Chinese General Practice

Chinese Expert Consensus on the Diagnosis and Treatment of Diabetes Comorbid with Depression

Psychosomatic Endocrinology Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, Diabetes Prevention and Control Committee of Chinese Preventive Medicine Association

2026, 29(03): 273-292. DOI: 10.12114/j.issn.1007-9572.2025.0216

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The comorbidity of diabetes and depression is relatively common in clinical practice,with a significant bidirectional association between the two conditions. This comorbid state not only increases the disease burden and treatment complexity but also severely impacts patients' quality of life and long-term prognosis. The shared pathophysiological mechanisms of diabetes and depression may involve neuroendocrine dysregulation, chronic inflammation, and unhealthy lifestyle factors. Currently, clinical management faces several major challenges: insufficient awareness and recognition of the comorbidity among healthcare providers often leads to underdiagnosis or misdiagnosis of depression; lack of effective interdisciplinary collaboration hampers the implementation of integrated care; and the absence of specific diagnostic and treatment guidelines both domestically and internationally results in a lack of standardized clinical practice. To address these issues, the Psychosomatic Endocrinology Collaboration Group of the Psychosomatic Medicine Society of the Chinese Medical Association, in collaboration with experts from endocrinology and metabolism, psychiatry, neurology, psychology, psychosomatic medicine, and traditional Chinese medicine, has developed the first Chinese Expert Consensus on the Diagnosis and Treatment of Diabetes Comorbid with Depression. This consensus systematically elaborates on the clinical features, pathophysiological mechanisms, assessment tools, and intervention strategies for the comorbidity, underscores the importance of multidisciplinary collaboration, proposes a standardized screening and diagnostic pathway, and provides specific recommendations for collaborative care. The release of this consensus aims to offer scientific and practical clinical guidance, improve the recognition and management of this comorbidity, and ultimately enhance overall patient care and long-term outcomes.

Interpretation of the Consensus Statement Physical by American College of Sports Medicine on Adults Activity and Excess Body Weight and Adiposity

ZHANG Ying, YANG Ziyu, LIU Lidi, LIAO Xiaoyang, JIA Yu, SHEN Can, YANG Rong

2026, 29(03): 293-298. DOI: 10.12114/j.issn.1007-9572.2025.0164

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Excess body weight and adiposity are closely related to the pathogenesis of various chronic diseases. To address this health crisis, the American College of Sports Medicine released the Consensus Statement on Adult Physical Activity and Excess Body Weight and Adiposity in 2024. This consensus supports the inclusion of physical activity in the medical treatment of excess body weight and adiposity (drug therapy, metabolic and bariatric surgery) when medically deemed appropriate. And put forward insights on the application of physical activity in these treatments. This consensus particularly points out: (1) For weight loss and the prevention of weight gain, the effect may be most significant when engaging in at least 150 minutes of moderate-intensity physical activity per week. (2) High-intensity interval training is not superior to the physical activity effect of moderate to high-intensity continuous training in terms of weight regulation. (3) Low-intensity physical activities can be used as an alternative under the premise of ensuring energy consumption. (4) Various forms of exercise are equivalent in weight management. To achieve overall health benefits beyond weight control and fat loss, it is recommended to adopt multiple modes of physical activity. This consensus emphasizes the importance of physical activity in the prevention, treatment and management of overweight and obesity. This guideline interpretation aims to conduct an in-depth analysis of the core points of this consensus statement, provide new suggestions for the prevention and treatment of overweight/obesity through physical activity in our country, and help primary care doctors manage overweight/obesity patients more effectively.

Effect of Blood Pressure Trajectory on Cardiovascular Disease in Population with High-normal Blood Pressure: a Study Based on the Kailuan Cohort

LU Yanqiu, WU Yuntao, LIU Shaopeng, LIN Haiying, DENG Huiyou, WU Ying, HUANG Zhe, YANG Peng, WU Shouling, LI Yun

2026, 29(03): 299-310. DOI: 10.12114/j.issn.1007-9572.2025.0109

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Background

Cardiovascular disease (CVD) is a leading cause of premature death and rising healthcare costs worldwide. An estimated 330 million people in China are affected by CVD, posing a substantial medical and financial burden to the nation. Among Chinese adults aged 18 and over without a prior hypertension diagnosis, 50.9% have high-normal blood pressure (BP). High-normal BP is associated with an increased risk of CVD incidence, and its effective control could prevent over 10% of CVD cases.

Objective

This study aimed to identify distinct BP trajectory patterns in individuals with high-normal BP using group-based trajectory modeling, investigate the impact of these trajectories on CVD risk, and provide a scientific basis for developing BP management and CVD prevention strategies for this population.

Methods

Participants from the Kailuan Study who underwent health examinations between 2006 and 2012 and were identified as having high-normal BP at their first examination were enrolled. Baseline data were collected via questionnaires, anthropometric measurements, and laboratory tests. Participants were followed until the first occurrence of a CVD event [myocardial infarction (MI) or stroke] or until December 31, 2022. Group-based trajectory modeling (GBTM) was used to model systolic BP (SBP) and diastolic BP (DBP) trajectories. Kaplan-Meier survival curves and Log-rank tests were used to compare cumulative CVD incidence across trajectory groups. Multivariable Cox proportional hazards regression models, or weighted Cox regression models when the proportional hazards assumption was violated, were used to analyze CVD risk across different BP trajectory groups. Multiplicative interactions between sex/age and BP trajectories were tested using Cox models, followed by stratified analyses. Sensitivity analyses were conducted to verify the robustness of the findings.

Results

A total of 21 745 subjects were ultimately included, with a mean age of (54.0±11.4) years; 17 556 (80.74%) were male and 4 289 (19.26%) were female. GBTM results identified four distinct SBP trajectories, each characterised by its SBP range and pattern of change over follow-up (i.e., stable, declining, or increasing). Among 7 088 subjects maintained stable SBP around 115 mmHg (1 mmHg=0.133 kPa), termed the "normal-high blood pressure decline group"; 11 662 subjects maintained stable SBP around 130 mmHg, termed the "normal-high blood pressure stable group"; 1 710 subjects exhibited a gradual increase from 129 mmHg to approximately 160 mmHg during the trajectory period, termed the "normal high blood pressure ascending cohort"; 1 285 subjects saw their SBP rise to around 158 mmHg before declining below 140 mmHg, termed the "normal high blood pressure ascending-descending cohort". DBP identified four distinct trajectories, each characterised by its DBP range and pattern of change over follow-up (i.e., stable, declining, or increasing). Among 4 856 subjects, DBP remained stable around 75 mmHg, termed the "normal-high blood pressure declining group"; 13 668 subjects exhibited stable DBP around 83 mmHg, termed the "normal-high blood pressure stable group"; 1 640 subjects exhibited a gradual increase in DBP from 82 mmHg to approximately 100 mmHg during the trajectory period, termed the "normal high blood pressure rising group"; 1 581 subjects experienced an increase in SBP to around 98 mmHg before declining below 90 mmHg, termed the "normal high blood pressure rising-falling group". Participants across different SBP trajectory groups were comparable in age, sex, BMI, educational attainment, smoking, alcohol consumption, physical activity, SBP, DBP, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), fasting blood glucose (FBG), high-sensitivity C-reactive protein, estimated glomerular filtration rate (eGFR), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), hypertension, diabetes, antihypertensive medication use, and antidiabetic medication use were compared across different DBP trajectory groups. Differences were statistically significant (P<0.05). Comparisons of age, gender, BMI, educational attainment, smoking, alcohol consumption, salt preference, SBP, DBP, HDL-C, LDL-C, TG, TC, FBG, high-sensitivity C-reactive protein, eGFR, ISH, IDH, hypertension, diabetes mellitus, and antihypertensive medication use showed statistically significant differences (P<0.05). The mean follow-up duration was (9.43±1.94) years, during which 1 429 CVD events occurred (259 MI, 1 170 strokes, and 20 concurrent events). The SBP trajectory subgroups (normal high blood pressure decline, stable, increase, and increase-decline) recorded 274, 794, 191, and 170 new CVD cases respectively. The DBP trajectory groups showed 227, 881, 163, and 158 new CVD cases in the normal-high blood pressure decline, stable, increase, and increase-decline groups respectively. Survival curves depicting cumulative CVD incidence were plotted for study subjects. Log-rank test results indicated statistically significant differences in cumulative CVD incidence between different SBP trajectory groups and DBP trajectory groups (χ²=275.39, 90.69; P<0.001). Using Cox proportional hazards regression models, the hazard ratios (HR) for CVD occurrence across different SBP trajectory groups (95%CI) were calculated, with the normal-high blood pressure decline group serving as the reference. The HR for CVD occurrence in the normal-high blood pressure stable group, normal-high blood pressure increase group, and normal-high blood pressure increase-decrease group were 1.41 (1.22-1.62), 1.92 (1.58-2.33), and 2.24 (1.84-2.74), respectively. The HR (95%CI) for stroke occurrence were 1.46 (1.25-1.71), 2.04 (1.65-2.53) and 2.37 (1.90-2.96), respectively. The HR (95%CI) for MI occurrence were 1.25 (0.92-1.72), 1.42 (0.90-2.23) and 1.81 (1.14-2.86), respectively. Using weighted multivariable Cox proportional hazards regression models unconstrained by the proportional hazards assumption, the aHR (95%CI) for CVD occurrence was calculated with the normal-to-high blood pressure decrease group as the reference. The aHR (95%CI) for CVD occurrence in the normal-to-high blood pressure stable group, the normal-to-high blood pressure increase group, and the normal-to-high blood pressure increase-decrease group were 1.43 (1.12-1.82), 2.59 (1.62-4.13), and 2.11 (1.40-3.17), respectively. The aHR (95%CI) for stroke occurrence were 1.45 (1.11-1.71), 2.95 (1.75-4.97) and 2.34 (1.48-3.71), respectively. The aHR (95%CI) for MI occurrence were 1.34 (0.76-2.34), 1.17 (0.62-2.19) and 1.32 (0.69-2.55), respectively. Stratified analysis indicated that only the SBP trajectory showed a statistically significant interaction with gender and age (P_interaction<0.05), whereas the DBP trajectory did not exhibit a statistically significant interaction with gender and age (P_interaction>0.05). In the male cohort, using the SBP trajectory normal-high blood pressure decreasing group as the reference group, the HR (95%CI) for CVD occurrence in the normal-high blood pressure stable group, normal-high blood pressure increasing group, and normal-high blood pressure increasing-decreasing group were 1.42 (1.20-1.67), 1.93 (1.53-2.42), and 2.30 (1.82-2.90), respectively; In the female cohort, using the SBP trajectory normal-high blood pressure decline group as the reference group, the HR (95%CI) for CVD occurrence in the stable, rising, and rising-decline groups were 1.80 (1.14-2.85), 2.91 (1.62-5.21), and 2.79 (1.43-5.43), respectively. Among individuals aged <60 years with prehypertension, using the SBP trajectory prehypertension decline group as reference, the HR (95%CI) for CVD occurrence were 1.48 (1.22-1.78), 2.00 (1.46-2.71), and 3.01 (2.24-4.06), respectively. Among normotensive individuals aged ≥60 years, with the declining SBP trajectory group as reference, CVD HR (95%CI) was 1.35 (1.01-1.79), 1.94 (1.40-2.69), and 1.91 (1.35-2.69), respectively.

Conclusion

Distinct BP trajectory patterns are associated with varying levels of CVD risk in individuals with high-normal BP. For SBP, trajectories characterized by high levels and large fluctuations carried the highest CVD risk. For DBP, trajectories with an ascending trend and high baseline DBP posed the greatest risk. Even individuals whose BP remains stable within the high-normal range (120-139/80-89 mmHg) without major fluctuations still face an elevated risk of CVD.

Expression and Clinical Implications of β-tropomyosin in Myocardial Tissues Across Cardiomyopathies

WANG Xuesheng, ZHANG Yusong, GONG Fuhan, JIANG Dingsheng

2026, 29(03): 311-315. DOI: 10.12114/j.issn.1007-9572.2025.0182

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Background

β-tropomyosin (TPM2) is a key structural protein that regulates muscle contraction, and its abnormal expression is closely associated with the development of various diseases. However, the expression patterns of TPM2 in different types of cardiomyopathies remain unclear.

Objective

To investigate the expression patterns and clinical relevance of TPM2 in myocardial tissues from patients with hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and coronary artery disease (CAD).

Methods

Myocardial tissue samples were collected from patients who underwent heart transplantation or septal myectomy at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2016 and June 2021, including HCM (septal tissues, n=13), DCM (left ventricular tissues, n=48), and CAD (peri-infarct and non-infarct regions of the left ventricular, n=8). Eight donor hearts (left ventricular tissues, n=8, and septal tissues, n=6) were included as controls. A tissue microarray containing 77 samples was constructed. TPM2 protein expression was assessed by immunohistochemistry and its clinical relevance was analyzed.

Results

Compared to the donor group, TPM2 expression was significantly reduced in the septal tissue of HCM patients (P<0.05). In the HCM group, TPM2 expression in septal tissue was positively correlated with left ventricular end-diastolic volume (r=0.478, P=0.018) and left ventricular lateral wall thickness (r=0.475, P=0.040). TPM2 expression was also significantly reduced in the left ventricular tissue of DCM patients compared to the donor group (P<0.05). In the CAD group, TPM2 expression levels in both peri-infarct and non-infarct regions showed no significant difference compared to controls (P>0.05).

Conclusion

TPM2 exhibits heterogeneous expression patterns across different cardiomyopathies. In HCM patients, downregulation of TPM2 in septal tissue is significantly associated with ventricular remodeling, suggesting that TPM2 may play a critical role in the pathogenesis of HCM and may serve as a potential therapeutic target.

Association between Physical Activity Changes Trajectories and Frailty in Older Adults

ZHENG Huatao, WANG Shiqiang, LI Dan, YANG E, LUO Dan, LAI Yu, MA Rentao

2026, 29(03): 316-324. DOI: 10.12114/j.issn.1007-9572.2025.0231

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Background

With the intensification of population aging in China, the issue of frailty among the elderly is becoming increasingly prominent, making research on its prevention and intervention particularly important. Currently, most studies lack discussion on the dynamic relationship between changes in physical activity and frailty.

Objective

This study is based on the five waves of data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, aiming to explore the association between physical activity changes trajectories and frailty in older adults, and to provide a scientific basis for the prevention and intervention of frailty in the elderly.

Methods

Group-based trajectory modeling (GBTM) was used to identify the potential subgroups and trajectory characteristics of physical activity over time among the survey participants during the follow-up period. Multivariate unconditional logistic regression models were employed to analyze the association between different physical activity trajectory types and frailty, as well as subgroup analyses.

Results

The physical activity trajectories of the survey participants were divided into four groups: persistent low group (262 individuals, 13.87%), low-to-increasing group (993 individuals, 52.57%), high-to-decreasing group (122 individuals, 6.46%), and persistent high group (512 individuals, 27.10%). There were significant differences in frailty among the four groups (χ²=20.867, P<0.001). After adjusting for confounding factors such as age and gender, multivariate unconditional Logistic regression indicated that compared with the persistent low group, the low-to-increasing group (OR=0.581, 95%CI=0.414-0.815, P=0.002) and the persistent high group (OR=0.546, 95%CI=0.373-0.799, P=0.002) had significantly lower risks of frailty. Subgroup analysis revealed that, compared with the consistently low group, the initially low then rising group demonstrated significant reductions in frailty risk among the following elderly subgroups: age≥65 years (OR=0.502, 95%CI=0.345-0.730), males (OR=0.539, 95%CI=0.326-0.891), urban residents (OR=0.441, 95%CI=0.211-0.922), those without a partner (OR=0.312, 95%CI=0.160-0.606) (P<0.05). Similarly, the consistently high group exhibited protective effects against frailty in elderly individuals aged≥65 years (OR=0.425, 95%CI=0.274-0.658), females (OR=0.539, 95%CI=0.328-0.886), urban residents (OR=0.280, 95%CI=0.101-0.780), and those without a partner (OR=0.347, 95%CI=0.164-0.737) (P<0.05).

Conclusion

Different trajectory groups are associated with the risk of frailty. Physical activity trajectories characterized by a low-to-increasing pattern and persistent high levels can significantly reduce the incidence of frailty in older adults.

Study on the Isochronous Substitution Effect of 24-hour Activity Behaviors on Metabolic Syndrome in Adolescents

FENG Zhanpeng, TAN Sijie, GUO Zhen, CAO Liquan

2026, 29(03): 325-330. DOI: 10.12114/j.issn.1007-9572.2024.0317

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Background

The onset of metabolic syndrome (MS) is becoming younger, and the incidence of MS in adolescents is annually increasing. The 24-hour activity behaviors consist of physical activity (PA), sedentary behavior (SB), and sleep (SLP). The substitution benefits generated by the mutual substitution of activity behaviors are of great significance to the prevention and control of adolescent MS.

Objective

To explore the substitution benefits of redistributing between SB, the Low Intensity Physical Activity (LPA), Moderate-to-High Intensity Physical Activity (MVPA), and SLP on the risk factors of adolescent MS based on the component isochronous substitution model.

Methods

From September 2022 to June 2023, 181 subjects aged 12-15 years old from Tianjin, China were randomly recruited, including 85 males and 96 females. SB, LPA, MVPA, SLP of subjects were collected using a 3D accelerometer. The height, body mass, and waist circumference (WC), as well as blood pressure after 15 minutes of rest were recorded. Triglycerides (TG), high-density lipoprotein cholesterol(HDL-C), and blood glucose (GLU) were examined using a fully automated biochemical analyzer and reagent kits. A component equal time substitution model was performed, and 15-minute substitution benefits and continuous substitution at 5-minute intervals were conducted.

Results

The time of SLP, SB, LPA, and MVPA of subjects were (586.5±66.2) min, (571.2±90.8) min, (233.8±67.2) min, and (49.5±17.8) min, respectively. With the increased MVPA activity time by 15 minutes, the standardized waist circumference decreased by 0.16-0.20 units, the standardized systolic blood pressure (SBP) decreased by 0.12-0.24 units, the standardized diastolic blood pressure (DBP) decreased by 0.18-0.29 units, the standardized blood glucose decreased by 0.03-0.10 units, the standardized TG decreased by 0.02-0.09 units, and the standardized HDL-C increased by 0.05-0.07 units. The utility generated by MVPA replacing SB was superior to the utility generated by MVPA replacing SLP, followed by the utility generated by MVPA replacing LPA. When the MVPA activity time increased by 60 minutes, the standardized waist circumference decreased by 0.02-0.62 units, standardized SBP decreased by 0.06-0.49 units, standardized DBP decreased by 0.08-0.64 units, standardized TG decreased by 0.01-0.14 units, standardized HDL-C increased by 0.03-0.23 units, and standardized blood glucose decreased by 0.01-0.12 units.

Conclusion

Changes in 24-hour activity behaviors have significant effects on waist circumference, SBP, DBP, blood glucose, TG, and HDL-C in adolescents, with MVPA replacing SB producing the greatest substitution benefit. MVPA is irreplaceable, and the negative benefits generated by other activities replacing MVPA far outweigh the positive benefits generated by MVPA replacing other activities.

Prevention and Treatment Effect of "General-Specialty" Graded Precision Management on Type 2 Diabetes Hypoglycemia: a Randomized Controlled Study

MA Tengteng, ZHU Binggen

2026, 29(03): 331-339. DOI: 10.12114/j.issn.1007-9572.2025.0189

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Background

With the rising prevalence of diabetes and the widespread adoption of intensive glucose-lowering therapies, the incidence of hypoglycemia has increased significantly. The hazards and management of hypoglycemia remain critical clinical challenges.

Objective

To investigate the effect of the "General-Specialty" graded precision management model on the physical and mental health of type 2 diabetes patients with hypoglycemia in the community.

Methods

A total of 120 T2DM patients with a history of hypoglycemia within 6 months, who attended Shanggang Community Health Service Center in Pudong New Area, Shanghai from January to July 2023, were enrolled. The patients were divided into a control group and an experimental group, with 60 cases in each group, using a random number table method. The control group received routine management, while the experimental group was subjected to the "General-Specialty" graded precision management model. Based on the severity of hypoglycemia and individual patient conditions, subjects in the experimental group were referred to general practice clinics, specialized diabetes clinics, or transferred to tertiary hospitals. Additionally, comprehensive interventions were implemented, including real-time data-driven precise management, psychological intervention, comprehensive health education, and the establishment of a family support system. After 6 months of intervention, the two groups were compared in terms of blood glucose control parameters [fasting plasma glucose (FPG), hemoglobin A_1c(HbA_1c), time in range (TIR), and blood glucose coefficient of variation (CV)], the number of hypoglycemic episodes (total, mild, moderate, and severe), scores on the Chinese Hypoglycemia Fear Survey-Worry Scale (CHFSⅡ-WS), and the total score and dimension scores of the Diabetes-Specific Quality of Life Scale (DSQL). To evaluate the impact of the "General-Specialty" graded precision management model on the blood glucose control and fear of type 2 diabetes patients with hypoglycemia, and then evaluate the significance of this management model on the management of type 2 diabetes patients with hypoglycemia in the community.

Results

During the intervention period, 1 patient in the experimental group was lost to follow-up due to residential relocation. The results of repeated measures ANOVA showed that there was no interaction between group and time on BMI and waist circumference (F_interaction =1.922, 1.134; P_interaction =0.162, 0.320).Time exerted a significant main effect on BMI and waist circumference (F_time=7.507, 4.097; P_time=0.003, 0.021), whereas group had no significant main effect on these parameters (F_group=0.598, 0.138; P_group=0.441, 0.711). No interaction between group and time was observed for systolic blood pressure (SBP) or diastolic blood pressure (DBP) (F_interaction =0.868, 0.151; P_interaction =0.419, 0.860), and neither time nor group had a significant main effect on SBP or DBP (F_time=1.295, 1.267; P_time=0.276, 0.284; F_group=1.750, 0.337; P_group=0.188, 0.562). Significant interactions between group and time were detected for FPG, HbA_1c, and CV (F_interaction =36.662, 15.157, 10.767, P_interaction <0.001). Both time and group had significant main effects on FPG, HbA_1c, and CV (F_time=105.098, 60.155, 41.307; P_time<0.001; F_group=6.916, 4.357, 4.094; P_group=0.010, 0.039, 0.045). A significant interaction between group and time was also found for TIR (F_interaction =4.767, P_interaction =0.012). Time had a significant main effect on TIR (F_time=13.456, P_time<0.001), but group did not (F_group=3.405, P_group=0.068). After 6 months of intervention, the total number of hypoglycemic episodes, as well as the number of mild and moderate episodes, was significantly lower in the experimental group than in the control group (all P<0.05). Post-intervention scores of CHFSⅡ-WS, total DSQL, and all DSQL dimension scores were significantly lower in the experimental group than in the control group (all P<0.05). Furthermore, these scores were significantly lower in the experimental group post-intervention compared with pre-intervention (all P<0.05).

Conclusion

The "General-Specialty" graded precision management model improves glycemic control, reduces glucose variability, and lowers hypoglycemia risk, thereby enhancing community-based T2DM hypoglycemia management. It alleviates fear of hypoglycemia, improves self-management, and enhances quality of life.

The Management Approach and Implementation Path for Major Chronic Diseases in Jiangxi Province: Focusing on the Integration of Medical Care and Prevention under the Framework of "Modernizing Health and Hygiene"

LI Liqing, WAN Jiawen, ZENG Chuanmei, LIN Huiying

2026, 29(03): 340-347. DOI: 10.12114/j.issn.1007-9572.2025.0006

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Background

The report of the 20th National Congress of the Communist Party of China pointed out that it is necessary to adhere to prevention, strengthen the health management of major chronic diseases, and improve the grassroots ability to prevent and treat diseases and health management. Faced with the dual challenges of high incidence of chronic diseases and emerging infectious diseases, the traditional mode of "emphasizing treatment and neglecting prevention" has been difficult to meet the growing health needs of the people. Jiangxi Province issued Several Opinions on Accelerating the Modernization of Health and Health and Action Plan for Building a New Era of Health and Health in Jiangxi Province (2024-2027), integrating health and health modernization into the province's development strategy and formulating a series of institutional measures.

Objective

Focusing on the management of major chronic diseases, this study systematically analyzed the main trends of the current integration of medical and prevention, and explored the five major challenges faced by the current management of chronic diseases: the imbalance of supply and demand of policy tools, the lack of coordination between management departments, the lack of cooperation between departments, the uneven guarantee of talents, and the lack of self-management enthusiasm of patients.

Methods

According to the practical experience of some provinces and cities in China, the "1+2+3" model in Yichun, the "hospital management" model in Jiujiang, the "project + grid" model in Pingxiang and the "Project + grid" model in Shangrao Wuyuan were put forward.

Results

The research has identified four representative chronic disease management models in Jiangxi Province: (1) The "1+2+3" integrated management model in Wan County, Yichun City, which uses family doctor contracting as the link to establish a closed-loop service system for prevention, diagnosis and rehabilitation; (2) The "hospital-run and hospital-managed" traditional Chinese medicine (TCM) characteristic prevention and treatment model in Jiujiang City, where public hospitals directly manage community health centers to achieve a deep integration of TCM applicable technologies and chronic disease prevention and control; (3) The close-knit medical consortium model in Pingxiang City, which relies on the three-level linkage of districts, towns and villages and information support to promote the downward flow of high-quality resources and the simultaneous management of chronic diseases; (4) The "project + grid-based" model in Wuyuan County, Shangrao City, with the H-type hypertension prevention and control project as the starting point, to build a chronic disease prevention and control network led by the government, with coordinated efforts from various departments and grid-based management. Further, four implementation paths for the integration of medical care and prevention of chronic diseases in Jiangxi Province have been condensed: coordinated governance of the system, refined integrated management, diversified TCM empowerment, and efficient linkage of medical consortia.

Conclusion

Jiangxi Province has initially established a replicable and scalable multi-mode approach in promoting the integration of medical care and prevention for chronic disease management. However, it still faces issues such as imbalance between policy supply and demand, poor cross-departmental collaboration, insufficient talent support, and weak patient self-management awareness. In the future, efforts should be made to improve the overall planning, strengthen policy coordination, optimize the integrated medical and prevention mechanism, leverage the advantages of traditional Chinese medicine, and provide information support. These measures aim to promote the high-quality development of the chronic disease management system and contribute to achieving the goal of modernizing health care in Jiangxi Province.

Construction of an Innovative Model for Driving Community Bone Health Management through Family Doctor Contracted Services

LI Linghui, WEI Xu, QIN Xiaokuan, ZHANG Yili, XU Xilin, YANG Shaofeng, FENG Tianxiao, WANG Zhenyu, YANG Kexin, SUN Kai, ZHU Liguo

2026, 29(03): 348-354. DOI: 10.12114/j.issn.1007-9572.2025.0179

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With the intensification of population aging, bone health diseases (e.g., osteoporosis, osteoarthritis, scoliosis) have become a major public health challenge in China. Traditional healthcare models, centered on acute-phase diagnosis and treatment, suffer from shortcomings such as overemphasis on treatment over prevention, fragmented services, and inadequate continuity of rehabilitation, leading to low early screening rates, poor patient compliance, and high recurrence risks. This study analyzes the core characteristics and management bottlenecks of bone health diseases. Drawing on international chronic disease management frameworks and domestic practical experience, and leveraging the resource integration advantages of family doctor contracted services, we innovatively constructed a "smart hierarchical early warning-multidisciplinary collaborative intervention-integrated medical and preventive care" model for full-cycle closed-loop management of bone health, aiming to address systemic challenges in bone health management. The innovation of this study lies in enhancing management efficiency through intelligent tools, optimizing resource allocation via multidisciplinary collaboration, and strengthening the sustainability of healthcare services through policy reforms, thereby providing a systematic paradigm for grassroots bone health management.

Study on the Effect of Energy-limited Intermittent Diet Patterns on Weight Management in Overweight and Obese People

ZHANG Wei, JIA Yuexiao, TANG Hongwei, XUE Xin, LEI Ying, DU Na, WANG Yumeng, YUAN Jiyun, LIU Huan

2026, 29(03): 355-360. DOI: 10.12114/j.issn.1007-9572.2025.0250

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Background

Overweight and obesity have become serious public health problems in China, threatening people's health. However, the weight management models currently available require further research and analysis.

Objective

To analyze the effect of an energy-limiting intermittent fasting mode combined with online intervention on weight management in overweight and obese people.

Methods

The overweight and obese people who underwent weight management in the Nutrition Department of Wuqing People's Hospital from January to October 2024 were selected as the research object, and divided into intervention (100 cases) and control (96 cases) groups by stratified random method. The control group adopted a conventional energy-limiting intermittent fasting diet model for weight management, while the intervention group used energy-limiting intermittent fasting diet model combined with online intervention for weight management. Changes in weight, metabolic rate, circumferences, muscle mass and before and BMI were assessed before the intervention, 2 months after intervention and 4 months after intervention.

Results

Interactions between group and time were observed for weight, waist circumference and BMI (P_interaction<0.05). Main effects of group were significant for weight, waist circumference and BMI (P_group<0.05), and main effects of time were significant for these variables as well (P_time<0.05). Before the intervention, there were no significant differences between the two groups in terms of weight, waist circumference, BMI, muscle mass, metabolic rate, upper arm muscle circumference, calf circumference or body fat percentage (P>0.05). Four months after the intervention, the intervention group showed significant reductions in weight, waist circumference, BMI and body fat rate, and increased metabolic rate and upper brachial muscle circumference compared to the control group (P<0.05). There was no significant difference in calf circumference between the groups (P>0.05). The weight loss efficiency rate (WLER) was significantly higher in the intervention group (66.0%, 66/100) compared to the control group (20.8%, 20/96)(χ²=10.20, P=0.006). Group and time interactions were observed for exercise, eating behavior, emotional control and total score (P_interaction<0.05). The group had significant main effects on exercise, eating behavior, emotional control and total score respectively (P_group<0.05), and time also had significant main effects on these variables (P_time<0.05). Before the intervention, there were no significant differences in these scores between the groups (P>0.05). After 2 or 4 months of intervention, the above scores of the intervention group were significantly higher than those of the control group (P<0.05).

Conclusion

The energy-limiting intermittent fasting model combined with online intervention significantly improved the weight, metabolic rate, circumference and muscle mass in overweight and obese individuals, compared to the conventional energy-limiting intermittent fasting diet modelIt also enhanced self-management abilities of patients.

Study on Dietary Factors Associated with Obesity Among University Freshmen

CHEN Zhixin, ZHANG Li, GUO Xinyue, ZHOU Zhongliang, ZHANG Jianduan, XU Jinhang, RONG Shengzhong, ZHAO Li, TIAN Qiyue, WANG Sufang, TIAN Xiangyang, GONG Shaoqing

2026, 29(03): 361-372. DOI: 10.12114/j.issn.1007-9572.2025.0017

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Backgroud

Adolescent obesity can lead to various diseases such as type 2 diabetes, fatty liver, and dyslipidemia, while increasing the risk of chronic diseases in adulthood. The development of obesity is influenced not only by food types and intake quantity but also by eating behaviors, including eating speed, meal timing, breakfast frequency, and nighttime eating. However, the association between dietary behaviors and obesity among Chinese adolescents remains unvalidated.

Objective

To explore the association between dietary behaviors and adolescent obesity, and to provide scientific evidence for effective obesity prevention strategies.

Methods

A multistage sampling approach was employed: simple random sampling selected 7 provinces nationwide; convenience sampling identified 16 universities within these provinces; cluster sampling included all first-year students aged 16-19 years from the selected universities. Data on current height, weight, and dietary behaviors were collected via self-administered electronic questionnaires. Statistical analyses (chi-square tests and Logistic regression) were performed using SPSS 26.0 and R 4.3.3.

Results

A total of 16 445 freshmen were surveyed, including 6 710 males (40.80%) and 9 735 females (59.20%), with an average age of (18.04±0.75) years. The highest proportions were in the 18 years (9 618 cases, 58.49%) and 19 years (4 169 cases, 25.35%) age groups, and 5 375 (32.68%) were only children. The overall obesity rate among adolescents was 10.48% (1 723/16 445). The obesity rates of adolescents with much faster, slightly faster, and much slower eating speeds were 15.02% (587/3 908), 9.41% (1 029/10 930), and 6.66% (107/1 607), respectively, and the obesity rate increased with the acceleration of eating speed (P<0.05). The obesity rate of adolescents whose parents were both obese was higher than that of those whose parents were both non-obese [18.89% (17/90) vs 10.10% (1 544/15 293), P<0.05]. There was no significant difference in the obesity rate between males and females whose parents were both obese [16.22% (6/37) vs 20.75% (11/53), P=0.79]; the obesity rate of males whose parents were both non-obese was higher than that of females [12.79% (796/6 225) vs 8.25% (748/9 068), P<0.05]. The obesity rate of adolescents whose fathers were obese but mothers were non-obese was 16.06% (88/548), and the obesity rate of males was lower than that of females [14.29% (38/266) vs 17.73% (50/282), P<0.05]. The obesity rate of adolescents whose mothers were obese but fathers were non-obese was 16.15% (26/161), and the obesity rate of males was higher than that of females [22.03% (13/59) vs 12.75% (13/102), P<0.05]. The results of multivariate Logistic regression analysis showed that males [OR (95%CI)=1.46 (1.31-1.62)], younger age [compared with 19 years old, OR (95%CI) of 16 years old was 1.37 (1.08-1.73), and OR (95%CI) of 17 years old was 1.27 (1.06-1.51)], much faster [OR (95%CI)=2.19 (1.76-2.74)] and slightly faster eating speeds [OR (95%CI)=1.42 (1.15-1.75)], and having breakfast and dinner at home and lunch at school [with an OR (95%CI)=0.86 (0.75-0.98) compared to those who eat at school] were more likely to be obese.

Conclusion

Key risk factors for adolescent obesity in China include male gender, younger age, parental obesity, fast eating speed, and eating location patterns (e.g., school lunches with home breakfast/dinner). Additionally, a potential X-chromosome dominant cross-inheritance pattern of obesity was observed, though further validation is required.

Effects of Short-term Dietary Intervention for Obese Patients with Abnormal Glucose Metabolism

SHENG Luguang, LIU Dandan, LIU Weibin, LU Jun, LEI Tao, CHEN Qingguang, LU Hao, XU Bilin

2026, 29(03): 373-379. DOI: 10.12114/j.issn.1007-9572.2025.0098

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Background

Recent studies show that dietary interventions can induce remission of type 2 diabetes mellitus (T2DM) in individuals with overweight or obesity, but related evidence from China remains limited.

Objective

To evaluate the clinical efficacy of a short-term dietary intervention in obese patients with abnormal glucose metabolism and to examine its impact on hepatopancreatic fat content and pancreatic β-cell function.

Methods

From March 2020 to August 2022, 60 obese adults with abnormal glucose metabolism attending the Obesity Clinic of the Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, were randomized to a low-calorie balanced diet (LCBD; n=30) or a meal-replacement diet (MRD; n=30) for 3 months. At baseline and post-intervention, group differences in changes in body composition, laboratory indices, and imaging examination were compared.

Results

Groups were comparable at baseline in sex distribution, body composition, laboratory variables, and imaging measures (all P>0.05). After intervention, both groups exhibited significant reductions from baseline in body weight (BW), body mass index (BMI), WC, body fat percentage (BFP), visceral fat area (VFA), subcutaneous fat area (SFA), fasting plasma glucose (FPG), 2-hour plasma glucose during oral glucose tolerance test (OGTT 2 hPG), hemoglobin A_1c (HbA_1c), HOMA-β, HOMA-IR, liver FF, pancreatic FF, and lipid measures (P<0.01). Across both groups, most glycemic indices, lipid parameters, uric acid (UA), alanine aminotransferase (ALT), and insulin resistance indices improved significantly (P<0.05), whereas HDL-C did not change significantly. Compared with the LCBD group, the MRD group achieved greater reductions in absolute and percentage BW, BMI, FPG, and VFA (P<0.05). ΔFPG was positively correlated with reductions in BW, WC, VFA, HOMA-IR, and liver FF (P<0.05). The change in HOMA-IR correlated positively with the change in liver FF (r=0.432, P=0.001).

Conclusion

The 3-month dietary intervention effectively reduced BW, BMI, WC, hepatic fat content, and insulin resistance in obese adults with abnormal glucose metabolism, leading to significant improvements in abnormal glucose metabolism.

Prevalence Trends and Influencing Factors for Post-stroke Cognitive Impairment in China: a Meta-analysis

ZHAO Xuejiao, LI Juan, LI Yujie, LU Ting, Xian Lihong, YAN Huan

2026, 29(03): 380-392. DOI: 10.12114/j.issn.1007-9572.2025.0073

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Background

Post-stroke cognitive impairment (PSCI) is a common sequela of stroke that severely impacts patients' quality of life and is often overlooked. The high incidence, subtle symptoms, and substantial social burden of PSCI make it a research priority. Understanding the prevalence and associated factors of PSCI is crucial for improving stroke prevention and treatment strategies.

Objective

To systematically evaluate the prevalence and trends of PSCI in China from 2014 to 2024 and summarize the related risk and protective factors.

Methods

Relevant studies on the prevalence and influencing factors of PSCI in China were retrieved from databases including PubMed, Web of Science, Embase, CNKI, Wanfang Data, VIP and CBM covering the period from January 2014 to November 2024. Stata 16.0 and SPSS 26.0 software were used to analyze the current status and trends of PSCI, and RevMan 5.4 software was employed to analyze related factor.

Results

A total of 59 studies were included in this analysis, revealing that the overall prevalence of PSCI in China was 51% (95%CI=48%-55%). The prevalence of PSCI among males and females was 50% (95%CI=46%-54%) and 56% (95%CI=51%-60%), respectively. Patients aged under 60 years and those aged 60 years and above exhibited prevalence rates of 47% (95%CI=40%-55%) and 59% (95%CI=50%-67%), respectively. The prevalence in East China, South China, North China, Central China, Northeast China, Northwest China and Southwest China was 49% (95%CI=42%-56%), 48% (95%CI=36%-61%), 53% (95%CI=44%-62%), 48% (95%CI=40%-56%), 57% (95%CI=54%-60%), 42% (95%CI=32%-52%) and 51% (95%CI=43%-59%), respectively. Furthermore, the prevalence of hemorrhagic and ischemic stroke was 54% (95%CI=41%-67%) and 52% (95%CI=48%-56%), respectively. At different time points (≤2 weeks, >2 weeks~3 months, >3~6 months, >6 months), the prevalence rates were 52% (95%CI=45%-58%), 52% (95%CI=45%-58%), 40% (95%CI=35%-44%) and 56% (95%CI=43%-70%) respectively. The highest prevalence rate of 63% (95%CI=55%-71%) was observed in individuals with lower education levels (primary school and below). Additionally, the prevalence among married and unmarried individuals was 57% (95%CI=46%-68%) and 64% (95%CI=52%-75%), respectively. The prevalence among employed and unemployed individuals was 64% (95%CI=44%-84%) and 71% (95%CI=56%-87%), respectively. Finally, the prevalence among mental workers and manual workers was 48% (95%CI=33%-64%) and 53% (95%CI=30%-76%), respectively, while those living with family members and living alone exhibited prevalence rates of 62% (95%CI=43%-82%) and 71% (95%CI=62%-81%), respectively. The prevalence of PSCI in China increased with age (χ²=73.805, P<0.01), and was notably higher among individuals with lower education levels (χ²_trend=164.711, P<0.01). There were significant differences among different regions (χ²=74.701, P<0.01). With the extension of assessment periods, the prevalence showed an upward trend (χ²_trend=186.504, P<0.05). Although a significant difference in prevalence rates was observed across different periods (χ²_trend=325.964, P<0.01), no linear correlation was identified (P=0.259). Factors such as age, female gender, hypertension, diabetes, hyperlipidemia, a history of stroke, carotid plaque, hyperhomocysteinemia, C-reactive protein levels, smoking, drinking and NIHSS score were identified as risk factors for PSCI in China, whereas education level and physical exercise emerged as protective factors.

Conclusion

The overall prevalence of PSCI in China is notably high, exhibiting significant regional and provincial variations, as well as a dynamic trend over time. The prevalence is particularly elevated among females, the elderly, and individuals with lower educational attainment. Additionally, hypertension, diabetes, and hyperlipidemia are identified as risk factors for PSCI. It is imperative for medical institutions at all levels to prioritize these high-risk groups, and expedite the development and implementation of comprehensive prevention and control strategies for PSCI to alleviate the social care burden and economic strain in China.

Systematic Review of Risk Prediction Models for Concurrent Heart Failure with Coronary Heart Disease

JIANG Xiaorui, YAN Yuyao, WEI Jingjing, QIAO Lijie, PENG Guangcao, ZHU Mingjun

2026, 29(03): 393-402. DOI: 10.12114/j.issn.1007-9572.2025.0038

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Background

Heart failure (HF) is a major chronic condition that significantly impacts humanl health. Coronary heart disease (CHD) is the leading cause of HF. Developing risk prediction models for HF in patients with CHD is crucial for enabling healthcare professionals to identify high-risk populations and implement timely interventions.

Objective

To systematically evaluate risk prediction models for HF with CHD in Chinese patients, serving as a reference for the development, selection, and dissemination of relevant predictive models.

Methods

CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science and the Cochrane Library were searched for relevant studies on risk prediction models for HF with CHD in Chinese patients up to October 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias and applicability of the included studies using the Prediction Model Risk of Bias Assessment Tool (PROBAST).

Results

A total of 27 studies were included, reporting 64 risk prediction models. The area under the receiver operating characteristic (ROC) curve (AUC) or these models ranged from 0.511 to 0.989, with 63 models achieving an AUC>0.7, indicating good predictive performance. However, PROBAST assessment revealed that all 27 studies had a high risk of bias and low applicability. Key predictive factors included age, left ventricular ejection fraction, history of diabetes, history of hypertension, N-terminal pro-B-type natriuretic peptide, and Gensini score.

Conclusion

The stability and external validity of existing risk prediction models for HF with CHD in Chinese patients require further validation through prospective, large-scale studies. Future model development should adhere strictly to PROBAST guidelines to ensure the design and implementation of high-quality, generalizable predictive models.

Progress in Pharmacotherapy of Heart Failure with Preserved Ejection Fraction

WANG Yiheng, XU Xiaoming, XIA Yunlong, XIA Linying, HAN Xue, GUO Yongzhen, LIU Quanchi, YAN Wenjun

2026, 29(03): 403-408. DOI: 10.12114/j.issn.1007-9572.2024.0589

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Heart failure with preserved ejection fraction (HFpEF) is a systemic condition characterized by complex pathophysiological mechanisms, affecting over 50% of all heart failure patients, with a five-year mortality rate ranging from 50% to 75%. HFpEF is highly heterogeneous, with diverse etiologies, pathophysiological mechanisms, and clinical manifestations, all of which complicate its management and treatment. Despite these present challenges, significant progresses have been made in the management of HFpEF in recent years. Certain medications have been shown to improve quality of life and reduce the risk of adverse events in HFpEF patients. This article provides a review of the latest clinical evidence on pharmacological treatments for HFpEF, focusing on the disease's unique pathophysiological mechanisms, thereby offering a solid theoretical foundation and practical guidance for its management.

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