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Miao S, Yang L. Association between diabetes mellitus and miscarriage, recurrent miscarriage: A meta-study. J Obstet Gynaecol Res 2024. [PMID: 39315484 DOI: 10.1111/jog.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 09/06/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Previous studies provided inconsistent associations between diabetes mellitus (DM) and miscarriage, recurrent miscarriage (RM). Therefore, this study aims to evaluate the association between DM and miscarriage, specifically RM, through a meta-analysis approach. METHODS We searched for articles published before July 2023 in PubMed and Web of Science databases. STATA 12.0 software was used to compute all the results collected from included studies. RESULTS DM was associated with a higher risk of miscarriage, RM (miscarriage: odds ratio [OR]/relative risk [RR] = 1.23, 95% confidence interval [CI] 1.13 to 1.34; RM: OR/RR = 1.73, 95% CI 1.55 to 1.94). T1DM was associated with a higher risk of miscarriage (OR/RR = 1.16, 95% CI 1.07 to 1.26). Similarly, T2DM showed a higher risk of miscarriage (OR/RR = 1.44, 95% CI 1.23 to 1.68). Miscarriage, RM were associated with a higher risk of DM (miscarriage: OR/RR = 1.14, 95% CI 1.08 to 1.19; RM: OR/RR = 1.14, 95% CI 1.08 to 1.20). Furthermore, miscarriage was found to be associated with a higher risk of T2DM (OR/RR = 1.08, 95% CI 1.05 to 1.11). CONCLUSION In conclusion, our meta-analysis findings indicate a significant association between DM and miscarriages as well as RM. As a result, women with a history of miscarriage should consider regular monitoring of their metabolic health as a potential benefit. Nevertheless, it is important to note that further research is needed to validate the results of our study and shed light on the biological mechanisms underlying these associations.
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Affiliation(s)
- Suying Miao
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
- Department of Obstetrics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Liwei Yang
- Department of Obstetrics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
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Yang X, Wang R, Zhang W, Yang Y, Wang F. Predicting risk of the subsequent early pregnancy loss in women with recurrent pregnancy loss based on preconception data. BMC Womens Health 2024; 24:381. [PMID: 38956627 PMCID: PMC11218098 DOI: 10.1186/s12905-024-03206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND For women who have experienced recurrent pregnancy loss (RPL), it is crucial not only to treat them but also to evaluate the risk of recurrence. The study aimed to develop a risk predictive model to predict the subsequent early pregnancy loss (EPL) in women with RPL based on preconception data. METHODS A prospective, dynamic population cohort study was carried out at the Second Hospital of Lanzhou University. From September 2019 to December 2022, a total of 1050 non-pregnant women with RPL were participated. By December 2023, 605 women had subsequent pregnancy outcomes and were randomly divided into training and validation group by 3:1 ratio. In the training group, univariable screening was performed on RPL patients with subsequent EPL outcome. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were utilized to select variables, respectively. Subsequent EPL prediction model was constructed using generalize linear model (GLM), gradient boosting machine (GBM), random forest (RF), and deep learning (DP). The variables selected by LASSO regression and multivariate logistic regression were then established and compared using the best prediction model. The AUC, calibration curve, and decision curve (DCA) were performed to assess the prediction performances of the best model. The best model was validated using the validation group. Finally, a nomogram was established based on the best predictive features. RESULTS In the training group, the GBM model achieved the best performance with the highest AUC (0.805). The AUC between the variables screened by the LASSO regression (16-variables) and logistic regression (9-variables) models showed no significant difference (AUC: 0.805 vs. 0.777, P = 0.1498). Meanwhile, the 9-variable model displayed a well discrimination performance in the validation group, with an AUC value of 0.781 (95%CI 0.702, 0.843). The DCA showed the model performed well and was feasible for making beneficial clinical decisions. Calibration curves revealed the goodness of fit between the predicted values by the model and the actual values, the Hosmer-Lemeshow test was 7.427, and P = 0.505. CONCLUSIONS Predicting subsequent EPL in RPL patients using the GBM model has important clinical implications. Future prospective studies are needed to verify the clinical applicability. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry with the registration number of ChiCTR2000039414 (27/10/2020).
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Affiliation(s)
- Xin Yang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Ruifang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, 730030, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, 471003, China
| | - Wei Zhang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Yanting Yang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Fang Wang
- Department of Reproductive Medicine, Lanzhou University Second Hospital, Lanzhou, 730030, China.
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Nisa M, Laila S, Muzzamil M, Ghafoor A, Zakir N, Zulfiqar T, Malik A, Malikzai A. "Translation, cultural adaptation, and validation of perinatal grief scale in Urdu: Addressing a gap in the research of perinatal loss in Pakistan-Cross-sectional validation study". Health Sci Rep 2024; 7:e1999. [PMID: 38605729 PMCID: PMC11007656 DOI: 10.1002/hsr2.1999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/05/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
Background and Aims Perinatal grief have a significant influence on maternal mental health, hence appropriate tools for assessment are necessary. In this study, we translated and validated the Perinatal Grief Scale in Urdu (PGS-Urdu) for use in Pakistan, therefore filling the gap in validated tools. Methods Data was collected from 165 women using consecutive sampling. Initially, "forward/backward" translation was used. For validity, content validity index and confirmatory factor analysis (CFA) were used respectively, and "Cronbach's-Alpha" for reliability. In the validity stage, items 8, 11, 23, and 32 of the original scale were eliminated based on feedback from the target groups and the expert panel. For data-analysis, SPSS 26 and Amos 26 were used. Results In analyzing the "Confirmatory factor analysis", the "all-fitness indicators" validated the three-factor structure of 29-item main scale. Cronbach alpha value was 0.83 for the entire scale The CFA results showed that all fitness indicators, with the exception of four, had loadings greater than 0.20, supporting the main scale's three-factor structure. With a Cronbach's Alpha value of 0.83 for overall reliability, and varied from 0.81 to 0.87 for the PGS-U variables. the PGS-U exhibits an acceptable level of internal consistency. Conclusion The PGS-U identifies women in perinatal grief for medical and social care. This research supports using the Urdu perinatal grief scale in obstetrics and bereavement counseling to reduce maternal mental health issues.
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Affiliation(s)
| | | | | | | | - Najma Zakir
- Department of BiosciencesCOMSATS University IslamabadIslamabadPakistan
| | - Tehzeeb Zulfiqar
- Department of Applied EpidemiologyNational Centre for Epidemiology and Population Health, ANU College of Health and Medicine the Australian National UniversityCanberraAustralia
| | - Abid Malik
- Health Services AcademyIslamabadPakistan
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Jia D, Sun F, Han S, Lu L, Sun Y, Song Q. Adverse outcomes in subsequent pregnancies in women with history of recurrent spontaneous abortion: A meta-analysis. J Obstet Gynaecol Res 2024; 50:281-297. [PMID: 38073001 DOI: 10.1111/jog.15848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/26/2023] [Indexed: 03/04/2024]
Abstract
OBJECTIVE This study aimed to investigate the association between a history of recurrent spontaneous abortion (RSA) and adverse outcomes in women with spontaneous conception. METHODS A search strategy from the inception to March 3, 2023 was run in PubMed, Embase, Cochrane Library, and Web of Science databases. The odds ratio (OR), and the 95% confidence interval (CI) or point estimation were used as the evaluation indexes. Each outcome measure tested was assessed for heterogeneity using the Cochran Q test. Sensitivity analyses were performed to test the credibility of the meta-analysis results. RESULTS Fifteen studies involving 1 475 389 pregnant women were included. A history of RSA was associated with gestational diabetes (OR: 2.21, 95% CI: 1.70-2.87, p < 0.001), preeclampsia (OR: 2.06, 95% CI: 1.49-2.86, p < 0.001), placenta previa (OR: 1.82, 95% CI: 1.09-3.02, p = 0.021), placental abruption (OR: 1.67, 95% CI: 1.36-2.06, p < 0.001), miscarriage (OR: 6.37, 95% CI: 3.83-10.57, p < 0.001), preterm birth (OR: 1.80, 95% CI: 1.36-2.37, p < 0.001), cesarean section (OR: 1.47, 95% CI: (1.13-1.91, p = 0.004), perinatal death (OR: 2.24, 95% CI: 1.39-3.60, p = 0.001), and neonatal intensive care unit admission (OR: 1.39, 95% CI: 1.01-1.92, p = 0.047). However, the associations of a history of RSA with gestational hypertension, small for gestational age, fetal anomalies, fetal growth restriction, and postpartum hemorrhage were not observed. CONCLUSION This meta-analysis indicates a history of RSA was associated with increased risks of several adverse outcomes in pregnant women with spontaneous conception.
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Affiliation(s)
- Dan Jia
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Fengdan Sun
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Sisi Han
- Department of Gynecology, Qingdao Women's and Children's Hospital, Qingdao, Shandong Province, People's Republic of China
| | - Lijuan Lu
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Yuanyuan Sun
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Qingxia Song
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
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Zhu F, Noordermeer D, Aribas E, Bos M, Boersma E, Kavousi M. Metabolic disorders mediate the relation of miscarriage with cardiovascular diseases. Eur J Prev Cardiol 2024; 31:330-336. [PMID: 37939791 DOI: 10.1093/eurjpc/zwad347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/18/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
AIMS The extent to which the contribution of pregnancy loss to cardiovascular diseases (CVDs) can be explained by metabolic disorders is poorly elucidated but holds insights for reducing long-term cardiovascular risk. The aim of this study is to investigate the mediating effects of hypertension, diabetes mellitus (DM), and lipoprotein metabolism disorders on the association of miscarriage and stillbirth with coronary heart disease (CHD), stroke, heart failure, atrial fibrillation, and composite outcomes. METHODS AND RESULTS A total of 163 283 ever-gravid women (age 55.3 ± 7.9 years) from the UK Biobank cohort without established metabolic disorders and CVDs were included and followed from 2007 to 2010 baseline until December 2020. Causal mediation analyses were used to estimate the proportion mediated. Hypertension mediated 11.1% (95% confidence interval, 3.7-18.5%) of the association between a history of miscarriage and incident CHD. Approximately, 9.5% (4.1-14.8%) of the effect of recurrent miscarriages on incident CHD was via hypertension, 8.4% (2.5-14.3%) of the effect was via lipoprotein metabolism disorders, 1.7% (0.5-2.9%) of the effect was via DM, and 10.7% (0.2-21.1%) of the effect of recurrent miscarriages on incident stroke was via hypertension. Hypertension mediated the largest proportion of effect for the atherosclerotic cardiovascular event (15.5% for a history of miscarriage and 9.4% for recurrent miscarriages), followed by lipoprotein metabolism disorders and DM. CONCLUSION Hypertension, DM, and lipoprotein metabolism disorders mediated the association between miscarriage and various cardiovascular outcomes in later life. In particular, hypertension mediated a large proportion of the relationship between miscarriage and atherosclerotic CVD.
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Affiliation(s)
- Fang Zhu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Daniëlle Noordermeer
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Maxime Bos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
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Bae JH, Jung YM, Lee J, Shivakumar M, Park CW, Park JS, Jun JK, Kim D, Kim SK, Lee SM. Future risk of metabolic syndrome after recurrent pregnancy loss: a cohort study using UK Biobank. Fertil Steril 2023; 120:1227-1233. [PMID: 38008468 DOI: 10.1016/j.fertnstert.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To evaluate the risk of metabolic syndrome (MS) after recurrent pregnancy loss (RPL) using UK Biobank data. A history of pregnancy loss is associated with the development of cardiovascular diseases in the future. However, the association between RPL and subsequent MS is poorly understood. Therefore, we aimed to check the risk of MS after RPL. DESIGN The study population was divided into 2 groups according to reproductive history: women with a history of RPL and women without a history of RPL. Recurrent pregnancy loss was defined as 2 or more spontaneous miscarriages, and MS was defined as at least 3 of the following: abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol levels, high-blood pressure, and hyperglycemia. SETTING UK Biobank resource. PATIENTS The UK Biobank is a prospective cohort study that enrolled individuals aged between 40 and 69 years whose medical and reproductive histories were retrieved at enrollment. In this cohort, only women with a history of at least one pregnancy were selected. INTERVENTIONS Recurrent pregnancy loss. MAIN OUTCOME MEASURES The primary outcome was the prevalence of MS. The secondary outcomes were 5 diagnostic components of MS. RESULTS We analyzed 228,674 women, including 15,702 with a history of RPL and 212,972 without a history of RPL. Women with a history of RPL have a higher prevalence of MS between the ages of 40 and 60 years (33.0% vs. 31.5%). After adjusting for covariates (age, race, number of live births, early menopause, smoking, alcohol consumption, and physical activity), the increased risk of MS after RPL remained significant (adjusted odds ratio, 1.10; 95% confidence interval, 1.06-1.15). Furthermore, in the analysis of the 5 diagnostic components of MS, a history of RPL significantly increased the risk of abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol levels, and hyperglycemia. CONCLUSION Middle-aged women with a history of RPL have an increased risk of MS.
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Affiliation(s)
- Ji Hye Bae
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea; Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jeesun Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Manu Shivakumar
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Dokyoon Kim
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea; Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea.
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Zhao Y, Liang X, Wang J, Baima K, Nima Q, Gao Y, Yin J, Liu Q, Zhao X. Association between pregnancy termination history and metabolic syndrome in southwestern Chinese women: modification effect of physical activity. Hum Reprod 2023:dead124. [PMID: 37366630 DOI: 10.1093/humrep/dead124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
STUDY QUESTION Is there a relationship between pregnancy termination history and metabolic syndrome (MetS), and if so, is the relationship moderated by physical activity (PA)? SUMMARY ANSWER Induced abortion, and both miscarriage and induced abortion, increased the risk of MetS, while leisure PA attenuated the effects of induced abortion, and both miscarriage and induced abortion, on the risk of MetS. WHAT IS KNOWN ALREADY Pregnancy termination history is a risk factor for cardiovascular disease, but studies on women's history of pregnancy termination and MetS are limited. PA is a preventive behavior for MetS, but its modification effect on any association between pregnancy termination history and MetS is unknown. STUDY DESIGN, SIZE, DURATION The cross-sectional study included 53 702 women (age range of 30-79 years old) from southwestern China who participated in the China Multi-Ethnic Cohort (CMEC) study from May 2018 to September 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants self-reported both the number and type of pregnancy termination. PA was assessed primarily by asking participants about the cumulative time they spent doing PA either as their occupation, transportation, housework, and leisure activity in the past year. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. MAIN RESULTS AND THE ROLE OF CHANCE After adjusting for all confounders, the risk of MetS was significantly increased in women who experienced induced abortion alone, and both miscarriage and induced abortion, with odds ratios (ORs) of 1.08 (95% CI = 1.03-1.13) and 1.20 (95% CI = 1.08-1.33), respectively. A dose-response relationship was observed between the number of induced abortions and MetS, with the risk increasing by 3.0% for every additional induced abortion (OR = 1.03, 95% CI = 1.01-1.05). Leisure PA had a significant modification effect on the relationship between pregnancy termination history and MetS, as leisure PA attenuates the negative effects of induced abortion on MetS. LIMITATIONS, REASONS FOR CAUTION Causality cannot be established in this study. Information on pregnancy termination and PA was collected by self-report, which might be subject to recall bias. WIDER IMPLICATIONS OF THE FINDINGS A history of induced abortion was associated with an increased risk of MetS, and the risk increased with the number of induced abortions. Leisure PA attenuated the negative effect of induced abortion on MetS, whereas occupational and transportation PA amplified the negative effect of induced abortion on glucose. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Key R&D Program of China (grant no.: 2017YFC0907300) and the National Nature Science Foundation of China (grant no.: 82273745). The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Ying Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xian Liang
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Junhua Wang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Kangzhuo Baima
- Division of Pulmonary Diseases, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
- School of Medicine, Tibet University, Lhasa, China
| | - Qucuo Nima
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | - Yang Gao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Jianzhong Yin
- Baoshan College of Traditional Chinese Medicine, Baoshan, China
- Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming, China
| | - Qiaolan Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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