Table of Content

20 July 2025, Volume 28 Issue 21

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Guidelines·Consensus

Expert Consensus on the Diagnosis, Treatment, and Management of Emaciation (2025)

Chinese Geriatrics Society, General Practice Branch of Zhejiang Medical Association, the Expert Collaboration Group on Medically Unspecified Disease in General Practice

2025, 28(21):  2577-2594.  DOI: 10.12114/j.issn.1007-9572.2025.0030

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Emaciation is a clinical manifestation caused by multiple factors, characterized by its complex etiology and wide range of associated diseases, posing significant challenges for healthcare professionals in terms of evaluation and management. Its intrinsic linkage to aging-related comorbidities and the imperative for multidisciplinary collaboration further underscore the necessity and urgency of establishing standardized diagnostic and therapeutic consensus guidelines. This consensus provides a comprehensive overview of the definition, epidemiology, etiology, and pathogenesis of emaciation. It systematically outlines diagnostic approaches, including detailed history-taking, physical examinations, and auxiliary tests. Furthermore, it elaborates on treatment principles and measures, as well as management strategies tailored for specific populations. Emphasis is placed on the importance of community-based management, encompassing follow-up, referral systems, three-level prevention strategies, and health education. The consensus aims to enhance clinicians' capabilities in diagnosing and managing emaciation, improve patients' quality of life, and reduce the healthcare and economic burden on families and society.

Original Research

Study on the Effect and Predictive Value of Obesity and Lipid-related Indices on Metabolic Syndrome in Adults

LI Chunxian, LIU Annuo

2025, 28(21):  2595-2603.  DOI: 10.12114/j.issn.1007-9572.2024.0559

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Background

Metabolic Syndrome (MetS) is an important risk factor for cardiovascular complications and kidney damage. Obesity and lipid-related markers are closely associated with MetS, and the predictive ability of different markers for MetS is still controversial.

Objective

The aim of this study was to evaluate the effect of 12 obesity and lipid-related indices, including lipid accumulation products, body mass index, visceral adiposity index, Chinese visceral adiposity index (CAVI) , abdominal volume index (AVI) , body fat index, BMI, body size index (ABSI) , triacylglycerol-glucose index (TyG) and its combined index TyG-BMI, TyG-waist circumference (TyG-WC) , and TyG-waist-height ratio (TyG-WHtR) , on the optimal cutoff values for MetS screening and prediction and to identify the most appropriate predictors.

Methods

The health checkup data of a state-owned enterprise in Anhui Province in 2023 were selected, and the correlation between 12 obesity and lipid-related indexes and MetS was analyzed by binary logistic regression. The work characteristics (ROC) curves of subjects with different obesity and lipid-related indexes assessing MetS were plotted, and the area under the ROC curve (AUC) was calculated and compared with its predictive value.

Results

A total of 4 028 employees of a state-owned enterprise were included in this study, and the overall prevalence of MetS in the study population was 23.43% (944/4 028) , with a prevalence of MetS of 26.53% (816/3 075) in males and 13.43% (128/953) in females.The results of the logistic model showed that the TyG-WHtR was associated with an OR (95%CI) of the total population =7.170 (5.411-9.500) , gender subgroup [male OR (95%CI) =16.277 (11.554-22.930) ; female OR (95%CI) =13.422 (5.388-33.435) ] , age subgroup of males >50 years old OR (95%CI) =31.411 (18.868-52.292) and 36~50 years old women OR (95%CI) =95.154 (22.610-400.465) had the strongest association with the odds of developing MetS. The predictive ability of CVAI for MetS showed the best predictive effect in the total population, males and age subgroups of males ≤35 years old group and 36~50 years old group, with AUCs of 0.926 (95%CI=0.917-0.936, P<0.001) , 0.941 (95%CI=0.933-0.949, P<0.001) , 0.931 (95%CI=0.917-0.946, P<0.001) , 0.947 (95%CI=0.934-0.961, P<0.001) ; the predictive ability of AVI for MetS was higher in women and the age subgroups of women ≤35 and >50 years old, and in the group of men >50 years old, with a higher discrimination ability, with AUCs of 0.951 (95%CI=0.938~0.963, P<0.001) , 0.961 [95%CI=0.943-0.978, P<0.001) , 0.909 (95%CI=0.857-0.961, P<0.001) , 0.962 (95%CI=0.951-0.974, P<0.001) ; TyG-WC in the age subgroup female 36-50 years group performed better in predicting MetS with an AUC of 0.949 (95%CI=0.925~0.972, P<0.001) .

Conclusion

TyG-WHtR had the strongest association with MetS. Except for ABSI, which had poor predictive ability for MetS, CVAI showed better predictive ability for MetS in the total population, males and age subgroups males ≤35 years old group and 36~50 years old group, AVI had higher discriminatory ability for MetS in females and age subgroups females ≤35 years old and >50 years old, and males >50 years old group, and TyG-WC showed better predictive ability for MetS in the age subgroup females 36-50 years old group. MetS predictive ability performed better.

Effects of Resistance Exercise Combined with Nutritional Intervention on Blood Glucose Stability in Elderly Patients with Type 2 Diabetes Mellitus with Sarcopenia

WANG Ying, YAN Yijun, LIU Lei, HU Yumin, ZHANG Yang, LIU Kai, JIANG Boren

2025, 28(21):  2604-2610.  DOI: 10.12114/j.issn.1007-9572.2024.0422

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Background

Type 2 diabetes mellitus (T2DM) and sarcopenia are common conditions that significantly impact the health of elderly individuals. However, clinical intervention studies focusing on T2DM with sarcopenia are relatively limited in China.

Objective

To investigate the effects of resistance exercise combined with nutritional intervention on skeletal muscle mass and blood glucose stability in elderly T2DM patients with sarcopenia at a primary care hospital.

Methods

A total of 61 elderly T2DM patients with sarcopenia (aged≥65) who attended the Shanghai Huangpu District Yuyuan Community Health Service Center between February 2022 and May 2024 were enrolled in the study. The patients were randomly assigned to a control group (n=30) and an intervention group (n=31) . All patients were managed by routine diabetes education, and those in the intervention group additionally received resistance exercise combined with nutritional intervention. A 12-week intervention was performed to compare the time in glucose target range (TIR) , mean amplitude of glycemic excursions (MAGE) , appendicular skeletal muscle mass index (ASMI) , grip strength, and 6-meter walking speed. The correlations between grip strength, 6-meter walking speed, ASMI with TIR and MAGE were assessed before and after the intervention.

Results

Before the intervention, there was no significant difference in parameters between the two groups (P<0.05) . After the 12-week intervention, significantly decreased TIR was detected in the control group (P<0.05) , and significantly improved glycated hemoglobin (HbA_1c) , TIR, MAGE, and 6-meter walking speed and grip strength were found in the intervention group (P<0.05) , with statistical differences between groups (P<0.05) . Before and after intervention, the change of HbA1c, TIR, MAGE, and 6-meter walking speed, ASMI, and grip strength showed statistically significant differences between control and intervention group (P<0.05) . The change in 6-meter walking speed was positively correlated with the change in TIR (r_s=0.411, P<0.05) , and negatively correlated with changes in MAGE (r_s=-0.472, P<0.05) and HbA_1c (r_s=-0.315, P<0.05) . No adverse events were reported.

Conclusion

Resistance exercise combined with nutritional intervention can not only increase muscle mass and physical function, but also improve blood glucose stability and TIR in elderly T2DM patients with sarcopenia. Our interventions are simple, easy to implement, with high safety, making them valuable for promotion in primary healthcare setting.

Effects of Exercise Training after Bariatric Surgery on Cardiopulmonary Function in Patients with Type 2 Diabetes Mellitus and Obesity: a Randomized Controlled Trial

JIN Yan, YANG Yang, WANG Lulu, ZHENG Qingwan, LI Xinyan, ZHANG Ning

2025, 28(21):  2611-2617.  DOI: 10.12114/j.issn.1007-9572.2024.0529

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Background

Type 2 diabetes mellitus (T2DM) combined with obesity is an increasingly concerned severe global public health issue. Patients typically experience insulin resistance, metabolic abnormalities, chronic inflammation, and impaired cardiopulmonary function. Bariatric surgery can reduce the BMI, and alleviate diabetic and hypertensive symptoms. However, postoperative cardiopulmonary function decline negatively influences the motor function and quality of life. Postoperative intervention of rehabilitation is an established way to improve the cardiopulmonary function, although the effect of postoperative aerobic and resistance training on the cardiopulmonary function of T2DM patients combined with obesity remains unclear.

Objective

To explore the effects of exercise training after bariatric surgery on cardiopulmonary function in T2DM patients combined with obesity.

Methods

Sixty T2DM patients combined with obesity admitted at the Nanjing Drum Tower Hospital in 2022, who were treated with an elective bariatric surgery were selected as study subjects. They were randomly divided into the exercise group (n=30) and control group (n=30) using a random number table method. A recovery period was defined as the first 4 weeks postoperatively, during which patients were encouraged to engage in physical activities at a moderate intensity. After 4 weeks, cardiopulmonary exercise tests were conducted in both the exercise group and the control group to assess cardiopulmonary function and tailor exercise prescriptions. The control group was instructed to perform daily activities that met general physical activity recommendations, while the exercise group was additionally given to moderate-intensity aerobic and resistance training at 80% of the anaerobic threshold. Both groups were intervened for 12 weeks. After 12 weeks of training, the morphological parameters, cardiopulmonary function indicators, and blood biochemical markers of the two groups were assessed.

Results

One patient in the control group was unable to continue with the study due to personal reasons. In the exercise group, 4 subjects were unable to complete the study, with 3 failing to meet the required exercise volume and 1 withdrew for personal reasons. Ultimately, 55 patients completed the trial, including 26 in the exercise group and 29 in the control group. The mixed ANOVA showed an interaction between group and time for abdominal circumference and cholesterol (P_intercation<0.05) . The main effects of the group were significant for abdominal circumference, postprandial 2-hour blood glucose, and cholesterol (P_group<0.05) . There was a significant interaction between group and time in the peak oxygen uptake, peak oxygen uptake in kg, peak METs (among of energy used during any activity) , peak work rate, anaerobic threshold (AT) power (power@AT) , peak work rate in kg, peak ventilatory equivalent (VE) , anaerobic threshold oxygen uptake (VO₂) , VO₂@AT/peakVO₂, peak O₂ pulse, and resting systolic blood pressure (SBP) (P_intercation<0.05) . In the exercise group, there were significant differences in the peak respiratory exchange ratio (RER) , peak watts, power@AT, peak VE, VE/VCO₂ slope, and anaerobic threshold oxygen uptake before and 4 weeks after surgery (P<0.05) . In the control group, there were significant differences in peak oxygen uptake, peak METs, power@AT, peak VE, VE/VCO₂ slope, and anaerobic threshold oxygen uptake before and 4 weeks after surgery (P<0.05) . After 12 weeks of training, there were significant differences in abdominal circumference, fasting blood glucose, postprandial 2-hour blood glucose, hemoglobin A_1C (HbA_1c) , cholesterol, peak oxygen uptake, power@AT, peak work rate, peak VE, anaerobic threshold oxygen uptake, anaerobic threshold oxygen uptake in kg and VO₂@AT/peakVO₂ between groups (P<0.05) .

Conclusion

Cardiopulmonary function decreases in T2DM patients combined with obesity at four weeks after bariatric surgery. Twelve weeks of exercise training post-surgery can reduce waist circumference, improve blood glucose and lipid levels, and enhance cardiopulmonary function.

Short-term Prognosis of Acute Stanford A Aortic Dissection in Young and Middle-aged Patients Treated with a Hybrid Surgery Versus Sun's Procedure

ZHANG Yunjing, SUN Yue, SU Peng, ZHAO Yongbo, MA Dong

2025, 28(21):  2618-2624.  DOI: 10.12114/j.issn.1007-9572.2023.0694

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Background

The incidence of acute Stanford A aortic dissection (ASAAD) is becoming younger and younger. Surgical procedures for ASAAD depend on the distinct characteristics of onset. Currently, the Sun's procedure and hybrid surgery are widely used surgical methods for treating ASAAD, but the short-term prognosis in young and middle-aged patients is rarely studied.

Objective

To compare the short-term prognosis of young and middle-aged ASAAD patients younger than 60 years treated with a hybrid surgery versus Sun's procedure.

Methods

Clinical data of 266 ASAAD patients younger than 60 years who were surgically treated in Department of Cardiac Surgery, the Fourth Hospital of Hebei Medical University from January 2015 to June 2021 were retrospectively analyzed, including 184 patients undergoing the Sun's procedure (Sun's procedure group) , and 82 treated with a hybrid surgery (hybrid surgery group) . Propensity score matching (PSM) with a caliper value of 0.03 was adopted, and a total of 78 pairs of matched patients were obtained. Kaplan-Meier survival curve was used to compare the in-hospital mortality between groups.

Results

After PSM, there were 78 patients in both groups, including 58 males and 20 females. Except for cardiac troponin I (cTnI) , there were no statistically significant differences in other indicators between the two groups (P>0.05) . After PSM, patients in the hybrid surgery group had significantly more coronary/femoral artery bypass grafting procedures (28.2% vs. 11.5%, P=0.009) , higher lowest nasal temperature [28.0 (27.0, 28.8) ℃ vs. 25.5 (24.6, 28.6) ℃, P<0.001] and lowest anal temperature [28.5 (27.5, 29.5) ℃ vs. 26.3 (26.0, 28.6) ℃, P<0.001] , lower highest lactate value [5.2 (1.9, 9.9) mmol/L vs. 9.9 (4.3, 15.1) mmol/L, P<0.001] , and less transfusions of erythrocytes [10.0 (6.0, 12.0) ×10⁹/L vs. 13.0 (8.0, 16.5) ×10⁹/L, P=0.004] , cold precipitation [ (12.8±2.8) µ vs. (16.4±4.3) µ, P<0.001] and plasma [600.0 (443.7, 800.0) mL vs. 800.0 (587.5, 1 412.5) mL, P=0.011] than those of the Sun's procedure group. After PSM, the incidence of hypoproteinemia was significantly higher in the hybrid surgery group than the Sun's procedure group (33.3% vs. 9.0%, P<0.001) . The Kaplan-Meier survival curve analysis showed a significantly lower 30-day in-hospital mortality in the hybrid surgery group than the Sun's procedure group (7.7% vs. 25.6%, P=0.030) .

Conclusion

A hybrid surgery leads to a lower 30-day in-hospital mortality in young and middle-aged ASAAD patients, but higher risk of complications like stroke, paraplegia and hypoproteinemia than the Sun's procedure. An individualized selection of the optimal surgical regimen is required for preventing risks and strengthening the management of postoperative complications.

Metabolomics Based Mediating Role of Non-lipid Metabolites in the Relationship between Obesity and Diabetic Retinopathy: a Mendelian Randomization Study

WANG Shuang, WU Shufa, LING Yao, TAN Xiwei, CAO Rudai, ZENG Huiting, KONG Danli, DING Yuanlin, YU Haibing

2025, 28(21):  2625-2634.  DOI: 10.12114/j.issn.1007-9572.2023.0641

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Background

Obesity can influence the occurrence and progression of diabetic retinopathy (DR) through various pathways, however there are limited studies on the mediation of DR by obesity through non-lipid metabolic pathways.

Objective

To investigate the mediating role of non-lipid metabolites in the relationship between obesity and DR.

Methods

In August 2023, we utilized genome-wide association study (GWAS) data and conducted Mendelian randomization (MR) analysis to explore the mediating role of non-lipid metabolites in the association between obesity and DR.

Results

BMI (OR=1.78, P=5.3E-12) and waist-to-hip ratio (WHR) (OR=1.91, P=1.3E-10) was associated with increased risk of DR, respectively. Lower levels of isoleucine (OR=0.62, P=0.039) , pyruvate (OR=0.60, P=0.039) , albumin (OR=0.65, P=0.002) , glycoprotein (OR=0.92, P=0.002) , and decreased ratio of dienes to double bonds (OR=0.93, P=0.048) was associated with increased risk of DR, respectively. Positive causal associations were observed between BMI and isoleucine (OR=1.21, P=1.0E-08) , glycoprotein (OR=1.33, P=3.2E-14) , pyruvate (OR=1.08, P=0.03) , and negative causal associations with albumin (OR=0.93, P=0.04) and the ratio of dienes to double bonds (OR=0.82, P=2.8E-05) . Positive causal associations were also found between WHR and isoleucine (OR=1.34, P=3.4E-08) and glycoprotein (OR=1.26, P=1.2E-04) . Isoleucine (β=-0.16, P=0.019) , glycoprotein (β=-0.05, P=0.029) , pyruvate (β=-0.07, P=0.027) , and the ratio of dienes to double bonds (β=0.02, P=0.036) mediated the causal association between BMI and DR, while isoleucine (β=-0.21, P=7.2E-04) and glycoprotein (β=-0.03, P=0.031) mediated the causal association between WHR and DR.

Conclusion

Obesity has a positive causal association with DR, with BMI's association with DR mediated by isoleucine, glycoprotein, pyruvate, and the ratio of dienes to double bonds, and WHR's association with DR mediated by isoleucine and glycoprotein. Non-lipid metabolic products play a mediating role between obesity and DR.

A Retrospective Analysis of the Association between Serum Uric Acid Levels and Insulin Resistance Degrees in Individuals Undergoing Health Examination

LIANG Hengmiao, HUANG Sizhe, CHEN Yuting, LIU Ce, WANG Huijun, DU Qingfeng

2025, 28(21):  2635-2642.  DOI: 10.12114/j.issn.1007-9572.2024.0330

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Background

Insulin resistance (IR) has been witnessing an upward trend in incidence rates, with a high comorbidity rate with obesity, dyslipidemia and hyperuricemia. However, the correlation between IR, obesity/dyslipidemia and SUA levels is not well understood.

Objective

To explore the dose-response correlation between homeostatic model assessment for IR (HOMA-IR) and SUA levels, and to evaluate the mediating effect of HOMA-IR on obesity/lipids and SUA levels.

Methods

We conducted a retrospective study that a total of 3 928 adults who underwent physical examination in the Seventh Affiliated Hospital, Southern Medical University from November 2021 to December 2022 were selected and divided into males and females, non-IR and IR subgroups. The dose-response correlation between HOMA-IR and SUA was analyzed by restricted cubic spline (RCS) . The mediating effects of HOMA-IR on correlation between obesity, total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , high-density lipoprotein cholesterol (HDL-C) and SUA levels were analyzed. Linear regression model was used to analyze the correlation between SUA levels and HOMA-IR, fasting blood insulin (FINS) , and fasting blood glucose (FBG) .

Results

Among the 3 928 patients, 3 026 were males and 902 were females. Among the 3 026 males, 757 were IR patients and 2 269 were non-IR patients. The levels of systolic blood pressure (SBP) , diastolic blood pressure (DBP) , SUA, HOMA-IR, FINS, FBG, BMI, waist-hip ratio (WHR) , TG, TC and LDL-C were higher in IR patients than in non-IR patients, age and HDL-C levels were lower in IR patients than in non-IR patients (P<0.05) . Among the 902 females, 226 were IR patients and 676 were non-IR patients. The levels of SBP, DBP, SUA, HOMA-IR, FINS, FBG, BMI, WHR, TG, LDL-C were higher in IR patients than in non-IR patients, HDL-C levels were lower in IR patients than in non-IR patients (P<0.05) . The RCS results showed that there was a non-linear dose-response correlation between HOMA-IR and SUA levels after adjusting covariates, with gender differences presented in this correlation. The SUA levels in males exhibited an approximate ∩-shaped trend (P_nonlinear=0.002) with the increase of HOMA-IR. While in females, SUA levels showed a trend of increasing and then constant (P_nonlinear=0.002) . Whereas, as SUA levels increased, HOMA-IR showed a trend of decreasing and constant in males (P_nonlinear=0.002) , while HOMA-IR showed a U-shaped trend in females (P_nonlinear=0.002) . The results of mediation analysis showed that HOMA-IR partially mediates the correlation between obesity, central obesity, TG and SUA, and the ratio of mediation effect to the total effect was 9.5%, 7.9% and 5.3% in males, 36.1%, 19.9% and 6.5% in females, respectively. HOMA-IR completely mediated the correlation between HDL-C and SUA, and the ratio of mediating effect to total effect was 20.0% in males and 22.0% in females. The patients were stratified by SUA=7.28 mg/dL in males and 4.70 mg/dL in females, respectively. After adjusting covariates, in males, the results of linear regression model analysis showed a negative correlation between SUA and FBG levels (P<0.05) , and individuals SUA≥7.28 mg/dL showed a positive correlation between SUA and FINS levels (P<0.05) ; in females, individuals SUA≥4.70 mg/dL showed a positive correlation between HOMA-IR, FINS and SUA (P<0.05) .

Conclusion

There is a nonlinear dose-response correlation between HOMA-IR and SUA levels. HOMA-IR has a partial mediating effect on the correlation between obesity, TG and SUA levels, and a complete mediating effect on the correlation between HDL-C and SUA levels. FBG is negatively correlated to SUA levels in males.

The Reliability and Validity of the Chinese Version of Self-Care of Diabetes Inventory

TANG Xiaorui, XU Jingjing, GU Zijun, WANG Qingyu, LIN Zheng, ZHU Qiurui, LEI Yang

2025, 28(21):  2643-2651.  DOI: 10.12114/j.issn.1007-9572.2024.0085

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Background

Diabetes mellitus is difficult to cure and has a long process. The level of self-care is crucial for determining the regression and health outcomes of patients with diabetes. A comprehensive and theory-based tool is urgently needed to assess the level of self-care of diabetes. In this way, the self-care of patients with diabetes can be kept up to date and accurate nursing care can be carried out.

Objective

To examine the psychometric properties of the Chinese version of Self-Care of Diabetes Inventory (SCODI) , and provide a scientifically validated assessment tool for the self-care of Chinese patients with diabetes.

Methods

The Brislin Translation Model was used for translation and cultural adaptation of the English version of the SCODI into Chinese. A total of 261 adult patients with diabetes were enrolled using a consecutive sampling method at the First Affiliated Hospital and the Affiliated Sir Run Run Hospital of Nanjing Medical University from December 2022 to June 2023. Data were collected using a self-developed general information questionnaire and the Chinese version of SCODI.Exploratory factor analysis was used to assess the structural validity. Cronbach's α, split-half reliability and composite reliability were used to describe the reliability. Glycosylated hemoglobin was used as a criterion to assess the criterion-related validity. Spearman's rank correlation analysis was used to examinate the correlation between the Chinese version of SCODI score and glycosylated hemoglobin.

Results

The Chinses version of SCODI contained 4 dimensions and 40 items: self-care maintenance score (75.94±13.15) , self-care monitoring score (70.65±18.71) , self-care management score (69.16±18.24) , and self-care confidence score (85.41±13.63) . In the self-care maintenance dimension, 4 factors were identified: complication screening behaviors, exercise behaviors, hygienic care behaviors and diet-medication behaviors. The self-care monitoring dimension had 2 factors: physical monitoring and symptom identification. The self-care management dimension included 2 factors: autonomous behaviors and counseling behaviors. Two factors were extracted from the self-care confidence dimension: monitoring and managing confidence, health maintenance confidence. The Cronbach's α, split-half reliability and composite reliability values for the total scale were 0.915, 0.836 and 0.912, respectively. The Cronbach's α for the four dimensions were 0.709-0.908. A significantly negative correlation was observed between each subscale and glycosylated hemoglobin (r_s=-0.160, -0.300, -0.177, -0.192; P<0.001) , serving as a criterion.

Conclusion

Based on the middle-range theory of self-care of chronic illness, the Chinese version of SCODI exhibits strong psychometric properties, making it a valid and reliable instrument for evaluating self-care of Chinese patients with diabetes.

Focus Groups·Pediatric Health Research

Quantitative Evaluation of China's Pediatric Drug Policies Based on Policy Modeling Consistency Index Model

LUO Jinping, SUN Jiaying, MOU Yifan, GENG Minghui, ZHANG Baoxuan, WANG Kang, YIN Wenqiang, CHEN Zhongming, MA Dongping

2025, 28(21):  2652-2660.  DOI: 10.12114/j.issn.1007-9572.2024.0456

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Background

Children, as a special group, have received public attention. Although a series of policies have been released in recent years to ensure the safety of children's medication, there are still problems such as fewer suitable varieties of drugs and irrational use of medication, which require scientific and reasonable policies on children's medication to promote their development.

Objective

To quantitatively evaluate China's pediatric drug policy texts and provide reference for the formulation and improvement of future pediatric drug policies.

Methods

Based on the text mining method, 23 pediatric drug policy documents issued at the national level from 2014 to 2023 were processed, the policy modeling consistency (PMC) index model of pediatric drug policy was constructed, and the quantitative evaluation and analysis of China's 23 pediatric drug policies were carried out through 10 primary variables and 41 secondary variables.

Results

The mean value of PMC index of the 23 policies on pediatric drug was 5.65, and the mean value of PMC depression index was 4.35, including 1 excellent-grade policy, 17 good-grade policies and 5 qualified-grade policies, and there were no perfect-grade policies and bad policies. 23 medication policies for children scored high on policy tools and policy receptors and low on publishing organizations and policy timeliness.

Conclusion

China's pediatric drug policy is generally at a good level, and can be further improved in terms of policy timeliness, issuing organization and policy content.

Factors Associated with Precocious Puberty in Chinese Children: a Meta-analysis

HU Wanqin, YU Shenyan, CAO Xuehua, XIANG Feng, JIA Yu

2025, 28(21):  2661-2671.  DOI: 10.12114/j.issn.1007-9572.2024.0459

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Background

The incidence of precocious puberty (PP) in Chinese children is increasing year by year, precocious children are more likely to have physical and mental health problems than normal children, and their growth can be affected. In view of the current clinical lack of understanding and prevention measures for PP, it's of great significance to clarify the relevant influencing factors and provide references for the prevention and treatment of PP.

Objective

To systematically evaluate the factors associated with PP in Chinese children.

Methods

We searched PubMed, Web of Science, Embase, Cochrane Library, CBM, CNKI, VIP and Wanfang databases, the search period was from the establishment of the database to April 30, 2024. Two researchers independently screened the literature, extracted data and assessed the quality of the included literature, and we performed Meta-analysis using Stata 15.0 software.

Results

A total of 41 studies covering 44 221 cases were selected, and 31 influencing factors were extracted. Methodological quality evaluation of the literature shows that 20 medium-quality and 21 high-quality studies were included. Meta-analysis demonstrated that: female (OR=1.64) , urban settlement (OR=4.13) , residential near chemical industry park (OR=2.52) , maternal age at menarche≤12 years old (OR=2.37) , >12-14 years old (OR=3.04) , low parental education (OR=2.41) , poor parental relationship (OR=4.37) , parental companionship <0.5 years (OR=2.05) , screen time (OR=3.07) , love romantic films and novels (OR=5.94) , outdoor activity<1 h/d (OR=3.86) , sleep with the light on (OR=2.48) , use of adult chemical products (OR=5.36) , plastic products are often used at home (OR=2.45) , heavy school workload (OR=2.63) , family history of PP (OR=3.23) , high BMI (OR=1.57) , sleep duration (OR=2.57) , frequent consumption of nutritional supplements (OR=3.01) , high-calorie and high-fat diets (OR=3.05) , high protein diets (OR=2.47) , animal food (OR=3.35) , sweets (OR=5.85) , food containing pigments or preservatives (OR=1.80) , leptin (OR=5.34) , estradiol (OR=3.32) , luteinizing hormone (OR=3.71) , insulin-like growth factor 1 (OR=2.70) and follicle stimulating hormone (OR=2.40) levels were the main risk factors for PP in Chinese children (P<0.05) , whereas maternal age at menarche >14 years (OR=0.64) , outdoor activity ≥2 h/d (OR=0.73) and consumption of vegetables and fruits ≥200 g/d (OR=0.60) were protective factors (P<0.05) .

Conclusion

Our findings show that the occurrence of PP in Chinese children is influenced by a multitude of sociodemographic, psychosocial, genetic, physiological, dietary, and environmental factors, among which the later age of mother´s menarche, the longer outdoor activities and the consumption of vegetables and fruits ≥200 g/d are protective factors. In the future, it is necessary to investigate and intervene on controllable factors. Families, schools and hospitals can work together to avoid or reduce the occurrence of PP in children.

Research Progress and Implications of Group Well-child Care

DU Qiongliang, LIN Bailang, GUO Honghua

2025, 28(21):  2672-2678.  DOI: 10.12114/j.issn.1007-9572.2024.0448

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With the decline in fertility rates, the state has adjusted its fertility policy and optimised complementary support measures, which has had a positive impact on the willingness of families to have children and on the increase in fertility levels, but the situation of declining births is still serious. Fertility is a natural and complex behaviour, which is affected by many factors, such as the level of economic development, the availability of childcare services, the level of reproductive health and family structure. To encourage people to respond to the latest fertility policy, it is important to build a comprehensive, accessible and convenient support system for infant and child care. Group well-child care (GWCC) facilitated by healthcare professionals, allows mothers to share and learn from each other's parenting experiences and postnatal health issues. This community-based group environment fosters the health of families and the improvement of professional capabilities, and promotes cooperation and interaction among healthcare professionals, parents, and different families. This new model of parenting will expand the depth and breadth of our country's postnatal maternal and child health services. In this paper, we will review the origin and development, service content, and application effect of GWCC, discuss the inspiration and applicability of GWCC to China, and look forward to the development direction of the group well-child care. In the future, GWCC can be combined with hospitals or communities to establish an integrated healthcare service system for postpartum and childcare, which will further solve the current problems in the field of postpartum childcare services in China, and promote the improvement of the infant and childcare system as well as the construction of a birth and parenting-friendly social environment.

Evidence-based Medicine

Efficacy and Safety of Danuglipron and Orforglipron in the Treatment of Type 2 Diabetes Mellitus: a Meta-analysis

MA Panpan, WANG Sijing, YOU Na, DING Dafa, LU Yibing

2025, 28(21):  2679-2685.  DOI: 10.12114/j.issn.1007-9572.2024.0484

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Background

Currently, there are several glucagon-like peptide-1 receptor agonists (GLP-1RAs) used for the treatment of type 2 diabetes (T2DM) , but most are administered by subcutaneous injection, which reduces patient compliance.Danuglipron and Orforglipron are novel oral small molecule GLP-1RAs, which may become a strong choice for hypoglycemic drugs in the future.

Objective

To systematically evaluate the efficacy and safety of Danuglipron and Orforglipron in the treatment of T2DM.

Methods

A computerized search was performed on several authoritative databases, including PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, Wanfang Data, and VIP databases. Randomized controlled trials (RCTs) comparing the efficacy and safety of Danuglipron or Orforglipron (test group) and placebo (control group) for the treatment of T2DM were collected, and the time frame for searching were all from the inception of the databases to May 2024. Screening was conducted based on pre-defined inclusion and exclusion criteria, and the quality of the screened literature was evaluated, the data were meta-analyzed using RevMan 5.4 software .

Results

A total of 6 studies were included in the analysis. The results indicated that in terms of efficacy, compared to the placebo group, the Danuglipron/Orforglipron group showed a reduction in glycosylated hemoglobin (HbA_1c) (MD=-1.04, 95%CI=-1.36 to -0.73, P<0.01) levels, fasting plasma glucose (FPG) (MD=-1.88, 95%CI=-2.53 to -1.23, P<0.01) levels, and an increase in fasting plasma insulin (FPI) (MD=4.68, 95%CI=2.42 to 6.95, P<0.01) levels. However, there was no statistically significant difference between the two groups in terms of weight reduction (MD=-4.00, 95%CI=-10.14 to 2.15, P=0.20) . Regarding safety, compared to the placebo group, the Danuglipron/Orforglipron group had increased rates of nausea (OR=7.85, 95%CI=4.25 to 14.50, P<0.01) , vomiting OR=9.45, 95%CI=4.19 to 21.31, P<0.01) , diarrhea (OR=1.96, 95%CI=1.13 to 3.39, P=0.02) , decreased appetite OR=4.56, 95%CI=1.75 to 11.91, P<0.01) , indigestion (OR=3.35, 95%CI=1.54 to 7.32, P<0.01) , belching OR=4.79, 95%CI=1.13 to 20.23, P=0.03) , constipation (OR=3.45, 95%CI=1.24 to 9.56, P=0.02) , and overall gastrointestinal adverse reactions (OR=5.37, 95%CI=3.32 to 8.69, P<0.01) . And there was no statistically significant difference in the occurrence rates of bloating (OR=2.67, 95%CI=0.72 to 9.86, P=0.14) and headache (OR=0.73, 95%CI=0.37 to 1.42, P=0.35) symptoms.

Conclusions

Oral administration of GLP-1 RAs Danuglipron and Orforglipron can effectively reduce the levels of HbA_1c and FPG, also increase the levels of FPI and the incidence of nausea, vomiting, diarrhea, decreased appetite, dyspepsia, belching, constipation and total gastrointestinal adverse reactions, but have no effect on the incidence of abdominal distension and headache.

Meta-analysis of the Efficacy and Safety of Finerenone in the Treatment of Type 2 Diabetic Nephropathy

ADILI Tuersun, CHENG Gang

2025, 28(21):  2686-2691.  DOI: 10.12114/j.issn.1007-9572.2024.0526

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Background

Finerenone, a nonsteroidal mineralocorticoid antagonist, is a novel therapeutic agent for renal protection in patients with diabetic kidney disease, joining the ranks of angiotensin-converting enzyme inhibitors and sodium-glucose cotransporter 2 inhibitors in providing renal protection for such patients. Recently, two meta-analyses focusing on patients with chronic kidney disease have yielded conflicting conclusions regarding the impact of finerenone on the decline of estimated glomerular filtration rate (eGFR) . In light of this, the present meta-analysis specifically targets the population with type 2 diabetes, aiming to thoroughly investigate the efficacy and safety of finerenone.

Objective

To systematically evaluate the efficacy and safety of finerenone in patients with type 2 diabetes and kidney disease.

Methods

A computerized search was conducted in the Cochrane Library, Web of Science, Embase, and PubMed databases, covering the period from their inception to April 2024. Literature was screened and data extracted according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman 5.3, comparing indicators such as the urine albumin-to-creatinine ratio and estimated glomerular filtration rate in type 2 diabetes patients treated with finerenone.

Results

A total of 7 articles were ultimately included, involving 15 528 patients. The results showed that compared with the control group, intervention group (using finerenone) had statistically significant differences in the urine albumin-to-creatinine ratio (SMD=-0.46, 95%CI=-0.48 to -0.39, P<0.05) , estimated glomerular filtration rate (SMD=-0.15, 95%CI=-0.19 to -0.10, P<0.05) , renal composite endpoint (OR=0.83, 95%CI=0.75 to 0.92, P<0.05) , all-cause mortality (OR=0.88, 95%CI=0.78 to 0.99, P<0.05) , and end-stage renal disease (OR=0.88, 95%CI=0.78 to 0.99, P<0.05) . Compared with the control group, intervention group significantly increased the risk of hyperkalemia (OR=2.13, 95%CI=1.89 to 2.39, P<0.05) .

Conclusion

Finerenone can significantly improve renal composite endpoint events in patients with type 2 diabetes and kidney disease, reduce the urine albumin-to-creatinine ratio, and slow down the decline of estimated glomerular filtration rate; however, attention should be paid to the risk of hyperkalemia during treatment.

Review & Perspectives

Research Progress of Heart Failure with Supra-normal Ejection Fraction

DONG Haocheng, HAO Xiao, AN Dong, LI Haohan, LI Shuren

2025, 28(21):  2692-2696.  DOI: 10.12114/j.issn.1007-9572.2024.0307

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More and more studies have proved that heart failure with supra-normal ejection fraction (HFsnEF) is a new heart failure phenotype with different characteristics, but its study is still in the exploratory stage at home and abroad. The critical value of supernormal ejection fraction (snLVEF) is still controversial, but most studies define it as left ventricular ejection fraction>65%; the proportion of elderly and female patients with HFsnEF is higher, with lower natriuretic peptide values and smaller left ventricles, and valvular disease, arrhythmia, and hypertensive heart disease are the main causes of heart failure; and the relationship between HFsnEF and mortality has a gender-dependent nature, possibly due to the prevalence of coronary microvascular disorders in elderly women, coupled with small heart size and high sympathetic excitability, making them more likely to suffer cardiovascular events; the current diagnosis and treatment of HFsnEF still follows the HFpEF approach. By combing the literature, this paper systematically discusses the research progress of HFsnEF, with a view to providing a reference for the in-depth study of HFsnEF.

Research Progress on the Role of Endothelial Cell Injury and Dysfunction in Atherosclerosis

GAO Haijun, REN Jiayu, WANG Ruolin, ZHOU Huiya, QU Peng

2025, 28(21):  2697-2704.  DOI: 10.12114/j.issn.1007-9572.2024.0440

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Cardiovascular disease is a prevalent condition characterized by a high incidence rate and mortality. Atherosclerosis (AS) serves as the underlying pathological mechanism for numerous cardiovascular diseases, primarily marked by lipid accumulation and plaque formation within arterial walls, thereby impacting tissue or organ ischemia or necrosis. This comprehensive article delves into the pivotal role of endothelial cells (ECs) in atherosclerosis, elucidating their mechanisms of injury and dysfunction, as well as their interactions with macrophages and vascular smooth muscle cells (VSMCs) during this process. The findings presented herein underscore the critical involvement of ECs in AS pathogenesis, emphasizing that mitigating damage to these cells and preserving their functionality can potentially ameliorate the onset and progression of AS. Our aim is to provide novel therapeutic avenues for AS.