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Introduction: This study aims to develop a comprehensive evaluation model for urban tourism competitiveness in China. Given China's transition into a mature tourist destination, there is a pressing need for a framework that can assess the effectiveness of its urban tourism strategies. The model presented in this study is designed to provide a holistic understanding of the factors influencing urban tourism competitiveness in the Chinese context., Methods: The methodology employed in this study combines both qualitative and quantitative approaches. A modified version of Porter's Diamond Model serves as the primary framework, augmented by the IMD World Competitiveness Center: International Institute for Management Development (IMD) framework to incorporate social governance and environmental dimensions. To derive comprehensive scores for sustainable development, a linear weighted evaluation method was used, incorporating the coefficient of variation entropy weight method. This approach allows for a quantitative assessment of urban tourism competitiveness from 2008 to 2019., Results: The key findings of the study reveal significant challenges within the current urban tourism landscape in China. These challenges include homogeneous competition, a lack of strategic management, and insufficient service quality. Furthermore, the study identifies the need for greater emphasis on sustainable tourism development, balancing economic benefits with the preservation of cultural and natural assets., Discussion: Based on the findings, the study proposes several solutions to address the identified challenges. These solutions include creating boutique inland tourism routes, developing unique urban tourism brands, and enhancing regional cooperation and management practices. Additionally, the study emphasizes the importance of integrating community development and services into the evaluation model to foster sustainable tourism development. The proposed solutions offer actionable insights for policymakers and planners seeking to improve the competitiveness and sustainability of urban tourism in China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhao, Shang, Qin and Li.)

Background: A gut-microbial metabolite, trimethylamine N-oxide (TMAO), has been associated with type 2 diabetes mellitus (T2DM). Few previous prospective studies have addressed associations between the changes in TMAO and T2DM incidence., Methods: Data were derived from a longitudinal cohort conducted from 2019 to 2021 in rural areas of Fuxin County, Liaoning Province, China, and 1515 diabetes-free participants aged above 35 years were included. The concentrations of serum TMAO and its precursors were measured at two time points, namely in 2019 and 2021. TMAO and TMAO changes (ΔTMAO) were separately tested in a logistic regression model. For further examination, the odds ratios (ORs) for T2DM were calculated according to a combination of TMAO levels and ΔTMAO levels., Results: During a median follow-up of 1.85 years, 81 incident cases of T2DM (5.35%) were identified. Baseline TMAO levels exhibited a nonlinear relationship, first decreasing and then increasing, and only at the highest quartile was it associated with the risk of T2DM. The OR for T2DM in the highest quartile of serum TMAO was 3.35 (95%CI: 1.55-7.26, p  = 0.002), compared with the lowest quartile. As for its precursors, only choline level was associated with T2DM risk and the OR for T2DM in the Q3 and Q4 of serum choline was 3.37 (95%CI: 1.41-8.05, p = 0.006) and 4.72 (95%CI: 1.47-15.13, p  = 0.009), respectively. When considering both baseline TMAO levels and ΔTMAO over time, participants with sustained high TMAO levels demonstrated a significantly increased risk of T2DM, with a multivariable-adjusted OR of 8.68 (95%CI: 1.97, 38.34)., Conclusion: Both initial serum TMAO levels and long-term serum TMAO changes were collectively and significantly associated with the occurrence of subsequent T2DM events. Interventions aimed at normalizing TMAO levels, such as adopting a healthy dietary pattern, may be particularly beneficial in T2DM prevention.