Yi-Hsuan Wu

All Publications

• Prevalence of traditional Chinese medicine body constitutions in a large community-based study in Hangzhou, China. Chinese medicine Wu, Y. H., Wang, J., Bai, M. H., Wang, Q., Myers, A., Gao, P., Delzell, E., Huang, D., Yang, F., He, W., Zhu, S., Hsing, A. W. 2025; 20 (1): 206

  Abstract

  Traditional Chinese medicine (TCM) views body constitution as a foundational determinant of health and disease risk. Understanding the distribution of body constitutions across the population can help in developing personalized strategies to prevent disease, but few studies have examined composite constitutions or unbalanced tendencies.This cross-sectional study assessed the prevalence of singular and composite (multiple) TCM body constitutions and tendencies in a sample of adult residents of Hangzhou, China. We used the 2016 version of the Constitution in Chinese Medicine Questionnaire (CCMQ, 54 items) to classify participants into nine body constitutions and tendencies toward those body constitutions and examined variations in those distributions by demographics and selected lifestyle factors.Among 8,665 participants aged 18-80 years, 74.2% had one or more body constitutions, and 25.8% had unbalanced tendencies only. The Balanced constitution was the most common (22.3%). Of the eight unbalanced constitutions, Qi Deficiency (16.4%), Phlegm Dampness (11.0%), and Yang Deficiency (9.4%) were most prevalent. Over half of the individuals with an unbalanced constitution also had other constitutions (composite). The most frequent composite combinations included Qi Stagnation with Qi Deficiency, Blood Stasis and Qi Deficiency, and Damp Heat with Phlegm Dampness. Body constitution distribution varied significantly by age, sex, and body mass index (BMI). Younger adults (18-39 years) were less likely to have the Balanced constitution (13.1%) and more likely to have composite unbalanced constitutions. Men were more likely to have Phlegm Dampness or Damp Heat, while women were more likely to have Yang Deficiency or Yin Deficiency. After adjusting for age and sex, individuals with obesity had a higher prevalence of Phlegm Dampness and a lower prevalence of the Balanced, Yang Deficiency, or Yin Deficiency constitutions.Our results provide a comprehensive profile of the patterns and distribution of TCM body constitutions across demographic and lifestyle subgroups. This more complete understanding of TCM body constitutions can inform personalized medicine, support individual risk assessment, and help improve health outcomes.

  View details for DOI 10.1186/s13020-025-01268-x

  View details for PubMedID 41310674

  View details for PubMedCentralID PMC12661724

• Smoking-related gut microbiota alteration is associated with obesity and obesity-related diseases: results from two cohorts with sibling comparison analyses. BMC medicine Duan, Y., Xu, C., Wang, W., Wang, X., Xu, N., Zhong, J., Gong, W., Zheng, W., Wu, Y. H., Myers, A., Chu, L., Lu, Y., Delzell, E., Hsing, A. W., Yu, M., He, W., Zhu, S. 2025; 23 (1): 146

  Abstract

  Individuals who smoke tend to have a lower body mass index (BMI) but face an increased risk of obesity-related diseases. This study investigates this paradox from the perspective of gut microbiota.We conducted microbiome analyses to identify smoking-related microbial genera and created a smoking-related microbiota index (SMI) using 16S rRNA sequencing data from 4000 male participants in WELL-China cohort and Lanxi cohort. We employed logistic regression to explore the association between SMI and obesity indices derived from dual-energy X-ray absorptiometry. Cox regression analyses were conducted to explore the association of SMI with incident of obesity-related diseases. To further control for unmeasured familial confounders, sibling comparison analyses were conducted using between-within (BW) model.The smoking-related microbiota index (SMI) showed a positive association with BMI and other obesity indices. Further analyses revealed that SMI is linked to obesity-related diseases, with hazard ratios (95% confidence intervals) of 1.97 (1.41-2.75) for incident diabetes, 1.31 (1.01-1.71) for major adverse cardiovascular events, and 1.70 (1.05-2.75) for obesity-related cancers. Results from sibling comparison analyses reinforced these findings.While smoking may reduce weight through various mechanisms, alterations in gut microbiota related to smoking are associated with weight gain. Further research is required to determine if changes in the smoking-related microbiome contribute to weight gain following smoking cessation.

  View details for DOI 10.1186/s12916-025-03969-4

  View details for PubMedID 40059170

  View details for PubMedCentralID PMC11892230

• Traditional Chinese medicine body constitution and sleep quality. Sleep advances : a journal of the Sleep Research Society Gao, P., Wang, J., Wu, Y., Bai, M., Myers, A., Wang, Q., Delzell, E., Kushida, C. A., Huang, D., Yang, F., He, W., Lu, Y., Zhu, S., Hsing, A. W. 2025; 6 (4): zpaf069

  Abstract

  Study Objectives: To investigate the relationships between Traditional Chinese Medicine (TCM) body constitution and sleep quality in a large population-based cohort.Methods: This cross-sectional study included 8517 participants from the WELL China cohort. We used the Wang Qi Nine Body Constitution Questionnaire (WQ-9BC) to assess TCM body constitution and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. We used multivariable logistic regression analyses to estimate odds ratios (ORs) for the association between body constitution and poor sleep quality (PSQI score>5), adjusting for demographics, lifestyle factors, and comorbidities.Results: Compared with a balanced body constitution (1898; 22%), individuals with an unbalanced constitution had a 2.6-fold risk (95% CI = 2.3% to 3.0%), and those with an unbalanced tendency had a 1.5-fold risk of poor sleep quality (95% CI = 1.3% to 1.8%). All eight unbalanced constitutions were associated with a higher risk of poor sleep quality, with Qi stagnation (OR 4.0 [95% CI = 3.0% to 5.5%]) and blood stasis (OR 3.8 [95% CI = 2.3% to 6.2%]) having the highest ORs. About 52% of participants had multiple unbalanced constitutions and/or tendencies. The OR for poor sleep quality increased with the composite number of Yang deficiency, Yin deficiency, Qi deficiency, heat dampness, blood stasis, and Qi stagnation constitutions and/or tendencies.Conclusions: All eight unbalanced constitutions are associated with poor sleep quality in a dose-dependent manner, with Qi stagnation and blood stasis displaying the strongest associations. Multiple unbalanced constitutions and/or tendencies are cumulatively associated with poor sleep quality. Identifying TCM body constitution could help in detecting high-risk groups and designing targeted interventions.

  View details for DOI 10.1093/sleepadvances/zpaf069

  View details for PubMedID 41210622

• Diet Quality and Resilience through Adulthood: A Cross-Sectional Analysis of the WELL for Life Study. Nutrients Springfield-Trice, S., Joyce, C., Wu, Y. H., Hsing, A. W., Cunanan, K., Gardner, C. 2024; 16 (11)

  Abstract

  Despite evidence suggesting the importance of psychological resilience for successful aging, little is known about the relationship between diet quality and resilience at different ages. Our study aims to examine the association between diet quality and resilience across the stages of adulthood. Using Stanfords' WELL for Life (WELL) survey data, we conducted a cross-sectional study of diet quality, resilience, sociodemographic, perceived stress, lifestyle, and mental health factors among 6171 Bay Area adults. Diet quality was measured by the WELL Diet Score, which ranges from 0-120. A higher score indicates a better diet quality. Linear regression analysis was used to evaluate the association between the WELL Diet Score and overall resilience and within the following age groups: early young (18-24), late young (25-34), middle (35-49), and late adulthood (≥50). To test whether these associations varied by age groups, an age group by resilience interaction term was also examined. In the fully adjusted model, the WELL Diet Score was positively and significantly associated with overall resilience (all ages (β = 1.2 ± sd: 0.2, p < 0.001)) and within each age group (early young (β = 1.1 ± sd: 0.3, p < 0.001); late young (β = 1.2 ± sd: 0.3, p < 0.001); middle (β = 0.9 ± sd: 0.3, p < 0.001); and late adulthood (β = 1.0 ± sd: 0.3, p < 0.001)). Young adults demonstrated the strongest associations between diet quality and resilience. However, there were no significant age-by-resilience interactions. Diet quality may be positively associated with resilience at all stages of adulthood. Further research is needed to determine whether assessing and addressing resilience could inform the development of more effective dietary interventions, particularly in young adults.

  View details for DOI 10.3390/nu16111724

  View details for PubMedID 38892657

  View details for PubMedCentralID PMC11174593

• Nonalcoholic fatty liver disease (NAFLD) detection and deep learning in a Chinese community-based population. European radiology Yang, Y., Liu, J., Sun, C., Shi, Y., Hsing, J. C., Kamya, A., Keller, C. A., Antil, N., Rubin, D., Wang, H., Ying, H., Zhao, X., Wu, Y. H., Nguyen, M., Lu, Y., Yang, F., Huang, P., Hsing, A. W., Wu, J., Zhu, S. 2023

  Abstract

  We aimed to develop and validate a deep learning system (DLS) by using an auxiliary section that extracts and outputs specific ultrasound diagnostic features to improve the explainable, clinical relevant utility of using DLS for detecting NAFLD.In a community-based study of 4144 participants with abdominal ultrasound scan in Hangzhou, China, we sampled 928 (617 [66.5%] females, mean age: 56 years ± 13 [standard deviation]) participants (2 images per participant) to develop and validate DLS, a two-section neural network (2S-NNet). Radiologists' consensus diagnosis classified hepatic steatosis as none steatosis, mild, moderate, and severe. We also explored the NAFLD detection performance of six one-section neural network models and five fatty liver indices on our data set. We further evaluated the influence of participants' characteristics on the correctness of 2S-NNet by logistic regression.Area under the curve (AUROC) of 2S-NNet for hepatic steatosis was 0.90 for ≥ mild, 0.85 for ≥ moderate, and 0.93 for severe steatosis, and was 0.90 for NAFLD presence, 0.84 for moderate to severe NAFLD, and 0.93 for severe NAFLD. The AUROC of NAFLD severity was 0.88 for 2S-NNet, and 0.79-0.86 for one-section models. The AUROC of NAFLD presence was 0.90 for 2S-NNet, and 0.54-0.82 for fatty liver indices. Age, sex, body mass index, diabetes, fibrosis-4 index, android fat ratio, and skeletal muscle via dual-energy X-ray absorptiometry had no significant impact on the correctness of 2S-NNet (p > 0.05).By using two-section design, 2S-NNet had improved the performance for detecting NAFLD with more explainable, clinical relevant utility than using one-section design.• Based on the consensus review derived from radiologists, our DLS (2S-NNet) had an AUROC of 0.88 by using two-section design and yielded better performance for detecting NAFLD than using one-section design with more explainable, clinical relevant utility. • The 2S-NNet outperformed five fatty liver indices with the highest AUROCs (0.84-0.93 vs. 0.54-0.82) for different NAFLD severity screening, indicating screening utility of deep learning-based radiology may perform better than blood biomarker panels in epidemiology. • The correctness of 2S-NNet was not significantly influenced by individual's characteristics, including age, sex, body mass index, diabetes, fibrosis-4 index, android fat ratio, and skeletal muscle via dual-energy X-ray absorptiometry.

  View details for DOI 10.1007/s00330-023-09515-1

  View details for PubMedID 36892645

  View details for PubMedCentralID 6770992

• Changes in lifestyles and depressive symptom among patients with chronic diseases during COVID-19 lockdown. Scientific reports He, W., Zhao, X., Yang, Z., Min, Y., Wu, Y. H., Kang, Q., Frost, E., Gao, P., Yang, Y., Chen, X., Chen, L., Lu, Y., Hsing, A. W., Zhu, S. 2022; 12 (1): 11407

  Abstract

  This study aims to investigate the impact of COVID-19 lockdown on lifestyle behaviors and depressive symptom among patients with NCDs (noncommunicable diseases). We incorporated a COVID-19 survey to the WELL China cohort, a prospective cohort study with the baseline survey conducted 8-16 months before the COVID-19 outbreak in Hangzhou, China. The COVID-19 survey was carried out to collect information on lifestyle and depressive symptom during lockdown. A total of 3327 participants were included in the COVID-19 survey, including 2098 (63.1%) reported having NCDs at baseline and 1457 (44%) without NCDs. The prevalence of current drinkers decreased from 42.9% before COVID-19 lockdown to 23.7% during lockdown, current smokers from 15.9 to 13.5%, and poor sleepers from 23.9 to 15.3%, while low physical activity increased from 13.4 to 25.2%, among participants with NCDs (P < 0.05 for all comparisons using McNemar's test). Participants with NCDs were more likely than those without to have depressive symptom (OR, 1.30; 95% CI 1.05-1.61), especially among those who need to refill their medication during the COVID-19 lockdown (OR, 1.52; 95% CI 1.15-2.02). Our findings provide insight into the development of targeted interventions to better prepare patients with NCDs and healthcare system to meet the challenge of future pandemic and lockdown.

  View details for DOI 10.1038/s41598-022-15333-0

  View details for PubMedID 35794125

• Cohort Profile: WELL living laboratory in China (WELL-China). International journal of epidemiology Min, Y., Zhao, X., Hsing, A. W., Zhu, S. 2021

  View details for DOI 10.1093/ije/dyaa283

  View details for PubMedID 33712826

• Characterization of dietary patterns and assessment of their relationships with metabolomic profiles: A community-based study. Clinical nutrition (Edinburgh, Scotland) Ru, Y., Wang, N., Min, Y., Wang, X., McGurie, V., Duan, M., Xu, X., Zhao, X., Wu, Y., Lu, Y., Hsing, A. W., Zhu, S. 2020

  Abstract

  BACKGROUND & AIMS: Determining dietary patterns in China is challenging due to lack of external validation and objective measurements. We aimed to characterize dietary patterns in a community-based population and to validate these patterns using external validation cohort and metabolomic profiles.DESIGN: We studied 5145 participants, aged 18-80 years, from two districts of Hangzhou, China. We used one district as the discovery cohort (N=2521) and the other as the external validation cohort (N=2624). We identified dietary patterns using a k-means clustering. Associations between dietary patterns and metabolic conditions were analyzed using adjusted logistic models. We assessed relationships between metabolomic profile and dietary patterns in 214 participants with metabolomics data.RESULTS: We identified three dietary patterns: the traditional (rice-based), the mixed (rich in dairy products, eggs, nuts, etc.), and the high-alcohol diets. Relative to the traditional diet, the mixed (ORadj=1.7, CI 1.3-2.4) and the high-alcohol diets (ORadj=1.9, CI 1.3-2.7) were associated with type 2 diabetes and hypertension, respectively. Similar results were confirmed in the external validation cohort. In addition, we also identified 18 and 22 metabolites that could distinguish the mixed (error rate=12%; AUC=96%) and traditional diets (error rate=19%; AUC=88%) from the high-alcohol diet.CONCLUSIONS: Despite the complexity of Chinese diet, identifying dietary patterns helps distinguish groups of individuals with high risk of metabolic diseases, which can also be validated by external population and metabolomic profiles.

  View details for DOI 10.1016/j.clnu.2020.12.006

  View details for PubMedID 33349486