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Background: Delirium is a common acute mental disorder, and its adverse outcomes often cause distress to both patients and their families. Despite its prevalence in patients treated in emergency departments, delirium is frequently overlooked. Aim: This study aims to systematically evaluated and meta‐analysis the prevalence of delirium among emergency patients, providing insights into its prevalence and offering guidance for its management and prevention. Study Design: Observational studies on the prevalence of delirium in emergency departments were systematically searched in PubMed, Embase, the Cochrane Library and Medline databases. Relevant English‐language studies published up to 18 September 2023 were reviewed, and meta‐analysis was conducted using Stata 14.0 software. Quality assessment of included literature was performed using the methodological index for non‐randomized studies (MINORS), and publication bias was assessed using Egger's test. Results: Thirteen studies encompassing a total sample size of 33 839 cases were included, with 3082 cases of delirium incidents. The findings revealed a 15% prevalence rate of delirium in emergency departments, with a 95% confidence interval (CI) of (0.10, 0.20) and an overall heterogeneity of 98.37% (p =.000). Among emergency department patients over 65 years of age, the prevalence of delirium was 12%, with a 95% CI of (0.07, 0.19) and a heterogeneity of 94.59%. For patients over 18 years of age, the prevalence was 17%, with a 95% CI of (0.10, 0.25) and a heterogeneity of 98.94%. Conclusions: This meta‐analysis reveals an overall 15% prevalence rate of delirium among patients in emergency departments. Relevance to Clinical Practice: In clinical practice, emergency medical staff should strengthen the screening and management of emergency delirium patients. [ABSTRACT FROM AUTHOR]

Background: Approximately 16%–89% of patients developed delirium during hospitalization in the intensive care unit (ICU). Studies on the accuracy and clinical application of ICU delirium screening tools exist, but the results are inconsistent. Moreover, the accuracy of different screening tools varied greatly. Aim: To compare the diagnostic accuracy of Confusion Assessment Method‐Intensive Care Unit (CAM‐ICU) and Intensive Care Delirium Screening Checklist (ICDSC) for delirium screening in critically ill patients in the ICU. Study Design: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Medline, and SciELO databases for relevant studies by combining relevant medical subject headings (MeSH) and keywords. Each database was searched from its creation to 30 January 2024. The included literature was screened by title, abstract, and full text. The diagnostic studies were summarized using Stata 14.0 software. SEN, SPE, PLR, NLR, DOR, and 95% confidence interval (CI) of the diagnostic studies were combined, the SROC analysis was performed, and the area under curve was estimated. Results: Thirty‐two articles from the database met the inclusion criteria. The number of studies on CAM‐ICU and ICDSC was 28 and 14, respectively. For CAM‐ICU, the pooled sensitivity and specificity were 0.81 (95% CI: 0.81–0.81) and 0.94 (95% CI: 0.94–0.94), and the hierarchical SROC curve was 0.96 (95% CI: 0.93–0.97). Regarding the ICDSC, The pooled sensitivity and specificity were 0.79 (95% CI: 0.68–0.86) and 0.90 (95% CI: 0.84–0.93), and the hierarchical SROC curve was 0.92 (95% CI: 0.89–0.94). Regarding the likelihood ratio, the CAM‐ICU has a high PLR of 14.24 (95% CI: 14.24–14.24) and a low NLR of 0.20 (95% CI: 0.20–0.20). The ICDSC has a low PLR of 7.64 (95% CI: 5.37–10.87) and a high NLR of 0.24 (95% CI: 0.16–0.35). Conclusions: CAM‐ICU showed good performance in terms of screening and diagnostic efficacies for delirium in critically ill patients. In view of the diagnostic accuracy of these two tools in delirium assessment, the strategies on how to increase their implementation in delirium screening among ICU patients are the focus of future research. Relevance for Clinical Practice: CAM‐ICU is recommended as the first choice to evaluate delirium in clinical practice, followed by ICDSC. Future studies can explore the predictive value of CAM‐ICU and ICDSC in different special populations and different types of delirium. [ABSTRACT FROM AUTHOR]

Background: In recent years, some studies classified patients with sepsis and predicted their mortality by using some evaluation scales. Several studies reported significant differences in the predictive values of several tools, and the non‐uniformity of the cut‐off value. Aim: To determine and compare the prognostic accuracy of Sequential Organ Failure Assessment (SOFA) score, Modified Early Warning Score (MEWS), and Systemic Inflammatory Response Syndrome (SIRS) criteria in predicting the mortality of patients with sepsis. Methods: This study comprised of systematic literature review and meta‐analysis according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. We searched PubMed, Embase, Web of Science and Cochrane Library databases from their establishment to July 31, 2022. The research articles published in the index journals provide sufficient data (true positive, false positive, true negative, and false negative results) for patients with sepsis. The combined sensitivity and specificity of the 95% confidence interval (CI) were calculated using the bivariate random effect model (BRM). The hierarchical overall subject working characteristics (HSROC) curve was drawn to evaluate the accuracy of the overall prognosis. Results: Data of 55 088 patients from 32 studies were included in this meta‐analysis. SOFA had an intermediate sensitivity of 0.73 (95% CI: 0.67–0.78) and a specificity of 0.70 (0.63–0.76). SIRS criteria had the highest sensitivity of 0.75 (0.66–0.82) and the lowest specificity of 0.40 (0.29–0.52). MEWS had the lowest sensitivity of 0.49 (0.40–0.59) and the highest specificity of 0.82 (0.78–0.86). Conclusions: Among SOFA, MEWS, and SIRS criteria, SOFA showed moderate sensitivity and specificity for predicting mortality in patients with sepsis, the highest sensitivity of SIRS and the strongest specificity of MEWS for predicting mortality in patients with sepsis. The future research direction is to combine the relevant indicators of MEWS and SIRS to develop a measurement tool with high reliability and validity. Relevance to clinical practice: The review provides useful insights into the prognostic accuracy of different assessment tools in predicting mortality in sepsis patients, which will help clinicians choose the most appropriate tool for early identification and treatment of sepsis. The findings may also contribute to the development of more accurate and reliable prognostic models for sepsis. [ABSTRACT FROM AUTHOR]

Background: To date, studies on the effects of preeclampsia on perinatal outcomes in women with gestational diabetes mellitus (GDM) are comparatively few, and the results are inconsistent. Objective: This study aimed to explore the effects of preeclampsia on perinatal outcomes in women with GDM. Methods: This retrospective cohort study collected data of women with GDM whose babies were delivered in a Chinese hospital between July 2017 and June 2020. We divided eligible pregnant women with GDM into two groups based on whether they were diagnosed with preeclampsia: GDM with preeclampsia group and GDM without preeclampsia group. Logistic regression analysis was performed to evaluate the risks for perinatal outcomes which were used as the dependent variables. Results: We identified 7533 eligible women with GDM (245 in GDM with preeclampsia group and 7288 in GDM without preeclampsia group). After adjusting for covariates, preeclampsia was significantly associated with higher risks of fetal malformations (OR: 1.67, 95% CI: 1.08–2.57), fetal growth restriction (OR: 5.36, 95% CI: 2.91–9.88), cesarean section (OR: 2.48, 95% CI: 1.83–3.37), emergency cesarean section (OR: 2.32, 95% CI: 1.77–3.05), preterm birth (OR: 1.89, 95% CI: 1.27–2.81), low birth weight (LBW) (OR: 3.30, 95% CI: 2.16–5.05), small for gestational age (SGA) (OR: 3.05, 95% CI: 2.01–4.63) and neonatal hypoglycemia (OR: 1.77, 95% CI: 1.10–2.85). Conclusion: Women with GDM complicated with preeclampsia were at higher risks of fetal malformations, fetal growth restriction, cesarean section, emergency cesarean section, preterm birth, LBW, SGA and neonatal hypoglycemia. [ABSTRACT FROM AUTHOR]

Background: Cancer screening is a pivotal method for reducing mortality from disease, but the screening coverage is still lower than expected. Telehealth interventions demonstrated significant benefits in cancer care, yet there is currently no consensus on their impact on facilitating cancer screening or on the most effective remote technology. Design: A network meta‐analysis was conducted to detect the impact of telehealth interventions on cancer screening and to identify the most effective teletechnologies. Methods: Six English databases were searched from inception until July 2023 to yield relevant randomized controlled trials (RCTs). Two individual authors completed the literature selection, data extraction, and methodological evaluations using the Cochrane Risk of Bias tool. Traditional pairwise analysis and network meta‐analysis were performed to identify the overall effects and compare different teletechnologies. Results: Thirty‐four eligible RCTs involving 131,644 participants were enrolled. Overall, telehealth interventions showed statistically significant effects on the improvement of cancer screening. Subgroup analyses revealed that telehealth interventions were most effective for breast and cervical cancer screening, and rural populations also experienced benefits, but there was no improvement in screening for older adults. The network meta‐analysis indicated that mobile applications, video plus telephone, and text message plus telephone were associated with more obvious improvements in screening than other teletechnologies. Conclusion: Our study identified that telehealth interventions were effective for the completion of cancer screening and clarified the exact impact of telehealth on different cancer types, ages, and rural populations. Mobile applications, video plus telephone, and text message plus telephone are the three forms of teletechnologies most likely to improve cancer screening. More well‐designed RCTs involving direct comparisons of different teletechnologies are needed in the future. Clinical Relevance: Telehealth interventions should be encouraged to facilitate cancer screening, and the selection of the optimal teletechnology based on the characteristics of the population is also necessary. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to assess the applicability of the National Academy of Medicine (NAM) interim guidelines for twin pregnancies to the specific population of gestational diabetes mellitus by exploring the relationship between gestational weight gain and adverse pregnancy outcomes in Chinese twin-pregnant women with gestational diabetes mellitus. Study Design This was a retrospective cohort study of women diagnosed with diabetes in pregnancy between July 2017 and December 2020 at the Maternal and Child Health Hospital in Chongqing, China. The primary variable of interest was maternal total gestational weight gain. The primary outcomes were perinatal outcomes, which included: preeclampsia, small for gestational age, large for gestational age, low birth weight, neonatal pneumonia, neonatal respiratory distress syndrome, and neonatal intensive unit admission, etc. The association between inappropriate gestational weight gain and adverse pregnancy outcomes was estimated using multiple logistic regression analysis. Results A total of 455 twin-pregnant women who had gestational diabetes mellitus were analyzed. Women with low gestational weight gain had reduced risk of preeclampsia (adjusted odds ratio [aOR], 0.32; 95% CI or confidence interval, 0.17–0.63; p = 0.001) and their infants had higher risks of small for gestational age (aOR, 1.93; 95% CI, 1.04–3.58; p = 0.037), low birth weight (aOR, 2.27; 95% CI, 1.32–3.90; p = 0.003), neonatal intensive unit admission (aOR, 3.29; 95% CI, 1.10–5.78; p = 0.038), pneumonia (aOR, 2.41; 95% CI, 1.08–5.33; p = 0.031), and neonatal respiratory distress syndrome (aOR, 2.29; 95% CI, 1.10–4.78; p = 0.027); the infants of women with excessive gestational weight gain had a higher risk of large for gestational age (aOR, 3.76; 95% CI, 1.42–9.96; p = 0.008). Conclusion Gestational weight gain controlled within the range recommended by the NAM could reduce the risk of perinatal adverse outcomes. The 2009 NAM gestational weight gain recommendations can be used for Chinese twin-pregnant women with gestational diabetes mellitus. Key Points Inappropriate gestational weight gain can lead to adverse perinatal outcomes in twin pregnancies. Gestational weight gain controlled within recommended range could reduce the risk of poor perinatal outcomes. The National Academy of Medicine recommendations are suitable for Chinese twin-pregnant women with GDM. [ABSTRACT FROM AUTHOR]

Background: The incidence of comorbidity between type 2 diabetes mellitus (T2DM) and metabolic-associated fatty liver disease (MAFLD) is high, and patients tend to be younger. When people develop metabolic diseases such as T2DM and MAFLD, the original homeostasis of the gut microbiota in the body is disrupted, and gut flora drift occurs. This study investigated the relationship between the number of gut flora and MAFLD in young-onset T2DM. Methods: This retrospective study analyzed 44 adolescent T2DM patients who were divided into a non-MAFLD group and a MAFLD group. Anthropometric measurements, clinical and biochemical markers, inflammatory markers, thyroid function assessments, and stool specimens were collected. Real-time PCR was performed to quantify several important gut flora constituents at the genus level. Student's t-test and the chi-square test were applied for group comparisons, and binary regression models were used to explore the relationship between gut flora and MAFLD in young-onset T2DM. Results: Among the 44 subjects, 26 (59.1%) were diagnosed with MAFLD, and 18 (40.9%) were not. Compared with the non-MAFLD group, body mass index (BMI), abdominal circumference, and levels of blood uric acid and thyroid stimulating hormone (TSH) in the MAFLD group were significantly increased, and age level and high-density lipoprotein cholesterol (HDL-C) were significantly decreased (p < 0.05). Compared with the non-MAFLD group, the abundance of Faecalibacterium prausnitzii and Bifidobacterium in the MAFLD group was significantly reduced, and the abundance of Enterococcus and Lactobacillus was significantly increased (p < 0.05). In the multivariate regression analysis, Faecalibacterium prausnitzii and Bifidobacterium were independent protective factors for MAFLD in young-onset T2DM, after excluding confounding factors. Conclusion: In young-onset T2DM, there was a difference in gut flora between patients with MAFLD and those without MAFLD. Faecalibacterium prausnitzii and Bifidobacterium were independent protective factors for MAFLD in young-onset T2DM. [ABSTRACT FROM AUTHOR]

This systematic review aimed to identify the prevalence of anxiety and depression in cardiac arrest (CA) survivors. A systematic review and network meta-analysis was performed on observational studies in adult cardiac arrest survivors with psychiatric disorders from PubMed, Embase, Cochrane Library and Web of Science. In the meta-analysis, we combined the prevalence quantitatively and analyzed the subgroup based on the classification indexes. We identified 32 articles that met the inclusion criteria. Regarding anxiety,the pooled prevalence was 24% (95% CI, 17–31%) and 22% (95% CI, 13–26%) in short-term and long-term respectively. The subgroup analysis showed that the pooled incidence in in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrests (OHCA) survivors was 14.0% (95%CI, 9.0–20.0%) and 28.0% (95%CI, 20.0–36.0%) for short-term anxiety.The incidence of anxiety measured by, Hamilton Anxiety Rating Scale(HAM-A) and State-Trait Anxiety Inventory(STAI) was higher than other tools(P < 0.01). Regarding depression,the data analysis showed that the pooled incidence of short-term and long-term depression was 19% (95% CI, 13–26%) and 19% (95% CI, 16–25%), respectively. The subgroup analysis showed that the incidence of short-term and long-term depression was 8% (95% CI, 1–19%) and 30% (95% CI, 5–64%) for IHCA survivors, and was 18% (95% CI, 11–26%) and 17% (95% CI, 11–25%) for OHCA survivors. The incidence of depression measured by Hamilton Depression Rating Scale(HDRS) and Symptom check list-90(SCL-90) was higher than other assessment tools(P < 0.01). The meta-analysis indicated a high prevalence of anxiety and depression in CA survivors, and those symptoms persisted 1 year or more after CA. Evaluation tool is an important factor affecting the measurement results. [ABSTRACT FROM AUTHOR]

Purpose: In this study, exercise interventions were evaluated for their effects on cancer-related fatigue (CRF) and quality of life (QoL) among cancer patients. Design: A meta-analysis was performed. Methods: We systematically searched the PubMed/Medline, Web of Science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, and CINAHL databases, and gray literature sources including the Virginia Henderson International Nursing Library and Google Scholar. This study only included randomized controlled trials (RCTs) examining how exercise interventions affect CRF and QoL among cancer patients. Based on the Cochrane Risk-of-Bias Assessment Tool, version 2 (RoB 2) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the methodological quality of the included studies was evaluated. In addition, standardized mean differences (SMDs) and 95% confidence intervals (CIs) were applied to assess the intervention effect with respect to CRF and QoL. Data analysis was performed using Review Manager (version 5.4). Results: There were a total of 1573 participants in the 28 included articles. According to the meta-analysis, CRF (SMD = -0.35, 95% CI: -0.63 to -0.07, p = 0.01) and QoL (SMD = 0.36, 95% CI: 0.20 to 0.53, p < 0.01) were positively affected by exercise interventions. Subgroup analyses revealed considerable improvements in CRF (SMD = -0.54, 95% CI: -1.00 to -0.09, p = 0.02) and QoL (SMD = 0.38, 95% CI: 0.16 to 0.59, p < 0.01) from aerobic exercise. An intervention duration less than 12 weeks had a better effect on CRF (SMD = -0.80, 95% CI: -1.43 to -0.17, p = 0.01) and QoL (SMD = 0.53, 95% CI: 0.21 to 0.85, p < 0.01), and three times per week was the most effective frequency in improving QoL (SMD = 0.69, 95% CI: 0.28 to 1.11, p < 0.01). Exercise intervention was more successful in improving CRF (SMD = -0.66, 95% CI: -1.10 to -0.21, p < 0.01) and QoL (SMD=-0.50, 95% CI: 0.23 to 0.78, p < 0.01) in female cancer patients. Sensitivity analyses showed that the pooled outcomes were reliable and stable. Conclusion: Exercise interventions are a workable approach to improve CRF and QoL among cancer patients. An aerobic exercise intervention of less than 12 weeks might be most effective in improving CRF and QoL, and three times per week might be the most appropriate frequency. Exercise might have a more positive effect on improving CRF and QoL in female cancer patients. Additionally, a larger number of high-quality RCTs should be conducted to further confirm the efficacy of exercise interventions on CRF and QoL among cancer patients. Registration number: CRD42022351137. [ABSTRACT FROM AUTHOR]

Background: The intensive care unit has a much higher pressure ulcers incidence than general wards. Predicting and eliminating the risk of pressure ulcer development is thus of utmost importance in health care, including clinical nursing practice. Aim: The meta‐analysis aimed to examine the predictive validity of the Jackson–Cubbin Scale. Methods: This study is a systematic literature review and meta‐analysis. Research articles published in periodicals indexed targeted the critical care patients and offered sufficient data(true‐positive, false‐positive, true‐negative and false‐negative results) in the EBSCO, PubMed, Ovid, Web of Science and Cochrane databases, as well as those from two journals indexed in a Chinese database (Wangfang Data and China National Knowledge Infrastructure) were reviewed. Preferred reporting items for systematic reviews and meta‐analyses were used; the internal validity of the diagnostic studies was analysed using Quality Assessment of Diagnostic Accuracy Studies 2. Sensitivity, specificity, positive and negative likelihood ratios were counted by STATA 15.0. Results: Nine diagnostic studies with high methodological quality, involving a total of 7684 patients, were retrieved and assessed. This meta‐analysis showed that the pooled sensitivity, specificity and area under the symmetric summary receiver operating characteristic curve of the Jackson–Cubbin Scale were 0.81 (95% confidence interval [CI], 0.58–0.88), 0.76 (95% CI, 0.51–0.95) and 0.84 (95% CI, 0.81–0.87), respectively. Conclusions: The study suggests that the Jackson–Cubbin Scale has a moderate level of predictive validity. Moreover, Jackson–Cubbin's predictive validity could be increased if it was implemented differently based on the attributes of the research participants. Relevance to Clinical Practice: The Jackson–Cubbin Scale has a moderate level of predictive validity with good sensitivity and specificity for the determination of the risk of PUs in adult ICU patients. Bedside nurses could use the Jackson–Cubbin scale for dailly assesment for ICU patients. [ABSTRACT FROM AUTHOR]

As an increasing number of people with disabilities become pregnant and give birth, understanding their vulnerabilities for poor mental health and life stress can help to improve their health and well-being. We examined whether people with disabilities are more likely to experience stressful life events 12 months before childbirth, postpartum depressive symptoms (PDS), and lack of postpartum partner and social support, and compared these associations by race/ethnicity. Using the Massachusetts Pregnancy Risk Assessment Monitoring System 2016–2020 data (n = 6,483), we used univariate and multivariable logistic regression models to estimate the associations of disability with stressful life events, PDS, and postpartum partner and social support, and calculated risk ratio (RR), adjusted RR, and 95% confidence interval (CI). We also conducted stratified analyses by race/ethnicity. The prevalence of disability was 10.7% overall, and 8.8% among White non-Hispanic people, 14.3% among Black non-Hispanic people, 15.5% among Hispanic people, and 8.3% among Asian non-Hispanic people. Compared with people without disabilities, those with disabilities were more likely to report emotional stress (RR, 1.54; 95% CI, 1.36–1.74), partner-related stress (RR, 2.55; 95% CI, 2.23–2.91), financial stress (RR, 1.55; 95% CI, 1.44–1.68), traumatic stress (RR, 2.27; 95% CI, 1.85–2.79), and PDS (RR, 3.77; 95% CI, 3.13–4.53). People with disabilities were also more likely to lack a partner's emotional support (RR, 2.57; 95% CI, 2.21–2.97), financial support from the newborn's father (RR, 2.89; 95% CI, 2.39–3.51), and social support while feeling tired or frustrated (RR, 2.05; 95% CI, 1.68–2.52). These associations remained statistically significant after adjustment for maternal factors and newborn's birth year. Strong associations of disability with stressful life events (including emotional stress and partner-related stress), PDS, lacking partner's emotional support, and social support existed across racial/ethnic groups. Pregnant people with disabilities may benefit from additional screening for stressful life events and depression during pregnancy and postpartum. Multidisciplinary efforts that combine mental health screening and treatment, peer support groups, increased health care provider training about caring for people with disabilities during pregnancy, and better access to care for pregnant people with disabilities are needed to improve their health and support their desire to become parents. [ABSTRACT FROM AUTHOR]

Aim: To examine the optimal gestational weight gain (GWG) for Chinese pregnant women with gestational diabetes mellitus (GDM) based on the Chinese‐specific body mass index (BMI) classification. Methods: A retrospective cohort study was conducted using the 2017–2020 data from pregnant women with GDM in a tertiary hospital. A quadratic function model and the total predicted probability of adverse pregnancy outcomes were developed to obtain the optimal GWG. Differences in the incidence of adverse pregnancy outcomes between our optimal GWG recommendations and the Institute of Medicine (IOM) 2009 GWG guidelines were also analyzed. Results: A total of 8103 pregnant women with GDM were analyzed. Based on the Chinese‐specific BMI classification, the optimal GWG range was 11.0–17.5 kg for underweight women, 3.7–9.7 kg for normal‐weight women, −0.6 to 4.8 kg for overweight women, and − 9.8 to 4.2 kg for obese women. Excessive GWG had a higher risk of large for gestational age (LGA) (OR: 2.99, 95% CI: 2.42–3.70), macrosomia (OR: 2.35, 95% CI: 1.77–3.12), pre‐eclampsia (OR: 1.91, 95% CI: 1.37–2.65), gestational hypertension (OR: 1.65, 95% CI: 1.24–2.19), cesarean section (OR: 1.29, 95% CI: 1.15–1.44), postpartum hemorrhage (OR: 1.29, 95% CI: 1.02–1.64); insufficient GWG had a higher risk of small for gestational age (OR: 1.82, 95% CI: 1.20–2.75). Compared to the IOM 2009 GWG guidelines, the prevalence of macrosomia, LGA, and postpartum hemorrhage were significantly lower in pregnant women following the implementation of our recommended GWG range (p < 0.05). Conclusions: Compared to the IOM 2009 GWG recommendations, our optimal GWG recommendations for Chinese pregnant women were more sensitive. [ABSTRACT FROM AUTHOR]

Background: The Nutritional Risk Screening 2002 (NRS-2002) scale is a rapid and effective screening instrument that assesses nutritional risk among hospitalized patients. Objective: The present study aimed to explore the prognostic value of the NRS-2002 scale in acute myocardial infarction (AMI) considering its uncertain role in this particular condition. Methods : Patients with AMI included in the Retrospective Multicenter Study for Early Evaluation of Acute Chest Pain were investigated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to analyze the association between NRS-2002 and mortality in patients with AMI. The primary and secondary endpoints were all-cause and cardiac mortality during the follow-up period. Results : A total of 2307 patients were enrolled, among whom 246 (10.7%) died within a median follow-up duration of 10.67 (8.04-14.33) months. Kaplan-Meier analysis revealed that patients with an NRS-2002 score of 3 or higher had poorer cumulative survival than those with an NRS-2002 score lower than 3 (P <.001). In the multivariate Cox regression analysis, patients with an NRS-2002 score of 3 or higher had more than double the risk for all-cause mortality (hazard ratio, 2.25; 95% confidence interval, 1.50-3.40; P <.001) and twice the risk for cardiac-related mortality (hazard ratio, 2.01; 95% confidence interval, 1.29-3.13; P =.002) than did patients with lower scores. Conclusions : Our results showed that the NRS-2002 screening instrument was an independent prognostic predictor for both all-cause and cardiac mortality in patients with AMI. Nutritional risk assessment based on the NRS-2002 scale may provide useful prognostic information of early nutritional risk stratification in patients with AMI. [ABSTRACT FROM AUTHOR]

Background The efficacy and factors associated with patient outcomes for a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (LFD) compared with traditional dietary advice (TDA) based on modified National Institute for Clinical Excellence guidelines for irritable bowel syndrome with diarrhea (IBS-D) in regions consuming a non-Western diet are unclear. Objectives We aimed to determine the efficacy of an LFD compared with TDA for the treatment of IBS-D in Chinese patients and to investigate the factors associated with favorable outcomes. Methods One hundred and eight Chinese IBS-D patients (Rome III criteria) were randomly assigned to an LFD or TDA. The primary endpoint was a ≥50-point reduction in the IBS Severity Scoring System at 3 wk. Fecal samples collected before and after the dietary intervention were assessed for changes in SCFAs and microbiota profiles. A logistic regression model was used to identify predictors of outcomes. Results Among the 100 patients who completed the study, the primary endpoint was met in a similar number of LFD (30 of 51, 59%) and TDA (26 of 49, 53%) patients (∆6%; 95% CI: −13%, 24%). Patients in the LFD group achieved earlier symptomatic improvement in stool frequency and excessive wind than those following TDA. LFD reduced carbohydrate-fermenting bacteria such as Bifidobacterium and Bacteroides , and decreased saccharolytic fermentation activity. This was associated with symptomatic improvement in the responders. High saccharolytic fermentation activity at baseline was associated with a higher symptom burden (P  = 0.01) and a favorable therapeutic response to the LFD (log OR: 4.9; 95% CI: −0.1, 9.9; P  = 0.05). Conclusions An LFD and TDA each reduced symptoms in Chinese IBS-D patients; however, the LFD achieved earlier symptomatic improvements in stool frequency and excessive wind. The therapeutic effect of the LFD was associated with changes in the fecal microbiota and the fecal fermentation index. At baseline, the presence of severe symptoms and microbial metabolic dysbiosis characterized by high saccharolytic capability predicted favorable outcomes to LFD intervention. This trial was registered at clinicaltrials.gov as NCT03304041. [ABSTRACT FROM AUTHOR]

Context Modifiable factors that reduce the burden of the metabolic syndrome (MetS), particularly plant-derived biomarkers, have been a recent focus of rising interest. Objective This systematic review and meta-analysis, which follows PRISMA guidelines, evaluates evidence from a period of 20 years that links vitamin A and carotenoids with the occurrence of MetS and following the PRISMA guidelines. Data Sources PubMed and Cochrane databases (January 1997 through March 2017) were systematically assessed for studies, including case–control, cross-sectional, and cohort studies, that evaluated the associations of MetS with carotenoids and retinyl esters and retinol (vitamin A). Data Extraction Key measures of associations were harmonized into odds ratios (ORs) and 95% confidence intervals (95%CI) of MetS per 1 standard deviation (SD) of exposure using forest plots and random effects models that pooled data points from 11 cross-sectional studies. Begg's funnel and harvest plots were constructed. Results An inverse association between total carotenoids and MetS was found [ORpooled, 0.66; 95%CI, 0.56–0.78; 1 SD ∼ 0.82 µmol/L; n = 5 studies]. This association was the strongest for β-carotene, followed by α-carotene and β-crypotoxanthin. No association was detected between retinol and MetS (ORpooled, 1.00; 95%CI, 0.88–1.13; 1 SD ∼ 2.14 µmol/L; n = 6 studies). Publication bias was absent, and harvest plots indicated consistency upon replication for β-carotene and total carotenoid exposures. Conclusions This review and meta-analysis suggests that, unlike retinol, total and individual carotenoids were inversely related to MetS. [ABSTRACT FROM AUTHOR]

Aim: The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio is well known to be related to metabolic syndrome (MS) and its components in adults of different races. There is low prevalence of MS but high occurrence of various metabolic disorders in Chinese adolescent women with polycystic ovary syndrome (PCOS). We sought to assess if the ApoB/ApoA1 ratio can be used as a predictive marker of MS and pre-MS in Chinese adolescent women with PCOS. Material and Methods: This cross-sectional study included 160 Chinese adolescent women. Based on International Diabetes Federation criteria for MS, patients who had no less than two components of MS but did not meet the criteria for the diagnosis of MS were considered as having pre-MS. Results: The ApoB/ApoA1 ratio was higher in obese subjects with high free androgen index (FAI). The ApoB/ApoA1 ratio increased significantly as the number of MS components increased and provided 87.5% of sensitivity and 78.9% of specificity with a threshold value of 0.63 for MS, 86.2% of sensitivity and 79.4% of specificity with a threshold value of 0.58 for pre-MS in Chinese adolescent women with PCOS. Conclusion: The ApoB/ApoA1 ratio was a good predictive marker of MS and pre-MS in Chinese adolescent women with PCOS. FAI could be involved in obesity-related metabolic abnormalities. [ABSTRACT FROM AUTHOR]

Abstract: Large disparities exist in obesity and other chronic diseases across racial/ethnic and socioeconomic status (SES) groups in the United States. This study examined how much of racial/ethnic differences in diet, exercise, and weight status could be explained by nutrition- and health-related psychosocial factors (NHRPF) and SES among US adults. Nationally representative data of 4,356 US adults from the 1994-1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. NHRPF were assessed using 24 questions and related index scores. Dietary intakes were assessed using two nonconsecutive 24-hour dietary recalls. The US Department of Agriculture 2005 Healthy Eating Index was applied to evaluate diet quality. Body mass index was calculated based on self-reported weight and height. SES was assessed using education and household income. Americans with higher SES had better NHRPF and Healthy Eating Index scores. There were some small racial/ethnic differences in NHRPF, including making food choices and awareness of nutrition-related health risks. Multivariable linear and logistic regression models revealed some racial/ethnic differences in diet, exercise, and body mass index, but few of these disparities was explained by NHRPF, whereas SES explained some. The odds ratio of body mass index ≥25 for non-Hispanic blacks compared with whites decreased by 38% after SES was adjusted for. For exercise, we found a smaller change (9.5%) in the racial/ethnic differences when controlling for SES. In conclusion, NHRPF may explain very few, but SES may contribute some of the racial/ethnic disparities in diet, exercise, and weight status in the United States. [Copyright &y& Elsevier]

Abstract: Background: Large disparities exist across ethnic and socioeconomic status groups regarding obesity and other chronic diseases. Eliminating health disparities is a national priority in the United States. Objective: To test between-group differences in nutrition- and health-related psychosocial factors (NHRPF) and their associations with US adults'' diet, exercise, and weight status. Design and participants/setting: Nationally representative data from the Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey 1994-96 from 4,356 US adults aged 20 to 65 years were used. Diet was assessed using 24-hour recalls, NHRPF was assessed by 25 questions, and weight status was determined by self-reported weight and height. Index scores were created to measure NHRPF. Diet quality was assessed using the US Department of Agriculture 2005 Healthy Eating Index (HEI). Statistical analyses: Multivariate linear and logistic regression models were conducted to examine the associations. Results: Some ethnic differences in NHRPF existed but were small. There were statistically significant (P<0.05) and large ethnic differences in diet (blacks had the worst average HEI and whites the best at 47.6 vs 52.3, respectively). Groups with higher socioeconomic status had better NHRPF (ie, had better nutrition knowledge and beliefs, made better food choices, and had better awareness of nutrition-related health risks) and HEI score. Subjects with high school education had higher NHRPF score (37.2 vs 35.7) and HEI score (54.5 vs 49.5) than those with less than a high school education. Conclusions: Ethnic differences among American adults'' NHRPF were small, but socioeconomic status differences were greater. More efforts are needed to study the influences of the complex interactions between individual and social environmental factors that affect Americans'' diet and weight status and to explain related ethnic disparities. [Copyright &y& Elsevier]