The risk of both osteoporosis and sarcopenia is high in inflammatory diseases, but there have been few reports of psoriatic arthritis (PsA). This study aimed to evaluate the rate of sarcopenia and osteoporosis, and the association of sarcopenia with osteoporosis in patients with PsA at our institution.
Methods
The data in this study were extracted from 320 patients with PsA meeting CASPAR criteria diagnosed between January 2010 and December 2021. The 156 patients who had undergone body composition measurements with dual-energy X-ray absorptiometry were included.
Results
Overall, the rate of sarcopenia and presarcopenia were 5.1% and 16.7%. Body mass index (BMI) was significantly lower in the presarcopenia and sarcopenia group. Furthermore, the presarcopenia and sarcopenia group had a significantly lower T-score in all regions. Multivariate analysis of the determinants of T-score for each site showed that SMI was significantly involved for the lumbar spine and the femoral neck, and BMI and rheumatoid factor positivity for the total hip.
Conclusions
In patients with PsA, the rate of sarcopenia was 5.1%. Osteoporosis rates for males and females were 5.7% and 7.5%, respectively. SMI, T-score, and BMI are significantly correlated with each other and should be considered in clinical practice.
{"title":"Sarcopenia and osteoporosis in patients with psoriatic arthritis: A single-center retrospective study","authors":"Kenji Takami M.D. , Mari Higashiyama M.D., Ph.D. , Shigeyoshi Tsuji M.D., Ph.D.","doi":"10.1016/j.nut.2024.112595","DOIUrl":"10.1016/j.nut.2024.112595","url":null,"abstract":"<div><h3>Objective</h3><div>The risk of both osteoporosis and sarcopenia is high in inflammatory diseases, but there have been few reports of psoriatic arthritis (PsA). This study aimed to evaluate the rate of sarcopenia and osteoporosis, and the association of sarcopenia with osteoporosis in patients with PsA at our institution.</div></div><div><h3>Methods</h3><div>The data in this study were extracted from 320 patients with PsA meeting CASPAR criteria diagnosed between January 2010 and December 2021. The 156 patients who had undergone body composition measurements with dual-energy X-ray absorptiometry were included.</div></div><div><h3>Results</h3><div>Overall, the rate of sarcopenia and presarcopenia were 5.1% and 16.7%. Body mass index (BMI) was significantly lower in the presarcopenia and sarcopenia group. Furthermore, the presarcopenia and sarcopenia group had a significantly lower T-score in all regions. Multivariate analysis of the determinants of T-score for each site showed that SMI was significantly involved for the lumbar spine and the femoral neck, and BMI and rheumatoid factor positivity for the total hip.</div></div><div><h3>Conclusions</h3><div>In patients with PsA, the rate of sarcopenia was 5.1%. Osteoporosis rates for males and females were 5.7% and 7.5%, respectively. SMI, T-score, and BMI are significantly correlated with each other and should be considered in clinical practice.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112595"},"PeriodicalIF":3.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.nut.2024.112597
Shanjun Tan M.D., Ph.D., Qiulei Xi M.D., Ph.D., Zhige Zhang M.D., Mingyue Yan M.D., Qingyang Meng M.D., Ph.D., Qiulin Zhuang M.D., Ph.D., Guohao Wu M.D., Ph.D.
Background and aims
Nutritional support after hospital discharge was found to enhance the nutritional condition of patients after cancer surgery. However, the effect of such support on long-term clinical outcomes is controversial. We thus investigated the effect of nutritional support after hospital discharge on long-term clinical outcomes in patients after gastric cancer surgery.
Methods
This was a secondary analysis on individuals at nutritional risk who underwent gastric cancer surgery and were included in a randomized controlled trial. The intervention group received oral nutritional supplements combined with dietary advice, and the control group received dietary advice alone. The long-term mortality (primary outcome) and other clinical outcomes were compared between the groups.
Results
In total, 321 patients were included in this analysis, with a median follow-up duration of 60.5 months. According to the Nutritional Risk Screening 2002 (NRS 2002), the presence of nutritional risk was found to be a significant predictor of death. This association remained independent even after adjusting for age, sex, comorbidity, and American Joint Committee on Cancer stage. The adjusted hazard ratio for mortality increased by 1.30 (95% confidence interval [CI] 1.05–1.60, P = 0.016) for each additional point rise in NRS. During the follow-up, a total of 64 individuals (39.5%) in the intervention group and 81 patients (50.9%) in the control group died. Consequently, the adjusted hazard ratio for mortality between the two groups was 0.69 (95% CI 0.50–0.96, P = 0.026). The results of interaction tests did not yield statistically significant variations in fatality rates across the age, sex, comorbidity, NRS, and American Joint Committee on Cancer stage subgroups. Nutritional support after hospital discharge significantly improved handgrip strength (adjusted coefficient 5.05, 95% CI 3.01–7.08, P = 0.000) in addition to other functional outcomes.
Conclusions
Nutritional support after hospital discharge reduced long-term mortality and improved handgrip strength among patients at nutritional risk after gastric cancer surgery. The current investigation provides evidence for the recommendation of nutritional support, for post-surgery patients after hospital discharge, in cancer management guidelines.
{"title":"Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial","authors":"Shanjun Tan M.D., Ph.D., Qiulei Xi M.D., Ph.D., Zhige Zhang M.D., Mingyue Yan M.D., Qingyang Meng M.D., Ph.D., Qiulin Zhuang M.D., Ph.D., Guohao Wu M.D., Ph.D.","doi":"10.1016/j.nut.2024.112597","DOIUrl":"10.1016/j.nut.2024.112597","url":null,"abstract":"<div><h3>Background and aims</h3><div>Nutritional support after hospital discharge was found to enhance the nutritional condition of patients after cancer surgery. However, the effect of such support on long-term clinical outcomes is controversial. We thus investigated the effect of nutritional support after hospital discharge on long-term clinical outcomes in patients after gastric cancer surgery.</div></div><div><h3>Methods</h3><div>This was a secondary analysis on individuals at nutritional risk who underwent gastric cancer surgery and were included in a randomized controlled trial. The intervention group received oral nutritional supplements combined with dietary advice, and the control group received dietary advice alone. The long-term mortality (primary outcome) and other clinical outcomes were compared between the groups.</div></div><div><h3>Results</h3><div>In total, 321 patients were included in this analysis, with a median follow-up duration of 60.5 months. According to the Nutritional Risk Screening 2002 (NRS 2002), the presence of nutritional risk was found to be a significant predictor of death. This association remained independent even after adjusting for age, sex, comorbidity, and American Joint Committee on Cancer stage. The adjusted hazard ratio for mortality increased by 1.30 (95% confidence interval [CI] 1.05–1.60, <em>P</em> = 0.016) for each additional point rise in NRS. During the follow-up, a total of 64 individuals (39.5%) in the intervention group and 81 patients (50.9%) in the control group died. Consequently, the adjusted hazard ratio for mortality between the two groups was 0.69 (95% CI 0.50–0.96, <em>P</em> = 0.026). The results of interaction tests did not yield statistically significant variations in fatality rates across the age, sex, comorbidity, NRS, and American Joint Committee on Cancer stage subgroups. Nutritional support after hospital discharge significantly improved handgrip strength (adjusted coefficient 5.05, 95% CI 3.01–7.08, <em>P</em> = 0.000) in addition to other functional outcomes.</div></div><div><h3>Conclusions</h3><div>Nutritional support after hospital discharge reduced long-term mortality and improved handgrip strength among patients at nutritional risk after gastric cancer surgery. The current investigation provides evidence for the recommendation of nutritional support, for post-surgery patients after hospital discharge, in cancer management guidelines.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112597"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.nut.2024.112602
Ana Maria dos S. Rodrigues Ph.D. , Laís B. Martins Ph.D. , Gabriela B.P. Fagundes Ph.D. , Jenneffer R.B. Tibaes Ph.D. , Matheus H.A. Amaral B.S. , Érica Leandro M. Vieira Ph.D. , Marina C. Oliveira Ph.D. , Maria Isabel T.D. Correia Ph.D. , Adaliene V.M. Ferreira Ph.D.
Objectives
We aimed to evaluate the acute effect of a fructose-rich single meal on metabolic and inflammatory biomarkers
Research Methods and Procedures
This single-center, double-masked, randomized crossover trial recruited females aged 20 to 47 with a normal body mass index and was conducted at Hospital das Clínicas (Belo Horizonte, MG, Brazil). Participants received a standardized meal with either sucrose, glucose, or a fructose overload. Blood samples were collected after overnight fasting (baseline) and at 30, 60, 120, and 240 minutes postprandial. Serum levels of glucose, triglycerides (primary outcome), total cholesterol, alanine aminotransferase, aspartate aminotransferase, adiponectin, leptin, resistin, interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-17, interferon-gamma, tumor necrosis factor, eotaxin, and total blood leukocytes were measured.
Results
This trial was completed with 25 enrolled participants, and three dropped out. The per-protocol analysis included 22 participants. As expected, postprandial glycemia increased 30 minutes after consuming meals rich in sucrose (P = 0.045) or glucose (P < 0.001). Triglyceride and leucocyte concentrations increased only at 240 minutes after consuming a high-fructose meal (P < 0.05). Regardless of the type of carbohydrate overload, leptin concentrations decreased postprandially compared to baseline at all time points (P < 0.05). Four participants reported adverse events after consuming the standardized meal with glucose or fructose, including nausea and malaise.
Conclusions
Our findings indicate that a fructose-rich single meal leads to a more significant increase in triglyceride and leukocyte concentrations compared to glucose and sucrose in healthy women. These findings support concerns regarding the potential inflammatory and metabolic dysfunction associated with frequent consumption of high-fructose meals.
{"title":"Acute inflammatory and metabolic effect of high fructose intake in normal-weight women: A randomized, double-masked, crossover trial","authors":"Ana Maria dos S. Rodrigues Ph.D. , Laís B. Martins Ph.D. , Gabriela B.P. Fagundes Ph.D. , Jenneffer R.B. Tibaes Ph.D. , Matheus H.A. Amaral B.S. , Érica Leandro M. Vieira Ph.D. , Marina C. Oliveira Ph.D. , Maria Isabel T.D. Correia Ph.D. , Adaliene V.M. Ferreira Ph.D.","doi":"10.1016/j.nut.2024.112602","DOIUrl":"10.1016/j.nut.2024.112602","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate the acute effect of a fructose-rich single meal on metabolic and inflammatory biomarkers</div></div><div><h3>Research Methods and Procedures</h3><div>This single-center, double-masked, randomized crossover trial recruited females aged 20 to 47 with a normal body mass index and was conducted at Hospital das Clínicas (Belo Horizonte, MG, Brazil). Participants received a standardized meal with either sucrose, glucose, or a fructose overload. Blood samples were collected after overnight fasting (baseline) and at 30, 60, 120, and 240 minutes postprandial. Serum levels of glucose, triglycerides (primary outcome), total cholesterol, alanine aminotransferase, aspartate aminotransferase, adiponectin, leptin, resistin, interleukin (IL)-2, IL-4, IL-5, IL-6, IL-10, IL-17, interferon-gamma, tumor necrosis factor, eotaxin, and total blood leukocytes were measured.</div></div><div><h3>Results</h3><div>This trial was completed with 25 enrolled participants, and three dropped out. The per-protocol analysis included 22 participants. As expected, postprandial glycemia increased 30 minutes after consuming meals rich in sucrose (<em>P</em> = 0.045) or glucose (<em>P</em> < 0.001). Triglyceride and leucocyte concentrations increased only at 240 minutes after consuming a high-fructose meal (<em>P</em> < 0.05). Regardless of the type of carbohydrate overload, leptin concentrations decreased postprandially compared to baseline at all time points (<em>P</em> < 0.05). Four participants reported adverse events after consuming the standardized meal with glucose or fructose, including nausea and malaise.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that a fructose-rich single meal leads to a more significant increase in triglyceride and leukocyte concentrations compared to glucose and sucrose in healthy women. These findings support concerns regarding the potential inflammatory and metabolic dysfunction associated with frequent consumption of high-fructose meals.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112602"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.nut.2024.112601
Ayush Mehra, Brooke E. Starkoff, Brett S. Nickerson
Body composition assessments are essential for understanding health and nutritional status. Traditional methods like deuterium oxide dilution, while accurate, are impractical due to cost and complexity. Bioimpedance analysis (BIA) has emerged as a preferred clinical and research technique. BIA measures total body water and, by extension, fat mass and fat-free mass, based on constant hydration assumptions. Wearable BIA technology provides real-time body composition data, enhancing at-home monitoring. Although these devices show promise in measuring parameters like body fat percentage and skeletal muscle mass, accuracy discrepancies compared to methods like dual-energy X-ray absorptiometry and the 4-compartment model require further validation. Addressing user adherence and environmental limitations is essential for reliable results. This narrative review examines the current landscape of wearable BIA technology. Despite challenges, wearable BIA devices offer significant benefits, emphasizing ongoing innovation and validation.
{"title":"The evolution of bioimpedance analysis: From traditional methods to wearable technology","authors":"Ayush Mehra, Brooke E. Starkoff, Brett S. Nickerson","doi":"10.1016/j.nut.2024.112601","DOIUrl":"10.1016/j.nut.2024.112601","url":null,"abstract":"<div><div>Body composition assessments are essential for understanding health and nutritional status. Traditional methods like deuterium oxide dilution, while accurate, are impractical due to cost and complexity. Bioimpedance analysis (BIA) has emerged as a preferred clinical and research technique. BIA measures total body water and, by extension, fat mass and fat-free mass, based on constant hydration assumptions. Wearable BIA technology provides real-time body composition data, enhancing at-home monitoring. Although these devices show promise in measuring parameters like body fat percentage and skeletal muscle mass, accuracy discrepancies compared to methods like dual-energy X-ray absorptiometry and the 4-compartment model require further validation. Addressing user adherence and environmental limitations is essential for reliable results. This narrative review examines the current landscape of wearable BIA technology. Despite challenges, wearable BIA devices offer significant benefits, emphasizing ongoing innovation and validation.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112601"},"PeriodicalIF":3.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.nut.2024.112599
Yuto Kiuchi M.S. , Kota Tsutsumimoto Ph.D. , Kazuhei Nishimoto M.S. , Yuka Misu Ph.D. , Tomoka Ohata B.S. , Hyuma Makizako Ph.D. , Hiroyuki Shimada Ph.D.
Objectives
The intent of the present study was to elucidate the association of eating alone and depressive symptoms with the development of disability among community-dwelling older adults, using a longitudinal study.
Method
Participants included 4648 Japanese older adults (mean age 73.8 ± 5.4 years; 44.3% men) aged ≥ 65 years at the time of the examination. Eating status was divided into two categories: “Eating with others at least once a day” and “Other.” The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Incident disability was certified by long-term care insurance (median duration: 36 months).
Results
During a median follow-up at 36 months, 8.0% of the participants developed an incident disability. Adjusted for covariates, the participants who ate alone were associated with a higher hazard ratio of incident disability compared to those who ate with others (hazard ratio: 1.36, 95% confidence interval: 1.05–1.75). However, adjusted for the covariate depressive symptoms, eating alone was not significantly associated with incident disability. Structural equation models revealed that the indirect model confirmed eating alone habits were associated with disability via depressive symptoms.
Conclusions
This study confirmed that eating alone was associated with an incident disability after adjusting for the covariates. Furthermore, the present study suggests an indirect relationship between eating alone and incident disability via depressive symptoms, the result of the structural equation model.
{"title":"Effect of eating alone and depression symptoms on incident disability among community-dwelling older adults","authors":"Yuto Kiuchi M.S. , Kota Tsutsumimoto Ph.D. , Kazuhei Nishimoto M.S. , Yuka Misu Ph.D. , Tomoka Ohata B.S. , Hyuma Makizako Ph.D. , Hiroyuki Shimada Ph.D.","doi":"10.1016/j.nut.2024.112599","DOIUrl":"10.1016/j.nut.2024.112599","url":null,"abstract":"<div><h3>Objectives</h3><div>The intent of the present study was to elucidate the association of eating alone and depressive symptoms with the development of disability among community-dwelling older adults, using a longitudinal study.</div></div><div><h3>Method</h3><div>Participants included 4648 Japanese older adults (mean age 73.8 ± 5.4 years; 44.3% men) aged ≥ 65 years at the time of the examination. Eating status was divided into two categories: “Eating with others at least once a day” and “Other.” The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Incident disability was certified by long-term care insurance (median duration: 36 months).</div></div><div><h3>Results</h3><div>During a median follow-up at 36 months, 8.0% of the participants developed an incident disability. Adjusted for covariates, the participants who ate alone were associated with a higher hazard ratio of incident disability compared to those who ate with others (hazard ratio: 1.36, 95% confidence interval: 1.05–1.75). However, adjusted for the covariate depressive symptoms, eating alone was not significantly associated with incident disability. Structural equation models revealed that the indirect model confirmed eating alone habits were associated with disability via depressive symptoms.</div></div><div><h3>Conclusions</h3><div>This study confirmed that eating alone was associated with an incident disability after adjusting for the covariates. Furthermore, the present study suggests an indirect relationship between eating alone and incident disability via depressive symptoms, the result of the structural equation model.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112599"},"PeriodicalIF":3.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.nut.2024.112600
Zhenyu Huo , Siyu Luo , Feifei Chong , Ning Tong , Zongliang Lu , Mengyuan Zhang , Jie Liu , Chunshu Fang , Wei Guo , Na Li , Hongxia Xu
Objectives
To assess the impact of the definition of the Global Leadership Initiative in Sarcopenia (GLIS) on mortality in esophageal cancer (EC) patients, postesophagectomy, within a Chinese cohort and to validate the effectiveness of a new GLIS framework in oncology.
Methods
We performed an observational real-world cohort study in a single center at Daping Hospital of the Army Medical University in China, spanning from December 2014 to July 2022. We used the combined definition of muscle mass and muscle strength in a new GLIS framework for the diagnosis of sarcopenia. Potential covariates were identified through univariate and multivariate analyses. The association between GLIS-defined sarcopenia and mortality was estimated using Kaplan–Meier curves and Cox models. We also conducted stratified analyses to assess the stability of multivariable Cox models.
Results
A total of 520 EC patients were included in the study, with a median follow-up of 48.7 months. A total of 229 EC patients (44.0%) were identified with GLIS-defined sarcopenia. Patients with GLIS-defined sarcopenia had significantly worse overall survival in Kaplan–Meier curves (log-rank P = 0.015). Age; sex; tumor, node, metastasis stage; blood glucose; bleeding volume in operation; and operating time were introduced as covariates in a fully adjusted Cox model. Multivariable-adjusted Cox models revealed that GLIS-defined sarcopenia was an independent prognostic factor for EC patients postesophagectomy (hazard ratio, 1.87, 95% confidence interval, 1.28–2.74, P = 0.001). Stratified analyses confirmed the stability of the relationship between GLIS-defined sarcopenia and mortality in EC patients.
Conclusions
GLIS-defined sarcopenia is prevalent among Chinese EC patients and is linked to increased mortality risk postesophagectomy. This finding offers compelling evidence and serves as a valuable reference for the establishment of an operational definition of GLIS sarcopenia.
{"title":"Global Leadership Initiative in Sarcopenia (GLIS)–defined sarcopenia increases the mortality of esophageal cancer patients after esophagectomy: A Chinese real-world cohort study","authors":"Zhenyu Huo , Siyu Luo , Feifei Chong , Ning Tong , Zongliang Lu , Mengyuan Zhang , Jie Liu , Chunshu Fang , Wei Guo , Na Li , Hongxia Xu","doi":"10.1016/j.nut.2024.112600","DOIUrl":"10.1016/j.nut.2024.112600","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the impact of the definition of the Global Leadership Initiative in Sarcopenia (GLIS) on mortality in esophageal cancer (EC) patients, postesophagectomy, within a Chinese cohort and to validate the effectiveness of a new GLIS framework in oncology.</div></div><div><h3>Methods</h3><div>We performed an observational real-world cohort study in a single center at Daping Hospital of the Army Medical University in China, spanning from December 2014 to July 2022. We used the combined definition of muscle mass and muscle strength in a new GLIS framework for the diagnosis of sarcopenia. Potential covariates were identified through univariate and multivariate analyses. The association between GLIS-defined sarcopenia and mortality was estimated using Kaplan–Meier curves and Cox models. We also conducted stratified analyses to assess the stability of multivariable Cox models.</div></div><div><h3>Results</h3><div>A total of 520 EC patients were included in the study, with a median follow-up of 48.7 months. A total of 229 EC patients (44.0%) were identified with GLIS-defined sarcopenia. Patients with GLIS-defined sarcopenia had significantly worse overall survival in Kaplan–Meier curves (log-rank <em>P =</em> 0.015). Age; sex; tumor, node, metastasis stage; blood glucose; bleeding volume in operation; and operating time were introduced as covariates in a fully adjusted Cox model. Multivariable-adjusted Cox models revealed that GLIS-defined sarcopenia was an independent prognostic factor for EC patients postesophagectomy (hazard ratio, 1.87, 95% confidence interval, 1.28–2.74, <em>P =</em> 0.001). Stratified analyses confirmed the stability of the relationship between GLIS-defined sarcopenia and mortality in EC patients.</div></div><div><h3>Conclusions</h3><div>GLIS-defined sarcopenia is prevalent among Chinese EC patients and is linked to increased mortality risk postesophagectomy. This finding offers compelling evidence and serves as a valuable reference for the establishment of an operational definition of GLIS sarcopenia.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112600"},"PeriodicalIF":3.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.nut.2024.112592
Michelle V. Dietz M.D., PhD , Karteek Popuri Ph.D. , Lars Janssen B.Sc. , Mushfiqus Salehin B.Sc. , Da Ma Ph.D. , Vincent Tze Yang Chow B.Sc. , Hyunwoo Lee Ph.D. , Cornelis Verhoef M.D., Ph.D. , Eva V.E. Madsen M.D., Ph.D. , Mirza F. Beg Ph.D. , Jeroen L.A. van Vugt M.D., Ph.D.
Introduction
Body composition evaluation can be used to assess patients’ nutritional status to predict clinical outcomes. To facilitate reliable and time-efficient body composition measurements eligible for clinical practice, fully automated computed tomography segmentation methods were developed. The aim of this study was to evaluate automated segmentation by Data Analysis Facilitation Suite in an independent dataset.
Materials and methods
Preoperative computed tomography images were used of 165 patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy from 2014 to 2019. Manual and automated measurements of skeletal muscle mass (SMM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intramuscular adipose tissue (IMAT) were performed at the third lumbar vertebra. Segmentation accuracy of automated measurements was assessed using the Jaccard index and intra-class correlation coefficients.
Results
Automatic segmentation provided accurate measurements compared to manual analysis, resulting in Jaccard score coefficients of 94.9 for SMM, 98.4 for VAT, 99.1 for SAT, and 79.4 for IMAT. Intra-class correlation coefficients ranged from 0.98 to 1.00. Automated measurements on average overestimated SMM and SAT areas compared to manual analysis, with mean differences (±2 standard deviations) of 1.10 (–1.91 to 4.11) and 1.61 (–2.26 to 5.48) respectively. For VAT and IMAT, automated measurements on average underestimated the areas with mean differences of –1.24 (–3.35 to 0.87) and –0.93 (–5.20 to 3.35), respectively.
Conclusions
Commercially available Data Analysis Facilitation Suite provides similar results compared to manual measurements of body composition at the level of third lumbar vertebra. This software provides accurate and time-efficient body composition measurements, which is necessary for implementation in clinical practice.
{"title":"Evaluation of a fully automated computed tomography image segmentation method for fast and accurate body composition measurements","authors":"Michelle V. Dietz M.D., PhD , Karteek Popuri Ph.D. , Lars Janssen B.Sc. , Mushfiqus Salehin B.Sc. , Da Ma Ph.D. , Vincent Tze Yang Chow B.Sc. , Hyunwoo Lee Ph.D. , Cornelis Verhoef M.D., Ph.D. , Eva V.E. Madsen M.D., Ph.D. , Mirza F. Beg Ph.D. , Jeroen L.A. van Vugt M.D., Ph.D.","doi":"10.1016/j.nut.2024.112592","DOIUrl":"10.1016/j.nut.2024.112592","url":null,"abstract":"<div><h3>Introduction</h3><div>Body composition evaluation can be used to assess patients’ nutritional status to predict clinical outcomes. To facilitate reliable and time-efficient body composition measurements eligible for clinical practice, fully automated computed tomography segmentation methods were developed. The aim of this study was to evaluate automated segmentation by Data Analysis Facilitation Suite in an independent dataset.</div></div><div><h3>Materials and methods</h3><div>Preoperative computed tomography images were used of 165 patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy from 2014 to 2019. Manual and automated measurements of skeletal muscle mass (SMM), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intramuscular adipose tissue (IMAT) were performed at the third lumbar vertebra. Segmentation accuracy of automated measurements was assessed using the Jaccard index and intra-class correlation coefficients.</div></div><div><h3>Results</h3><div>Automatic segmentation provided accurate measurements compared to manual analysis, resulting in Jaccard score coefficients of 94.9 for SMM, 98.4 for VAT, 99.1 for SAT, and 79.4 for IMAT. Intra-class correlation coefficients ranged from 0.98 to 1.00. Automated measurements on average overestimated SMM and SAT areas compared to manual analysis, with mean differences (±2 standard deviations) of 1.10 (–1.91 to 4.11) and 1.61 (–2.26 to 5.48) respectively. For VAT and IMAT, automated measurements on average underestimated the areas with mean differences of –1.24 (–3.35 to 0.87) and –0.93 (–5.20 to 3.35), respectively.</div></div><div><h3>Conclusions</h3><div>Commercially available Data Analysis Facilitation Suite provides similar results compared to manual measurements of body composition at the level of third lumbar vertebra. This software provides accurate and time-efficient body composition measurements, which is necessary for implementation in clinical practice.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112592"},"PeriodicalIF":3.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.nut.2024.112594
Pengxia Guo M.M., M.P.H. , Hongxia Xu M.D., Ph.D. , Min Weng M.D., Ph.D. , Fuxiang Zhou M.D., Ph.D. , Wen Hu M.D., Ph.D. , Suyi Li M.D., Ph.D. , Yuan Lin M.D., Ph.D. , Chunling Zhou M.D., Ph.D. , Hu Ma M.D., Ph.D. , Wei Li M.D., Ph.D. , Jiuwei Cui M.D., Ph.D. , Haoqing Cheng M.M., M.P.H. , Saba Fida M.M., M.P.H. , Hanping Shi M.D., Ph.D. , Chunhua Song M.D., Ph.D. , The Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Group
Objectives
The aim of this study was to evaluate the combined prognostic value of calf circumference (CC) and serum albumin on mortality in patients with cancer cachexia aged ≥65 years.
Methods
This multicenter cohort study involved 5322 older patients in hospital with cancer cachexia. The combined indicator of CC and albumin was defined as the calf circumference-albumin (CCA) index. Harrell's C index, a time-dependent receiver operating characteristic curve analysis, was used to assess the prognostic performance of the CCA index and other indices. The optimal thresholds method was used to determine the cutoff values of CC and albumin, and the association between the CCA index and all-cause mortality was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models.
Results
A total of 3875 men and 1447 women with a mean age of 72.0 years (range: 68.0–78.0 years) and a mean follow-up time of 55.0 months (range: 25.0–85.0 months) were included in the study. A total of 1269 patients were classified into the low CCA index group (0 score) by the optimal thresholds method. In the overall population, the CCA index showed better differentiating power at predicting mortality in older patients with cancer cachexia compared with CC or albumin alone (C index = 0.639; 95% CI: 0.612–0.666; P < 0.05). The time-dependent receiver operating characteristic curve showed that the CCA index had the highest prognostic value of all the measures studied (P < 0.05). In the overall population, male and female patients with a high CCA index (2 score) showed better performance than those with a low CCA index (0 or 1 score).
Conclusions
The CCA index could significantly predict the mortality of older patients with cancer cachexia, which might provide renewed assistance for future clinical management.
研究目的本研究旨在评估小腿围（CC）和血清白蛋白对年龄≥65 岁癌症恶病质患者死亡率的综合预后价值：这项多中心队列研究涉及 5322 名住院的癌症恶病质老年患者。CC和白蛋白的综合指标被定义为小腿围度-白蛋白（CCA）指数。哈雷尔 C 指数是一种时间依赖性接收器操作特征曲线分析法，用于评估 CCA 指数和其他指数的预后效果。采用最佳阈值法确定CC和白蛋白的临界值，并使用卡普兰-梅耶分析和考克斯比例危险回归模型评估CCA指数与全因死亡率之间的关系：研究共纳入 3875 名男性和 1447 名女性，平均年龄为 72.0 岁（范围：68.0-78.0 岁），平均随访时间为 55.0 个月（范围：25.0-85.0 个月）。按照最佳阈值法，共有 1269 名患者被归入低 CCA 指数组（0 分）。在总体人群中，CCA 指数与单独的 CC 或白蛋白相比，在预测老年癌症恶病质患者死亡率方面显示出更好的区分能力（C 指数 = 0.639；95% CI：0.612-0.666；P <0.05）。与时间相关的接收器操作特征曲线显示，在所有研究指标中，CCA 指数的预后价值最高（P < 0.05）。在总体人群中，CCA指数高（2分）的男性和女性患者比CCA指数低（0分或1分）的患者表现更好：结论：CCA指数能明显预测老年癌症恶病质患者的死亡率，这可能为今后的临床管理提供新的帮助。
{"title":"Calf circumference-albumin index significantly predicts the prognosis of older patients with cancer cachexia: A multicenter cohort study","authors":"Pengxia Guo M.M., M.P.H. , Hongxia Xu M.D., Ph.D. , Min Weng M.D., Ph.D. , Fuxiang Zhou M.D., Ph.D. , Wen Hu M.D., Ph.D. , Suyi Li M.D., Ph.D. , Yuan Lin M.D., Ph.D. , Chunling Zhou M.D., Ph.D. , Hu Ma M.D., Ph.D. , Wei Li M.D., Ph.D. , Jiuwei Cui M.D., Ph.D. , Haoqing Cheng M.M., M.P.H. , Saba Fida M.M., M.P.H. , Hanping Shi M.D., Ph.D. , Chunhua Song M.D., Ph.D. , The Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Group","doi":"10.1016/j.nut.2024.112594","DOIUrl":"10.1016/j.nut.2024.112594","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this study was to evaluate the combined prognostic value of calf circumference (CC) and serum albumin on mortality in patients with cancer cachexia aged ≥65 years.</div></div><div><h3>Methods</h3><div>This multicenter cohort study involved 5322 older patients in hospital with cancer cachexia. The combined indicator of CC and albumin was defined as the calf circumference-albumin (CCA) index. Harrell's C index, a time-dependent receiver operating characteristic curve analysis, was used to assess the prognostic performance of the CCA index and other indices. The optimal thresholds method was used to determine the cutoff values of CC and albumin, and the association between the CCA index and all-cause mortality was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models.</div></div><div><h3>Results</h3><div>A total of 3875 men and 1447 women with a mean age of 72.0 years (range: 68.0–78.0 years) and a mean follow-up time of 55.0 months (range: 25.0–85.0 months) were included in the study. A total of 1269 patients were classified into the low CCA index group (0 score) by the optimal thresholds method. In the overall population, the CCA index showed better differentiating power at predicting mortality in older patients with cancer cachexia compared with CC or albumin alone (C index = 0.639; 95% CI: 0.612–0.666; <em>P</em> < 0.05). The time-dependent receiver operating characteristic curve showed that the CCA index had the highest prognostic value of all the measures studied (<em>P</em> < 0.05). In the overall population, male and female patients with a high CCA index (2 score) showed better performance than those with a low CCA index (0 or 1 score).</div></div><div><h3>Conclusions</h3><div>The CCA index could significantly predict the mortality of older patients with cancer cachexia, which might provide renewed assistance for future clinical management.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112594"},"PeriodicalIF":3.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.nut.2024.112593
Yang Jiang Ph.D. , Mouqing Huang M.D. , Yufei Zhao Ph.D. , Jingyue Dai Ph.D. , Qingwen Yang M.D. , Xingzhe Tang M.D. , Xinxiang Li Ph.D. , Ying Cui M.D. , Jingqi Zhang M.D. , Jialu Sun M.D. , Lin Fu M.D. , Hui Mao Ph.D. , Xin-Gui Peng M.D., Ph.D.
Objectives
Cancer patients with cachexia face poor prognosis and shortened survival. Early diagnosis and accurate prognosis prediction remain challenging. This multi-center study aims to develop and externally validate a nomogram integrating [18F]fluoro-2-deoxy-D-glucose ([18F]FDG) PET findings and routine clinical biochemistry tests for predicting cancer-associated cachexia, while also assessing its potential prognostic value.
Research Methods & Procedures
A retrospective analysis of 658 cancer patients (390 in the development cohort, 268 in the validation cohort) utilized [18F]FDG PET/CT data from two centers. Logistic regression identified organ-specific standardized uptake values (SUVs) and clinical variables associated with cancer-associated cachexia. Diagnostic accuracy, discriminative ability, and clinical effectiveness were assessed using area under the curve (AUC), calibration curve, and decision curve. Nomogram predictability for overall survival was evaluated through Cox regression and Kaplan–Meier curves.
Results
The combined nomogram incorporating age (odds ratio [OR] = 1.893; P = 0.012), hemoglobin (OR = 2.591; P < 0.001), maximum SUV of the liver (OR = 3.646; P < 0.001), and minimum SUV of the subcutaneous fat (OR = 5.060; P < 0.001) achieved good performance in predicting cancer-associated cachexia (AUC = 0.807/0.726, development/validation). Calibration and decision curve analyses confirmed its clinical effectiveness. Kaplan–Meier curves analysis showed that overall survival can be categorized using the combined nomogram (P < 0.001).
Conclusion
Combining radiological information from clinical standard [18F]FDG PET data from cancer patients with biochemical results in their routine clinical blood tests through a well-constructed nomogram enables predicting cachexia and its effect on the prognosis of cancer patients.
{"title":"A [18F]FDG PET based nomogram to predict cancer-associated cachexia and survival outcome: A multi-center study","authors":"Yang Jiang Ph.D. , Mouqing Huang M.D. , Yufei Zhao Ph.D. , Jingyue Dai Ph.D. , Qingwen Yang M.D. , Xingzhe Tang M.D. , Xinxiang Li Ph.D. , Ying Cui M.D. , Jingqi Zhang M.D. , Jialu Sun M.D. , Lin Fu M.D. , Hui Mao Ph.D. , Xin-Gui Peng M.D., Ph.D.","doi":"10.1016/j.nut.2024.112593","DOIUrl":"10.1016/j.nut.2024.112593","url":null,"abstract":"<div><h3>Objectives</h3><div>Cancer patients with cachexia face poor prognosis and shortened survival. Early diagnosis and accurate prognosis prediction remain challenging. This multi-center study aims to develop and externally validate a nomogram integrating [<sup>18</sup>F]fluoro-2-deoxy-D-glucose ([<sup>18</sup>F]FDG) PET findings and routine clinical biochemistry tests for predicting cancer-associated cachexia, while also assessing its potential prognostic value.</div></div><div><h3>Research Methods & Procedures</h3><div>A retrospective analysis of 658 cancer patients (390 in the development cohort, 268 in the validation cohort) utilized [<sup>18</sup>F]FDG PET/CT data from two centers. Logistic regression identified organ-specific standardized uptake values (SUVs) and clinical variables associated with cancer-associated cachexia. Diagnostic accuracy, discriminative ability, and clinical effectiveness were assessed using area under the curve (AUC), calibration curve, and decision curve. Nomogram predictability for overall survival was evaluated through Cox regression and Kaplan–Meier curves.</div></div><div><h3>Results</h3><div>The combined nomogram incorporating age (odds ratio [OR] = 1.893; <em>P</em> = 0.012), hemoglobin (OR = 2.591; <em>P</em> < 0.001), maximum SUV of the liver (OR = 3.646; <em>P</em> < 0.001), and minimum SUV of the subcutaneous fat (OR = 5.060; <em>P</em> < 0.001) achieved good performance in predicting cancer-associated cachexia (AUC = 0.807/0.726, development/validation). Calibration and decision curve analyses confirmed its clinical effectiveness. Kaplan–Meier curves analysis showed that overall survival can be categorized using the combined nomogram (<em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Combining radiological information from clinical standard [<sup>18</sup>F]FDG PET data from cancer patients with biochemical results in their routine clinical blood tests through a well-constructed nomogram enables predicting cachexia and its effect on the prognosis of cancer patients.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112593"},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.nut.2024.112591
Katarzyna Skrypnik Ph.D. , Agnieszka Olejnik-Schmidt D.Sc. , Joanna Mikołajczyk-Stecyna Ph.D. , Marcin Schmidt D.Sc. , Joanna Suliburska D.Sc.
Objectives
A high-fat, iron (Fe)-deficient Western diet induces obesity and dysregulates Fe metabolism. We compared the influence of Lactiplantibacillus plantarum and Latilactobacillus curvatus with and without Fe supplementation on duodenal Fe uptake under high-fat diet conditions.
Methods
Rats were fed a high-fat diet (HF group) or high-fat, Fe-deficient diet (HFDEF group) or control diet (C group) for 8 wk. For the next 8 wk, the rats in the C and HF groups continued on the same diet, whereas the rats in the HFDEF group were divided into six groups and fed high-fat, Fe-deficient diet combinations with L. plantarum (Lp), L. curvatus (Lc), and Fe supplementation (HFDEF, HFDEFFe, HFDEFLp, HFDEFLc, HFDEFFeLp, HFDEFFeLc). Duodenum and serum samples were collected for analysis.
Results
In the duodenum, the Fe content was higher in the HFDEFFeLp and HFDEFFeLc groups; the ferroportin level was higher in the HFDEFFeLp and HFDEFFeLc groups versus the HF group; the divalent metal transporter 1 level was higher in the HFDEFFeLc group versus the C and HF groups; and duodenal cytochrome B was higher in the HFDEFLc versus all the other groups. In addition, duodenal expression of the solute carrier family 11 member 2 gene was higher in the HFDEF group versus the C, HF, HFDEFFe, HFDEFFeLp, and HFDEFFeLc groups; that of the TFRC gene was higher in the HFDEFFeLc group versus the C, HF, HFDEF, and HFDEFFe groups; and that of the HJV gene was higher in the HFDEFFeLp group versus the C, HF, HFDEF, HFDEFFe, and HFDEFLc groups.
Conclusions
L. plantarum and L. curvatus supplementation shows some potential to enhance duodenal cellular Fe uptake in rats on a high-fat, Fe-deficient diet.
{"title":"Influence of supplementation with probiotic bacteria Lactiplantibacillus plantarum and Latilactobacillus curvatus on selected parameters of duodenum iron metabolism in rats on a high-fat, iron-deficient diet","authors":"Katarzyna Skrypnik Ph.D. , Agnieszka Olejnik-Schmidt D.Sc. , Joanna Mikołajczyk-Stecyna Ph.D. , Marcin Schmidt D.Sc. , Joanna Suliburska D.Sc.","doi":"10.1016/j.nut.2024.112591","DOIUrl":"10.1016/j.nut.2024.112591","url":null,"abstract":"<div><h3>Objectives</h3><div>A high-fat, iron (Fe)-deficient Western diet induces obesity and dysregulates Fe metabolism. We compared the influence of <em>Lactiplantibacillus plantarum</em> and <em>Latilactobacillus curvatus</em> with and without Fe supplementation on duodenal Fe uptake under high-fat diet conditions.</div></div><div><h3>Methods</h3><div>Rats were fed a high-fat diet (HF group) or high-fat, Fe-deficient diet (HFDEF group) or control diet (C group) for 8 wk. For the next 8 wk, the rats in the C and HF groups continued on the same diet, whereas the rats in the HFDEF group were divided into six groups and fed high-fat, Fe-deficient diet combinations with <em>L. plantarum</em> (Lp), <em>L. curvatus</em> (Lc), and Fe supplementation (HFDEF, HFDEFFe, HFDEFLp, HFDEFLc, HFDEFFeLp, HFDEFFeLc). Duodenum and serum samples were collected for analysis.</div></div><div><h3>Results</h3><div>In the duodenum, the Fe content was higher in the HFDEFFeLp and HFDEFFeLc groups; the ferroportin level was higher in the HFDEFFeLp and HFDEFFeLc groups versus the HF group; the divalent metal transporter 1 level was higher in the HFDEFFeLc group versus the C and HF groups; and duodenal cytochrome B was higher in the HFDEFLc versus all the other groups. In addition, duodenal expression of the solute carrier family 11 member 2 gene was higher in the HFDEF group versus the C, HF, HFDEFFe, HFDEFFeLp, and HFDEFFeLc groups; that of the <em>TFRC</em> gene was higher in the HFDEFFeLc group versus the C, HF, HFDEF, and HFDEFFe groups; and that of the <em>HJV</em> gene was higher in the HFDEFFeLp group versus the C, HF, HFDEF, HFDEFFe, and HFDEFLc groups.</div></div><div><h3>Conclusions</h3><div><em>L. plantarum</em> and <em>L. curvatus</em> supplementation shows some potential to enhance duodenal cellular Fe uptake in rats on a high-fat, Fe-deficient diet.</div></div>","PeriodicalId":19482,"journal":{"name":"Nutrition","volume":"129 ","pages":"Article 112591"},"PeriodicalIF":3.2,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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