Incidence, prevalence, and burden of type 2 diabetes in China: Trend and projection from 1990 to 2050

BACKGROUND

Type 2 diabetes is common in China without comprehensive summary and future anticipation of its incidence, prevalence, associated death, and disability. This analysis described the epidemiological transition of type 2 diabetes in the past three decades and projected the trend in the future three decades in China.

METHODS

Age-, sex-, and year-specific incidence, prevalence, death, and disability-adjusted life years (DALYs) for people with 15 years or older and diabetes or high fasting glucose in China and related countries from 1990 to 2021 were obtained from the Global Burden of Disease. We obtained the trends of age-, sex-, and year-specific rates and absolute numbers of incidence, prevalence, deaths, and DALYs attributable to type 2 diabetes in China from 1990 to 2021. Using the Lee-Carter model, we projected the incidence, prevalence, deaths, and DALYs attributable to type 2 diabetes to 2050 stratified by age and sex.

RESULTS

The age-standardized incidence of type 2 diabetes was 341.5 per 100,000 persons (1.6 times in 1990) and the age-standardized prevalence was 9960.0 per 100,000 persons (2.5 times in 1990) in China 2021. In 2021, there were 0.9 million deaths and 26.8 million DALYs due to type 2 diabetes or hyperglycemia, as 2.9 and 2.7 times the data in 1990, respectively. In the projection, the age-standardized incidence (449.5 per 100,000 persons in 2050) will continue to increase but the growing rate will slow down in the future decades. With the population aging, there will be estimated 211.2 million Chinese people with type 2 diabetes with an anticipated age-standardized prevalence of 18,171.2 per 100,000 persons, 244.6 per 100,000 deaths, and 4720.2 per 100,000 DALYs in 2050. The incidence of type 2 diabetes kept growing among adolescents and young adults in the past three decades (128.7, 439.9, and estimated 1870.8 per 100,000 persons in 1990, 2021, and 2050, respectively).

CONCLUSIONS

The incidence, prevalence, and disease burden of type 2 diabetes grew rapidly in China in the past three decades. The greatest challenges in the future three decades will be the prevention of type 2 diabetes in young people and the care for elder adults.

Exploring the role of the atherogenic index of plasma as a mediator between body roundness Index and cardiovascular events in older adults: a NHANES-based study

Background

The rising incidence of cardiovascular diseases (CVD) in the elderly highlights the need for effective preventive strategies. Recent studies suggest that obesity, through metabolic factors, contributes to the development of CVD. This study aims to explore how body roundness index (BRI) levels affect the occurrence of CVD using data from the National Health and Nutrition Examination Survey (NHANES) (2003-2016), to better understand the role of obesity in CVD prevention and management.

Methods

The study analyzed data from 3,584 NHANES participants over seven cycles (2003-2016), dividing them into three groups (T1, T2, T3) based on BRI values. Univariate and multivariate regression analyses were used to assess the association between BRI and atherogenic index of plasma (AIP) levels with the occurrence of CVD. The mediating effect of AIP on BRI and CVD was also analyzed.

Results

Compared to the lowest tertile of BRI, participants with higher BRI levels had a higher proportion of females, smokers, drinkers, and individuals with lower educational attainment. Poverty-income ratio (PIR) and AIP levels were significantly higher, and the prevalence of CVD was also higher. BRI and AIP were both independent risk factors for CVD, with AIP having a significant mediating effect between BRI and CVD.

Conclusion

BRI levels significantly impact the occurrence of CVD through AIP mediation.

Glucagon-Like Peptide 1 Receptor Agonists and Mental Health: A Systematic Review and Meta-Analysis

Importance

People with obesity and diabetes have poorer psychiatric and cognitive outcomes and lower quality of life (QOL) compared with those without. Glucagon-like peptide 1 receptor agonists (GLP1-RAs) are treatments for diabetes and obesity that may also influence psychiatric outcomes.

Objective

To conduct a meta-analysis of randomized placebo-controlled trials to evaluate psychiatric, cognitive, and QOL outcomes with GLP1-RA treatment.

Data Sources

MEDLINE, Embase, PsycINFO, and CENTRAL databases were searched from inception through June 24, 2024.

Study Selection

Double-blind placebo-controlled trials comparing GLP1-RA to placebo in adults with overweight/obesity and/or diabetes, reporting on psychiatric, cognition, or QOL outcomes, were included.

Data Extraction and Synthesis

Data extraction was performed in parallel by 2 reviewers. Random-effects meta-analysis was performed. Effect size measures were log risk ratios (log[RR]) and standardized mean differences (Hedges g). The quality of studies was appraised using the Cochrane risk-of-bias tool (RoB2). Certainty of evidence was assessed via GRADEpro.

Main Outcomes and Measures

Main outcomes were risk of psychiatric adverse events (serious and nonserious) and change in mental health symptom severity, health-related quality of life, and cognition.

Results

Eighty randomized clinical trials involving 107 860 patients were included in the meta-analysis. The mean (SD) age of participants across studies in the meta-analysis was 60.1 (7.1) years; 43 251 were female (40.1%) and 64 608 male (59.9%). GLP1-RA treatment was not associated with a significant difference in risk of serious psychiatric adverse events (log[RR] = -0.02; 95% CI, -0.20 to 0.17; P = .87) and nonserious psychiatric adverse events (log[RR] = -0.03; 95% CI, -0.21 to 0.16], P = .76), or depressive symptom change (g = 0.02; 95% CI, -0.51 to 0.55; P = .94), compared with placebo. GLP1-RA treatment was associated with improvements in restrained eating (g = 0.35; 95% CI, 0.13 to 0.57; P = .002) and emotional eating behavior (g = 0.32; 95% CI, 0.11 to 0.54; P = .003) and in mental health-related QOL (g = 0.15; 95% CI, 0.07 to 0.22; P < .001), physical health-related QOL (g = 0.20; 95% CI, 0.14 to 0.26; P < .001), diabetes-related QOL (g = 0.23; 95% CI, 0.15 to 0.32; P < .001), and weight-related QOL (g = 0.27; 95% CI, 0.18 to 0.35; P < .001) compared with placebo.

Conclusions and Relevance

In patients with overweight/obesity and/or diabetes , GLP1-RA treatment is not associated with increased risk of psychiatric adverse events or worsening depressive symptoms relative to placebo and is associated with improvements in QOL, restrained eating, and emotional eating behavior. These findings provide reassurance regarding the psychiatric safety profile of GLP1-RAs and suggest that GLP1-RA treatment contributes to both physical and emotional well-being.

Relationship between atherosclerotic burden and sarcopenia in U.S. adults: A cross-sectional study based on the NHANES database

Sarcopenia, characterized by the progressive loss of skeletal muscle mass and strength, significantly impacts the people, leading to increased frailty and mortality. The atherogenic index of plasma (AIP), a biomarker for lipid imbalance, may be linked to sarcopenia due to shared pathways of inflammation and metabolic dysregulation. Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 cycles were analyzed. The AIP was calculated as the logarithm of the ratio of triglycerides to High density lipoprotein cholesterol. Sarcopenia was defined using the appendicular skeletal muscle mass index (ASMBMI) adjusted for body mass index (BMI). Multivariable linear regression and logistic regression models were employed to assess the association between AIP and ASMBMI, as well as sarcopenia. Restrictive cubic spline curves were utilized to analyze potential nonlinear associations between AIP and outcome indicators. Additionally, subgroup analyses and intergroup interaction tests were performed. Elevated AIP levels were associated with decreased ASMBMI and an increased risk of sarcopenia. After adjusting for confounding factors, the association between AIP and ASMBMI remained significant (Beta [95% CI] = -0.02 [-0.03, -0.01], P < 0.001). AIP was significantly associated with sarcopenia (OR [95% CI] = 2.6 [1.78, 3.81], P = < 0.001). AIP is significantly associated with reduced muscle mass and potentially with sarcopenia, suggesting that lipid metabolism plays a critical role in muscle health. Identifying AIP as a modifiable risk factor could have important public health implications for managing sarcopenia.

Comparison of Different Intermittent Fasting Patterns or Different Extents of Calorie Restriction for Weight Loss and Metabolic Improvement in Adults: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

CONTEXT

Continuous energy restriction (CER) and intermittent fasting (IF) are both prevalent diet regimens recommended for weight loss and metabolic improvement.

OBJECTIVE

The objective of this study was to evaluate the efficacy of CER and IF on weight loss and metabolic improvement in adults with overweight, obesity, or metabolic abnormalities.

DATA SOURCES

PubMed, Embase, and the Cochrane Library (CENTRAL) were searched for randomized controlled trials of 3 degrees of CER diet regimens and 4 categories of IF diet regimens, from inception of the databases to December 2022.

DATA EXTRACTION

Two reviewers independently extracted demographic information, the intervention duration, details of the dietary interventions, and data on the outcomes of interest.

DATA ANALYSIS

Bayesian random-effect network meta-analyses were used to pool the results and the Grading of Recommendations, Assessment, Development, and Evaluation framework was used to assess the certainty of the evidence and to present the findings.

RESULTS

The study included 167 eligible trials with a total enrollment of 11 998 participants. Most IF diet regimens induced significant weight loss that was comparable with that induced by CER diet regimens with a similar absolute energy restriction, based on low- to high-certainty evidence. Severe CER proved to be the most effective regimen for obtaining weight loss, based on moderate-certainty evidence (mean difference of weight change 11.50 kg [95% CI 10.07 to 12.93]), followed by alternate-day fasting, based on high-certainty evidence (mean difference of weight change (5.07 kg [95% CI 3.44 to 6.72]) and moderate CER, based on moderate-certainty evidence (6.09 kg [95% CI 5.26 to 6.93]), when the regimens being compared were consistent in their absolute energy restriction extent. Similar results were noticed for body measurements, blood pressure, blood lipids, and glycemic profiles. In the subgroup analysis, the weight-loss effects of the IF but not the CER diet regimens experienced rebound after 12 weeks.

CONCLUSION

In adults with overweight, obesity, or metabolic abnormalities, effectiveness in weight loss mainly depends on the extent of the energy restriction, regardless of the mealtime patterns.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022379621.

The contemporary landscape of cardiovascular optimization in type 2 diabetes: overcoming barriers to evidence-based use of newer antihyperglycemic agents

INTRODUCTION

Cardiometabolic diseases, particularly type 2 diabetes (T2D) and cardiovascular disease (CVD), represent leading global health challenges with rising incidence and prevalence. Despite strong evidence supporting the benefits of sodium-glucose cotransporter inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in managing CVD risk in T2D, these therapies remain underutilized.

AREAS COVERED

This review discusses the present state of SGLT2i and GLP-1 RA usage, emphasizing barriers to their adoption, including clinical inertia, high costs, and misconceptions about injectable therapies. The literature search was conducted using PubMed, UpToDate, major society journals, and clinical guidelines. Information was gathered from cohort studies, survey reports, randomized controlled trials, and meta-analyses that examine the effectiveness and challenges surrounding these treatments.

EXPERT OPINION

Addressing the underuse of SGLT2i and GLP-1 RA requires a multifaceted approach. Key strategies include improving prescriber awareness, reducing out-of-pocket costs, fostering interdisciplinary collaboration, and leveraging digital health tools. Implementation science has shown promise in enhancing therapy uptake. Future efforts must integrate these therapies into value-based care models to ensure timely, equitable access, ultimately reducing cardiovascular (CV) morbidity and mortality in high-risk T2D populations.

Understanding Epidemiology of Physical Activity and Sedentary Behaviour Among Adults in Haryana: Insights from the ICMR-INDIAB Study [ICMR-INDIAB-19]

INTRODUCTION

Physical inactivity contributes to non-communicable disease (NCD) health burden, making it essential to study and address this issue at a population level. The present research aims to explore the patterns of physical activity (PA) in Haryana through a subgroup analysis of the national Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study.

METHODS

This study was conducted between December 2018 and July 2019 in Haryana and included 3918 adult participants. Physical activity was assessed using the validated MDRF Physical Activity Questionnaire (MPAQ), which has domain-wise assessments of PA. Weighted prevalence was estimated using state-specific sampling weights, and associations between PA, anthropometric and biochemical profiles were assessed using bivariate analysis done using Student's unpaired t tests, one-way analysis of variance (ANOVA), or chi-square tests. Factors describing the likelihood of being active were ascertained using a multivariable nominal regression analysis.

RESULTS

About 73% of the study participants were physically inactive, and only 27% were moderately to vigorously active. The time spent in different PA domains varied significantly across sociodemographic variables, including sex, education, region, occupation, and socioeconomic status. Participants from the middle socioeconomic class spent more time in work-related PA, compared to low and upper-class participants who spent more time in general and transport-related PA. There were significant statistical differences between active and non-active groups concerning their mean blood glucose levels, body mass index, waist circumference and systolic blood pressure, but the differences in the lipid profile were non-significant. However, regression analysis showed higher odds of being physically active among younger participants, men, residents in rural areas, and those having fewer years of education.

CONCLUSION

We highlight the alarmingly high prevalence of physical inactivity across different segments of society in Haryana with significant sociodemographic disparities. Considering the increasing prevalence of NCDs, it is high time to prioritise health promotion measures and inculcate more physical activity amongst the population to achieve health-related sustainable development goals.

Mealworm hydrolysate ameliorates dexamethasone-induced muscle atrophy via sirtuin 1-mediated signaling and Akt pathway

Loss of skeletal muscle mass and strength can result from various factors, including malnutrition, glucocorticoid usage, and diseases. The mealworm (Tenebrio molitor larvae) is an edible insect gaining popularity as an alternative protein-rich diet. Mealworms are expected to help alleviate muscle atrophy based on their rich, high-quality protein and peptide content, but it remains unclear whether mealworms ameliorate muscle loss. This study aimed to investigate the potential of mealworm hydrolysate (MH) in mitigating dexamethasone (DEX)-induced muscle atrophy and to elucidate the underlying mechanisms. MH ameliorates muscle atrophy by activating sirtuin 1 (SIRT1) and Akt, reducing muscle-specific RING finger protein-1 and atrogin-1 expression, and inhibiting apoptosis in DEX-treated C2C12 cells. Additionally, MH significantly increased the muscle mass, grip strength, and muscle fiber cross-sectional area by activating SIRT1 and Akt in DEX-treated rats. These findings suggest that MH has the potential in alleviating dexamethasone-induced muscle atrophy.

A novel approach to cardiovascular events in patients with systemic lupus erythematosus: risk factor assessment and treatment analysis

Systemic lupus erythematosus (SLE) patients have a significantly increased risk of developing cardiovascular disease (CVD). Despite the implementation of preventive measures and treatment of lipid disorders, as well as reduced use of glucocorticoids, CVD remains one of the leading causes of death in this patient group. It is crucial to develop an appropriate CVD risk assessment strategy that considers the distinctive characteristics of this patient population. This paper provides a comprehensive analysis of the methods used to assess CVD risk in SLE patients. It also presents effective strategies for the reduction of the effects of traditional and non-traditional risk factors for atherosclerosis.

Associations of Academic Study- and Non-Study-Related Sedentary Behaviors with Incident Obesity in Children and Adolescents

Objective: To assess the associations between academic study- and non-study-related sedentary behaviors and the risk of overweight/obesity in children and adolescents, as well as their joint association with sugar-sweetened beverage (SSB) consumption. Methods: Sedentary behaviors and SSB consumption were assessed using self-reported questionnaires. Overweight/obesity were defined by age- and sex-specific body mass index cut-off values according to the criteria of "Screening for overweight and obesity among school-age children and adolescents" in China. Poisson regression with robust error variance was used to assess the associations of sedentary behaviors and/or SSB consumption with the risk of overweight/obesity, yielding relative risks (RRs) and 95% confidence intervals (CIs). The Shapley additive explanations (SHAP) method was used to rank the contribution of five specific sedentary behaviors to obesity risk. Results: Among 47,148 participants with a 3-year follow-up, longer durations of screen-related, academic study-related, and total sedentary time were each associated with a higher risk of overweight/obesity (adjusted RR (95% CI) per hour increment: 1.01 (1.00-1.02), 1.03 (1.01-1.06), and 1.02 (1.01-1.03)). After mutual adjustment, the associations of engaging in homework, attending tutorial classes, and using mobile electronic devices remained significantly associated with higher overweight/obesity risk. The SHAP summary plot shows that using mobile electronic devices, attending tutorial classes, and doing homework were the three most important sedentary obesogenic contributors. A significant interaction of age with sedentary time was found (p for interaction < 0.05). No significant interaction was found between SSB consumption and sedentary time. Conclusions: Excessive sedentary behaviors were associated with a higher risk of overweight/obesity, particularly due to mobile electronic device use, attending tutorial classes, and doing homework.

Antiobesity Pharmacotherapy for Patients With Genetic Obesity Due to Defects in the Leptin-Melanocortin Pathway

Lifestyle interventions are the cornerstone of obesity treatment. However, insufficient long-term effects are observed in patients with genetic obesity disorders, as their hyperphagia remains untreated. Hence, patients with genetic obesity often require additional pharmacotherapy to effectively manage and treat their hyperphagia and obesity. Recent advancements in antiobesity pharmacotherapy have expanded the range of available antiobesity medications (AOM). This includes the targeted AOM setmelanotide, approved for specific genetic obesity disorders, as well as nontargeted AOMs such as naltrexone-bupropion and glucagon-like peptide-1 analogues. Targeted AOMs have demonstrated significant weight loss, reduced obesity-related comorbidities, and improved hyperphagia and quality of life in patients with specific genetic obesity disorders. Small observational studies have shown that similar benefits from nontargeted AOMs or off-label pharmacotherapies can be achieved in patients with specific genetic obesity disorders, compared to common multifactorial obesity. In the future, novel and innovative pharmacotherapeutical options, including combination therapies and possibly gene therapy, will emerge, offering promising effects on body weight, hyperphagia, and, most importantly, quality of life for patients with a variety of genetic obesity disorders.

A 3-month integrated exercise intervention improves diagnostic parameters of sarcopenia in ambulatory community-dwelling older adults with Dementia: A two-group pre-test/post-test design

This quasi-experimental study aimed to evaluate the effects of a 3-month exercise intervention program on diagnostic parameters of sarcopenia in community-dwelling older adults with dementia. Eighty participants were recruited: the intervention group (n = 40) engaged in integrated exercise sessions three times per week; the control group (n = 40) received usual care. Pre-test, only the physical performance parameter differed between groups, which was better for the intervention group (p < .05). Compared with controls, the intervention group had significantly better post-test parameters of muscle strength, and physical performance; fewer participants were categorized as having sarcopenia (p = .012). However, sarcopenia distribution pre-test vs. post-test within the intervention group was not significant. These findings suggest that a 3-month exercise intervention can effectively improve diagnostic parameters of sarcopenia in community-dwelling older adults with dementia. This intervention positively affected diagnostic parameters of sarcopenia however further modifications will be required to reduce sarcopenia.

Systematic Engineering for Efficient Uric Acid-Degrading Activity in Probiotic Yeast Saccharomyces boulardii

Hyperuricemia, caused by uric acid disequilibrium, is a prevalent metabolic disease that most commonly manifests as gout and is closely associated with a spectrum of other comorbidities such as renal disorders and cardiovascular diseases. While natural and engineered probiotics that promote catabolism of uric acid in the intestine have shown promise in relieving hyperuricemia, limitations in strain efficiency and the requirements for achieving high performance remain major hurdles in the practical application of probiotic-mediated prevention and management. Here, we employed a systematic strategy to engineer a high-efficiency uric acid catabolism pathway in S. cerevisiae. An uricase from Vibrio vulnificus, exhibiting high-level activity in S. cerevisiae, was identified as the uric acid-degrading component. The expression level and stability of urate transporter UapA were improved by constructing a chimera, enabling reliable uric acid import in S. cerevisiae. Additionally, constitutive promoters were selected and combinatorially assembled with the two functional components, creating a collection of pathways that confer varied levels of uric acid catabolic activity to S. cerevisiae. The best-performing pathway can express uric acid-degrading activity up to 365.32 ± 20.54 μmol/h/OD, requiring only simple cultivation steps. Eventually, we took advantage of the genetic similarity between model organism S. cerevisiae and probiotic S. boulardii and integrated the optimized pathway into identified high-expression integration loci in the S. boulardii genome. The activity can be stably maintained under high-density fermentation conditions. Overall, this study provided a high-potential hyperuricemia-managing yeast probiotic strain, demonstrating the capabilities of developing recombinant probiotics.

Study on the comorbid mechanisms of sarcopenia and late-life depression

The increasing global aging population has brought greater focus to age-related diseases, particularly muscle-brain comorbidities such as sarcopenia and late-life depression. Sarcopenia, defined by the gradual loss of muscle mass and function, is notably prevalent among older individuals, while late-life depression profoundly affects their mental health and overall well-being. Epidemiological evidence suggests a high co-occurrence of these two conditions, although the precise biological mechanisms linking them remain inadequately understood. This review synthesizes the existing body of literature on sarcopenia and late-life depression, examining their definitions, prevalence, clinical presentations, and available treatments. The goal is to clarify the potential connections between these comorbidities and offer a theoretical framework for the development of future preventive and therapeutic strategies.

The 2024 revised clinical guidelines on the management of thyroid tumors by the Japan Association of Endocrine Surgery

The Japan Association of Endocrine Surgery published the first edition of the "Clinical guidelines on the management of thyroid tumors" in 2010 and the revised edition in 2018. The guideline presented herein is the English translation of the revised third edition, issued in 2024. The aim is to enhance health outcomes for patients suffering from thyroid tumors by facilitating evidence-based shared decision-making between healthcare providers and patients, as well as standardizing the management of thyroid tumors. The focus is on adult patients with thyroid tumors, addressing clinically significant issues categorized into areas such as an overview of the diagnosis and treatment of thyroid nodules, treatment strategies by histological type, radioactive iodine therapy, treatment of advanced differentiated carcinoma, pharmacotherapy, and complications and safety management associated with thyroid surgery. Thirty-two clinical questions were established in these areas. Following a comprehensive search of the literature and systematic review to evaluate the overall evidence, we aimed to present optimal recommendations by considering the balance of benefits and harms from the patient's perspective. We integrated evidence and clinical experience to determine the "Certainty of evidence" and "Strength of recommendations". Based on these, we illustrated overall flows of care as "Clinical algorithms". Necessary background knowledge of diseases and established clinical procedures for understanding the recommendations are presented in "Notes", while information that may be clinically useful but for which evidence remains insufficient is included in "Columns", based on the current state of evidence. Finally, future challenges for the next revision are presented as "Future research questions".

Synergistic Effects of Medium-Chain Triglyceride Supplementation and Resistance Training on Physical Function and Muscle Health in Post-Stroke Patients

Background/Objectives: Sarcopenia and malnutrition are common in post-stroke patients, impairing recovery. Medium-chain triglycerides (MCT) may support muscle metabolism, while chair-stand exercises improve strength and mobility. However, their combined effects remain unclear. This study evaluated the synergistic effects of MCT supplementation and high-frequency chair-stand exercise on physical function and muscle health in post-stroke patients. Methods: A retrospective cohort study included 1080 post-stroke patients categorized into three groups: (1) MCT supplementation alone, (2) chair-stand exercise alone, and (3) both combined. MCT supplementation consisted of ~40 g/day MCT oil or powder. Functional outcomes were assessed using the Functional Independence Measure (FIM-motor), while muscle health was evaluated by handgrip strength (HGS) and skeletal muscle index (SMI). Multiple linear regression analyses were performed, adjusting for confounders. Results: The combined intervention group showed significantly greater improvements in FIM-motor scores at discharge (B = 8.79, 95% CI: 5.64-11.95, β = 0.32, p < 0.001) and FIM-motor gain (B = 6.02, 95% CI: 3.42-8.62, β = 0.29, p < 0.001) compared to the control. Increases in HGS (B = 2.441, 95% CI: 0.483-4.398, β = 0.18, p = 0.015) and SMI (B = 0.194, 95% CI: 0.102-0.419, β = 0.12, p = 0.039) were also observed. Chair-stand exercise was performed a median of 62 times/day and independently improved outcomes, while MCT alone had limited effects. Conclusions: MCT supplementation combined with chair-stand exercise enhances functional recovery and muscle health in post-stroke patients, supporting its role in rehabilitation. Further research is needed to evaluate long-term effects and to examine the pharmacokinetics of MCTs, including blood concentrations, in broader populations.

Defining Reference Values for Skeletal Muscle Metrics on Abdominal CT Using Data From Healthy Young Adult Populations: A Systematic Review and Meta-Analysis

BACKGROUND. CT muscle metrics hold promise for opportunistic sarcopenia screening and individualized clinical risk stratification, but reference values applicable across broad populations are lacking. OBJECTIVE. To estimate reference cutoff values for CT skeletal muscle metrics using data from populations of healthy young adults. EVIDENCE ACQUISITION. The PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were searched through January 1, 2025 for studies reporting skeletal muscle index (SMI) and/or skeletal muscle density (SMD) on CT at the L3 vertebral level in healthy young adults (age range, 18-45 years). For SMI and SMD in both men and women, a random effects meta-analysis was used to estimate interstudy SD (as a measure of variance among studies) and mean values for a theoretic global population of healthy young adults. Presence of significant heterogeneity among individual study means was assessed using the Q statistic. Cutoff values for the theoretic global population corresponding with a T-score of -2 (i.e., values ≥ 2 SDs below the population's mean value) were calculated, incorporating the meta-analysis results and pooled intrastudy variance. EVIDENCE SYNTHESIS. The meta-analysis included 14 studies (16,958 individuals; 11,819 men, 5139 women) reporting SMI, of which seven studies (11,175 individuals; 8372 men, 2803 women) also reported SMD. The estimated global mean value for SMI was 54.6 in men and 42.4 in women and for SMD was 47.4 HU in men and 43.6 HU in women. The interstudy SD for SMI was 5.4 in men and 4.3 in women and for SMD was 1.9 in men versus 3.2 in women; significant heterogeneity was present among individual study means for both SMI and SMD in both men and women (all p<.001). The cutoff value corresponding with a T-score of -2 for SMI was 36.3 in men and 27.5 in women and for SMD was 36.4 HU in men and 28.1 HU in women. CONCLUSION. This meta-analysis of studies performed in healthy young adults provides reference mean values and standardized cutoffs analogous to a T-score of -2 for SMI and SMD at the L3 level on abdominal CT. CLINICAL IMPACT. These results can aid opportunistic screening for sarcopenia.

HbA1c variability and all-cause mortality in type 1 and type 2 diabetes: A population-based cohort study using electronic health records

AIMS

To investigate associations between HbA1c variability and all-cause mortality in individuals with diabetes, accounting for average HbA1c level.

METHODS

Mean HbA1c and variability score (HVS) were estimated for people aged 31-90 with diabetes (type 1 = 20,347, type 2 = 409,821) with 4 + HbA1c measurements recorded in the Clinical Practice Research Datalink in 2011-14 and alive on 1/1/2015. Cox models estimated hazard ratios (HR) for all-cause mortality, ascertained from national linked mortality data during 2015-17. HbA1c level and variability were mutually adjusted for each other and other measured confounders.

RESULTS

Greater HbA1c variability was associated with younger age, non-white ethnicities (type 1 only), obesity, co-morbidities, and living in deprived areas. During follow-up, 1,043 (5.1 %) individuals with type 1 diabetes and 40,723 (9.9 %) individuals with type 2 diabetes died. In those with the most HbA1c variability compared to the least (HVS = 80-100 vs 0-20), the estimated adjusted HRs for mortality were 2.78 (95 %CI 2.15, 3.60) in type 1 diabetes and 1.91 (1.83, 1.99) in type 2 diabetes.

CONCLUSIONS

Variability in HbA1c was associated with greater subsequent mortality among people living with diabetes, independent from average HbA1c. Future research should investigate whether reducing HbA1c variability over time in selected patients lowers mortality risk independent of HbA1c level improvements.

Glabridin Alleviates Metabolic Disorders in Diet-Induced Diabetic Mice

Glabridin (GLD) is a flavonoid derived from licorice. This study aims to evaluate GLD's therapeutic potential in ameliorating type 2 diabetes mellitus (T2DM) and elucidate its underlying mechanisms of action. A T2DM model was established using male C57BL/6J mice fed a high-fat, high-glucose diet. GLD was administered via intraperitoneal injection at doses of 10, 20, and 30 mg/kg BW, with MET (200 mg/kg BW) as a positive control. Fasting blood glucose levels, glucose tolerance, insulin tolerance, pyruvate tolerance, and serum parameters were analyzed, along with key markers of glycogen synthesis, gluconeogenesis, lipid metabolism, mitochondrial function, and endoplasmic reticulum (ER) stress. GLD significantly lowered blood glucose levels in the diabetic mice. It suppressed gluconeogenesis by inhibiting PEPCK and G6P, while promoting glycogen synthesis by activating GCK and inhibiting GSK-3β. Additionally, GLD enhanced insulin signaling by increasing IRS1 and IRS2 levels and promoting AKT phosphorylation, thereby improving insulin sensitivity. In lipid metabolism, GLD reduced hepatic steatosis and lipid accumulation by downregulating lipogenesis-related genes (SREBP1c, FAS, ACC1, and SCD1) and upregulating lipolysis-related genes (PPARα and LCAD). In energy metabolism, GLD increased mitochondrial membrane potential, reduced reactive oxygen species levels, and enhanced the expression of genes associated with mitophagy (PINK1 and Parkin) and mitochondrial biogenesis (PGC-1α, SIRT1, and TFAM). Moreover, GLD mitigated ER stress by decreasing GRP78 and CHOP levels, suppressing PERK phosphorylation, and inhibiting key stress response genes. GLD improves insulin sensitivity and exerts antidiabetic effects by ameliorating metabolic disorders, supporting its potential as a therapeutic agent for T2DM.

Cardiovascular and Renal Risk Factors in the Argentine First Nations: A Study of the Qom and Wichi Indigenous Groups

The "10 Recommendations for Global Kidney Health" developed at the Global Policy 2017 constitute a commitment by and challenge to all stakeholders. Achieving these goals in disadvantaged population such as the First Nation Peoples (FNP) is even more challenging. Qom and Wichi ethnics are isolated Argentine FNP with poor access to health care. Research on chronic kidney disease (CKD) in Qom FNP in the Chaco Province, Argentina showed high rates of proteinuria without a decrease of the glomerular filtration rate in a group of 385 persons in 2003. In 2018, a subsequent cross-sectional evaluation in those individuals still living in the area revealed that diabetes mellitus (DM) increased sixfold (from 2% to 14%) and obesity increased threefold (from 21% to 61%). Infections (tuberculosis) and cardiovascular disease were the main causes of mortality in the whole sample, whereas gynecologic cancer was the first cause of death in women and cardiovascular disease in men. In 2018, a new group of subjects (not those originally assessed in 2003) showed a remarkably high prevalence of renal risk factors despite being as young as those originally evaluated in 2003 but with a prevalence of renal risk factors as high as when the latter were assessed 15 years afterward. Wichi FNP, in 2020, showed lower proteinuria rates (14%) with virtually no presence of DM. FNP deserve the creation of public policies for CKD detection and treatment, but they must be based on local scientific evidence, with continuous monitoring and learning and scalable strategies.

Reciprocal Associations Between Trajectories of Physical Activity and Physical Function Among Older Women: Findings From the Australian Longitudinal Study on Women's Health

BACKGROUND

Although physical activity (PA) is known to improve physical function (PF), and functional decline impacts the capacity to engage in PA, the reciprocal relationship between PA and PF remains unclear.

METHODS

Data were from participants in the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health (N = 8 238). PA and PF were assessed at 3-year intervals from 1999 (73-78 y) to 2011 (85-90 y). Group-based trajectory modeling was used to identify PA and PF trajectories, and associations between PA and PF were examined using mixed-effects models and restricted cubic spline modeling.

RESULTS

Three trajectories for PA and PF were identified: Low, Moderate, and High. Women in the High PA group maintained high PF and did not reach the starting PF level of the Low PA group (at age 73) until they were 87. Similarly, women in the High PF group maintained higher PA than those in the other groups. Women in the Low PF group never met PA guidelines and had PF scores below the disability threshold throughout the study. Restricted cubic splines showed that higher PA was associated with better PF 3 years later, and vice versa, indicating that PA and PF influence each other.

CONCLUSION

There are reciprocal relationships between PF and PA; higher levels of PA promote better PF, and higher PF may help slow the decline in PA. Although rates of decline in PF show little variation with PA in women during their 80s, habitually high PA confers considerable benefits, contributing to additional years of healthy life.

Prospective registration was associated with a reduced risk of bias for randomized controlled trials: a meta-research study

OBJECTIVES

To investigate the association between trial registration and the risk of bias (RoB).

STUDY DESIGN AND SETTINGS

Randomized controlled trials (RCTs) from systematic reviews of medication-related harm published between January 1, 2015, and January 1, 2020, were used, assessing first post and start dates on open registries along with RoB. Multivariable logistic regression analyses for both individual safeguards and overall RoB by registration status (ie, nonregistered, retrospectively registered, and prospectively registered) were conducted.

RESULTS

A total of 2030 RCTs were identified from 151 systematic reviews; 65.46% (851/1300) were registered prospectively and 34.54% (449/1300) retrospectively among 64.04% (1300/2030) registered RCTs. Regression analysis indicated that when compared to nonregistered trials, prospective registration was associated with safeguards against bias using randomization sequence generation (odds ratio [OR] = 1.51, 95% CI: 1.09, 2.07), allocation concealment (OR = 1.69, 95% CI: 1.22, 2.36), blinding of outcome assessors (OR = 1.65, 95% CI: 1.14, 2.38), as well as lower overall RoB (OR = 2.04, 95% CI: 1.19, 3.50). When comparing prospectively and retrospectively registered trials, prospective registration was more likely to have lower overall and individual RoB, but this was not statistically significant. Prospective registration was associated with blinding of participants (OR = 1.70, 95% CI: 1.26, 2.30) and health-care providers (OR = 1.68, 95% CI: 1.25, 2.28), but not lower overall RoB as compared to retrospective registration.

CONCLUSION

Prospectively registered trials were more likely than nonregistered trials to implement adequate procedures against bias. Prospectively registered trials may also serve as an indicator of lower overall RoB in RCTs.

Prevalence of sarcopenia in middle-aged and older adults with cognitive impairment: a meta-analysis

BACKGROUND

Cognitive impairment, dementia and sarcopenia significantly reduce the quality of life in middle-aged and older adults by impairing daily functioning, making cognitive decline a major concern for healthcare professionals.

OBJECTIVE

To estimate the prevalence of sarcopenia and probable sarcopenia in middle-aged and older adults with cognitive impairment.

METHODS

Six databases-Embase, Ovid MEDLINE, PubMed, CINAHL, Scopus and Web of Science was conducted through February 2025. Cohort and cross-sectional studies included, and a random-effects model was used for pooled prevalence analysis. Cognitive impairment is a decline in cognitive functions, including memory, attention and executive function, covering mild cognitive impairment and dementia. Sarcopenia is decreased skeletal muscle mass and function, assessed by muscle strength or physical performance.

RESULTS

A total of 67 studies involving 23 532 participants revealed a pooled sarcopenia prevalence of 30.1% and a probable sarcopenia prevalence of 40.5%. Additionally, amongst adults aged 65 and older, the prevalence of sarcopenia was 32.7%. The prevalence of sarcopenia varied by setting: 25.3% in community-dwelling populations, 35.5% in hospitals and 41.5% in institutional settings. Moderating factors included age, female, body mass index, comorbidities and risk factors such as depression, diabetes, hypertension, malnutrition, osteoarthritis, alcohol consumption and smoking.

CONCLUSIONS

Approximately one-third of middle-aged and older adults with cognitive impairment demonstrate to have sarcopenia. Early detection and tailored interventions by public health professionals are crucial, particularly for individuals with mild cognitive impairment and dementia. Enhanced preventive strategies are essential to improving outcomes and reducing healthcare costs.

Relationship between stress hyperglycaemic ratio (SHR) and critical illness: a systematic review

Stress-induced hyperglycemia (SIH) is a physiological response to acute or chronic stress characterized by elevated blood glucose levels. It is prevalent in both patients with and without diabetes, particularly those with acute or critical illnesses. The development of SIH is characterized by complex interactions among catecholamines, cortisol, and inflammatory mediators such as cytokines, resulting in increased hepatic glucose production and insulin resistance. While mild to moderate SIH may provide a protective mechanism during stress, prolonged or excessive hyperglycemia can exacerbate inflammation and oxidative stress, contributing to adverse outcomes in conditions such as acute myocardial infarction, heart failure, and cerebrovascular diseases. The stress-hyperglycemia ratio (SHR), defined as the ratio of admission glucose to estimated mean glucose (derived from glycated hemoglobin [HbA1c]), has emerged as a valuable tool for quantifying stress hyperglycemia. Unlike absolute glucose levels, the SHR accounts for background hyperglycemia and provides a more accurate indicator of the relative glucose elevation associated with critical illness. Extensive research has demonstrated a U-shaped or J-shaped relationship of the SHR with disease outcomes, indicating that both low and high SHRs are associated with increased mortality and morbidity. The SHR has shown significant predictive value in cardiovascular diseases (e.g., acute coronary syndrome, heart failure), cerebrovascular diseases (e.g., acute ischemic stroke, intracerebral hemorrhage), and infectious diseases (e.g., sepsis, pneumonia). It also plays a role in other conditions, such as acute pancreatitis and certain cancers. The ease of calculating the SHR from widely available admission glucose and HbA1c tests makes it a practical and valuable prognostic marker in clinical settings. This review examines the relationship between the SHR and critical illnesses, highlighting its mechanisms and predictive value across various diseases.

Solidified ionic liquid-based formulations of metformin with enhanced GI epithelial permeability

Active Pharmaceutical Ingredient-Ionic Liquids (API-ILs) can enhance intestinal epithelial membrane permeability of poorly bioavailable APIs, improving bioavailability. However, clinical and commercial application is to date limited due to challenging physical handling properties. Lipid-based formulations (LBFs) are commonly used to enhance intestinal drug absorption but face challenges including low drug-loading capacity and limited stability. To address these issues, a method for transforming liquid API-ILs and LBFs into high-loading solid forms via spray-encapsulation with polymers was developed. Here the method was applied to a lipophilic API-IL of BCS Class III, namely metformin, and multi-component API-IL solutions containing known intestinal permeation enhancers (Labrasol®, docusate). The spray-encapsulated solid formulations exhibited improved handling, self-emulsified in both phosphate buffer (pH 6.8) and fasted state simulated intestinal fluid (FaSSIF), while exhibiting superior in vitro release profiles compared to the liquid formulations. Ex vivo permeability studies on metformin docusate formulations using rat intestinal mucosae in Ussing chambers demonstrated a 2.3- to 6.3-fold increase in permeability (Papp) for solidified formulations, with metformin hydrochloride as the control. Further studies revealed a correlation between docusate concentration and permeability enhancement. These findings highlight the potential of solidified docusate-based lipophilic API-IL formulations to improve membrane permeability of poorly bioavailable APIs.

Automated cohort database system for cardiopulmonary physiotherapy: A comprehensive tool supporting research on cardiac surgery patients-framework design, development and validation

BACKGROUND

The shared goal of clinical physicians and cardiopulmonary physiotherapists is to tailor optimal comprehensive rehabilitation strategies for each patient undergoing cardiac surgery to improve outcomes. The sustained and large-scale acquisition of patient course and rehabilitation treatment-related data faces numerous challenges. This necessitates research and analysis based on large sample size data from cardiac surgery patients.

OBJECTIVE

The Cardiopulmonary Physiotherapists Database System (CPPTherapists-DBS) was developed to enhance the management and analysis of data for researching risk factors associated with postoperative pulmonary complications (PPCs) in cardiac surgery patients. This system aims to establish comprehensive system design standards, frameworks, and validation procedures to support research in both cardiac surgery and cardiopulmonary physiotherapy.

METHODS

The development of the CPPTherapists-DBS involved: (1) establishing system design standards and frameworks through a detailed software engineering requirements analysis, where clinical researchers defined data collection standards, business scope, and identification rules based on international guidelines and previous research; (2) designing and developing the system to integrate advanced functionalities for data management and analysis within the established frameworks; (3) validating the system by constructing a retrospective cohort for PPCs and developing and evaluating a predictive model based on the collected data.

RESULTS

The CPPTherapists-DBS successfully established design standards and frameworks for system development. It has collected clinical data from 27,027 cardiac surgery patients across multiple medical centers from 2010 to 2021. Since January 2022, it has also included physical rehabilitation treatment records for 5,335 patients. The system's CCVPRA tool provides advanced visualization capabilities, enabling rapid data modeling for 6,608 patients and development of a predictive model for PPCs. The model demonstrated strong performance with an AUC of 0.78 in the training set and 0.76 in the testing set.

CONCLUSIONS

The CPPTherapists-DBS effectively automates the collection and management of clinical and rehabilitation data, adhering to established system design standards and frameworks. It offers powerful tools for data visualization and modeling, representing a significant advancement in cohort database systems and providing a replicable model for supporting research on cardiac surgery patients and cardiopulmonary physiotherapy.

Enhanced recovery in cardiac surgery patients with frailty through comprehensive perioperative nursing interventions: A randomized controlled trial

ObjectiveTo evaluate the effects of comprehensive perioperative nursing interventions on postoperative recovery in cardiac surgery patients with frailty, with a focus on physical activity, nutritional status, and cognitive function.DesignA prospective, randomized, single-blind, parallel-group design with a 1:1 allocation ratio.SettingCardiac surgery department in a tertiary care hospital.ParticipantsThis study included 300 patients with frailty after cardiac surgery. Using a computer-generated random number table, patients were randomly assigned to the experimental group (150 patients) and the control group (150 patients). The intervention group received preoperative psychological counseling, targeted nutritional support, skincare, and continuous hemodynamic monitoring; the control group received routine care, including postoperative vital sign monitoring, basic nutritional support, wound care, and standard cardiovascular assessments (e.g., heart rate and blood pressure).Primary outcomesPostoperative recovery was assessed through improvements in physical activity (Barthel Index), nutritional status (Mini Nutritional Assessment), cognitive function (Mini-Mental State Examination), biostatistical data and cardiopulmonary function indicators.ResultsThe intervention group showed significant improvements: Barthel Index increased by 20 points (95% CI: 15-25, p < 0.01), Mini Nutritional Assessment scores by 3 points (95% CI: 1-5, p < 0.05), and Mini-Mental State Examination scores by 4 points (95% CI: 2-6, p < 0.05). Hospital stay was reduced by 5 days (95% CI: 3-7, p < 0.01), and the 6-month survival rate was 10% higher (95% CI: 5-15%, p < 0.05) compared to the control group.ConclusionsComprehensive perioperative nursing interventions significantly improve postoperative recovery, self-care ability, nutritional status, cognitive function, and short-term survival in cardiac surgery patients with frailty.

Illnesses associated with ketosis including diabetic ketoacidosis during very low carbohydrate and ketogenic diets

AIMS

Ketogenic diets are used by individuals with obesity and type 2 diabetes for improved glycaemic control, reduced appetite and weight loss. However, the risks associated with higher ketone levels, including diabetic ketoacidosis (DKA), in individuals with and without diabetes are not well-documented.

MATERIALS AND METHODS

We analysed real world data from a single-centre telemedicine clinic specializing in a very low carbohydrate ketogenic diet (VLCKD) as a lifestyle intervention. Illnesses associated with ketosis (IAK) were defined as beta-hydroxybutyrate (BHB) levels ≥3 mmol/L when patients sought in-person care. We estimated the IAK and DKA incidence rate in individuals with and without type 2 diabetes.

RESULTS

In 72 751 patient-years of follow-up, 86 people had IAK (incidence rate 1.18 per 1000 person-years). In 22 347 patient-years of follow-up of people without diabetes, the incidence rate of IAK was 0.04 per 1000 person-years with no DKA cases. In 50 404 patient-years of follow-up in people with type 2 diabetes (PWD), the incidence rates of IAK and of DKA were 1.69 and 1.01 per 1000 person-years, respectively. In 12 763 person-years of follow-up of PWD using SGLT2-inhibitors, the DKA incidence was 2.90 per 1000 patient-years.

CONCLUSIONS

Very low carbohydrate ketogenic diets are generally safe with low rates of IAK, including DKA, in people with and without type 2 diabetes. The higher incidence of DKA in PWD on VLCKD who are also on SGLT2-inhibitors may be manageable through at-home monitoring of BHB levels.

Association of Skeletal Muscle Mass with Habitual Exercise, Mealtime and Sleep in Middle-Aged Men: Cross-Sectional Study

Objective: To investigate the cross-sectional association between skeletal muscle mass and lifestyles including exercise, mealtime, and sleep habits in adult men aged under 64. Materials and Methods: A total of 101 Japanese men aged under 64 who underwent "Anti-aging Health Checkups" were enrolled in the study. Cross-sectional analyses were conducted using the subjects' data such as body mass index, skeletal muscle mass index (SMI), and self-reported lifestyle information. The physical activity (PA) value of habitual exercise per week (metabolic equivalent hr/week) was categorized into three groups. Mealtime combination of breakfast and dinner time was categorized into five groups. A multiple regression analysis demonstrated how each PA group has an association with SMI. Moreover, an analysis of covariance was performed to investigate the association between "mealtime combined with PA" and SMI levels by comparison and to investigate the association between "sleep duration or satisfaction combined with PA" and SMI levels, respectively. Results: The subjects with "breakfast before 8 a.m." had a significant positive association between SMI and PA levels; in addition, among the subjects from the "dinner before 8 p.m." group, as the PA level was higher, the SMI level increased. Consequently, the SMI level increased as the PA level was higher among the subjects who had "breakfast before 8 a.m. and dinner before 8 p.m." Furthermore, sufficient sleep such as more than 6 hr and satisfied sleep had positive associations with SMI as PA levels increased. Conclusion: These findings suggest a potential benefit of habitual exercise with breakfast before 8 a.m., dinner before 8 p.m., and sufficient sleep for maintaining skeletal muscle mass among middle-aged men.

Natural Experiments to Inform Clinical Practice

AbstractNatural experiments refer to events or practices that result in similar individuals receiving different services or interventions for arbitrary reasons. In the clinical context, researchers may wish to leverage natural experiments to estimate the causal impact of a particular treatment on a health outcome in situations where randomized clinical trial data are unavailable and other observational research designs are likely to yield biased results. This review provides an overview of natural experiments, discusses the potential for natural experiments to establish cause and effect, illustrates applications to specific clinical questions, and outlines situations and practices where natural experiments are most likely to answer the question at hand. Overall, while natural experiments have become popular in health policy, the widespread application of these approaches to specific clinical questions faces several challenges.

GLP-1 receptor agonists and cardiovascular events in metabolically healthy or unhealthy obesity

AIMS

The associations of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and outcomes among patients with obesity according to the presence of cardiovascular risk factors (metabolically healthy obesity (MHO) or metabolically unhealthy obesity (MUHO)) remain unclear. We examined the associations of GLP-1RAs with mortality and adverse cardiovascular events in patients with MHO and MUHO.

METHODS

The TriNetX network was utilized to select a cohort of patients with MHO or MUHO, and use or non-use of GLP-1RAs with propensity score matching (1:1). Cardiovascular events were identified during follow-up.

RESULTS

A total of 2 983 151 patients with obesity (512 434 with MHO and 2 470 717 with MUHO) were included in the study. Among these, 416 713 (13.9%) were GLP-1RA users. After propensity score matching, GLP-1RA use in MUHO was associated with a significantly lower risk of mortality (HR 0.580 [95% CI, 0.566-0.595]), ischemic stroke (HR 0.921 [0.890-0.953]), AF (HR 0.913 [0.888-0.938]) and hospitalization for HF (HR 0.925 [0.900-0.949]) during follow-up compared with non-use of GLP-1RA. Patients with MHO had a markedly lower risk of clinical events than those with MUHO. A trend towards a lower risk of cardiovascular events associated with GLP-1RA was seen among patients with MHO. There was no statistical interaction in the risk of cardiovascular outcomes with GLP-1RA use for MHO and MUHO patients.

CONCLUSIONS

The use of GLP-1RAs was associated with lower rates of cardiovascular events than no use in patients with MUHO. Similar but non-statistically significant trends were seen in patients with MHO.

Trends in cardiometabolic risk factors according to body mass index in Peru between 2015 and 2023

BACKGROUND

Global evidence has shown rising trends in the prevalence of cardiometabolic risk factors. Whether the same trends are observed according to body mass index (BMI) cut-offs is unknown, though critical to focus on specific BMI populations.

METHODS

We conducted a pooled analysis of national health surveys in Peru, grouped into three-year periods (2015-17 [n = 97,079], 2018-20 [n = 98,540], 2021-23 [n = 94,850]). BMI (kg/m²) was classified into four categories: normal weight (18-24.9), overweight (25-29.9), obesity I (30-34.9), and obesity II (≥35). For each period-BMI category, we computed the age-sex-standardized prevalence of cardiometabolic risk factors: raised blood pressure with and without self-reported antihypertensive treatment, self-reported diabetes with and without treatment, daily smoking, alcohol consumption in the last month, and fruits/vegetables consumption in the last week.

RESULTS

The proportion of people with raised blood pressure increased in the overweight and obesity groups, with the largest increase observed in the obesity II group (22 % relative increase). Diabetes prevalence rose substantially among normal weight (89 %) and overweight individuals (58 %). Smoking, alcohol, and fruit/vegetable consumption showed no major changes across BMI categories.

CONCLUSIONS

The prevalence of raised blood pressure has increased between 2015 and 17 and 2020-23, with greater increases observed in the overweight and obesity groups; conversely, the prevalence of self-reported diabetes has increased across BMI categories. These findings highlight the need for tailored interventions targeting both overweight/obese individuals and normal weight populations with diabetes risk.

Effect of physical activity on tissue perfusion in patients with diabetes mellitus: Systematic review and meta-analysis

AIMS

The objective of this systematic review and meta-analysis is to identify and assess the literature exploring the impact of physical activity on enhancing tissue perfusion in the feet of patients with diabetes mellitus (DM).

MATERIALS AND METHODS

All the selected studies were evaluated using the Cochrane risk of bias tool, to assess the risk of bias for randomized controlled trials. A thorough search was conducted in April 2024 through PubMed and Web of Science to identify randomized clinical trials (RCTs) and comparative studies that assessed the effect of physical activity enhancing tissue perfusion. Data analysis was performed using RevMan v5.4., employing the Mantel-Haenszel method for dichotomous outcomes.

RESULTS

A total of nine studies compared changes in microcirculation before and after physical exercise in patients with DM. A meta-analysis of the data collected from seven studies estimated a mean difference of 4.87 (95 % CI 2.37-7.38) favouring the improvement of microvascular parameters post-exercise, with a minor level of heterogeneity (x2 = 10.54, df = 6, p = 0.1, I2 = 43 %) and a statistically significant difference between the two groups (p ≤ 0.001). However, a second evaluation, which included four studies involving patients with and without DM, indicated high heterogeneity (x2 = 661.32, df = 3, p ≤ 0.00001, I2 = 100 %) with no observable statistically significant differences between the two groups (p = 0.62).

CONCLUSION

Physical activity in patients with DM may be effective in improving blood microcirculation in the lower limbs.

Scoping review indicates heterogeneous methods for developing and integrating patient decision aids in the context of clinical practice guidelines

OBJECTIVES

To review the methods used to develop and integrate patient decision aids (PDAs) based on the recommendations of clinical practice guidelines (CPGs).

STUDY DESIGN AND SETTING

We conducted a scoping review covering bibliographic databases (PubMed, Embase; searched until December 2023), gray literature, references, and expert consultations to identify eligible documents. Documents published from 2000 onwards and describing methods related to guideline-based PDA development or linking CPGs and PDAs were included. Two reviewers independently selected and analyzed the documents. Results were synthesized and presented narratively.

RESULTS

Based on 24 included documents, we categorized their methods into 4 topics. For topic (1), the selection of CPG recommendations for which PDAs are (most) needed, we found a total of 14 selection factors across n = 11 documents, with uncertainty/variability in patient preferences and trade-offs between options being the most frequently mentioned. Topic (2) (n = 24) covers methods for developing and/or updating guideline-based PDAs, such as forming a multidisciplinary development group, using CPGs and their evidence summaries along with other sources as the evidence base, and using digital solutions for semi-automated development and updating. Topic (3) (n = 12) covers methods for PDA quality assessment and/or user testing, such as finalizing and approving the PDAs after a review and feedback process from the CPG group and an iterative user testing process. Topic (4) (n = 20) covers methods for linking CPGs and PDAs, often through digital strategies.

CONCLUSION

We identified heterogeneous methods for developing and integrating PDAs based on CPG recommendations. Empirical testing is required to determine the most useful and practically feasible (combination of) methods. CPG organizations should focus on establishing adequate methods for linking CPG and PDA development to foster shared decision-making.

Capturing the Additional Cardiovascular Benefits of SGLT2 Inhibitors and GLP-1 Receptor Agonists Beyond the Control of Traditional Risk Factors in People With Diabetes

OBJECTIVES

This study aimed to quantify the additional cardioprotective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) beyond the traditional risk factors control in individuals with type 2 diabetes. This helps calibrate the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes simulation model to capture the total cardiovascular benefits of new diabetes medications accurately.

METHODS

We extracted patient characteristics and treatment efficacy data from 4 cardiovascular outcome trials (CVOTs) of SGLT2is and 4 CVOTs of GLP-1RAs completed before May 2023. Using the BRAVO diabetes simulation model, we translated reductions in traditional risk factors (ie, glycated hemoglobin, systolic blood pressure, low-density lipids, and body mass index) from the newer drugs into risk reductions in cardiovascular outcomes (ie, myocardial infarction [MI], stroke, congestive heart failure [CHF], and mortality), assuming that the drug-associated risk reductions were only driven by traditional risk factors. Then, we compared the simulated risk-factor-driven risk reductions of cardiovascular outcomes with observed risk reductions from the trials and calculated drug-specific incremental benefits (DIB).

RESULTS

After accounting for the cardiovascular effects from traditional risk factors control, SGLT2is was associated with an additional 19% risk reduction in CHF (DIB: 0.81, 95% CI 0.72-0.90). Furthermore, the uncalibrated model predicted a risk reduction in stroke with SGLT2is, which was not observed in CVOTs. This discrepancy highlights the need for an SGLT2i-specific calibrator to align the simulation results with the observed outcomes. In contrast, no additional cardiovascular benefit was associated with GLP-1RAs after controlling for traditional risk factors.

CONCLUSIONS

Our study revealed that SGLT2is could further reduce CHF risk beyond the control of traditional risk factors but may offer additional pathways to offset the overall benefits of traditional risk factor control in stroke risk. No additional cardiovascular benefits were observed for GLP-1RAs beyond traditional risk factor control. The BRAVO model calibration enhances cardiovascular outcome prediction with these newer antidiabetic therapies.

Clinical Profile and Treatment Patterns in Individuals with Type 2 Diabetes and Chronic Kidney Disease Who Initiate a GLP-1 Receptor Agonist: A Multinational Cohort Study

INTRODUCTION

Novel therapies are emerging for the prevention of chronic kidney disease (CKD) progression in patients with type 2 diabetes (T2D). Within the FOUNTAIN platform (NCT05526157; EUPAS48148), this real-world study aimed to characterize cohorts of adults with CKD and T2D starting therapy with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in Europe, Japan, and the United States (US) during 2012-2021.

METHODS

This multinational, multicohort study was conducted in five data sources: the Danish National Health Registers (DNHR) (Denmark), PHARMO Data Network (PHARMO) (The Netherlands), Valencia Health System Integrated Database (VID) (Spain), Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex) (Japan), and Optum's de-identified Clinformatics® Data Mart Database (CDM) (US). Eligible patients had T2D (defined by data source-specific algorithms) and CKD (based on diagnosis codes, estimated glomerular filtration rate values, and/or urine albumin-to-creatinine ratio) and initiated an GLP-1 RA during 2012-2021. Baseline demographic, lifestyle, and clinical characteristics were analyzed, and treatment patterns were described.

RESULTS

Study cohorts included 18,929 GLP-1 RA initiators in DNHR; 476 in PHARMO; 11,798 in VID; 329 in J-CKD-DB-Ex; and 70,158 in CDM. Across cohorts, mean age ranged from 66.1 years in J-CKD-DB-Ex to 67.9 years in CDM, and between 46.6% (PHARMO) and 59.6% (J-CKD-DB-Ex) of patients were men. There was a steady increase in GLP-1 RA initiators from 2012 (when 1.6-4.8% of GLP-1 RA initiators started therapy) to 2019 (when 19.8-31.5% started therapy). The median duration of initial treatment with a GLP-1 RA ranged from 2.3 months (PHARMO) to 12.4 months (VID). At 1-year follow-up, between 52% (CDM) and 78% (DNHR) of patients were receiving treatment. Findings suggested that GLP-1 RA use was independent of CKD severity.

CONCLUSIONS

During 2012-2021, GLP-1 RA use steadily increased across multinational cohorts of patients with T2D and CKD, and persistence with treatment was high. GLP-1 use was independent of CKD severity.

A grip strength prediction tool for older adults based on logistic regression: construction, validation, and clinical application value

Handgrip strength is a key indicator of overall health in older adults, and its decline is linked to various adverse health outcomes. Despite numerous studies on factors influencing handgrip strength, few attempts have integrated multiple factors into a practical clinical tool. This study aims to develop and validate a nomogram based on a logistic regression model to predict the risk of low handgrip strength in older adults. Using data from the China Health and Retirement Longitudinal Study (CHARLS), 1138 participants were included. Firth-adjusted logistic regression identified predictors of low handgrip strength, with variable selection based on the Bayesian Information Criterion (BIC). Model performance was assessed using calibration curves, ROC curves, and decision curve analysis (DCA). Internal validation was performed with 10-fold cross-validation and bootstrapping, determining the optimal risk threshold. Key predictors identified included age, chronic disease history, marital status, lifestyle, education, BMI, activities of daily living, and glycated hemoglobin. The simplified model exhibited good discriminatory ability (AUC = 0.78) and calibration performance. The optimal threshold (0.40) yielded sensitivity of 72.5% and specificity of 69.8%. Decision curve analysis confirmed significant net benefit within the clinically relevant threshold range. The nomogram provides a practical tool for identifying at-risk individuals and guiding intervention, integrating modifiable and non-modifiable factors for personalized risk assessment and early intervention.

The impact of lifestyle factors across the life course on sarcopenia and physical frailty

PURPOSE OF REVIEW

Muscle health helps maintain locomotor capacity, a key component of intrinsic capacity, which is required for healthy ageing. Sarcopenia is characterized by the age-related decline in muscle mass and strength leading to impaired physical performance, and has been described as a biological substrate of physical frailty. Both sarcopenia and physical frailty share phenotypic features of weakness and slowness, lead to common adverse outcomes, and have potential for reversal through early identification and intervention. The purpose of this review is to present recent evidence for the impact of lifestyle interventions across the life course on sarcopenia and physical frailty.

RECENT FINDINGS

Resistance exercise alone or combined with balance and aerobic training as part of a multicomponent exercise program and high-quality diets incorporating adequate protein remain the mainstay of treatment for sarcopenia and physical frailty. Reducing sedentary time and increasing physical activity, adherence to Mediterranean diet, increasing vegetable and caffeinated beverage intake, cardiovascular risk factor modification, improving sleep hygiene and depressive symptoms may also contribute to slowing down age-related decline in muscle health.

SUMMARY

Lifestyle interventions such as physical activity, diet, sleep and mental health are effective against sarcopenia and physical frailty. Targeting lifestyle modifications in early to midlife may retard further decline in locomotor capacity and optimize intrinsic capacity of older persons, reducing the risk of sarcopenia, physical frailty and their attendant negative health outcomes.

Comparative risk of dementia in diabetic stroke patients prescribed SGLT2 vs. DPP-4 inhibitors: A propensity-matched retrospective cohort study

OBJECTIVE

Diabetes is a significant risk factor for both stroke and dementia. This study aimed to compare the risk of incident dementia between sodium-glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors in diabetic patients with a history of ischemic stroke.

MATERIALS

We conducted a propensity-matched retrospective cohort study using observational data from the TriNetX global federated health research network. Patients aged 18 years or older with type 2 diabetes (T2D) and a history of ischemic stroke, newly prescribed either an SGLT2 or DPP-4 inhibitor from July 1, 2013, to June 30, 2024, were included. Propensity score matching was employed to balance baseline characteristics between treatment groups. The primary outcome was incident dementia, with secondary outcomes including degenerative and vascular dementia.

RESULTS

After propensity score matching, each group consisted of 15901 patients. Over a mean follow-up of 2.52 years, SGLT2 inhibitor use was associated with lower risks of overall dementia (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.59-0.74), degenerative dementia (HR 0.68; 95% CI 0.60-0.76), and vascular dementia (HR 0.59, 95% CI 0.49-0.70) compared to DPP-4 inhibitor use. These findings remained consistent across various sensitivity and subgroup analyses.

CONCLUSIONS

In diabetic patients with a history of ischemic stroke, initiating SGLT2 inhibitors, compared to DPP-4 inhibitors, is associated with a lower risk of incident dementia. This association was observed for both degenerative and vascular dementias. These findings support the preferential use of SGLT2 inhibitors in this high-risk population, warranting further investigation through randomized clinical trials.

Residual inflammatory risk is associated with leukoaraiosis in patients with ischemic stroke

OBJECTIVE

Emerging evidence has highlighted the clinical significance of residual inflammation risk (RIR) in cardiovascular and cerebrovascular diseases, with studies demonstrating its association with disease recurrence and poor prognosis. This study aimed to investigate the relationship between RIR and leukoaraiosis (LA) severity in patients with ischemic stroke.

METHODS

In this observational cohort study, we classified patients into four groups based on low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) levels: RIR (LDL-C < 2.6 mmol/L and hsCRP ≥ 2 mg/L), residual cholesterol risk (RCR) (LDL-C ≥ 2.6 mmol/L and hsCRP < 2 mg/L), both risk or residual cholesterol and inflammatory risk (RCIR) (LDL-C ≥ 2.6 mmol/L and hsCRP ≥ 2 mg/L) and neither risk (LDL-C < 2.6 mmol/L and hsCRP < 2 mg/L). LA presence and severity were assessed using magnetic resonance imaging (MRI) and graded according to the Fazekas scale. Ordinal logistic regression analyses were performed to evaluate the association between RIR and LA severity.

RESULTS

Among 643 enrolled patients, 413 (64.2 %) exhibited LA. The distribution of patients across RIR, RCR, RCIR, and neither risk groups was 28.9 %, 19.8 %, 20.4 %, and 30.9 %, respectively. Comparative analysis revealed that LA patients exhibited significantly higher age (P < 0.001), elevated BMI (P < 0.001), increased hypertension prevalence (P = 0.004), greater RIR proportion (P < 0.001), and higher smoking rates (P = 0.007) compared to non-LA counterparts. Ordinal logistic regression analysis demonstrated that RIR (OR 1.447, 95 % CI 1.044-1.851, P < 0.001) was independently associated with the severity of LA after adjusting for multiple confounding variables. Subgroup analysis stratified by BMI further revealed that RIR (OR 2.994, 95 % CI 2.259-3.730, P < 0.001) was significantly correlated with LA severity in patients with a BMI ≥ 25.0.

CONCLUSIONS

These findings suggest that RIR may serve as an independent risk factor for LA in patients with ischemic stroke, particularly among those with a BMI ≥25.0.

Connection between Impaired Fasting Glucose or Type 2 Diabetes Mellitus and Sepsis: A 10-Year Observational Data from the National Health Screening Cohort

BACKGRUOUND

The mortality of sepsis without direct drugs is high. The association between prediabetes, based on a single fasting glucose (FG), or long-term type 2 diabetes mellitus (T2DM) and sepsis remains unclear.

METHODS

Of the adults aged ≥20 years who were included in the National Health Screening Program (NHSP) in 2009, 40% were randomly sampled. After excluding patients with type 1 diabetes mellitus, with missing information, and who were diagnosed with sepsis during the wash-out (between 2001 and the NHSP) or 1-year lag period, a cohort comprised of 3,863,323 examinees. Body mass index (BMI) measurements, FG tests, and self-reported questionnaires on health-related behaviors were conducted. Individual information was followed up until 2020 and censored upon the first occurrence of sepsis or death. The incidence of sepsis was compared using a multivariable regression adjusted for age, sex, income, BMI, smoking, drinking, physical activity levels, and chronic diseases.

RESULTS

The cohort was divided into those with normal FG (n=2,675,476), impaired fasting glucose (IFG) (n=890,402, 23.0%), T2DM <5 years (n=212,391, 5.5%), or T2DM for ≥5 years (n=85,054, 2.2%). The groups with IFG (adjusted hazard ratio [aHR], 1.03; 95% confidence interval [CI], 1.01 to 1.05), T2DM <5 years (aHR, 1.43; 95% CI, 1.40 to 1.47), and T2DM for ≥5 years (aHR, 1.82; 95% CI, 1.77 to 1.87) exhibited significantly higher incidence of sepsis (P<0.001), with the greatest risk in patients with T2DM aged <40 years (aHR, 1.96; 95% CI, 1.71 to 2.25).

CONCLUSION

Patients with long-standing and young-onset T2DM show a substantially high risk of sepsis, emphasizing the need for infection prevention and vaccination.

Hamman Syndrome Caused by a Sodium Glucose Cotransporter 2 Inhibitor in an Elderly Patient with Diabetes Which Mimicked of Boerhaave Syndrome

A 70-year-old man with diabetes was treated with a sodium glucose cotransporter 2 (SGLT2) inhibitor. He developed vomiting and epigastric pain and was diagnosed with diabetic ketoacidosis (DKA). Computed tomography (CT) revealed mediastinal emphysema. As Boerhaave syndrome could not be ruled out, treatment was initiated in parallel with DKA treatment. After the DKA healed, the mediastinal emphysema disappeared. DKA combined with mediastinal emphysema is known as Hamman syndrome. There have been no reports of Hamman syndrome in elderly patients with diabetes caused by SGLT2 inhibitors. His symptoms mimicked the course of Boerhaave syndrome, and such cases have a high risk of misdiagnosis.

Urogenital side effects in male subjects with type 2 diabetes treated with SGLT-2 inhibitors: A single centre, longitudinal observation

OBJECTIVE

SGLT-2 inhibitors (SGLT-2i) provide good glycaemic control and weight loss, ensuring clinically relevant cardiorenal benefits in subjects with and without type 2 diabetes (T2D); however, their use is related to an enhanced risk of urogenital infections, mainly in female subjects. We performed a prospective observation to assess incidence of urogenital complications in male sex new users of gliflozins.

SUBJECTS AND METHODS

In the 2021-2023 years, solely based on clinical indication, we started such therapy in 272 male T2D subjects; follow up visits were performed after about 1 year.

RESULTS

At follow up, 90 subjects had discontinued SGLT-2i; 36 of them (40 %) due to onset of urogenital symptoms. We observed 6 cases of phimosis. Subjects who discontinued the treatment due to these side effects had a higher BMI and a better eGFR at baseline and they were less frequently treated with DPP-IV inhibitors.

CONCLUSIONS

A proper evaluation of the patient's phenotype might be useful in identifying subjects less prone to develop side effects driving SGLT-2i discontinuation; the combined use of SGLT-2i and DPP-IV inhibitors appears to be associated to a better long-term compliance to therapy in men.

Macrophage exosomes mediate palmitic acid-induced metainflammation by transferring miR-3064-5p to target IκBα and activate NF-κB signaling

INTRODUCTION

High palmitic acid (PA) levels trigger metainflammation, facilitating the onset and progression of chronic metabolic diseases. Recently, exosomes were identified as new inflammation mediators. However, the mechanism by which macrophage exosomes mediate PA-induced inflammation remains unclear.

OBJECTIVES

To explore how PA induces metainflammation through macrophage exosomes.

METHODS

Exosomes secreted by RAW264.7 mouse macrophages stimulated with PA (ExosPA) or not (Exos) were prepared by ultracentrifugation. The differential miRNAs between ExosPA and Exos were identified by high-throughput sequencing, and their targeted mRNAs and proteins were bioinformatically analyzed and verified by qPCR and western blot. Mouse macrophages and metabolic cells (AML-12 hepatocytes, C2C12 myocytes or 3T3-L1 adipocytes) were treated with ExosPA or Exos. The verified miRNAs and its targeted molecules related to inflammation were analyzed in recipient cells. Furthers, exosomes were prepared from primary peritoneal macrophages isolated from AIN93G diet-fed (Control PM-Exos) or HPD-fed (PA PM-Exos) mice. Control or PA PM-Exos were then tail vein injected (30 μg) into mice (n = 10), once a week for 2 weeks. The verified miRNA and its targets in blood, blood exosomes, and metabolic tissues were detected. Finally, measured the levels of miRNA, inflammatory factors, and fatty acids in the blood of 20 obese/overweight individuals and 20 healthy individuals.

RESULTS

ExoPA activate NF-κB signaling and enhance inflammatory enzyme/cytokine production in macrophages and metabolic cells. ExoPA enrich miR-3064-5p and target to inhibit IκBα as verified by exosome inhibitors and miR-3064-5p mimics and inhibitors. HPD elevates exosomal miR-3064-5p, macrophage exosomal miR-3064-5p, and inflammatory cytokine levels in mice circulation. PA PM-Exos from HPD-fed mice triggered inflammation in the circulation and metabolic tissues/organs of chow diet-fed mice. Overweight/obese individuals exhibit increased levels of circulating palmitoleic acid, exosomal miR-3064-5p, and high-sensitivity C-reactive proteins.

CONCLUSIONS

Macrophage exosomes transferring miR-3064-5p to target IκBα and activate NF-κB signaling in metabolic cells is a mechanism of PA-induced metainflammation.

Global research trends in perioperative care for diabetic patients: a bibliometric and visualized study

Perioperative management in diabetic patients is important since their postoperative mortality and morbidity are higher than that of non-diabetic patients, which will exacerbate the burden on public health. We selected relevant publications from the WoSCC-SCIE between 2007 and 2024, utilizing VOSviewer and CiteSpace to analyze the collected information and generate knowledge maps. A total of 3167 articles from 792 journals and 83 countries/regions were included for analysis. Overall, there has been a continuous increase in publication volume. From the result of academic collaboration between different countries/regions and institutions, the USA occupies a central position in research strength. A total of 18,101 authors participated in research on "perioperative management in diabetic patients" with Dr. Guillermo E. Umpierrez from Emory University School of Medicine being the most productive author. We conclude that perioperative adverse clinical outcomes in diabetic patients and perioperative blood glucose management have consistently been research hotspots in this field. Additionally, continuous glucose monitoring and insulin administration under computer guidance, as well as the use of merging medications are likely to be frontier directions for future research. Research on perioperative care for diabetic patients has been further deepened worldwide, which will be crucial in further improving perioperative care for diabetic patients and enhancing postoperative recovery.

Building capacity for genomics in primary care: a scoping review of practitioner attitudes, education needs, and enablers

Introduction

Improving clinical capacity for genomics in primary care promises to lead to better health, but genomics uptake in the sector is slow and patchy. This review aimed to identify the attitudes of primary care practitioners (PCPs) and the education needs and enablers in applying genomics to inform priorities in education and implementation.

Methods

Searches were conducted across Medline, Scopus, CINAHL, Embase, and Cochrane CENTRAL until November 2023. Barriers and enablers were mapped to the Theoretical Domains Framework and the Genomic Medicine Integrative Research Framework.

Results

A total of 52 studies were included, and the most frequently mapped domains from the Theoretical Domains Framework were 'Knowledge' (65.4% of papers), 'Environmental context and resources' (40.4%), 'Skills' (38.5%), and 'Social/professional role and identity' (32.7%). Four key implications were identified: knowledge as a major barrier and enabler, education to build capacity, uncertainty about the role of PCPs, and additional needs beyond education alone.

Discussion

While PCPs are optimistic about genomics, long-standing barriers to delivery in primary care remain. Multifaceted, evidence-based education strategies, including interactive components to change behaviour, will help to address barriers. Clarifying the role of PCPs, referral pathways, and collaboration with tertiary genetics services will further build capacity for genomics delivery in primary care.

Falls among older adults: An exploration of trends, clinical outcomes, predisposing risk factors, and intervention strategies

BACKGROUND

The aim of this study is to evaluate fall trends, risk factors, and interventions aimed at reducing falls in older adult trauma patients in the healthcare & community settings in the United States.

METHODS

A review was conducted utilizing PubMed, ProQuest, Cochrane, and Google Scholar search databases to identify relevant articles published prior to July 7, 2024. Studies were included if they assessed falls among the older adult population aged 55 years and older.

RESULTS

A total of 29 studies assessed met the inclusion criteria. Despite decreasing fall incidence in the community and hospital setting, fall-associated injuries, hospitalizations, and mortality in older adults have increased. Common predisposing factors for falls among older adults in the community and healthcare settings include advanced age, history of falls, recent hospitalization, and comorbid conditions affecting cognition, gait, and visual acuity. Interventions including strengthening exercise programs and individualized multifactorial plans reduced falls and fall-associated injuries in most studies.

CONCLUSION

Recent years demonstrated an increase in fall-associated injuries, hospitalizations, and mortality which underscores the urgent need for targeted multifactorial interventions.

NOR-1 Overexpression Elevates Myoglobin Expression via PERM1 and Enhances Mitochondrial Function and Endurance in Skeletal Muscles of Aged Mice

Skeletal muscle health and function deteriorate with age, ultimately leading to impaired mobility and disability. Exercise is among the most effective interventions to mitigate muscle dysfunction in aging and reverse deficits. However, low attrition and an impaired capacity to exercise may limit its utility in improving muscle function in aged persons. Therefore, it is crucial to advance our mechanistic understanding of the molecular transducers of exercise to identify new and innovative drug targets to improve muscle health. Transcriptomic profiling of the human response to exercise has revealed that the nuclear receptor NR4A3 (NOR-1) is among the most responsive genes to acute exercise. Previously, we observed that in vitro knockdown of NOR-1 alters metabolic signaling in C2C12 myotubes. Specifically, we found that expression of PERM1, CKMT2, myoglobin, and mTORC1 signaling were perturbed during the knockdown of NOR-1. Herein, we extend these findings and observe that a NOR-1-PERM1-myoglobin axis regulates myoglobin expression in vitro. Furthermore, we found that aging is associated with reduced skeletal muscle NOR-1 expression. Although it is well known that exercise improves aged muscle function, whether overexpression of the exercise-responsive gene NOR-1 can confer benefits and improve muscle function in an aged context has not been evaluated. We found that the overexpression of NOR-1 in aged muscle results in enhanced muscle endurance, mitochondrial respiration, and elevated expression of NOR-1 responsive genes that we previously identified in loss of function studies. However, we also observed that overexpression of NOR-1 did not improve maximal muscle torque production and resulted in a small but significant loss of muscle wet weight that was concomitant with elevated autophagy signaling. Our data suggest that NOR-1 expression may reduce muscle fatigability and that NOR-1 drives myoglobin expression in a PERM1-dependent manner.

The effect of Kuiyuan chewing tablet on hyperuricemia: protocol for a randomized, double-blind, multicenter, parallel-controlled trial

Background

Hyperuricemia (HUA) is a metabolic disorder characterized by elevated serum uric acid levels resulting from dysfunction in purine metabolism and/or inadequate uric acid excretion. It is an independent risk factor for many chronic diseases and is associated with a poor long-term prognosis. Existing uric acid-lowering drugs often lead to numerous adverse reactions, resulting in poor patient compliance and limited clinical application. Therefore, this study aims to investigate the effect of Kuiyuan Chewing Tablet (KYCT) on serum uric acid (SUA) levels in patients with HUA, and to seek a safe alternative therapy for reducing uric acid.

Methods and analysis

This study is a multicenter, randomized, double-blind, parallel-controlled trial. HUA patients who meet the inclusion criteria will be randomly assigned in a 1:1 ratio to either (1) the control group (placebo of KYCT, specifications: 0.3g per tablet, 1.2g per dose, twice a day, taken with warm water 30 minutes after meals) or (2) the experimental group (KYCT, specifications: 0.3g per tablet, 1.2g per dose, twice a day, taken with warm water 30 minutes after meals). Both groups will receive dietary control, comorbidity prevention, and health education during the intervention period. The primary outcome will be the proportion of subjects with SUA levels <420 umol/L. Secondary outcomes will include the proportion of subjects with SUA levels <360 umol/L, the percentage change in SUA levels from baseline to each visit, the maximum percentage change in SUA levels from baseline to the third month, the number of gout attacks, changes in body measurements (weight, waist circumference, hip circumference, BMI), blood pressure, blood lipids, fasting blood glucose levels, and the proportion of subjects reporting gout attacks (cumulative up to each visit). Each group of patients will be assessed at baseline, as well as at the 4th, 8th, and 12th weeks.

Discussion

This study aims to evaluate the effects of a 12-week treatment with KYCT on patients with HUA. We hypothesize that compared to placebo, KYCT would significantly improve SUA levels without provoking significant adverse reactions. These findings potentially pave the way for a safe and effective alternative therapy for HUA.