Association between the traditional Chinese medicine constitution and metabolic dysfunction-associated fatty liver disease in older people: A cross-sectional study.

Background: Few studies have focused on the relationship between the traditional Chinese medicine constitution (TCMC) and metabolic dysfunction-associated fatty liver disease (MAFLD) in older populations. We sought to investigate the distribution of MAFLD and the TCMC in older people, and provide a theoretical basis for TCMC-based management of MAFLD in this population. Methods: A cross-sectional study was conducted among older (≥65 years) individuals in Zhongshan, China. Information on common sociodemographic characteristics, medical history, anthropometric measurements, and the TCMC was collected. The chi-square test, multivariable logistic regression analysis, subgroup analysis, and inverse probability weighting of the propensity score were used to explore the relationship between MAFLD and the TCMC. Results: Of 7085 participants, 1408 (19.9 %) had MAFLD. The three most common TCMC types in MAFLD patients were "phlegm-dampness", "gentleness", and "yin-deficiency". After adjustment for gender, age, tobacco smoking, alcohol consumption, body mass index, abnormal waist-to-hip ratio, hypertension, diabetes mellitus, and dyslipidemia, MAFLD was positively associated with the phlegm-dampness constitution (PDC) (ORadjusted (95 % CI) = 1.776 (1.496-2.108), P < 0.001), and negatively correlated with the qi-depression constitution (0.643 (0.481-0.860), 0.003). A stronger correlation between the PDC and MAFLD was observed in men compared with women (ORadjusted = 2.04 (95%CI = 1.47-2.84) vs. 1.70 (95%CI = 1.39-2.08), Pinteraction = 0.003) as well as between people who smoked tobacco and non-tobacco-smoking individuals (2.11 (1.39-3.21) vs. 1.75 (1.45-2.12), 0.006). Conclusions: A positive relationship was observed between MAFLD and the PDC in older people living in Zhongshan. Early detection and treatment of the PDC (especially in men and smokers) could prevent the occurrence and development of MAFLD.

Differences in vascular endothelial function and serum proteome between obese people with phlegm-dampness constitution and balanced constitution.

OBJECTIVE: To evaluate the extent of vascular endothelial dysfunction and preliminary identify serum protein biomarkers associated with obese individuals at risk for cardiovascular disease (CVD). METHODS: Fifteen obese volunteers with the phlegm-dampness constitution or balanced constitution were recruited for this study respectively. The clinical baseline data was collected, and the vascular endothelial function was evaluated using the EndoPATTM. Blood samples were collected for the serum proteome analysis. The differences in the serum protein expression levels between the two groups were detected and the protein interaction network analysis, correlation analysis, receiver operating characteristic (ROC) curve analysis, and random forest model investigation were conducted. RESULTS: There were no statistical differences found in the baseline data. For vascular endothelial function, the reactive hyperemia index (RHI) of the phlegm-dampness constitution obese group was significantly lower than that of the balanced constitution obese group (1.46 ± 0.30 vs 2.82 ± 0.78, P < 0.0001), indicating vascular endothelial dysfunction. There are 66 differentially expressed serum proteins between the two groups. apolipoprotein A2 (ApoA2), angiotensin-converting enzyme 2 (ACE-2), interleukin-33 (IL-33), and forkhead box P3 (FoxP3) showed significant differences and area under curve values of their ROC curves were greater than 0.7 and correlated significantly with RHI. CONCLUSION: Vascular endothelial dysfunction was present in the phlegm-dampness constitution obese group. Thus, alterations in the expression levels of key serum proteins, including ApoA2, ACE-2, IL-33, and FoxP3 could serve as potential biomarkers in the obese population at risk of CVD.

Obese Individuals With and Without Phlegm-Dampness Constitution Show Different Gut Microbial Composition Associated With Risk of Metabolic Disorders.

Background: Obesity is conventionally considered a risk factor for multiple metabolic diseases, such as dyslipidemia, type 2 diabetes, hypertension, and cardiovascular disease (CVD). However, not every obese patient will progress to metabolic disease. Phlegm-dampness constitution (PDC), one of the nine TCM constitutions, is considered a high-risk factor for obesity and its complications. Alterations in the gut microbiota have been shown to drive the development and progression of obesity and metabolic disease, however, key microbial changes in obese patients with PDC have a higher risk for metabolic disorders remain elusive. Methods: We carried out fecal 16S rRNA gene sequencing in the present study, including 30 obese subjects with PDC (PDC), 30 individuals without PDC (non-PDC), and 30 healthy controls with balanced constitution (BC). Metagenomic functional prediction of bacterial taxa was achieved using PICRUSt. Results: Obese individuals with PDC had higher BMI, waist circumference, hip circumference, and altered composition of their gut microbiota compared to non-PDC obese individuals. At the phylum level, the gut microbiota was characterized by increased abundance of Bacteroidetes and decreased levels of Firmicutes and Firmicutes/Bacteroidetes ratio. At the genus level, Faecalibacterium, producing short-chain fatty acid, achieving anti-inflammatory effects and strengthening intestinal barrier functions, was depleted in the PDC group, instead, Prevotella was enriched. Most PDC-associated bacteria had a stronger correlation with clinical indicators of metabolic disorders rather than more severe obesity. The PICRUSt analysis demonstrated 70 significantly different microbiome community functions between the two groups, which were mainly involved in carbohydrate and amino acid metabolism, such as promoting Arachidonic acid metabolism, mineral absorption, and Lipopolysaccharide biosynthesis, reducing Arginine and proline metabolism, flavone and flavonol biosynthesis, Glycolysis/Gluconeogenesis, and primary bile acid biosynthesis. Furthermore, a disease classifier based on microbiota was constructed to accurately discriminate PDC individuals from all obese people. Conclusion: Our study shows that obese individuals with PDC can be distinguished from non-PDC obese individuals based on gut microbial characteristics. The composition of the gut microbiome altered in obese with PDC may be responsible for their high risk of metabolic diseases.

Etiology Exploration of Non-alcoholic Fatty Liver Disease From Traditional Chinese Medicine Constitution Perspective: A Cross-Sectional Study.

Background: From the traditional Chinese medicine (TCM) constitution theory perspective, the phlegm-dampness constitution is thought to be closely related to the occurrence of non-alcoholic fatty liver disease (NAFLD). However, this viewpoint still lacks rigorous statistical evidence. This study aimed to test the association between the phlegm-dampness constitution and NAFLD. Methods: We conducted a cross-sectional study. Participants were residents living in Chengdu, China, undergoing health checkups at the health management center of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine between December 2018 and September 2020. TCM constitution type was diagnosed by DAOSH four examinations instrument, NAFLD was diagnosed according to the liver ultrasonography and medical history. Multivariate logistic regression and propensity score matching (PSM) were used to analyze a total of 1,677 qualified data. Results: 1,037 participants had biased constitution(s), 67.8% of which had mixed constitutions (with at least two constitutions). Among 1,677 participants, the phlegm-dampness constitution was associated with the yang-deficiency, yin-deficiency, dampness-heat, qi-depression, and blood-stasis constitutions. The correlation coefficients were 0.11, 0.32, 0.42, 0.20, 0.14, respectively. Between the phlegm-dampness constitution and NAFLD, the odds ratio (OR) and the 95% confidence interval (CI) was 2.05 (1.57-2.69) in the crude model. After adjusting for age, gender, Body mass index (BMI), other biased constitutions, smoking, high blood pressure, diabetes, and dyslipidemia, the OR reduced to 1.51 (1.04-2.18). The associations of seven other biased TCM constitutions and NAFLD were not statistically significant in the fully adjusted model. The PSM analysis showed consistent results with the logistic regression. Conclusions: Among eight biased TCM constitutions, the phlegm-dampness constitution is independently associated with NAFLD. We speculate the phlegm-dampness constitution is a risk factor of NAFLD. Longitudinal studies are needed to confirm this causal relationship in the future. In addition, inconsistent with some TCM practitioners' experience, we disagree that the blood-stasis constitution is associated with NAFLD.

Optimal exercise intensity and volume to impact rats with Traditional Chinese Medicine phlegm-dampness constitution.

Objective: We aim to investigate the effects of different exercise intensities and volumes on Phlegm-dampness constitution (PDC). Methods: The rats were fed with high-fat food and lived in 75%-85% humidity for 6 weeks to establish the model of PDC. Then PDC rats were screened and intervened by varying exercise intensities for 8 weeks. Weight, constitution scores, blood and liver tissues were collected to detect the concentration of serum total cholesterol (Tch), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), homocysteine (Hcy), blood glucose (GLU), alanine transaminase (ALT) and percentage of lipid droplet area in liver tissue (PLDA). Results: The weight, Tch, TG, HDL-C, LDL-C, Hcy, GLU, and ALT of rats in moderate-intensity exercise group returned to normal. The rats with high-intensity or low-intensity exercise did not recover as well as moderate-intensity. Conclusion: Different exercise intensities and volumes have different effects on PDC, moderate-intensity exercise over an 8-week intervention is most appropriate.

Genome-Wide DNA Methylation Profiles of Phlegm-Dampness Constitution.

BACKGROUND/AIMS: Metabolic diseases are leading health concerns in today's global society. In traditional Chinese medicine (TCM), one body type studied is the phlegm-dampness constitution (PC), which predisposes individuals to complex metabolic disorders. Genomic studies have revealed the potential metabolic disorders and the molecular features of PC. The role of epigenetics in the regulation of PC, however, is unknown. METHODS: We analyzed a genome-wide DNA methylation in 12 volunteers using Illumina Infinium Human Methylation450 BeadChip on peripheral blood mononuclear cells (PBMCs). Eight volunteers had PC and 4 had balanced constitutions. RESULTS: Methylation data indicated a genome-scale hyper-methylation pattern in PC. We located 288 differentially methylated probes (DMPs). A total of 256 genes were mapped, and some of these were metabolic-related. SQSTM1, DLGAP2 and DAB1 indicated diabetes mellitus; HOXC4 and SMPD3, obesity; and GRWD1 and ATP10A, insulin resistance. According to Ingenuity Pathway Analysis (IPA), differentially methylated genes were abundant in multiple metabolic pathways. CONCLUSION: Our results suggest the potential risk for metabolic disorders in individuals with PC. We also explain the clinical characteristics of PC with DNA methylation features.

Study on Alcohol-induced Osteonecrosis of Femoral Head of Phlegm-dampness Constitution with CYP2C8 Gene Polymorphism / 中国中医药信息杂志

Objective To study the relation between alcohol-induced osteonecrosis of femoral head (AIONFH) related with high morbidity TCM constitution type with CYP2C8 gene polymorphisms.Methods Totally 152 Han nationality NONFH cases from Feburary 2014 to September 2015 from outpatient and the inpatient departments in Gansu Province Hospital of TCM were collected. 50 AIONFH cases were set as medical case group; meanwhile, 45 healthy volunteers were enrolled as control group. Database for medical materials of all patients and volunteers was established. TCM distribution for AIONFH patients was determined. Solution DNA extraction kit was used to extract DNA, and detect the concentration and purity of DNA. The target gene was amplified by PCR and the target gene was amplified by gel electrophoresis. The length of the fragment was confirmed to conduct target gene sequencing. With the results of sequencing and gel electrophoresis, the relation of AIONFH with CYP2C8 gene polymorphism in AIONFH patients with phlegm-dampness syndrome and the control group.ResultsThe CYP2C8 gene loci rs17110453 gene polymorphism was not statistically significant between the two groups (χ2=0.253,P>0.05). There was no significant difference in allele between the two groups (χ2=0.077,P>0.05). The risk of disease in CC genotype was 1.37 times higher than the AA genotype (95%CI: 0.339-5.540), without statistical significance (P>0.05). There was no significant difference in genotype and allele distribution between AIONFH patients with phlegm-dampness and non-phlegm-dampness and the control group (P>0.05).Conclusion CYP2C8 gene loci rs17110453 gene polymorphism A/C mutation has no obvious relation with AIONFH risk. There is no clear relationship between CYP2C8 gene loci rs17110453 gene polymorphism with AIONFH.

Weight-reduction Effect of Shanzha Xiaozhi Capsules on Obesity Patients with Phlegm-Dampness Constitution / 广州中医药大学学报

Objective To investigate the effect of Shanzha Xiaozhi Capsules (SXC) on body weight, metabolic indexes, body fat accumulation and distribution of obesity patients with phlegm-dampness constitution. Methods Fifty obesity patients with phlegm-dampness constitution were randomized into control group and medicine group, 25 cases in each group. The control group was given lifestyle instructions for diet and exercises, and the medicine group was treated with SXC orally besides the instructions for lifestyle. The treatment for both groups covered 12 weeks. Before and after treatment, we observed the outcomes including scores of phlegm-dampness, body weight, waist circumference, hip circumference, blood pressure, fasting blood glucose, serum lipid profile, urine acid, body fat accumulation and distribution, and visceral fat accumulation. Results(1) The scores of phlegm-dampness were decreased significantly in both groups after treatment (P0.05). Hip circumference was decreased significantly in both groups(P 0.05).(3) Systolic pressure and diastolic pressure were decreased significantly in both groups (P 0.05).(4) Fasting blood glucose, 2-hour blood glucose after oral glucose tolerance test, serum lipid profile and urine acid remained unchanged in both groups after treatment (P>0.05). (5) The general body fat accumulation of both groups was decreased significantly after treatment (P 0.05). Waist fat accumulation had no significant decrease in the control group (P > 0 . 05), but was decreased in the medicine group (P<0.01). Visceral fat accumulation was decreased significantly in both groups after treatment(P<0.01), and the decrease was obvious in the medicine group (P<0.01). Conclusion In addition to its contribution to body weight loss, SXC also contribute to the reduction of visceral fat accumulation in obesity patients with phlegm-dampness constitution .

Effect of India buead and coix seed powder on phlegm-dampness constitution dyslipidemia in population studies / 中华健康管理学杂志

Objective To explore the anomalous effects of India buead and coix seed powder on phlegm-dampness constitution dyslipidemia through population-based intervention studies. Methods According to the experimental results of the model group with dyslipidemia, the phlegm-dampness population meeting the inclusion criteria were chosen as the samples for the randomized controlled trial, who were divided into test meal (21 males and 39 females) and blank control (23 males and 37 females) groups with 60 cases in each, aged 18 to 65 y and the total of 120 cases completed the study. Statistical analyses were performed with SPSS 18.0 statistical software. The self comparison wass conducted by the method of paired-sample t test and the comparison between groups was conducted by using independent sample t test. The categorical statistics were described as frequency and compared throughc2 test, P<0.05 was considered as statistically significant. Without changing the original way of life, the meal group having taken the India buead and coix seed powder was compared independently and with the control group for TC, TG, HDL-C and LDL-C to detect the trends and degrees of the level changes. Meanwhile, according to efficacy tests and standards, the changes in the level of TC, TG and HDL-C have been evaluated and the efficiency and total effective rates of all the variables have been calculated. Results After the intervention, there was a declining tendency in each variable, 8.9%in TC, 21.4%in TG, and 27.2%in LDL-C, except for an increase of 0.13 mmol/L in HDL. There were significant differences in the variables before and after the intervention (P<0.05 in each). As for the test meal group after the intervention, the effectiveness of TC has been obtained in 25 cases and inefficacy in 35 cases, with efficiency of 41.7%;the effectiveness of TG has been shown in 53 cases and inefficacy in 7 cases, with efficiency of 88.3%;the effectiveness of HDL-C has been gained in26 cases and inefficacy in 34 cases, with efficiency of 43.3%; and the total effective rate was 57.8%. Conclusions There are significant changes and improvements in TC, TG, HDL-C and LDL-C in the test meal group after the intervention with the powder, which demonstrate that the powder is effective in the reduction of TG for animals with dyslipidemia and populations with phlegm-dampness constitution.

A viewpoint of environment concerned therapy through exploring the body constitute distribution of Shimian county / 国际中医中药杂志

Objective To investigate the difference of TCM body constitution betweenpeople of the Shimian county and Chengdu city. Methods 200 sub-health patients in clinic of Shimian TCM Hospital were selected randomly. Another 200 sub-health patients in clinic of the Second Sichuan Province Hospital of TCM wererandomly selected. The two groups were identified with TCM body constitution based on the clinical symptoms, tongue, pulse condition, etc. Comparisons on body constitution were made between the two groups. Results In Chengdu, patients withbalance constitution and Qi deficiency constitution (respectively have the proportion of 33.0% and 20.0%)were significantly higher than thoseof Shimian County(the proportion of the two wererespectively 4.0% and 6.0%);while Shimian County have a significantly higher ratio of phlegm dampness and blood stasis constitution(43.5% and 13.0%)than those in Chengdu city(the proportion of the two wererespectively 8.0%and 4.0%), P<0.01. Conclusion Because of different regions, the population constitution ratio wasdifferent, so the disease tendency wasalso somewhat different. Therefore, physicians should give full consideration to the regional factors in diagnosing and treating patients.

Relation of Phlegm-dampness Constitution and Insulin Resistance in the First-degree Non-diabetic Relatives of Patients with type 2 Diabetes / 国际中医中药杂志

Objective Observe the relation of phlegm-dampness constitution and insulin resistance in first-degree non-diabetic relatives of patients with type 2 diabetes.Methods Collected first-degree relatives without mabetes of patients with type 2 diabetic patients 87 cases.Among these 87 cases,39 cases were phlegm-dampness constitution and 48 were not.Fasting plasma glucose(FPG)and fasting insulin(FINS)were measured,and insulin resistance index(IR)was calculated.Results There were significant differences between the two groups in FINS and IR(P＜0.05)..Conclusion The IR of the First-degree non-diabetic relatives with phlegm-dampness constitution of patients with type 2 diabetes have greater insulin resistance than the First-degree non-diabetic relatives with non-phlegm-dampness constitution of patients with type 2 diabetes.

Analysis and expectation of the current research on phlegm-dampness constitution / 中华中医药杂志

Phlegm-dampness constitution is one of the popular somatotypes.By analysizing the pertinent literature of modern researches,we think since the late 1970s,modern Chinese medical physicians have systemic studied phlegm-dampness constitution from aspect of theory,clinic and experiment.Theoretical and applied basis of TCM phlegm-dampness constitution has been constructed,but still need to be supplemented.The future of research methods and direction is prospected in this paper.

Research on diagnosis standard of phlegm-dampness constitution of TCM / 中华中医药杂志

Classification is a foundational problem in TCM Constitution Theory,phlegm-dampness constitution is one kind of elementary constitutions type.To normalize and deepdeepen research on classification of Constitution,we generalize the characteristics and establish diagnosis standard of phlegm-dampness constitutions.In our study,we examined gene expression profiles of peripheral blood cells by using Affymetrix GeneChip Human Genome U133A,revealed special expressed genes of phlegm-dampness constitutions.

ZHU Dan-xi’s discussion on obese female reproductive dysfunction from phlegm-dampness constitution / 中华中医药杂志

Phlegm is an important etiopathogenisis of female reproductive dysfunction in TCM.ZHU Dan-xi put forward the famous constitution theory of "phlegm in fat people",and there was internal regularity in pathogenesis of wemen with phlegm-dampness constitution.His viewpoint guided the clinical treatment objectively and provided a solid theorectical basis of preventing and treating female reproductive dysfunction induced by phlegm-dapness.Therefore,this paper will discuss the relationship between phlegm-dampness constitution and female reproductive dysfunction from the characteristics of pglegm-dampness constitute,correlation of obesity and pglegm-dampness constitute,and so on.