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Viscous fingering, a classic hydrodynamic instability, is governed by the the competition between destabilising viscosity ratios and stabilising surface tension or thermal diffusion. We show that the channel confinement can induce ‘diffusion’-like stabilising effects on viscous fingering even in the absence of interfacial tension and thermal diffusion, when a clear oil invades the mixture of the same oil and non-colloidal particles. The key lies in the generation of long-range dipolar disturbance flows by highly confined particles that form a monolayer inside a Hele-Shaw cell. We develop a coarse-grained model whose results correctly predict universal fingering dynamics that is independent of particle concentrations. This new mechanism offers insights into manipulating and harnessing collective motion in non-equilibrium systems.
Spherical robots face significant challenges in motion control on non-horizontal terrains, such as slopes, due to their unique spherical structure. This paper systematically investigates the motion stability of spherical robots on inclined surfaces through modeling, control algorithm design, and experimental validation. Precise Equilibrium Modeling: Using the virtual displacement method, the precise equilibrium equation for spherical robots on slopes is derived, addressing the issue of insufficient accuracy in describing the actual center of gravity in existing studies. Control Algorithm Design: For known slope conditions, a Backstepping Control (BSC) algorithm is designed, demonstrating excellent tracking performance. For unknown slope conditions, an Adaptive Backstepping Control (ABSC) algorithm is proposed, which significantly reduces tracking errors and enhances system robustness through parameter adaptation. Simulation and Physical Validation: Simulations confirm the effectiveness of the algorithms: BSC achieves high-precision control under known slopes, while ABSC exhibits strong adaptability under unknown slopes. Physical experiments validate the stability of the algorithms in a $5^\circ$ slope environment, demonstrating reliable performance across different control angles.
The relationship between emotional symptoms and cognitive impairments in major depressive disorder (MDD) is key to understanding cognitive dysfunction and optimizing recovery strategies. This study investigates the relationship between subjective and objective cognitive functions and emotional symptoms in MDD and evaluates their contributions to social functioning recovery.
Methods
The Prospective Cohort Study of Depression in China (PROUD) involved 1,376 MDD patients, who underwent 8 weeks of antidepressant monotherapy with assessments at baseline, week 8, and week 52. Measures included the Hamilton Depression Rating Scale (HAMD-17), Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16), Chinese Brief Cognitive Test (C-BCT), Perceived Deficits Questionnaire for Depression-5 (PDQ-D5), and Sheehan Disability Scale (SDS). Cross-lagged panel modeling (CLPM) was used to analyze temporal relationships.
Results
Depressive symptoms and cognitive measures demonstrated significant improvement over 8 weeks (p < 0.001). Baseline subjective cognitive dysfunction predicted depressive symptoms at week 8 (HAMD-17: β = 0.190, 95% CI: 0.108–0.271; QIDS-SR16: β = 0.217, 95% CI: 0.126–0.308). Meanwhile, baseline depressive symptoms (QIDS-SR16) also predicted subsequent subjective cognitive dysfunction (β = 0.090, 95% CI: 0.003-0.177). Recovery of social functioning was driven by improvements in depressive symptoms (β = 0.384, p < 0.0001) and subjective cognition (β = 0.551, p < 0.0001), with subjective cognition contributing more substantially (R2 = 0.196 vs. 0.075).
Conclusions
Subjective cognitive dysfunction is more strongly associated with depressive symptoms and plays a significant role in social functioning recovery, highlighting the need for targeted interventions addressing subjective cognitive deficits in MDD.
Hand, foot, and mouth disease (HFMD) shows spatiotemporal heterogeneity in China. A spatiotemporal filtering model was constructed and applied to HFMD data to explore the underlying spatiotemporal structure of the disease and determine the impact of different spatiotemporal weight matrices on the results. HFMD cases and covariate data in East China were collected between 2009 and 2015. The different spatiotemporal weight matrices formed by Rook, K-nearest neighbour (KNN; K = 1), distance, and second-order spatial weight matrices (SO-SWM) with first-order temporal weight matrices in contemporaneous and lagged forms were decomposed, and spatiotemporal filtering model was constructed by selecting eigenvectors according to MC and the AIC. We used MI, standard deviation of the regression coefficients, and five indices (AIC, BIC, DIC, R2, and MSE) to compare the spatiotemporal filtering model with a Bayesian spatiotemporal model. The eigenvectors effectively removed spatial correlation in the model residuals (Moran’s I < 0.2, p > 0.05). The Bayesian spatiotemporal model’s Rook weight matrix outperformed others. The spatiotemporal filtering model with SO-SWM was superior, as shown by lower AIC (92,029.60), BIC (92,681.20), and MSE (418,022.7) values, and higher R2 (0.56) value. All spatiotemporal contemporaneous structures outperformed the lagged structures. Additionally, eigenvector maps from the Rook and SO-SWM closely resembled incidence patterns of HFMD.
Upper extremity rehabilitation robots have become crucial in stroke rehabilitation due to their high durability, repeatability, and task-specific capabilities. A significant challenge in assessing the comfort performance of these robots is accurately calculating the human-robot interaction forces. In this study, a four-degree-of-freedom (4-DOF) upper extremity rehabilitation robot mechanism, kinematically compatible with the human upper limb, is proposed. Based on this mechanism, an algorithm for estimating human-robot interaction forces is developed using Newton-Euler dynamics. A prototype of the proposed robot is constructed, and a series of comparative experiments are carried out to validate the feasibility of the proposed force estimation approach. The results indicate that the proposed method reliably predicts interaction forces with minimal deviation from experimental data, demonstrating its potential for application in upper limb rehabilitation robots. This work provides a foundation for future studies focused on comfort evaluation and optimization of rehabilitation robots, with significant practical implications for improving patient rehabilitation outcomes.
We studied flow organization and heat transfer properties in mixed turbulent convection within Poiseuille–Rayleigh–Bénard channels subjected to temporally modulated sinusoidal wall temperatures. Three-dimensional direct numerical simulations were performed for Rayleigh numbers in the range $10^6 \leqslant Ra \leqslant 10^8$, a Prandtl number $Pr = 0.71$ and a bulk Reynolds number $Re_b \approx 5623$. We found that high-frequency wall temperature oscillations had minimal impact on flow structures, while low-frequency oscillations induced adaptive changes, forming stable stratified layers during cooling. Proper orthogonal decomposition (POD) analysis revealed a dominant streamwise unidirectional shear flow mode. Large-scale rolls oriented in the streamwise direction appeared as higher POD modes and were significantly influenced by lower-frequency wall temperature variations. Long-time-averaged statistics showed that the Nusselt number increased with decreasing frequency by up to 96 %, while the friction coefficient varied by less than 15 %. High-frequency modulation predominantly influenced near-wall regions, enhancing convective effects, whereas low frequencies reduced these effects via stable stratified layer formation. Phase-averaged statistics showed that high-frequency modulation resulted in phase-stable streamwise velocity and temperature profiles, while low-frequency modulation caused significant variations due to weakened turbulence. Turbulent kinetic energy (TKE) profiles remained high near the wall during both heating and cooling at high frequency, but decreased during cooling at low frequencies. A TKE budget analysis revealed that during heating, TKE production was dominated by shear near the wall and by buoyancy in the bulk region; while during cooling, the production, distribution and dissipation of TKE were all nearly zero.
Substantial changes resulting from the interaction of environmental and dietary factors contribute to an increased risk of obesity, while their specific associations with obesity remain unclear. We identified inflammation-related dietary patterns (DP) and explored their associations with obesity among urbanised Tibetan adults under significant environmental and dietary changes. Totally, 1826 subjects from the suburbs of Golmud City were enrolled in an open cohort study, of which 514 were followed up. Height, weight and waist circumference were used to define overweight and obesity. DP were derived using reduced rank regression with forty-one food groups as predictors and high-sensitivity C-reactive protein and prognostic nutritional index as inflammatory response variables. Altitude was classified as high or ultra-high. Two DP were extracted. DP-1 was characterised by having high consumptions of sugar-sweetened beverages, savoury snacks, and poultry and a low intake of tsamba. DP-2 had high intakes of poultry, pork, animal offal, and fruits and a low intake of butter tea. Participants in the highest tertiles (T3) of DP had increased risks of overweight and obesity (DP-1: OR = 1·37, 95 % CI 1·07, 1·77; DP-2: OR = 1·48, 95 % CI 1·18, 1·85) than those in the lowest tertiles (T1). Participants in T3 of DP-2 had an increased risk of central obesity (OR = 2·25, 95 % CI 1·49, 3·39) than those in T1. The positive association of DP-1 with overweight and obesity was only significant at high altitudes, while no similar effect was observed for DP-2. Inflammation-related DP were associated with increased risks of overweight and/or obesity.
The school–vacation cycle may have impacts on the psychological states of adolescents. However, little evidence illustrates how transition from school to vacation impacts students’ psychological states (e.g. depression and anxiety).
Aims
To explore the changing patterns of depression and anxiety symptoms among adolescent students within a school–vacation transition and to provide insights for prevention or intervention targets.
Method
Social demographic data and depression and anxiety symptoms were measured from 1380 adolescent students during the school year (age: 13.8 ± 0.88) and 1100 students during the summer vacation (age: 14.2 ± 0.93) in China. Multilevel mixed-effect models were used to examine the changes in depression and anxiety levels and the associated influencing factors. Network analysis was used to explore the symptom network structures of depression and anxiety during school and vacation.
Results
Depression and anxiety symptoms significantly decreased during the vacation compared to the school period. Being female, higher age and with lower mother's educational level were identified as longitudinal risk factors. Interaction effects were found between group (school versus vacation) and the father's educational level as well as grade. Network analyses demonstrated that the anxiety symptoms, including ‘Nervous’, ‘Control worry’ and ‘Relax’ were the most central symptoms at both times. Psychomotor disturbance, including ‘Restless’, ‘Nervous’ and ‘Motor’, bridged depression and anxiety symptoms. The central and bridge symptoms showed variation across the school vacation.
Conclusions
The school–vacation transition had an impact on students’ depression and anxiety symptoms. Prevention and intervention strategies for adolescents’ depression and anxiety during school and vacation periods should be differentially developed.
Conservation agriculture (CA), as a key component of sustainable intensification, has been widely promoted across sub-Saharan Africa (SSA) to address low crop productivity. However, the focus has mainly been on improving cereal grain yields, with less focus to its impact on nutritional outcomes. This study sought to assess the productivity potential of CA crop diversification systems and associated crop establishment techniques in terms of grain, protein, and energy yields. An on-station trial was implemented in Malawi for four cropping seasons (2014/15 to 2017/18). Four crop establishment techniques (ridge and furrow, jab planter, dibble sticks, and CA basins) were tested, while cropping systems included conventional cropping system (Conv), CA sole cropping (CaSole), CA intercropping (CA-intercropping), and CA rotations (CA-rotation). In 2014/15 and 2015/16 cropping seasons, characterised by medium and low rainfall, respectively, planting basins and ridge-furrow systems produced higher maize yields compared to jab planter and dibble stick systems. In 2015/16, big and small basins yielded 5061 and 3969 kg ha–1, while jab planter and dibble stick yielded 3476 and 3213 kg ha–1. When there was high and persistent rainfall (2016/17 and 2017/18), direct seeding (jab planter and dibble stick) outperformed basins and ridge-furrow systems. Therefore, the choice of planting basin sizes and whether or not to use dibble stick and jab planter needs to be guided by location or site-specific seasonal forecasts for best results. Grain yield in maize-legume rotation systems consistently outperformed other systems, with maize-groundnut rotations surpassing maize-cowpea intercrops by 987–2700 kg ha–1 over four cropping seasons. In intercropping systems, maize-pigeon pea outperformed maize-cowpea by 4–45% during the same period, while maize-cowpea rotation consistently out yielded maize-cowpea intercropping. Intercropping systems, however, provided substantial protein benefits, with maize-pigeon yielding +9.5% (2015/2016), +29.1% (2016/2017) over CA sole, and +2.2% (2017/2018) over cowpea intercropping. Sole systems (conventional and CA sole) yielded the highest caloric energy, while maize-cowpea rotation consistently reduced energy yield by 35% to 54% compared to the highest-yielding systems. Overall intercropping systems can outperform rotation systems in nutritional security but when focus is on maize grain yield alone, intercropping may reduce maize yield when compared to both cereal sole and maize-legume rotation systems.
The collapse of an initially spherical cavitation bubble near a free surface leads to the formation of two jets: a downward jet into the liquid, and an upward jet penetrating the free surface. In this study, we examine the surprising interaction of a bubble trapped in a stable cavitating vortex ring approaching a free surface. As a result, a single fast and tall liquid jet forms. We find that this jet is observed only above critical Froude numbers ($Fr$) and Weber numbers ($We$) when ${Fr}^2 (1.6-2.73/{We}) > 1$, illustrating the importance of inertia, gravity and surface tension in accelerating this novel jet and thereby reaching heights several hundred times the radius of the vortex ring. Our experimental results are supported by numerical simulations, revealing that the underlying mechanism driving the vortex ring acceleration is the disruption of the equilibrium of high-pressure regions at the front and rear of the vortex ring caused by the free surface. Quantitative analysis based on the energy relationships elucidates that the velocity ratio between the maximum velocity of the free-surface jet and the translational velocity of the vortex ring is relatively stable yet is attenuated by surface tension when the jet is mild.
Pro-environmental behavior, including waste sorting and recycling, involves a combination of future-oriented (futureness) and other-oriented (otherness) attributes. Inspired by the perspective of intergenerational choice, this work explores whether eliciting concerns for future others could increase public support for recycling policy and recycling behavior. Study 1 consisted of an online random controlled trial and a laboratory experiment. In Study 1A (N = 400), future other-concern was primed using a static text manipulation, whereas in Study 1B (N = 192), a dynamic virtual manipulation was employed. The results showed that people in the conditions that elicited future other-concern reported greater household recycling intentions and more actual recycling behavior than those in the control conditions. Study 2A (N = 467) and Study 2B (N = 600) generalized this effect on the acceptance of the ‘Certain Time Certain Place’ waste sorting policy in China. Consistent with the intergenerational choice model, envisioning the future of subsequent generations is more impactful in gaining policy approval than merely envisioning a future time. These findings provide a new method for promoting public policy approval and recycling behavior, suggesting that people could become environmentally friendly when they are guided to consider future others.
The self-generated magnetic field in three-dimensional (3-D) single-mode ablative Rayleigh–Taylor instability (ARTI) relevant to the acceleration phase of a direct-drive inertial confinement fusion (ICF) implosion is investigated. It is found that stronger magnetic fields up to a few thousand teslas can be generated by 3-D ARTI rather than by its two-dimensional (2-D) counterpart. The Nernst effects significantly alter the magnetic field convection and amplify the magnetic fields. The magnetic field of thousands of teslas yields the Hall parameter of the order of unity, leading to profound magnetized heat flux modification. While the magnetic field significantly accelerates the bubble growth in the short-wavelength 2-D modes through modifying the heat fluxes, the magnetic field mostly accelerates the spike growth but has little influence on the bubble growth in 3-D ARTI. The accelerated growth of spikes in 3-D ARTI is expected to enhance material mixing and degrade ICF implosion performance. This work is focused on a regime relevant to direct-drive ICF parameters at the National Ignition Facility, and it also covers a range of key parameters that are relevant to other ICF designs and hydrodynamic/astrophysical scenarios.
Natural infection by Trichinella sp. has been reported in humans and more than 150 species of animals, especially carnivorous and omnivorous mammals. Although the presence of Trichinella sp. infection in wild boars (Sus scrofa) has been documented worldwide, limited information is known about Trichinella circulation in farmed wild boars in China. This study intends to investigate the prevalence of Trichinella sp. in farmed wild boars in China. Seven hundred and sixty-one (761) muscle samples from farmed wild boars were collected in Jilin Province of China from 2017 to 2020. The diaphragm muscles were examined by artificial digestion method. The overall prevalence of Trichinella in farmed wild boars was 0.53% [95% confidence interval (CI): 0.51–0.55]. The average parasite loading was 0.076 ± 0.025 larvae per gram (lpg), and the highest burden was 0.21 lpg in a wild boar from Fusong city. Trichinella spiralis was the only species identified by multiplex polymerase chain reaction. The 5S rDNA inter-genic spacer region of Trichinella was amplified and sequenced. The results showed that the obtained sequence (GenBank accession number: OQ725583) shared 100% identity with the T. spiralis HLJ isolate (GenBank accession number: MH289505). Since the consumption of farmed wild boars is expected to increase in the future, these findings highlight the significance of developing exclusive guidelines for the processing of slaughtered farmed wild boar meat in China.
The proton–boron ${}^{11}{\text{B}}\left( {p,\alpha } \right)2\alpha $ reaction (p-11B) is an interesting alternative to the D-T reaction ${\text{D}}\left( {{\text{T}},{\text{n}}} \right)\alpha $ for fusion energy, since the primary reaction channel is aneutronic and all reaction partners are stable isotopes. We measured the α production yield using protons in the 120–260 keV energy range impinging onto a hydrogen–boron-mixed target, and for the first time present experimental evidence of an increase of α-particle yield relative to a pure boron target. The measured enhancement factor is approximately 30%. The experiment results indicate a higher reactivity, and that may lower the condition for p-11B fusion ignition.
Accurately converting satellite instantaneous evapotranspiration (λETi) over time to daily evapotranspiration (λETd) is crucial for estimating regional evapotranspiration from remote sensing satellites, which plays an important role in effective water resource management. In this study, four upscaling methods based on the principle of energy balance, including the evaporative fraction method (Eva-f method), revised evaporative fraction method (R-Eva-f method), crop coefficient method (Kc-ET0 method) and direct canopy resistance method (Direct-rc method), were validated based on the measured data of the Bowen ratio energy balance system (BREB) in maize fields in northwestern (NW) and northeastern (NE) China (semi-arid and semi-humid continental climate regions) from 2021 to 2023. Results indicated that Eva-f and R-Eva-f methods were superior to Kc-ET0 and Direct-rc methods in both climatic regions and performed better between 10:00 and 11:00, with mean absolute errors (MAE) and coefficient of efficiency (ɛ) reaching <10 W/m2 and > 0.91, respectively. Comprehensive evaluation of the optimal upscaling time using global performance indicators (GPI) showed that the Eva-f method had the highest GPI of 0.59 at 12:00 for the NW, while the R-Eva-f method had the highest GPI of 1.18 at 11:00 for the NE. As a result, the Eva-f approach is recommended as the best way for upscaling evapotranspiration in NW, with 12:00 being the ideal upscaling time. The R-Eva-f method is the optimum upscaling method for the Northeast area, with an ideal upscaling time of 11:00. The comprehensive results of this study could be useful for converting λETi to λETd.
Text readability assessment aims to automatically evaluate the degree of reading difficulty of a given text for a specific group of readers. Most of the previous studies considered it as a classification task and explored a wide range of linguistic features to express the readability of a text from different aspects, such as semantic-based and syntactic-based features. Intuitively, when the external form of a text becomes more complex, individuals will experience more reading difficulties. Based on this motivation, our research attempts to separate the textual external form from the text and investigate its efficiency in determining readability. Specifically, in this paper, we introduce a new concept, namely textual form complexity, to provide a novel insight into text readability. The main idea is that the readability of a text can be measured by the degree to which it is challenging for readers to overcome the distractions of external textual form and obtain the text’s core semantics. To this end, we propose a set of textual form features to express the complexity of the outer form of a text and characterize its readability. Findings show that the proposed external textual form features can be used as effective evaluation indexes to indicate the readability of text. It brings a new perspective to the existing research and provides a new complement to the existing rich features.
Slender Russian thistle (Salsola collina Pall.) is a troublesome weed distributed mainly in the cropping regions of northern China that produces heteromorphic seeds in the same plant. However, limited information is available on the germination ecology of heteromorphic seeds in S. collina. Thus, the present study was conducted to verify the effect of alternating temperature conditions, light conditions, winged perianth, salt concentrations, water stress, and burial depths on the seed germination or seedling emergence of S. collina. The results showed that S. collina produced two different types of fruits/seeds that significantly differed in seed size, seed color, external structure, and germination/dormancy behavior. The type A seeds (green seeds) were nondormant, and the germination percentage was >96% at all alternating day/night temperatures and light conditions; whereas type B seeds (yellow seeds) exhibited dormancy characteristics and poor germination (≤1%). Moreover, the winged perianth did not inhibit the germination of S. collina green seeds. The germination of green seeds declined rapidly when NaCl concentration exceeded 100 mM, and only 2.22% germination was observed at 600 mM NaCl. About 62.00% of green seeds germinated at −0.6 MPa, and 8.00% germination was obtained at −1.2 MPa. The seedling emergence declined with an increase of burial depth, and decreased sharply when the burial depth exceeded 1.0 cm. Only 8.33% seedling emergence occurred at a burial depth of 4.0 cm. The results gathered from present study will help to illustrate the ecological adaptation strategy of S. collina and indicate that shallow tillage can effectively minimize the seedling emergence of S. collina.
Social determinants of health (SDoH), such as socioeconomics and neighborhoods, strongly influence health outcomes. However, the current state of standardized SDoH data in electronic health records (EHRs) is lacking, a significant barrier to research and care quality.
Methods:
We conducted a PubMed search using “SDOH” and “EHR” Medical Subject Headings terms, analyzing included articles across five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions.
Results:
Of 685 articles identified, 324 underwent full review. Key findings include implementation of tailored screening instruments, census and claims data linkage for contextual SDoH profiles, NLP systems extracting SDoH from notes, associations between SDoH and healthcare utilization and chronic disease control, and integrated care management programs. However, variability across data sources, tools, and outcomes underscores the need for standardization.
Discussion:
Despite progress in identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical for SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately, widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
This study investigated the impact of diallyl disulfide (DADS) on oxidative stress induced by hydrogen peroxide (H2O2) in ovine rumen epithelial cells (RECs). Initially, the effects of DADS were evaluated on cellular reactive oxygen species (ROS) levels, antioxidant capacity in RECs were estimated. Then, RNA-seq analysis was conducted in DADS-treated and untreated cells to analyze the differential gene expression, as well as Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Finally, the effects of DADS on Kelch-like ECH associated protein 1/the nuclear factor erythroid 2-related factor 2 (Keap1/Nrf2) signaling pathway in RECs were evaluated. Results showed that DADS remarkably enhanced superoxide dismutase (SOD) activity and total antioxidant capacity (T-AOC) (P < 0.05) while reducing ROS and malonaldehyde production (P < 0.05) in H2O2-treated RECs. Transcriptomic analysis revealed that DADS might influence glutathione synthesis through cysteine and methionine metabolism, thereby affecting the transcription of genes involved in immunity and oxidative stress. The DADS treatment resulted in increased nuclear translocation of Nrf2 and upregulation of mRNA and protein levels of quinone oxidoreductase 1, heme oxygenase 1, and Nrf2. The Nrf2-specific inhibitor nullified the protective effects of DADS on malonaldehyde formation induced by H2O2 and decreased T-AOC and SOD activities. In conclusion, DADS demonstrated the ability to alleviate oxidative stress in RECs by promoting antioxidative capacity through the Keap1/Nrf2 signaling pathway.
The potential threshold for dietary energy intake (DEI) that might prevent protein-energy wasting (PEW) in chronic kidney disease (CKD) is uncertain. The subjects were non-dialysis CKD patients aged ≥ 14 years who were hospitalised from September 2019 to July 2022. PEW was measured by subjective global assessment. DEI and dietary protein intake (DPI) were obtained by 3-d diet recalls. Patients were divided into adequate DEI group and inadequate DEI group according to DEI ≥ 30 or < 30 kcal/kg/d. Logistic regression analysis and restricted cubic spline were used in this study. We enrolled 409 patients, with 53·8 % had hypertension and 18·6 % had diabetes. The DEI and DPI were 27·63 (sd 5·79) kcal/kg/d and 1·00 (0·90, 1·20) g/kg/d, respectively. 69·2 % of participants are in the inadequate DEI group. Malnutrition occurred in 18·6 % of patients. Comparing with patients in the adequate DEI group, those in the inadequate DEI group had significantly lower total lymphocyte count, serum cholesterol and LDL-cholesterol and a higher prevalence of PEW. For every 1 kcal/kg/d increase in DEI, the incidence of PEW was reduced by 12·0 % (OR: 0·880, 95 % CI: 0·830, 0·933, P < 0·001). There was a nonlinear curve relationship between DEI and PEW (overall P < 0·001), and DEI ≥ 27·6 kcal/kg/d may have a preventive effect on PEW in CKD. Low DPI was also significantly associated with malnutrition, but not when DEI was adequate. Decreased energy intake may be a more important factor of PEW in CKD than protein intake.