Background The prevalence of obesity is increasing rapidly worldwide, including in Asia. Visceral obesity, i.e., intra-abdominal fat accumulation, precedes the development of obesity-related metabolic syndrome, based on the cluster of hyperglycemia, dyslipidemia, and hypertension, leading to atherosclerosis and cardiovascular disease. Visceral fat area (VFA) ≥ 100 cm2 has been defined as an appropriate threshold for assessing the prevalence of obesity-related metabolic syndrome; however, there information regarding the predictors for VFA ≥ 100 cm2 in middle-aged Chinese individuals in the general population is lacking. Methods We investigated the predictors for VFA ≥ 100 cm2 in middle-aged Chinese individuals (n = 148; 49.3 ± 10.8 years; 54% male) who underwent health check-ups. VFA and subcutaneous fat area were determined by computed tomography, and arterial stiffness and fatty liver were diagnosed by brachial-ankle pulse wave velocity (baPWV) and abdominal ultrasonography, respectively. We compared parameters between individuals with VFA ≥ 100 cm2 and < 100 cm2 using unpaired t-tests and Mann-Whitney U tests and identified predictors by binary regression analysis. Results Single regression analysis identified body mass index > 25 kg/dL, waist circumference (WC) > 85 cm, red blood cells > 470×104/µL, hemoglobin > 14.2 g/dL, alanine aminotransferase > 29 U/L, uric acid > 5.7 mg/dL, triglycerides > 150 mg/dL, fasting blood glucose (FBG) > 100 mg/dL, baPWV > 1,400 cm/s, male, and fatty liver as significant predictors for VFA ≥ 100 cm2. Multiple regression analysis also identified baPWV > 1,400 cm/s (odds ratio [OR] = 5.82, P = 0.008), WC > 85 cm (OR = 6.37, P = 0.013), FBG > 100 mg/dL (OR = 6.73, P = 0.025), male (OR = 10.54, P = 0.025), and fatty liver (OR = 4.11, P = 0.034) as independent predictors for VFA ≥ 100 cm2. The strongest predictor of VFA ≥ 100 cm2 was baPWV > 1,400 cm/s, with a significant positive correlation (γ = 0.365, P < 0.001). Conclusions High baPWV, high FBG, high WC, fatty liver, and male sex are independent predictors for VFA ≥ 100 cm2 in middle-aged Chinese individuals. High baPWV, as a measure of arterial stiffness, was the strongest predictor of VFA ≥ 100 cm2, indicating the importance of visceral obesity for arterial stiffness. Visceral obesity is thus a central target for interventions in metabolic syndrome, metabolic dysfunction-associated fatty liver, and cardiovascular disease, especially in males.

Background: Immoderate use of broad-spectrum antimicrobials could lead to emergence of resistant bacteria. The purpose of this study was to identify factors associated with Pseudomonas aeruginosa bacteraemia and develop an exclusion scoring system to help clinicians select an appropriate antimicrobial treatment. Methods: This single-centre case-control study recruited inpatients and outpatients (age ≥ 20 years) with P. aeruginosa or Escherichia coli bacteraemia at St. Luke’s International Hospital in Tokyo from April 2005 to March 2020. Bivariate associations were assessed using χ2 test, Fisher's exact test, or Mann–Whitney U test, and the relationship between P. aeruginosa bacteraemia and other variables was determined using multivariable logistic regression analysis. Results: A total of 1562 patients (208 patients with P. aeruginosa bacteraemia and 1354 patients with E. coli bacteraemia) were included. Multivariable analysis revealed 11 variables associated with P. aeruginosa bacteraemia: Nosocomial infections, Pneumonia, Sex (males), Exposure to antibiotics within 90 days, Urinary tract infection, Urinary catheterization, abDOminal infection, Age < 77 years, Body mass index < 19, presence of Central venous catheter, and Central line-associated bloodstream infection/peripheral line-associated bloodstream infection; these variables were used to develop the Non-PSEUDO-AntiBiotiCs score. The area under the receiver operating characteristic curve was 0.89 (95% confidence interval: 0.88–­0.92), and the best cut-off-point was 5; a score of ≥ 5 had a sensitivity of 80% and a specificity of 83%. Conclusion: We developed the Non-PSEUDO-AntiBiotiCs score. This score may allow clinicians to rule out the possibility of P. aeruginosa bacteraemia and prevent the abuse of broad-spectrum antimicrobials.