90) (P 0.0001). In addition, a linear inverse association was demonstrated between GLV intake and NAFLD in women (P for trend = 0.04), but ORs for any intake category did not reach significance. Stratified analyses suggested a potential effect modification by obesity status; the ORs (95% CIs) for comparing the highest vs. lowest GLV intake categories was 0.72 (0.54, 0.97) in normal/overweight individuals and 1.04 (0.65, 1.65) in obese individuals (P-interaction 0.0001).This large population-based study shows that high GLV intake is inversely associated with NAFLD, particularly in women and non-obese participants.

BACKGROUND Wholegrains contribute a range of beneficial nutrients, such as dietary fiber and several minerals and vitamins, that are beneficial to depressive symptoms. However, there are a few studies aimed at exploring whether a wholegrain diet is related to depressive symptoms. We conducted this study to investigate the relationship between wholegrains consumption and depressive symptoms. METHODS This cross-sectional study included a total of 24,776 (mean age: 39.9 years, age range: 18.1-91.3 years; males, 54.1%) inhabitants living in Tianjin, China. Wholegrains consumption was assessed using a valid self-administered food frequency questionnaire. Depressive symptoms were evaluated using the Chinese version of Zung Self-Rating Depression Scale (SDS) and the cutoff point was set at 45. Multiple logistic regression analysis was used to estimate the relationship between wholegrains consumption and depressive symptoms. RESULTS The prevalence of depressive symptoms was 19.1% and 22.4% in males and females, respectively. After adjustments for potential confounding factors, the odds ratios (95% confidence intervals) of depressive symptoms across wholegrains consumption were 0.77 (0.65-0.91) for

Thyroid hormones (THs) play an important role in both serum uric acid (SUA) excretion and purine nucleotide metabolism. Past research mainly focused on the relationships between thyroid dysfunction and hyperuricemia. Although most subjects at risk for hyperuricemia are euthyroid, few studies have investigated the predictive values of THs on incident hyperuricemia in euthyroid adults. This study aimed to examine how free triiodothyronine, thyroxine, and thyroid-stimulating hormone are related to incident hyperuricemia in euthyroid subjects.Participants without baseline hyperuricemia were recruited from Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study and followed up for ∼6 years. Thyroid function was determined by chemiluminescence immunoassay methods. Hyperuricemia was defined as SUA ≥416.5 μmol/L for males and ≥357.0 μmol/L for females. Thyroid function and SUA were assessed yearly during follow-up. Adjusted Cox proportional hazards regression models were used to assess the relationship between thyroid function and hyperuricemia.The incidence rates of hyperuricemia were 109 and 50 per 1000 person-years in males and females, respectively. In males, compared with the lowest quartile, the multivariable-adjusted hazards ratios for hyperuricemia in the highest quartiles of triiodothyronine, thyroxine, and thyroid-stimulating hormone were 0.57 (0.50-0.66), 0.63 (0.54-0.73), and 1.03 (0.90-1.19) (P for trend.0001,.0001, and .51), respectively. However, no statistically significant correlations between thyroid function and incident hyperuricemia in females were found.This cohort study is the first to demonstrate that higher THs are related to lower risk of incident hyperuricemia in a male population with euthyroid status.

Seaweeds have numerous biologically active ingredients, such as polysaccharides, polyphenols and carotenoids, that are beneficial to human health. Although these benefits might be related to the synthesis, secretion or reabsorption of uric acid, no studies have explored the relationship between seaweeds consumption and hyperuricaemia (HUA) in the general population. The aim of this study was to investigate whether seaweeds consumption is related to HUA in a large-scale adult population. A cross-sectional study was conducted with 32 365 adults (17 328 men and 15 037 women) in Tianjin, People’s Republic of China. Frequency of seaweeds consumption was assessed by a validated self-administered FFQ. HUA was defined as serum uric acid levels >420 μmol/L in men and >350 μmol/L in women. The association between seaweeds consumption and HUA was assessed by multiple logistic regression analysis. Restricted cubic spline functions were used for non-linearity tests. The prevalence of HUA in men and women was 21·17 % and 5·93 %, respectively. After adjustments for potential confounding factors, the OR (95 % CI) for HUA across seaweed consumption (g/1000 kcal per d) were 1·00 (reference) for level 1, 0·91 (95 % CI 0·81, 1·02) for level 2; 0·90 (95 % CI 0·81, 1·01) for level 3; 0·86 (95 % CI 0·78, 0·97) for level 4 in men and 0·90 (95 % CI 0·73, 1·10) for level 2; 0·82 (95 % CI 0·67, 1·00) for level 3; 0·84 (95 % CI 0·68, 1·03) for level 4 in women, respectively. A negative correlation between seaweeds consumption and HUA in males but not in females was observed. Further studies are needed to explore the causal relationship.

Thyroid hormones, including free triiodothyronine (FT3), free thyroxine (FT4), have well-recognized effects on the cardiovascular system. However, the evidence is lacking regarding the relationship between repeated FT3, FT4, and thyroid-stimulating hormone (TSH) measurements and incident hypertension. The aim of this cohort study was to examine how longitudinal trends of serum FT3, FT4, and TSH levels are related to the development of hypertension in a euthyroid population. A prospective study (n = 5926) was performed in Tianjin, China. Participants without a history of hypertension were followed up for ~4 years (median: 3 years). Hypertension was defined according to the criteria of JNC7. FT3, FT4, and TSH were determined by chemiluminescence immunoassay methods. FT3, FT4, TSH, and blood pressure were assessed yearly during follow-up. Adjusted Cox proportional hazards regression models were used to assess the relationships between baseline, means, and annual changes in FT3, FT4, TSH, and hypertension. The incidence rate of hypertension per 1000 person-years was 73. Compared with the lowest quartile, the multivariable-adjusted hazards ratios (95% confidence interval) for hypertension in the highest quartiles of changes in FT3, FT4, and TSH were 1.51 (1.23-1.84), 2.04 (1.67-2.48), and 1.20 (0.99-1.45), respectively. Similar relationships were observed between the means of FT3, FT4, TSH, and hypertension. However, we found no correlations between baseline FT3, FT4, TSH, and incident hypertension. The present study is the first to demonstrate that the annual changes and means, but not baseline FT3 and FT4 values are independently related to the risk of incident hypertension in the euthyroid general population.

Background Previous studies suggest that muscle-derived cytokines (myokines) are linked with brain function. Although muscle strength measured by handgrip strength is a prognostic indicator of functional decline, epidemiological studies directly examining the association between grip strength and mental health remain scarce. The aim of this study is to clarify the association between grip strength and depressive symptoms in the general adult population. Methods This is a cross-sectional study of 24,109 Chinese adults (41. 5 ± 11.9 years; 46.0% females). Grip strength was measured by dynamometer and the greatest force was normalized to body weight (NGS, kg/kg). Depressive symptoms were assessed using the Self-Rating Depression Scale (SDS). Models of logistic regression were conducted to assess the association between NGS and depressive symptoms, with adjustment for established confounding factors. Results Of the 24,109 participants, the prevalence of depressive symptoms (SDS ≥45) was 16.8% (males 15.7%, females 18.0%). After adjusting for multiple confounding factors, the odds ratios and 95% confidence interval for depressive symptoms in the quartiles of NGS were 1.00, 0.96 (0.84–1.10), 0.91 (0.79–1.05), and 0.91 (0.78–1.07) (P = 0.03) in males; 1.00, 0.92 (0.80–1.06), 0.90 (0.77–1.04), and 0.80 (0.69–0.94) (P = 0.0002) in females, respectively. Limitations This cross-sectional study cannot determine causality. Conclusions Grip strength was inversely associated with depressive symptoms, with stronger association observed among females than males. Further prospective studies or randomized trials are required to clarify these findings.

BACKGROUND Animal studies have shown that soy protein and isoflavones can increase antioxidant capacity and improve insulin resistance, and thus ameliorate nonalcoholic fatty liver disease (NAFLD). However, only limited epidemiological studies have examined the association of soy food intake with NAFLD. OBJECTIVES We investigated the association between soy food intake and NAFLD in a Chinese cohort. METHODS A total of 24,622 participants aged 20-90 y were included in the study. Diet information was collected using a validated 100-item FFQ. NAFLD was defined as having fatty liver diagnosed by ultrasonography and excluding men and women who consumed >210 g alcohol/wk and >140 g/wk, respectively. Logistic regression analysis was used to assess the association of soy food intake with NAFLD. RESULTS After adjustment for potential confounders, and taking those with

Research evidence supports a positive link between sugar-containing soft beverages and hyperuricemia. However, data thus far are mostly from Caucasian populations. And in sugar-containing soft beverages overall, sugar-containing carbonated beverages are purchased most often. Therefore, we investigated whether the high consumption of sugar-containing carbonated beverages was associated with the prevalence of hyperuricemia among adults in China.A cross-sectional study was conducted with 25,507 adults (13,013 men and 12,494 women) in Tianjin, China. Sugar-containing carbonated beverages intake was assessed by a validated semi-quantitative food frequency questionnaire. Hyperuricemia was defined as serum uric acid levels ≥7.0 mg/dL in men and ≥ 6 mg/dL in women. The association between carbonated beverages consumption and hyperuricemia was assessed by multiple logistic regression analysis. The prevalence of hyperuricemia in men and women was 23.4% and 8.2%, respectively. After adjustments for potential confounding factors, the odds ratios (95% confidence interval) for hyperuricemia across sugar-containing carbonated beverages consumption were 1.00 (reference) for almost never, 1.18 (1.05, 1.32) for1-3 cups/week, 1.49 (1.25, 1.77) for ≥4 cups/week in men (P for trend 0.005) and 1.11 (0.91, 1.34) for1-3 cups/week (P for trend = 0.27), 1.70 (1.23, 2.31) for ≥4 cups/week in women (P for trend0.001), respectively.This cross-sectional survey demonstrated that increased consumption of sugar-containing carbonated beverages is associated with hyperuricemia among adults in China. Restricted sugar-containing carbonated beverages intake might be beneficial to the prevention of hyperuricemia in the general population.

Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. Recent evidence has suggested the protective effects of honey consumption against the metabolic syndrome, but the association between honey intake and NAFLD is still unclear. We investigated how the consumption frequency of honey was associated with NAFLD in the general population. This was a cross-sectional study of 21 979 adults aged 20–90 years. NAFLD was diagnosed based on the ultrasound-diagnosed fatty liver without significant alcohol intake and other liver diseases. Diet information, including consumption frequency of honey, was assessed by a validated 100-item FFQ. OR with 95 % CI were calculated by the binary logistic regression model, adjusting for confounding factors identified by the directed acyclic graph. Overall, 6513 adults (29·6 %) had NAFLD. Compared with participants consuming ≤1 time/week of honey, the multivariable OR of NAFLD were 0·86 (95 % CI 0·77, 0·97) for 2–6 times/week and 1·10 (95 % CI 0·95, 1·27) for ≥1 times/d (Pfor trend = 0·90). The results were generally similar in subgroups of BMI at a cut-point of 24·0 kg/m2 (Pfor interaction = 0·10). In this large-scale study, consuming honey 2–6 times/week was inversely associated with NAFLD, whereas consuming honey ≥1 times/d had no association with NAFLD. These results need replication in other large-scale prospective studies.

Thyroid hormones (THs) have multiple effects on lipid synthesis, mobilization, and degradation, suggesting that THs may affect the development of dyslipidemia. However, prospective studies on the association between serum THs levels and incident dyslipidemia in euthyroid subjects are limited. Therefore, we conducted a cohort study (~5-year follow-up period, median: 3.0 years) to explore whether THs can affect incident dyslipidemia in a general euthyroid population aged 18 years old and over. Dyslipidemia is characterized by elevated total cholesterol (TC), triglyceride (TG), or low-density lipoprotein cholesterol (LDL-C), or reduced high-density lipoprotein cholesterol (HDL-C). Serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were determined by chemiluminescence immunoassay. Multivariable Cox proportional hazards regression models were used to assess the association between baseline FT3, FT4, TSH, and the risk of various dyslipidemias. During follow-up period, the incidence of elevated TC, TG, LDL-C, and reduced HDL-C was 29.3%, 20.7%, 24.8%, and 19.5%, respectively. After adjustment for multiple confounders, we found that per unit increase in FT3 concentrations were associated with decreased incidence of elevated TC and LDL-C, and the hazard ratios (95% confidence interval) were 0.87 (0.79–0.97) (P

Garlic-derived organosulfur compounds have numerous potential benefits (e.g. antioxidant and anti-inflammatory effects) on human health. Although these functions might be related to the onset and progression of muscle strength decline, no studies have explored the relationship between garlic consumption and muscle strength in the general population. The aim of this study was to investigate whether raw garlic consumption is related to handgrip strength in a large-scale adult population.A cross-sectional study (n = 28,958) was performed in Tianjin, China. Frequency of raw garlic consumption was assessed using a valid self-administered food frequency questionnaire. Handgrip strength was measured using a handheld digital dynamometer. Analysis of covariance and multiple logistic regression were used to evaluate the relationship between raw garlic consumption and handgrip strength.In males, after adjusted potential confounding factors, the least square means (95% confidence intervals) of handgrip strength across raw garlic consumption categories were 42.5 (40.2-44.9) for almost never; 43.0 (40.7-45.5) for1 time/week; 43.4 (41.0-45.8) for 1 time/week; and 43.8 (41.5-46.3) for ≥2-3 times/week (P for trend0.0001). The adjusted odds ratios (95% confidence intervals) of low handgrip strength (20th percentile of handgrip strength) across the categories of raw garlic consumption in males were 1.00, 0.86 (0.76, 0.98), 0.76 (0.67, 0.87), and 0.66 (0.58, 0.74) (P for trend0.0001). Similar results were also observed in females.The study firstly revealed a positive correlation between raw garlic consumption and handgrip strength in both males and females. Further studies are needed to explore the casual relationship.

A cross-sectional study was conducted to explore the association between soft drink consumption and handgrip strength (HGS) in subjects aged 40 years and older (n = 14,925). After multivariable-adj...

Banana contains many kinds of substances that are beneficial to depressive symptoms. However, there are no epidemiological researches directly to explore the association between banana consumption and depressive symptoms. This study aimed to investigate whether the banana consumption is related to depressive symptoms in a general adult population.A cross-sectional study was performed in 24,673 adults in Tianjin. Banana consumption was evaluated via a validated food frequency questionnaire. Depressive symptoms were assessed by using Self-Rating Depression Scale (SDS). The association between banana consumption and depressive symptoms was analyzed by multiple logistic regression analysis.The prevalence of depressive symptoms was 16.1% in males and 18.4% in females (SDS ≥ 45), respectively. In males, comparing to the reference group (almost never), the multivariable adjusted odds ratios (ORs) (95% confidence intervals) of depressive symptoms across banana consumption were 0.86 (0.74, 0.99) for1 time/week, 0.76 (0.66, 0.88) for 1-3 times/week and 0.97 (0.82, 1.16) for ≥4 times/week. By contrast, the multivariable adjusted ORs (95% confidence intervals) were 1.11 (0.94, 1.32) for1 time/week, 0.99 (0.85, 1.16) for 1-3 times/week and 1.22 (1.02, 1.46) for ≥4 times/week in females. Similar association was observed when other cut-offs (SDS ≥ 48 and 50) were used to define depressive symptoms.This is a cross-sectional study, causality remains unknown.Findings from this study suggested a negative association between moderate banana consumption and depressive symptoms in males. In females, high banana consumption is positively related to depressive symptoms.

Purpose: This study aimed to determine the longitudinal association between hand grip strength (HGS) and the development of non-alcoholic fatty liver disease (NAFLD) in adults.Design: A cohort study.Methods: This study was conducted in a general Chinese population (n = 14,154) from 2013–2018. NAFLD was diagnosed by liver ultrasonography during evaluating alcohol consumption. The associations between the HGS and NAFLD were assessed using a multivariable Cox proportional hazards regression model.Results: During the study period with a mean follow-up duration of 3.20 years, 2,452 participants developed NAFLD. The risk of NAFLD decreased progressively with increasing HGS in both men and women (P for trend CI) for NAFLD incidence across the quartiles of HGS were 1 (reference), 0.90 (0.79, 1.02), 0.69 (0.60, 0.79), and 0.44 (0.37, 0.52) for men and 1 (reference), 0.82 (0.69, 0.96), 0.54 (0.45, 0.66), and 0.41 (0.33, 0.52) for women, respectively. The interaction terms for body mass index (BMI)-HGS and waist-HGS were significant in men and women (all P < 0.0001). The participants with normal BMIs and waist circumferences had the lowest hazard ratios on the subgroup analyses. The sensitivity analysis that defined NAFLD using the hepatic steatosis and fatty liver indices revealed results that were similar to the main analyses.Conclusion: The present study indicates that the HGS is inversely associated with the incidence of NAFLD.

Background: Timing the fixator removal is vital for a successful external fixation treatment. The purpose of this study was to determine the effectiveness of axial load-share ratio in vivo as a supplemental decision support tool for the safe removal of an Ilizarov external fixator.Methods: This prospective observational study consists of 83 patients undergoing tibial or femoral lengthening with Ilizarov circular external fixation in our institution, from January 2011 to October 2019. In group Ⅰ (38 patients), the external fixator was removed based on the surgeon’s clinical experience and radiographs from January 2011 to June 2015. In group Ⅱ (45 patients), from July 2015 to October 2019, the supplemental axial load-share (LS) ratio test was accomplished without the knowledge of the clinical results by another medical team. The test was performed by electronically measuring forces in the fixator rods and in a ground force plate. When the LS ratio < 10% was consistent with the conclusion (dense bone formation was achieved in the distraction zone) drawn from the corresponding routine radiographs by the treating surgeon, the external fixator was removed.Results: There was no statistical significance in demographic data between the two groups (P>0.05). In group Ⅰ, 4 of the 38 patients suffered refracture (the refracture rate was 10.5%) after fixator removal, and bone union was finally achieved with further intervention by intramedullary nail. In group Ⅱ, 36 patients terminated the external fixation after the first mechanical test, and another 9 patients terminated the external fixation at the subsequent test. None of the 45 patients in group Ⅱ suffered refracture (the refracture rate was 0%). There was statistical significance in the refracture rate between the two groups (PConclusions: Adequate assessment of bone regenerate is crucial before removing an external fixator to prevent deformation or refracture. The axial load-share ratio in vivo is a practically quantitative method to supplement radiography and clinical experience for the assessment of regenerate healing, and the axial load-share ratio dropped below 10% is a safe limit for the Ilizarov external fixator removal.

Background: Basic studies have found that xanthine oxidase inhibitors extracted from mushrooms have inhibitory effects on hyperuricemia. However, the association between mushroom consumption and hyperuricemia is unknown in humans. Objective: We therefore designed a large-scale cohort study to examine whether mushroom consumption is a protective factor for developing hyperuricemia in adults. Methods: This prospective cohort study investigated 19 830 participants (mean age: 39.4 years; and 9906 [50.0%] men) who were free of hyperuricemia, cardiovascular disease, and cancer at the baseline. Mushroom consumption was measured at the baseline using a validated food frequency questionnaire. Hyperuricemia is defined as serum uric acid levels >420 μmol L−1 in men and >350 μmol L−1 in women. Cox proportional hazards regression models were used to examine the association of mushroom consumption with incident hyperuricemia. Restricted cubic spline regression was used to estimate the dose–response relationship between mushroom consumption and risk of hyperuricemia. Results: A total of 4260 first incident cases of hyperuricemia occurred during 61 421 person-years of follow-up (median follow-up of 4.2 years). After adjusting for demographic characteristics, lifestyle factors, dietary intake, and inflammatory markers, the multivariable hazard ratios (95% confidence intervals) for incident hyperuricemia were 1.00(reference) for 5.52 g per 1000 kcal per day, respectively (P for trend = 0.007). Conclusions: This population-based prospective cohort study has firstly demonstrated that higher mushroom consumption is significantly associated with lower incidence of hyperuricemia among general adults.

High dietary fibre intake has been associated with a lower risk of diabetes, but the association of dietary fibre with prediabetes is only speculative, especially in China, where the supportive data from prospective studies are lacking. This study aimed to examine the association between dietary fibre intake and risk of incident prediabetes among Chinese adults. We performed a prospective analysis in 18 085 participants of the Tianjin Chronic Low-grade Systemic Inflammation and Health cohort study who were free of diabetes, prediabetes, cancer and CVD at baseline. Dietary data were collected using a validated 100-item FFQ. Prediabetes was defined based on the American Diabetes Association diagnostic criteria. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95 % CI. During 63 175 person-years of follow-up, 4139 cases of incident prediabetes occurred. The multivariable HR of prediabetes for the highest v. lowest quartiles were 0·85 (95 % CI 0·75, 0·98) (P for trend = 0·02) for total dietary fibre, 0·84 (95 % CI 0·74, 0·95) (P for trend < 0·01) for soluble fibre and 1·05 (95 % CI 0·93, 1·19) (P for trend = 0·38) for insoluble fibre. Fibre from fruits but not from cereals, beans and vegetables was inversely associated with prediabetes. Our results indicate that intakes of total dietary fibre, soluble fibre and fibre derived from fruit sources were associated with a lower risk of prediabetes.

Background Previous studies have reported that tea extract supplementation has potential benefits on the risk factors of non-alcoholic fatty liver disease (NAFLD); however, no study has investigated the direct effect of daily tea consumption on the prevalence of NAFLD in the general population. This cross-sectional study aimed to evaluate the associations between tea consumption and the prevalence of newly diagnosed NAFLD among Chinese adults. Methods The present cross-sectional study was based on the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. In total, 19,350 participants were enrolled in the analyses. Tea consumption was assessed via a self-administered food frequency questionnaire. NAFLD was diagnosed via liver ultrasonography and no history of heavy alcohol intake. Logistic regression analysis was used to estimate the associations between tea consumption and the prevalence of NAFLD. Results Consumption of green tea, oolong tea, and black tea were positively associated with the prevalence of newly diagnosed NAFLD before adjustments. Compared with the participants who never drink tea, the odds ratios (95% confidence interval) of newly diagnosed NAFLD in the highest categories (≥ 1 cup/day) of green tea, oolong tea, black tea, and jasmine tea were 1.48 (1.33, 1.65), 1.50 (1.33, 1.68), and 1.28 (1.13, 1.46), and 1.36 (1.20, 1.54) before adjustments, respectively. However, no significant association was found between tea consumption and the prevalence of NAFLD after adjusting for socio-demographic, behavioural, anthropometric, dietary, and clinical confounding factors. Conclusion There is no significant association between daily tea drinking and newly-diagnosed NAFLD in general Chinese adults.

Background/Objectives Many studies have suggested that probiotics may be applied as a therapeutic agent for non-alcoholic fatty liver disease (NAFLD). However, the effects of frequent yogurt consumption (as a natural probiotic source) on NAFLD remain poorly understood. This study was to examine the association of habitual yogurt consumption with newly diagnosed NAFLD in the general adult population. Subject/Methods Overall, 24,389 adults were included in this cross-sectional study. Yogurt consumption was estimated by using a validated self-administered food frequency questionnaire. NAFLD was diagnosed by abdominal ultrasonography. We used logistic regression models to assess the association between yogurt consumption categories and newly diagnosed NAFLD. Results The multivariable odds ratios with 95% confidence interval of newly diagnosed NAFLD were 1.00 (0.88, 1.14) for 1 time/week, 0.91 (0.81, 1.02) for 2–3 times/week, and 0.86 (0.76, 0.98) for ≥4 times/week (P for trend = 0.01), compared with those who consumed Conclusion Higher yogurt consumption was inversely associated with the prevalence of newly diagnosed NAFLD. These results are needed to be confirmed in randomized controlled trials or prospective studies.

Background and aims Metabolic syndrome (MetS) is a combination of metabolic disorders that increase the risk of developing cardiovascular disease, and inflammation is considered as a pathological basis for MetS. Immunoglobulins (Igs) are the major secretory products of the adaptive immune system. However, no large-scale population study has focused on a possible relationship between Igs and MetS. We designed a cross-sectional study to investigate the relationship between Igs and prevalence of MetS in a large-scale adult population. Methods and results A total of 10,289 participants were recruited among residents in Tianjin, China. Metabolic syndrome was defined in accordance with the criteria of the American Heart Association scientific statements of 2009. Serum levels of Igs were determined by immunonephelometry. Multiple logistic regression models were used to assess the relationship between the quintiles of serum levels of Igs and the prevalence of MetS. The overall prevalence of MetS was 36.1%. The mean (standard deviation) values of Igs (IgG, IgE, IgM, and IgA) were 1205.7 (249.3) mg/dL, 93.1 (238.9) IU/mL, 105.7 (57.3) mg/dL, and 236.2 (97.6) mg/dL, respectively. The adjusted odds ratios (95% confidence interval) of MetS for the highest quintile of Igs (IgG, IgE, IgM, and IgA), when compared to the lowest quintile, were 0.81 (0.70, 0.95), 0.97 (0.83, 1.12), 1.13 (0.97, 1.33), and 1.52 (1.30, 1.77), respectively. Conclusions This study demonstrated that decreased IgG and increased IgA are independently related to a higher prevalence of MetS. The results indicate that the Igs might be useful predictive factors for MetS in the general adult population.

BACKGROUND Red blood cell distribution width (RDW) was related with increased risk of mortality and adverse cardiovascular outcomes. However, it is uncertain whether RDW is related to the prevalence of atrial fibrillation (AF) in Asian population. The aim of this study was to assess the relationship between RDW and AF in a large Chinese population. METHODS We performed a cross-sectional study to examine the relationship between RDW and AF among 106 998 subjects who were from the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. AF was diagnosed using electrocardiography, and RDW was measured using an automated hematology analyzer. Multiple logistic regression models were conducted to examine the relation between tertiles of RDW and AF. RESULTS The overall prevalence of AF was 0.1% (129/106 998). After adjustments for potential confounding factors, the odds ratios (95% confidence intervals) of AF across increasing tertiles of RDW were 1.00 (reference), 1.08 (0.69, 1.67), and 2.65 (1.75, 4.07) (P for trend

Context Thyroid hormones (THs) have direct and indirect effects on hematopoiesis. However, few studies have directly evaluated the effect of THs on incident anemia among euthyroid subjects. This cohort study aimed to explore whether THs under physiological conditions can affect the development of anemia in the general population. Design A total of 12,310 participants were enrolled in the cohort study (∼5-year follow-up period; mean, 3.1 years). A chemiluminescence immunoassay was used to measure free T3 (FT3), free T4 (FT4), and TSH, and anemia was defined according to the World Health Organization recommendation. THs, TSH, and Hb were assessed yearly during follow-up. Multivariable Cox proportional hazards regression models were used to assess the association between THs, TSH, and incident anemia. Results The fully adjusted hazards ratios (95% CI) of anemia per 1-unit change in FT3, FT4, and TSH concentrations were 0.70 (0.56, 0.87), 0.93 (0.88, 0.98), and 1.19 (0.94, 1.50) (P < 0.01, P < 0.01, and P = 0.14, respectively). Moreover, a significant and positive association between FT3, FT4, and annual changes in Hb (standard regression coefficients of 0.056 and 0.028, respectively; both P < 0.01) was observed. Similar associations were observed when the participants who had thyroid dysfunction upon follow-up were excluded. Conclusions The current study demonstrated that THs significantly predict future anemia and annual changes in Hb, even in the euthyroid population.

Many components in diet have regulated oxidative stress, inflammatory reaction and even balance oestrogen levels. Because these factors are closely associated with depressive symptoms in postmenopausal women, it is considered that dietary factors are able to prevent and control depressive symptoms. On the other hand, a dietary pattern that considers the correlations and synergies between foods and nutrients is expected to have a greater impact on disease risk. The aim of the present study is to evaluate whether dietary patterns are associated with depressive symptoms in Chinese postmenopausal women. A cross-sectional study of 2051 postmenopausal women (mean age: 58·8 (sd 7·4) years) was conducted in Tianjin, China. Dietary consumption was assessed by a valid self-administered FFQ. Principal component analysis was used to derive three major dietary patterns: ‘healthy’, ‘sweets’ and ‘traditional Tianjin’ from eighty-eight food items. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale, and cut-off point of 48 indicating serious depressive symptoms. The association between quartile of dietary patterns and depressive symptoms was assessed using multiple logistic regression analysis. The multivariable-adjusted OR of having depressive symptoms for increasing quartile of dietary patterns were as follows: healthy, 1·00, 0·79 (95 % CI 0·49, 1·28), 0·62 (95 % CI 0·37, 1·04) and 0·57 (95 % CI 0·33, 0·97); sweets, 1·00, 0·75 (95 % CI 0·42, 1·3), 1·08 (95 % CI 0·64, 1·81) and 1·66 (95 % CI 1·03, 2·71); and traditional Tianjin, 1·00, 1·02 (95 % CI 0·58, 1·79), 0·96 (95 % CI 0·54, 1·71) and 2·53 (95 % CI 1·58, 4·16), respectively. The present study demonstrated that a healthy dietary pattern was inversely associated with depressive symptoms. On the contrary, greater adherence to sweets and traditional Tianjin dietary patterns was associated with a higher prevalence of depressive symptoms.

Prediabetes has been a growing health problem in China, and it is a high-risk state for developing diabetes and cardiovascular disease. In previous studies, low grip strength has been associated with diabetes. However, few population-based studies have examined the relationship between grip strength and prediabetes. Thus, the purpose of this study was to investigate whether grip strength is related to prediabetes in a large-scale adult population.A total of 27,295 participants aged 20 to 90 years were included from the 2013-2016 Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. Grip strength was assessed using an electronic hand-grip dynamometer and the greatest force was normalized to body weight. Prediabetes was diagnosed based on the American Diabetes Association criteria. Multiple logistic regression analysis was conducted in 2018 to assess the relationship of grip strength to the prevalence of prediabetes, while controlling for age, BMI, smoking, drinking, physical activities, dietary patterns, and other confounders.Of the 27,295 participants, 28.5% (7,783) had prediabetes. After adjusting for potential confounders, a one unit increase in grip strength per body weight was associated with 52% lower odds of having prediabetes for men (OR=0.48, 95% CI=0.30, 0.74, p0.01) and 62% lower odds of having prediabetes for women (OR=0.38, 95% CI=0.20, 0.70, p0.01).Increased grip strength is independently associated with lower prevalence of prediabetes in Chinese adults, suggesting that grip strength may be a useful marker for screening individuals at risk of prediabetes.

Objectives Non-alcoholic fatty liver disease (NAFLD) is one of the most common public health issues worldwide. Oranges are the most popular fruit consumed in the world. Admittedly, flavonoids in oranges act as antioxidants and improve liver steatosis. However, oranges also are rich in fructose, which is a risk factor in the progress of NAFLD. Therefore, we hypothesize that orange intake may be a double-edged sword in the development of NAFLD. To our knowledge, there currently is little evidence of the effect of dietary orange intake on NAFLD. The aim of this study was to investigate how orange intake is related to NAFLD in a general adult population. Methods We randomly recruited 27,214 adults into the Tianjin Chronic Low-Grade Systemic Inflammation and Health Cohort Study. NAFLD was diagnosed by liver ultrasonography. Raw orange intake was assessed by a validated self-administered food frequency questionnaire. Multiple logistic regression analysis was used to evaluate the association between orange intake and the prevalence of NAFLD. Results There was a 27.18% prevalence of NAFLD among the participants. Consumption of orange was positively associated with the prevalence of NAFLD after adjustment for all potential confounding factors (Ptrend = 0.04). The odds ratios (95% confidence interval) of the categories of orange intake in the NAFLD were 1.00 (reference) for less than once per week, 1.02 (0.95–1.11) for 1 to 6 times per week, and 1.17 (1.03–1.33) for ≥7 times per week, respectively. Conclusions The present study demonstrated that orange intake is positively associated with the prevalence of NAFLD.

OBJECTIVE Handgrip strength (HGS) begins an accelerating decline around 50 years. Many of the studies performed in old adults have demonstrated a significant relationship between vitamin D and HGS, but the studies performed in participants with a broad age range have yielded conflicting results. The purpose of the study was to investigate the relationship between vitamin D and HGS using age 50 as a specific cut-off. DESIGN Population-based, cross-sectional study. PARTICIPANTS Totally 5102 participants (2911 males, 2191 females) from the TCLSIH Cohort. MEASUREMENTS Serum concentration of 25-hydroxyvitamin D (25(OH)D) was measured using an enzyme immunoassay. We divided participants into quartiles according to 25(OH)D, and the ranges for increasing quartiles were as follows: (males [≥50 years]: 10.94-31.85, 31.88-43.01, 43.20-56.06, 56.20-143.0; males [

Background: The relationship between dietary patterns and atherosclerosis is inconclusive. Usually, diets vary greatly among different regions due to cultural differences and lifestyles. Few studies to date based on a Chinese population have investigated the relationship between dietary patterns and the formation of atherosclerosis in carotid arteries. We aimed to investigate whether dietary patterns are related to carotid atherosclerosis among an adult population in Tianjin, China. Methods: This cross-sectional study included a total of 2,346 participants aged 50 years or older (mean: 59.7  6.29 years). Dietary intakes were assessed using a validated 81-item semi-quantitative food frequency questionnaire, and factor analysis was used to identify dietary patterns. Carotid atherosclerosis was defined as common carotid artery intima-media thickness 1.0 mm or plaques, or a carotid bifurcation intima-media thickness ≥1.2 mm. Multiple logistic regression models were used to explore the relationship between dietary patterns and carotid atherosclerosis. Results: Three factors were determined: ‘‘health’’ dietary pattern (factor 1), ‘‘Traditional Tianjin’’ dietary pattern (factor 2), and “sweets’’ dietary pattern (factor 3). The multivariable-adjusted odds ratios (95% confidence intervals) of carotid atherosclerosis across the increasing quartiles of different dietary patterns scores were as follows: males, health, 1.00 (reference), 1.31 (0.92, 1.85), 1.40 (0.97, 2.02), 1.24 (0.81, 1.91); traditional Tianjin, 1.00 (reference), 1.20 (0.84, 1.70), 1.00 (0.70, 1.43), 1.11 (0.75, 1.62); sweets, 1.00 (reference), 1.20 (0.85, 1.71), 1.24 (0.87, 1.77), 0.95 (0.65, 1.39); females, health, 1.00 (reference), 1.04 (0.70, 1.55), 0.92 (0.60, 1.40), 1.03 (0.64, 1.66); traditional Tianjin, 1.00 (reference), 1.04 (0.70, 1.54), 0.88 (0.59, 1.29), 0.91 (0.61, 1.36); sweets,1.00 (reference), 1.33 (0.91, 1.97), 1.21 (0.82, 1.79), 1.64 (1.08, 2.51) (P for trend < 0.05). Conclusion: Greater adherence to sweets dietary pattern was positively related to a higher prevalence of carotid atherosclerosis in females aged 50 or older. No relationship was found between any dietary pattern and carotid atherosclerosis in males. Further prospective studies are warranted to test this finding in other populations.

Objective Prospective cohort studies linking dietary patterns and hyperuricemia (HUA) are limited, especially in Asian populations. The aim of this study was to prospectively investigate the association between various dietary patterns and risk for HUA in a general adult population. Method We used data from the TCLSIH (Tianjin Chronic Low-grade Systemic Inflammation and Health) cohort study of 20 766 men and women who were free from HUA, cancer, and cardiovascular disease at baseline. Dietary patterns at baseline were identified with factor analysis based on responses to a validated 81-item food frequency questionnaire. HUA was defined as serum uric acid levels >420 μmol/L in men and >350 μmol/L in women. Cox proportional hazards regression models were used to examine the association of dietary patterns with incident HUA. Results In all, 4389 first incident cases of HUA occurred during 73 822 person-years of follow-up (median follow-up of 4.2 y). Three main dietary patterns were extracted. They were the vegetable, sweet food, and animal food patterns. After adjusting for demographic characteristics, lifestyle factors, other dietary pattern scores, and inflammatory markers, comparing the highest with the lowest quartiles of dietary pattern scores, the multivariable hazard ratios (95% confidence interval) of HUA were 0.79 (0.72–0.87; Ptrend Conclusions Dietary patterns rich in animal or sweet foods were positively associated with a higher risk for HUA, whereas the vegetable pattern was negatively associated.

Background: Previous animal and clinical studies have reported beneficial effects of garlic preparations on carotid intima-media thickness (cIMT). However, no epidemiological study has yet investigated the association between dietary raw garlic consumption and cIMT in the general population. The objective of this study was investigating the association between dietary raw garlic consumption and thickened cIMT in Chinese adults.Methods: This cross-sectional study used data from the Tianjin Chronic Low-grade Systemic Inflammation and Health Cohort Study. A total of 4,329 general adults from 2015 to 2017 were included in this study. Frequency of consumption of raw garlic was summarized as four categories for analysis: < 1 time/week, 1 time/week, 2-3 times/week, ≥4 times/week with a validated food frequency questionnaire. The thickened cIMT was defined as common carotid artery IMT ≥ 1.0 mm or a carotid bifurcation IMT ≥ 1.2 mm by ultrasonography. Multivariable logistic regression analysis was used to examine the association between frequency of raw garlic consumption and thickened cIMT.Results: The prevalence of thickened cIMT is 22.9% among these participants. The adjusted odds ratios (95% confidence intervals) associated with the different frequencies were 1.00 (reference) for < 1 time/week, 0.74 (0.59, 0.94) for 1 time/week, 0.71 (0.55, 0.92) for 2–3 times/week, and 0.94 (0.71, 1.25) for ≥ 4 times/week.Conclusions: Light-to-moderate raw garlic consumption was inversely associated with thickened cIMT, whereas greater raw garlic consumption (i.e., ≥4 times/week) was not associated with thickened cIMT. Future longitudinal studies should be conducted to test these findings.

Background & AimsThe protective effect of onion against thyroid hypofunction has been reported in animal studies. However, in humans, the association between onion consumption and subclinical hypothyroidism are unclear. The study sought to explore the association between habitual onion intake and subclinical hypothyroidism among adult population from an iodine-replete area.ObjectiveWe aimed to investigate the relationship between dietary onion intake and subclinical hypothyroidism in Chinese populationMethodsA cross-sectional study (6,515 men and 5,290 women) was performed in Tianjin, China. Frequency of onion consumption was assessed using a valid self-administered food frequency questionnaire. Serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were determined by chemiluminescence immunoassay. Subclinical hypothyroidism was diagnosed with TSH >4.78 IU/mL. Multiple logistic regression was used to evaluate the association of onion intake with subclinical hypothyroidism.ResultsThe prevalence of subclinical hypothyroidism was 2.56% in men and 7.18% in women, respectively. In women, the fully adjusted odds ratios [95% confidence interval (CI)] of having subclinical hypothyroidism across increasing frequency of onion intake were 1.00 (reference) for 60 women.ConclusionsFrequent consumption of onion is inversely associated with subclinical hypothyroidism in adult women from an iodine-replete area. Further studies are needed to explore the casual relationship.

Background: Serum uric acid (SUA) is a major antioxidant molecule in the human blood. It provides a protective role in red blood cells (RBCs) and hemoglobin (Hb) by antioxidant defense. However, studies directly assessing the association between SUA and anemia are rare. This study aimed to prospectively investigate the association between SUA and incident anemia in a general adult population. Methods: A total of 23,004 participants with no history of anemia were enrolled in the cohort study. SUA levels were measured by enzymatic colorimetric test. Hb was determined by sodium lauryl sulfate methemoglobin methods and anemia was defined as fasting blood Hb below 130g/L for men and 120 g/L for women. Cox proportional hazards regression models were used to examine the association of SUA with incident anemia. Results: A total of 1,268 first incident cases of anemia occurred during 87,835 person-years of follow-up (median follow-up of 4.2 years). The fully adjusted hazards ratios (95% confidence interval) of anemia across increasing quartiles of SUA were 1.00(reference), 0.80(0.49, 1.30), 0.71(0.42, 1.22) and 0.83(0.49, 1.43) ( P for trend=0.92) in men, 1.00(reference), 0.84(0.71, 0.99), 0.82(0.69, 0.97) and 0.72(0.60, 0.86) ( P for trend=0.0003) in women, respectively. When comparing hyperuricemia to the lowest SUA level, the fully adjusted HRs (95% CIs) were 0.87 (0.49, 1.54) ( P value=0.64) in men and 0.77 (0.57, 1.03) ( P value=0.07) in women. Conclusions: Higher SUA is significantly associated with lower risk of incident anemia in women with normouricemia. This suggests that SUA may be a protective factor in the early detection of individuals at risk of anemia. Funding: This study was supported by grants from the National Natural Science Foundation of China (No. 91746205 and 81941024). Declaration of Interest: The authors declared they have no potential conflicts of interest. Ethical Approval: The study protocol complied with the Declaration of Helsinki and was approved by the institutional review board of the Tianjin Medical University.

Background and aims Emerging evidence suggests that consumption of ultra-processed foods (UPF) plays a role in the development of chronic diseases, but evidence of their influence on hyperuricemia is limited. We therefore designed a cohort study to examine whether UPF consumption increase the risk of hyperuricemia in adults. Methods and results This was a prospective study (n = 18,444) performed in Tianjin, China from 2013 to 2019. Participants that were aged 18 years and over and with no history of hyperuricemia, were followed up for 1–6 years (median follow-up duration = 4.2 years). UPF consumption was assessed by a validated semi-quantitative food frequency questionnaire. Hyperuricemia was defined as serum uric acid levels ≥7.0 mg/dL in males and ≥ 6 mg/dL in females. Multivariable Cox proportional hazards regression models were used to assess the association between UPF consumption and the risk of hyperuricemia. Restricted cubic spline regression was used to estimate the dose–response association between UPF consumption and risk of hyperuricemia. During follow-up period, the incidence of hyperuricemia was 20.3% in general population (27.7% in males and 13.2% in females). In the final multivariate models, the hazard ratios (95% confidence interval) for hyperuricemia across energy adjusted UPF consumption quartiles were 1.00 (reference), 1.04 (0.94, 1.14), 1.11 (1.01, 1.23), 1.16 (1.05, 1.28) (p for trend = 0.02) in general population. Conclusions This population-based prospective cohort study suggests that increased consumption of UPF is independently associated the risk of hyperuricemia.

Objectives: The present study aimed to develop a random forest (RF) based prediction model for hyperuricemia (HUA) and compare its performance with the conventional logistic regression (LR) model. Methods: This cross-sectional study recruited 91,690 participants (14,032 with HUA, 77,658 without HUA). We constructed a RF-based prediction model in the training sets and evaluated it in the validation sets. Performance of the RF model was compared with the LR model by receiver operating characteristic (ROC) curve analysis. Results: The sensitivity and specificity of the RF models were 0.702 and 0.650 in males, 0.767 and 0.721 in females. The positive predictive value (PPV) and negative predictive value (NPV) were 0.372 and 0.881 in males, 0.159 and 0.978 in females. AUC of the RF models was 0.739 (0.728–0.750) in males and 0.818 (0.799–0.837) in females. AUC of the LR models were 0.730 (0.718–0.741) for males and 0.815 (0.795–0.835) for females. The predictive power of RF was slightly higher than that of LR, but was not statistically significant in females (Delong tests, P=0.0015 for males, P=0.5415 for females). Conclusion: Compared with LR, the good performance in HUA status prediction and the tolerance of features associations or interactions showed great potential of RF in further application. A prospective cohort is necessary for HUA developing prediction. People with high risk factors should be encouraged to actively control to reduce the probability of developing HUA.

Background Growing evidence supports a link between ultra-processed food consumption and human health outcomes. However, the association between ultra-processed food consumption and non-alcoholic fatty liver disease (NAFLD) is not known. We aimed to explore the association between ultra-processed food consumption and risk of NAFLD. Methods The prospective study included 16 168 participants aged 18–90 years from the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) Cohort Study. Information on ultra-processed food consumption was collected at baseline using a validated food frequency questionnaire. NAFLD was defined as the presence of sonographic fatty liver in the absence of significant alcohol intake (≥210 g/week for men and ≥140 g/week for women, respectively) and other liver diseases. Multivariable Cox proportional hazards models were used to examine the association between ultra-processed food consumption and risk of NAFLD. Results During 56 935 person-years of follow-up, we documented 3752 incident NAFLD cases. After adjusting for age, sex, body mass index, smoking, alcohol drinking, education, occupation, income, physical activity, total energy intake, personal and family history of disease and overall diet quality, the multivariable hazard ratios (95% confidence interval) of NAFLD across increasing quartiles of ultra-processed food consumption were 1.00 (reference), 0.99 (0.90, 1.08), 1.13 (1.03, 1.25) and 1.18 (1.07, 1.30), respectively (P for trend Conclusions Our study indicates that higher ultra-processed food consumption is associated with a higher risk of NAFLD. This finding suggests that ultra-processed food, which is widely consumed worldwide, might be a modifiable dietary target to reduce the risk of NAFLD.

This cross-sectional study aimed to examine the associations between dietary fibre (DF) intake and depressive symptoms in a general adult population in Tianjin, China. A total of 24 306 participants (mean age 41 years; range 18–91 years) were enrolled. DF intake was assessed using a validated self-administered FFQ. Depressive symptoms were assessed using the Self-Rating Depression Scale. Associations between DF intake and depressive symptoms were estimated using logistic regression analysis. Socio-demographic, behavioural, health status and dietary factors were adjusted. In men, compared with participants in the lowest quartiles for total, soluble, vegetable and soya DF, OR for depressive symptoms in the highest were 0·83 (95 % CI 0·69, 0·99), 0·74 (95 % CI 0·63, 0·87), 0·79 (95 % CI 0·65, 0·96) and 0·69 (95 % CI 0·60, 0·81), respectively. In women, compared with participants in the lowest quartiles for vegetable and soya DF, the OR for depressive symptoms in the highest were 0·77 (95 % CI 0·64, 0·93) and 0·82 (95 % CI 0·70, 0·95), respectively. No association was found between total or soluble DF intake and depressive symptoms in women. No association was found between insoluble, cereal, fruit or tuber DF intake and depressive symptoms in men and women. Linear associations between DF intake and depressive symptoms were only detected for soya DF (men, β = –0·148, P < 0·0001; women, β = –0·069, P = 0·04). Results suggest that intake of soluble, vegetable and soya DF was inversely associated with depressive symptoms. These results should be confirmed through prospective and interventional studies.

BACKGROUND Epidemiological evidence for the association of soft drink consumption with nonalcoholic fatty liver disease (NAFLD) is inconsistent, and such association has not been prospectively examined in the general adult population. OBJECTIVES We aimed to investigate the prospective association between soft drink consumption and the risk of NAFLD in a Chinese adult population. METHODS This prospective cohort study investigated 14,845 participants [mean age: 39.3 y; 6203 (41.8%) men] who were free of liver disease, cardiovascular disease, and cancer at baseline. Soft drink consumption (mainly sugar-containing carbonated beverages) was measured at baseline using a validated FFQ. NAFLD was diagnosed based on abdominal ultrasound without significant alcohol consumption and other causes of liver disease. Hepatic steatosis index (HSI) was calculated based on sex, BMI, and blood transaminase levels. Cox proportional hazards regression models were used to examine the association of soft drink consumption with incident NAFLD. RESULTS A total of 2888 first-incident cases of NAFLD occurred during 42,048 person-years of follow-up (median follow-up: 4.2 y). After adjusting for demographic characteristics, lifestyle factors, dietary intake, and inflammatory markers, the multivariable HRs (95% CIs) for incident NAFLD were 1.00 (reference) for

Background/objectives High plain water intake (PWI) lowered body weight, reduced total energy intake, and increased fat oxidation and energy consumption. Because such factors are closely linked to metabolic disorders, which are the main risk factors for nonalcoholic fatty liver disease (NAFLD) onset, it was speculated that higher PWI was associated with a lower risk of NAFLD. However, no prior human studies have examined such relationship. Therefore, the purpose of this study was to evaluate the relationship between PWI and newly diagnosed NAFLD in a large-scale adult population. Subjects/methods A total of 16,434 participants from 2010 to 2019 in Tianjin, China, were included in this cross-sectional study. PWI was assessed by using a validated self-administered food frequency questionnaire, and it was categorized into three subgroups for analysis: ≤3 cups/day, 4-7 cups/day, and >7 cups/day. NAFLD was diagnosed by abdominal ultrasound. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the relationship between PWI and NAFLD. Results Among 16,434 participants, 20.5% (3,364) had newly diagnosed NAFLD. After controlling for demographic characteristics, lifestyle risk factors, and dietary intake, the adjusted ORs (95% CIs) for having NAFLD across PWI categories were 1.00 (reference) for ≤3 cups/day, 0.84 (0.72, 0.97) for 4-7 cups/day, and 0.77 (0.63, 0.94) for >7 cups/day in males and 1.00 (reference) for ≤3 cups/day, 1.02 (0.81, 1.27) for 4-7 cups/day, and 1.08 (0.78, 1.49) for >7 cups/day in females, respectively. Conclusions This study is the first to show that higher PWI is independently related to lower newly diagnosed NAFLD among males, but not females. Further studies are needed to explore the causal relationship.

Evidence has suggested that honey intake has a beneficial impact on glycaemic control in patients with type 2 diabetes. Whether these findings apply to adults with prediabetes is yet unclear. The aim of the present study was to examine whether honey intake is associated with a lower prevalence of prediabetes. A cross-sectional study was performed in 18 281 participants (mean age 39·6 (sd 11·1) years; men, 51·5 %). Dietary intake was assessed through a validated 100-item FFQ. Prediabetes was defined according to the American Diabetes Association criteria: impaired fasting glucose, impaired glucose tolerance or raised glycosylated Hb. Multivariable logistic regression models were used to estimate the association between honey consumption and prediabetes. As compared with those who almost never consumed honey, the multivariable OR of prediabetes were 0·94 (95 % CI 0·86, 1·02) for ≤3 times/week, 0·77 (95 % CI 0·63, 0·94) for 4–6 times/week and 0·85 (95 % CI 0·73, 0·99) for ≥1 time/d (Pfor trend < 0·01). These associations did not differ substantially in sensitivity analysis. Higher honey consumption was associated with a decreased prevalence of prediabetes. More large prospective cohort studies are needed to investigate this association.

Objectives The present study aimed to develop a random forest (RF) based prediction model for hyperuricemia (HUA) and estimate associated risk factors. Methods This cross-sectional study recruited 91,690 participants (52,607 males, 39,083 females). The prediction models were derived from training sets using RF learning machine. Performances of the prediction model were evaluated in validation datasets. Significant indicators were produced after comparing between true positive set and true negative set. Odds ratio was calculated by binary logistic regression models. Results The area under the receiver-operating curve was 0.732 in males and 0.837 in females in the RF prediction models. The sensitivity, specificity and negative predictive value of the models were 0.686, 0.656 and 0.882 in males, 0.786, 0.738 and 0.978 in females, respectively. According to the feature value of each index in RF, a total of 10 explanatory variables were selected for each gender. Triglyceride, creatinine, body mass index, waist circumference, alanine transaminase, age, weight and total cholesterol were high-risk factors for HUA in both genders. Conclusion RF demonstrated good stability and strong predictive power in predicting HUA in Chinese population. People with high risk factors should be encouraged to actively control the above factors to reduce the probability of developing HUA.

Previous studies have shown that many nutrients play an essential role in maintaining skeletal muscle strength. Hand grip strength (HGS) is frequently used as an objective and reliable method to evaluate overall body muscle strength and physical function. Some studies have demonstrated that some specific single nutrients such as PUFA, fiber, vitamin C, fruits and vegetables are associated with muscle strength. However, few studies have explored the relationship between dietary patterns and HGS in the adult population. The aim of this study was to investigate how dietary patterns are related to HGS in a large-scale Chinese population. A cross-sectional study (n = 35,175) was performed in Tianjin, China. Adherence to dietary patterns was measured by a valid self-administered food frequency questionnaire with 81 food items. Principal-components analysis was used to derive three major dietary patterns: “sweet”, “healthy” and “animal food”. HGS was measured using a handheld digital dynamometer. Analysis of covariance and multiple logistic regression were employed to explore the relationship between dietary patterns and HGS. After adjustment for potential confounders, the means (95% confidence interval) of HGS for increasing quartile of dietary patterns were as follows: “sweet”, 0.50 (0.49–0.51), 0.50 (0.49–0.51), 0.50 (0.49–0.51), 0.50 (0.48–0.51) (P value = 0.07); “healthy” 0.50 (0.49–0.51), 0.50 (0.49–0.51), 0.50 (0.49–0.51), 0.50 (0.49–0.51) (P value

Background & Aims: Seaweeds are rich sources of anti-oxidants and anti-inflammatory properties, which are beneficial to non-alcoholic fatty liver disease (NAFLD). However, whether seaweed consumption is associated with NAFLD is unknown. We investigated the association of seaweed consumption with newly diagnosed NAFLD in a large-scale adult population. Methods: This cross-sectional study involved 24,572 participants aged over 18 years. NAFLD was diagnosed by results of liver ultrasonography and alcohol intake. Dietary information was assessed using a validated and standardized 100-item food frequency questionnaire. Multivariate logistic analysis was used to evaluate the association between seaweed consumption and NAFLD. Results: The prevalence of newly diagnosed NAFLD was 20.1%. After adjustment for sociodemographic characteristics, lifestyle factors, and other dietary intakes, the multivariable adjusted odds ratios (95% confidence intervals) of newly diagnosed NAFLD across seaweed consumption were 1.00 (reference) for almost never, 1.03 (0.93, 1.15) for

Background Early-life hormonal and nutritional factors can greatly influence the risk of non-alcoholic fatty liver disease (NAFLD). Adult height is a simple marker for these factors. This study aimed to investigate the association between adult height and NAFLD. Methods We performed a prospective cohort study of 35,994 participants aged 25 years or over with measured height at baseline. NAFLD was diagnosed by abdominal ultrasound and self-reported history of alcohol intake. Multivariable Cox proportional hazards regression models were conducted to assess the gender-specific association between height and the risk of NAFLD. Results During a follow-up period of 5.5 years, 6245 of 35,994 subjects developed NAFLD. The adjusted hazard ratios (95% confidence interval) of NAFLD for increasing quintiles of height were 1.00 (reference), 0.82 (0.73, 0.92), 0.84 (0.73, 0.97), 0.72 (0.61, 0.85) and 0.63 (0.50, 0.79) (P for trend P for trend Conclusions A higher adult height was associated with lower risk of NAFLD among males and females in Tianjin, China.

BackgroundThe health benefits of dietary fibre (DF) intake on non-alcoholic fatty liver disease (NAFLD) are controversial. Thus, this large cross-sectional study aimed to determine the associations between DF intake and the prevalence of newly-diagnosed NAFLD in a large general population.MethodsA total of 23,529 participants were enrolled in the analyses. Newly-diagnosed NAFLD was diagnosed according to liver ultrasonography and history of alcohol intake.DF intake was assessed using a validated self-administered food frequency questionnaire. Logistic regression analysis was applied to estimate the associations between DF intake and NAFLD.ResultsIn total, 18.81% (n = 4426) of the participants were newly diagnosed with NAFLD. Compared with the participants in the lowest quartile of DF intake, the ORs (95% CI) for the participants in the highest quartile were 0.81 (0.67, 0.97), 0.78 (0.62, 0.99), and 0.85 (0.62, 1.17) for all participants, men, and women, respectively. Compared with the participants in the lowest quartile of insoluble DF intake, the ORs (95% CI) for the participants in the highest quartile were 0.70 (0.58, 0.85), 0.60 (0.47, 0.76), and 0.95 (0.68, 1.32) in all participants, men, and women, respectively. No association was observed between soluble DF intake and NAFLD. DF from whole grain, soy foods, vegetables, and nuts but not fruits were negatively associated with NAFLD.ConclusionsA higher intake of insoluble DF is associated with lower prevalence of newly-diagnosed NAFLD in men. Moreover, intake DF from whole grain, soy foods, vegetables, and nuts, but not fruits have favorable effect on the prevalence of newly diagnosed NAFLD. Further cohort studies and randomized controlled trials are needed to validate this finding.

Fast eating speed is a risk factor for obesity, which is also closely related to nonalcoholic fatty liver disease (NAFLD), suggesting that fast eating speed may contribute to the development of NAFLD. But the extent to which obesity may mediate the association between eating speed and NAFLD is uncertain. We hypothesized that obesity plays a mediating role in the association between eating speed and prevalence of NAFLD in the general population. A cross-sectional study (n = 23,611) was conducted in a general population sample from Tianjin, China. We measured anthropometrics and biochemical variables. The self-reported eating speed per meal was recorded and classified into 4 categories: slow, medium, relatively fast, and very fast. NAFLD was diagnosed by liver ultrasonography. Multiple logistic regression analysis was used to assess the associations between the eating speed and the prevalence of NAFLD, as well as the mediation effects of obesity on the association between eating speed and NAFLD. The prevalence of newly diagnosed NAFLD was 19.0%. After adjusting for potentially confounding factors, the odds ratios (95% confidence interval) of NAFLD across categories of eating speed were 1.00 (reference), 1.39 (1.18-1.64), 1.71 (1.45-2.01), and 2.04 (1.70-2.46). All these significant odds ratios were attenuated to be nonsignificant by adjustment for body mass index and/or waist circumference. This is the first study to demonstrate that eating speed is not independently associated with increased risk of NAFLD.