Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA)

Associations of overweight with insulin resistance, beta-cell function and inflammatory markers in Chinese adolescents

BACKGROUND

Obesity is a growing global health problem. Obesity-associated inflammatory and metabolic consequences may vary in different ethnic populations, and data in Chinese adolescents are sparse. In this study, we analysed the clinical and biochemical factors associated with overweight and obesity in Chinese adolescents.

METHODS

This is a cross-sectional cohort study with 2102 Chinese adolescents randomly selected from 14 secondary schools in Hong Kong. Clinical and biochemical parameters including inflammatory markers, among different groups stratified by degrees of obesity, were compared by multivariate logistic regression analysis.

RESULTS

The median age was 16 yr (interquartile range: 14-17 yr) (45.6% boys and 54.4% girls). Among the boys, 16.5% were overweight and 6.8% were obese. The respective percentages in girls were 8.2 and 5.8%. Compared with the group with normal weight in both boys and girls, high systolic blood pressure (SBP), increased insulin resistance (by homoeostasis model assessment, HOMA-IR), elevated high-sensitivity C-reactive protein (hsCRP) level and low high-density lipoprotein cholesterol (HDL-C) level were independently associated with overweight/obesity. In boys, the respective odds ratio (95% CI) was 1.03 (1.01-1.05) for SBP, 21.0 (12.0-36.8) for HOMA-IR, 3.65 (2.10-6.35) for hsCRP and 0.24 (0.11-0.51) for HDL-C. In girls, the respective figures were 1.02 (1.00-1.04), 9.82 (5.65-17.1), 6.28 (3.12-12.6) and 0.18 (0.08-0.41). In girls, low-density lipoprotein cholesterol was also independently associated with overweight/obesity [1.56 (1.09-2.24)].

CONCLUSIONS

In Chinese adolescents, overweight/obesity is independently associated with SBP, insulin resistance, hsCRP and low HDL-C. Early intervention in overweight and obese adolescents may potentially retard the development of these cardiovascular risk factors.

Diabetes and impaired glucose tolerance prevalences in Turkish patients with impaired fasting glucose

Impaired fasting glucose (IFG) like impaired glucose tolerance (IGT) has increased risk of progressing to diabetes mellitus (DM). The aim of the study was to evaluate prevalance of IGT and type 2 DM with oral glucose tolerance test (OGTT) in Turkish patients who had fasting glucose of 110 and 125 mg/dl. Hundred and forty-eight (67.3%) women and 72 (32.7%) men (30-65 years old with mean age of 51.3 +/- 8.7 year) who had fasting glucose range 110-125 mg/dl were evaluated with OGTT. Seventy-two patients had IGT (32.8%), 74 (33.6%) patients had type 2 diabetes and 74 (33.6%) patients had normal glucose tolerance (NGT). Mean fasting glucose and insulin levels were higher in the IGT group than in the NGT group. Mean level of total cholesterol was higher in DM than that in NGT and IGT groups. Mean triglyceride (TG) (P = 0.476), high-density lipoprotein (HDL) (P = 0.594), low-density lipoprotein (LDL) (P = 0.612), Apoproteine A (P = 0.876), Apoproteine B (P = 0.518), uric acid (P = 0.948) and ferritin (P = 0.314) were found higher in diabetic patients. Lipoproteine a (P = 0.083), fibrinogen (P = 0.175) and hsCRP (P = 0.621) levels were higher in IGT. Mean HOMA S% levels of NGT, IGT and DM were found to be 65.0 +/- 13.0%, 60.9 +/- 16.0% and 50.1 +/- 11.1%, respectively. HOMA B% levels were measured to be 80.4 +/- 29.1% in NGT, 85.3 +/- 14.59% in IGT and 60.1 +/- 10.1% in DM. Significant difference was found between IFG and DM (P = 0.043) groups. The prevalences of diabetes and IGT were found to be 33.63 and 32.7% in IFG, respectively.

Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka--Sri Lanka Diabetes, Cardiovascular Study (SLDCS)

AIMS

To determine the prevalence of diabetes mellitus and pre-diabetes (impaired fasting glucose and impaired glucose tolerance) in adults in Sri Lanka. Projections for the year 2030 and factors associated with diabetes and pre-diabetes are also presented.

METHODS

This cross-sectional study was conducted between 2005 and 2006. A nationally representative sample of 5000 adults aged >or= 18 years was selected by a multi-stage random cluster sampling technique. Fasting plasma glucose was tested in all participants and a 75-g oral glucose tolerance test was performed in non-diabetic subjects. Prevalence was estimated for those > 20 years of age.

RESULTS

Response rate was 91% (n = 4532), males 40%, age 46.1 +/- 15.1 years (mean +/- standard deviation). The age-sex standardized prevalence (95% confidence interval) of diabetes for Sri Lankans aged >or= 20 years was 10.3% (9.4-11.2%) [males 9.8% (8.4-11.2%), females 10.9% (9.7-12.1%), P = 0.129). Thirty-six per cent (31.9-40.1%) of all diabetic subjects were previously undiagnosed. Diabetes prevalence was higher in the urban population compared with rural [16.4% (13.8-19.0%) vs. 8.7% (7.8-9.6%); P < 0.001]. The prevalence of overall, urban and rural pre-diabetes was 11.5% (10.5-12.5%), 13.6% (11.2-16.0%) and 11.0% (10.0-12.0%), respectively. Overall, 21.8% (20.5-23.1%) had some form of dysglycaemia. The projected diabetes prevalence for the year 2030 is 13.9%. Those with diabetes and pre-diabetes compared with normal glucose tolerance were older, physically inactive, frequently lived in urban areas and had a family history of diabetes. They had higher body mass index, waist circumference, waist-hip ratio, systolic/diastolic blood pressure, low-density lipoprotein cholesterol and triglycerides. Insulin was prescribed to 4.4% (2.7-6.1%) of all diabetic subjects.

CONCLUSIONS

One in five adults in Sri Lanka has either diabetes or pre-diabetes and one-third of those with diabetes are undiagnosed.

An increase in prevalence of diabetes mellitus in Jordan over 10 years

OBJECTIVE

This study aimed to determine the prevalence of type 2 diabetes mellitus (DM) and impaired fasting glycemia (IFG), identify their associated factors, determine how the prevalence of type 2 DM has changed over 10 years, and assess the awareness and state of control of diabetes in Jordan.

METHODS

Data were analyzed from a cross-sectional study that included a random sample of 1121 Jordanians aged 25 years and above. A subject was deemed affected by DM if this diagnosis was known to the patient or if his or her condition complies with the American Diabetes Association definition. IFG was defined as a fasting serum glucose level of >or=6.1 mmol/l (110 mg/dl) but <7 mmol/l. HbA(1c) >7.5% was defined as "unsatisfactory" metabolic control.

RESULTS

The age-standardized prevalence of diabetes and IFG was 17.1% and 7.8%, respectively, with no significant differences between women and men. Of the 195 diabetic subjects, 146 (74.9%) had been previously diagnosed. More than half (54%) of those previously diagnosed were found to be with unsatisfactory glycemic control. Compared to the 1994 survey, there was a significant increase in the prevalence of diabetes by 31.5%. Increase in age, increase in body mass index, and having a family history of diabetes were associated with increased odds of diabetes and IFG. While the level of education had no effect on IFG, higher level of education was associated with a decrease in the odds of having diabetes.

CONCLUSION

The prevalence of type 2 diabetes and IFG is high in Jordan and is increasing. More than half of the patients with diabetes have unsatisfactory control. Therefore, they are likely to benefit from programs aimed at encouraging behaviors toward achieving optimum weight as well as physical activity behaviors. Physicians caring for patients with diabetes may need to adopt a more vigorous approach for diabetes control.

Exon sequencing and association analysis of polymorphisms in TCF7L2 with type 2 diabetes in a Chinese population

AIMS/HYPOTHESIS

Recently, variants in the transcription factor 7-like 2 (TCF7L2) gene have been found to be consistently associated with type 2 diabetes in different populations. In this study, we hypothesized that TCF7L2 also contributed to genetic susceptibility for type 2 diabetes in a Chinese population.

METHODS

We looked for new variants by direct sequencing of all exons and intron-exon junctions of TCF7L2 in 100 Chinese type 2 diabetic patients, and then we genotyped five single nucleotide polymorphisms (SNPs) by Snapshot technology in 1,000 Chinese individuals.

RESULTS

By sequencing, we identified six SNPs (c.1,637C>A; c.1,674C>G; c.1,709G>A; c.1,846C>G; c.1,888C>T; and c.1,876T>G), and three of them led to non-synonymous polymorphisms (c.1,637C>A, His-->Gln or Pro-->Thr; c.1,674C>G, Pro-->Arg; and c.1,709G>A, Ala-->Thr). All of them are rare except c.1,637C>A, which had a frequency of 0.23 for the minor A allele in 98 sequenced individuals. In a case-control study, one of the newly discovered SNPs (c.1,637C>A), together with four reported ones (rs7903146, rs12255372, rs290487 and rs3814573) were genotyped. Comparison between allele and genotype frequencies of these SNPs in patients and controls showed marginal association for rs7903146 and rs290487 with type 2 diabetes (p = 0.063, OR 1.982, 95% CI 1.128-3.485; p = 0.071, OR 1.237, 95% CI 0.983-1.557, respectively). No association was found for rs12255372, rs3814573, c.1,637C>A and type 2 diabetes (p = 0.278-1.000).

CONCLUSIONS/INTERPRETATION

With the current sample size, we did not find any mutation in the coding sequence of TCF7L2 that confers a genetic risk for type 2 diabetes in a Chinese population, and did not replicate some of the major positive results obtained in other populations.

Insulin resistance and depressive symptoms in middle-aged and elderly Chinese: findings from the Nutrition and Health of Aging Population in China Study

BACKGROUND

Depression is associated with an increased risk of incident diabetes, and insulin resistance is thought to be the underlying link between them. Nevertheless, only a few studies have explored the association between insulin resistance and depression with contradictory results, and none have been conducted in Chinese populations.

METHODS

We aimed to determine the association between insulin resistance and depressive symptoms among middle-aged and elderly Chinese using data from the Nutrition and Health of Aging Population in China Study, a population-based cross-sectional study conducted in 2005 in China. Participants included 3285 community residents aged 50-70 years. Depressive symptoms were defined as a Center for Epidemiological Studies of Depression Scale (CES-D) score of 16 or higher. Insulin resistance was calculated using the updated homeostasis model assessment (HOMA2-IR) methods.

RESULTS

Value of HOMA2-IR was significantly higher in participants with depressive symptoms (0.284 vs. 0.261, P=0.008), even after adjustment for various confounding factors in the regression model (0.311 vs. 0.291, P=0.026). Logistical regression analyses showed that participants with depressive symptoms had a higher risk of having insulin resistance (defined as in the top quartile of HOMA2-IR values, odds ratio=1.54, 95% confidence intervals=1.17-2.04).

LIMITATIONS

Due to the cross-sectional study design, causal relation remains unknown.

CONCLUSIONS

The present study found positive associations between depressive symptoms and insulin resistance among Chinese populations. Further prospective studies are needed to validate the results and find the temporal and causal relation between them.

Prevalence and antihyperglycemic prescribing trends for patients with type 2 diabetes in Italy: a 4-year retrospective study from national primary care data

To estimate the prevalence of type 2 diabetes in Italy and to investigate patient-related variables associated with the use of different antihyperglycemic therapies. This study was conducted between the years 2000-2003 from a source population comprising a cumulative sample of 394,719 patients from 320 General Practitioners across Italy, who provide information to the Health Search/Thales Database (HSD). A total sample of 23,729 of patients with type 2 diabetes age 15 years or older was selected from the source population. During the study years, the prevalence of type 2 diabetes increased from 4.7 to 6.0%. A significant increase in the use of antihyperglycemic therapy was also observed between 2000 and 2003. In particular, the use of biguanides increased. During the same period, the use of sulfonylurea monotherapy, oral combination therapy and insulin with oral combination therapy decreased. The results from the multivariate analysis revealed that healthier patients were more likely to be prescribed biguanide and sulfonylurea monotherapy, whereas patients with more diabetes complications and poorer glycemic control were more likely to be prescribed oral combination therapy or insulin (monotherapy or combination therapy). In conclusion, the study results appear to suggest that the prescribing patterns of Italian GPs and the predictors of different antihyperglycemic drug use are consistent with recent scientific evidence.

Effects of age, time period, and birth cohort on the prevalence of diabetes and obesity in Korean men

OBJECTIVE

We examined changes in the prevalence of diabetes, obesity, and overweight in 412,881 Korean men in birth cohorts from 1933 to 1972 over 8 years from 1992 to 2000 and separately analyzed the effects of age, time period, and birth cohort.

RESEARCH DESIGN AND METHODS

The study included male employees of Korean government organizations and schools who were between 20 and 59 years of age in 1992. Diabetes was diagnosed on the basis of self-reports in 1992 or fasting blood glucose levels (>or=126 mg/ml, 7.0 mmol/l). The age-period-cohort model was used to estimate the effects of age, time period, and birth cohort.

RESULTS

In Korean male birth cohorts from 1933 to 1972, the age-specific prevalence of diabetes, obesity, and overweight in men aged 28-59 years increased annually by 0.41% (3.03 to 6.29%), 0.18% (0.70 to 2.16%), and 1.49% (23.48 to 35.41%), respectively, from 1992 to 2000. The relative change in diabetes was largest among the younger cohorts (>400% increase over 8 years) and corresponded to the change in obesity. Apart from the contribution of age, clear cohort and period effects were evident for diabetes, although the magnitude of the effect was slightly less than that for obesity.

CONCLUSIONS

Prevention of diabetes through the control of obesity, particularly in young men, clearly needs to be emphasized.

Impaired fasting glucose and the prevalence and severity of angiographic coronary artery disease in high-risk Chinese patients

We assessed the relation between different fasting plasma glucose (FPG) levels of 5.6 to 6.9 mmol/L and the prevalence and severity of angiographic coronary artery disease (CAD) in high-risk Chinese patients. Among 512 subjects who were to undergo coronary angiography for the confirmation of suspected myocardial ischemia, 409 subjects were enrolled and categorized into 3 groups based on FPG levels: (1) </=5.5 mmol/L, (2) 5.6 to 6.0 mmol/L, and (3) 6.1 to 6.9 mmol/L. Each of these groups was further divided into subgroups by sex; the second and third groups were combined as an additional group according to the 2003 definition of impaired fasting glucose (FPG at 5.6-6.9 mmol/L). We analyzed the coronary artery stenosis score, the prevalence of angiographic CAD, and the percentage of stenosis in the 3 main arteries among the groups and examined the risk factors for angiographic CAD prevalence by logistic regression analysis. A higher correlation was observed between angiographic CAD prevalence and FPG levels of 6.1 to 6.9 mmol/L as compared with FPG levels </=5.5 mmol/L (adjusted odds ratio [OR], 2.67; 95% confidence interval [CI], 1.72-4.10; P = .011). The FPG levels of 5.6 to 6.9 mmol/L (adjusted OR, 2.57; 95% CI, 1.65-4.02; P < .001) and 5.6 to 6.0 mmol/L (adjusted OR, 2.33; 95% CI, 1.58-3.49; P = .008) were modestly correlated with angiographic CAD prevalence. The angiographic CAD prevalence, coronary artery stenosis score, and the percentage of stenosis in the left anterior descending branch increased corresponding to increasing FPG levels from </=5.5 mmol/L to 5.6 to 6.0 mmol/L to 6.1 to 6.9 mmol/L. We concluded that FPG levels of 5.6 to 6.9 mmol/L as well as of 6.1 to 6.9 mmol/L may be an independent risk factor for angiographic CAD; furthermore, there was a progressive and graded relation between FPG levels of 5.6 to 6.9 mmol/L and angiographic CAD prevalence and severity in high-risk Chinese patients.

Body mass index and risk of ESRD in China

BACKGROUND

The relationship between body mass index (BMI) and risk of end-stage renal disease (ESRD) in Asians has not been well established.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

143,802 men and women 40 years and older in China.

PREDICTOR

Body weight, height, and covariables were obtained at a baseline examination in 1991 by following a standardized protocol. BMI was calculated as weight in kilograms divided by the square of height in meters.

OUTCOMES

Time to onset of ESRD, ascertained in 1999 to 2000 from medical records, death certificates, and interviews with participants or their proxies.

RESULTS

During 1,112,667 person-years of follow-up, 350 participants initiated renal replacement therapy or died of renal failure. After adjustment for age, sex, geographic region (north versus south China), urbanization (urban versus rural residence), education, physical activity, cigarette smoking, and alcohol consumption, a J-shaped association between BMI and all-cause ESRD was observed. Compared with those with normal body weight (BMI, 18.5 to 24.9 kg/m(2)), multivariate-adjusted relative risks for all-cause ESRD for underweight (BMI < 18.5 kg/m(2)), overweight (BMI, 25.0 to 29.9 kg/m(2)), and obese subjects (BMI >or= 30 kg/m(2)) were 1.39 (95% confidence interval [CI], 1.02 to 1.91), 1.21 (95% CI, 0.92 to 1.59), and 2.14 (95% CI, 1.39 to 3.29), respectively. The J-shaped association existed even after additional adjustment for systolic blood pressure and history of diabetes and cardiovascular disease.

LIMITATIONS

Although patients with ESRD at baseline were excluded, information for chronic kidney disease at the baseline examination was not available.

CONCLUSION

Strategies aimed at preventing the development of ESRD should incorporate measures to maintain a normal body weight.

A comparison of two proposed definitions for metabolic syndrome in the Chinese adult population

BACKGROUND

The metabolic syndrome is a major risk factor for cardiovascular disease (CVD). We estimated the prevalence of the metabolic syndrome using the definitions proposed by the International Diabetes Federation (IDF) and the American Heart Association and the National Heart, Lung, and Blood Institute (revised ATP III), and compared the 2 definitions in the Chinese adult population.

METHODS

We conducted a cross-sectional study among a nationally representative sample of 15,838 Chinese adults ages 35 to 74 years in 2000 to 2001. Waist girth, blood pressure, and blood levels of HDL-cholesterol, triglycerides, and glucose were measured according to standard methods.

RESULTS

The overall age-standardized prevalence of the metabolic syndrome by the IDF and revised-ATP III definitions was 16.5% and 23.3%, respectively. The overall agreement of being classified as having or not having the metabolic syndrome was 93.2% for the 2 definitions, with a Kappa coefficient of 0.80. The prevalence significantly increased with age and was higher in women than in men by both definitions (23.3% vs 10.0% for IDF and 29.1% vs 17.7% for revised ATP III). Compared with men, women had a significantly higher prevalence of central obesity (37.6% vs 16.0%) and reduced HDL-cholesterol (46.5% vs 21.9%), whereas men had a significantly higher prevalence of raised blood pressure (44.2% vs 38.0%) compared with women.

CONCLUSIONS

The metabolic syndrome is very common in China regardless of the definition used. Prevention and treatment of the metabolic syndrome should become a public health priority to reduce the CVD-related burden in China.

Implications of increased weight and waist circumference on vascular risk in an older Chinese population: the Guangzhou Biobank Cohort Study

BACKGROUND

The relationships between weight and waist on vascular risk are well described, but the long-term impact of these parameters is less clearly defined, particularly in Chinese populations.

METHODS

Ten thousand four hundred and ten older subjects (50-85 years) were recruited and blood pressure, anthropometric, and fasting vascular risk factors measured. Socioeconomic and demographic data, including self-reported weight and waist gain since 18 years. The association of weight and waist gain with these vascular risk factors was analysed.

RESULTS

Weight, and particularly waist gain were associated with a more adverse vascular risk factor profile, with the most adverse profile associated with gains in both weight and waist. Anthropometric gains were associated with increased risk even in non-obese subjects (p<0.05). Even after adjustment for a range of demographic and socioeconomic factors, waist gain was associated with additional risk of having the metabolic syndrome and its components and self-reported vascular disease in those centrally obese subjects (p<0.05 for all).

CONCLUSION

Increased weight and waist increased the level of vascular risk factors and self-reported disease in both non-obese and obese subjects. The high prevalence of vascular risk factors in this population forewarns of a major developing health burden in the rapidly modernising 1.2 billion Chinese population.

Progression to impaired glucose regulation, diabetes and metabolic syndrome in Chinese women with a past history of gestational diabetes

BACKGROUND

To examine the risk of developing impaired glucose regulation (IGR), diabetes mellitus (DM) and metabolic syndrome (MetS) in Chinese women with history of gestational diabetes.

METHODS

203 Chinese women enrolled in a previous study were followed up at a median of 8 (range 7-10) years of whom 136 had normal glucose tolerance (NGT) and 68 had gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT).

RESULTS

In women with a history of gestational diabetes (n = 4), GIGT (n = 63) and NGT (n = 136), 2 (50%), 19 (30.2%) and 21 (15.4%) developed IGR while 2 (50%), 4 (6.3%), 3 (2.2%) developed DM respectively. Most women developed IGR (86%, n = 36) or DM (78%, n = 7) were undiagnosed. MetS occurred in 16 (7.9%) women with similar rates between those with and those without a history of gestational diabetes (7.5% vs 8.1%; p = 0.85). History of gestational diabetes [OR: 3.8 (95% CI 1.9-7.8)] and body mass index (BMI) >/= 23 kg/m(2) [OR: 3.4 (95% CI 1.7-6.8)] at first antenatal visit were predictors for IGR or DM. Family history of DM [OR: 5.0 (95% CI 1.5-16.4)] and BMI >/= 23 kg/m(2) [OR: 28.3 (95% CI 3.6-223)] at first antenatal visit were predictors for MetS.

CONCLUSIONS

Chinese women with a history of gestational diabetes have a high risk of IGR or DM. Overweight at the first antenatal visit is a common risk factor for IGR, DM and MetS. A prior history of gestational diabetes was predictive of IGR and DM while a positive family history of DM was predictive of MetS.

Rapid increase in the incidence of clinically diagnosed type 2 diabetes in Chinese in Harbin between 1999 and 2005

AIM

To examine the recent trend in the incidence of clinically diagnosed type 2 diabetes during the period of 1999-2005 in Harbin, China.

METHODS

The records of newly diagnosed type 2 diabetes from hospitals and clinics in Harbin were reported to the Harbin Centre for Disease Control and Prevention. About 3 million (33%) of the total population were from six metropolitan districts and over 6 million (67%) from the surrounding counties. Incidence rates and incidence rate ratios (IRR) were estimated using Poisson regression.

RESULTS

During the observational period, 26,953 new cases of diagnosed type 2 diabetes were reported. Among them, 16,367 were from the metropolitan region and 10,586 from the surrounding counties. The incidence rate of type 2 diabetes in the metropolitan region was 3.19 (95% CI: 3.11, 3.27) times as high as that in the surrounding counties. Females had higher incidence rates in younger age groups (<54 years) and lower rates in older age groups (55+ years) than their male counterparts. The incidence increased over time during the period of 1999-2005 by an average of 12% per year (IRR=1.12, 95% CI: 1.11, 1.13). Similar increasing rates were observed in both the county and metropolitan regions.

CONCLUSIONS

The incidence of diagnosed type 2 diabetes has increased dramatically in recent years. Although an increasing trend in the incidence of type 2 diabetes exists in both metropolitan and county regions, the county region currently has a substantially lower incidence rate than the metropolitan region.

Prevalence and management of diabetes and associated risk factors by regions of Thailand: Third National Health Examination Survey 2004

OBJECTIVE

The aim of this study was to determine the prevalence of diabetes and impaired fasting glucose (IFG) and their association with cardiovascular risk factors and to evaluate the management of blood glucose, blood pressure, and cholesterol in individuals with diabetes by geographical regions of Thailand.

RESEARCH DESIGN AND METHODS

With the use of a stratified, multistage sampling design, data from a nationally representative sample of 37,138 individuals aged > or = 15 years were collected using questionnaires, physical examination, and blood samples.

RESULTS

The prevalence of diabetes and IFG weighted to the national 2004 population was 6.7% (6.0% in men and 7.4% in women) and 12.5% (14.7% in men and 10.4% in women), respectively. Diabetes was more common in urban than in rural men but otherwise prevalence was relatively uniform across geographical regions. In more than one-half of those with diabetes, the disease had not been previously diagnosed, although the majority of those with diabetes were treated with oral antiglycemic agents or insulin. The prevalence of associated risk factors was high among individuals with diabetes as well as those with IFG. Two-thirds of those with diabetes and concomitant high blood pressure (> or = 130/80 mmHg) were not aware that they had high blood pressure, and > 70% of those with diabetes and concomitant high cholesterol (total cholesterol > or = 6.2 mmol/l) were not aware that they had high cholesterol.

CONCLUSIONS

The prevalences of diabetes and IFG were uniformly high in all regions. Improvements in prevention, diagnosis, and treatment of diabetes and associated risk factors are required if the health burden of diabetes in Thailand is to be averted.

A qualitative review of the role of qigong in the management of diabetes

OBJECTIVE

To review the evidence relating to the effectiveness of qigong in the management of diabetes.

METHODS

We performed a systematic literature review of qigong intervention studies published in English or Chinese since 1980, retrieved from English-language databases and Chinese journals. Qigong intervention studies conducted with adults with diabetes, which reported both preintervention and postintervention measures of fasting blood glucose and/or hemoglobin A(1c)(HbA(1c)) were included. Sample characteristics, intervention frequency/duration, and metabolic outcomes were reviewed.

RESULTS

Sixty-nine intervention studies were located. Of these, only 11 met the criteria for inclusion. There were consistent and statistically significant positive associations between participation in qigong and fasting and 2-hour oral glucose tolerance test results, blood glucose, and triglycerides and total cholesterol. Effects on insulin and HbA(1c) were inconsistent. There was no evidence of any effect of qigong on weight. Most of the studies were of short duration, involved small samples, and did not include a control group.

CONCLUSIONS

Although qigong has beneficial effects on some of the metabolic risk factors for type 2 diabetes, methodologic limitations make it difficult to draw firm conclusions about the benefits reported. Randomized controlled trials are required to confirm the potential beneficial effects of qigong on the management of type 2 diabetes.

Lower urinary tract symptoms and uroflowmetry in women with type 2 diabetes mellitus with and without bladder dysfunction

OBJECTIVES

To study the presence of lower urinary tract symptoms and parameters of uroflowmetry in women with type 2 diabetes mellitus with and without bladder dysfunction versus healthy controls.

METHODS

After eliminating the possible confounders that might cause bladder dysfunction, 182 female patients at a diabetic clinic were evaluated by the American Urological Association Symptom Index (AUA-SI) questionnaire and uroflowmetry with postvoid residual (PVR) urine volume estimate. Their data were compared with the data from 197 healthy women, frequency-matched by age.

RESULTS

Using a cutoff value of bladder voiding efficiency of less than 75% with a PVR greater than 50 mL but less than 100 mL, a PVR greater than 100 mL, or a total volume greater than 500 mL, 47 patients (25.8%) were stratified as having bladder dysfunction. These patients had a significantly greater mean AUA-SI score (mean +/- standard error of the mean 9.6 +/- 0.8, P <0.001), as well as a lower maximum uroflow value (15.2 +/- 1.2 mL/s, P <0.001) compared with the control groups. The odds ratio of each lower urinary tract symptom was significantly greater in this group, except for straining (P = 0.12). A high proportion with an intermittent uroflow pattern (odds ratio 4.42, P <0.001) was also noted. Compared with the healthy controls, the diabetic women had no bladder dysfunction and seemed unaffected by the lower urinary tract symptoms as defined by the AUA-SI scoring system, with the exception of nocturia (odds ratio 2.62, P = 0.006).

CONCLUSIONS

Women with diabetes may have an increased risk of nocturia even without bladder dysfunction. A high AUA-SI score and lower maximum uroflow are likely to be good markers for diabetic bladder dysfunction.

An urban-rural comparison of the prevalence of the metabolic syndrome in Eastern China

OBJECTIVE

To assess the impact of urbanisation on the prevalence of the metabolic syndrome in Chinese adults.

DESIGN

As part of a community-based cross-sectional survey conducted in 2002, a sample from rural and urban populations in East China was obtained. The metabolic syndrome is defined by the National Cholesterol Education Program Adult Treatment Panel III criteria (ATP III) and the modified ATP III, which recommended a lower waist circumference cut-off for Asians. Setting Field sites in Jiangxi and Anhui provinces and the Jing'an District of Shanghai, China.

SUBJECTS

A total of 529 non-pregnant, non-lactating urban and rural adults, aged 20-64 years without diagnosed diabetes.

RESULTS

Dwelling in urban areas was associated with higher dietary fat intake and slightly lower total energy intake, and with significantly lower occupational physical activity. Using the ATP III criteria, the prevalence of the metabolic syndrome was significantly higher for urban than rural men (12.7 vs. 1.7%, P < 0.001), and was similar between urban and rural women (10.1 vs. 9.7%, P = 0.17). These urban-rural differences were greatly enhanced when the modified ATP III criteria for the syndrome were used, for men (34.3 vs. 2.7%, P < 0.01) and women (24.1 vs. 11.4%, P = 0.07). The Asian waist circumference cut-offs (90 and 80 cm for men and women, respectively) had a better combination of sensitivity and specificity in identifying other metabolic disorders, which included high glucose, high blood pressure, high triglycerides and low high-density lipoprotein cholesterol, for this population. Conclusion For the Chinese population, urban dwelling was associated with higher prevalence of the metabolic syndrome, especially in men.

Epidemiological characteristics of diabetes mellitus and impaired glucose regulation in a Chinese adult population: the Shanghai Diabetes Studies, a cross-sectional 3-year follow-up study in Shanghai urban communities

AIMS/HYPOTHESIS

To estimate the prevalence and incidence of diabetes mellitus and impaired glucose regulation (IGR) in a Chinese population aged 20-94 years.

SUBJECTS AND METHODS

A group of 5,628 randomly selected adults, aged 20-94 years, living in the Huayang and Caoyang communities in Shanghai, China, were investigated between 1998 and 2001. During 2002-04, 2,666 subjects were followed up. All the participants underwent anthropometric measurements, blood biochemical analyses and a 75-g OGTT.

RESULTS

Based on the 2000 census data of China, the age-standardised prevalences were 6.87% for diabetes and 8.53% for IGR at baseline. More than two in five cases with diabetes were undiagnosed. The age-adjusted prevalence of diabetes and IGR increased with age. The age-adjusted prevalences of hypertension, dyslipidaemia and overweight in males were significantly higher (p < 0.001) than in females. The 3-year cumulative incidence rates of diabetes and IGR were 4.96 and 11.10%, respectively. The relative risk of developing diabetes was significantly higher in subjects with IGR than in subjects with NGT (p < 0.001).

CONCLUSIONS/INTERPRETATION

The prevalence and incidence rates for diabetes or IGR have increased dramatically over the last decades, especially in younger age groups. A large proportion of cases are undiagnosed. We strongly recommend that population-based diabetes screening programmes should be implemented and generalised for younger people.

Post-Marketing Surveillance of Acarbose Treatment in Patients with Type 2 Diabetes Mellitus and Subjects with Impaired Glucose Tolerance in China

OBJECTIVE

This open, prospective, non-interventional, non-randomised, multi-centre postmarketing surveillance study was conducted over a mean period of 13.9 weeks to assess the efficacy, safety and acceptance of acarbose in Chinese patients with type 2 diabetes mellitus and subjects with impaired glucose tolerance (IGT) in routine clinical practice. Subjects with IGT were included in analyses because acarbose has been approved for treatment of this condition since 2002.

PATIENTS AND METHODS

A total of 2550 study participants were enrolled by 133 physicians throughout China. Efficacy parameters were the changes from initial visit to the end of study in glycosylated haemoglobin (HbA(1c)), fasting blood glucose (FBG), postprandial BG and bodyweight.

RESULTS

The majority of study participants (74.7%) were newly diagnosed. Most (77.0%) were administered acarbose 50mg three times daily (the recommended standard dose in China) throughout the study and more than half (51.7%) received concomitant antihyperglycaemic treatment. Acarbose treatment reduced HbA(1c) by 1.4% to 6.7%, FBG by 38.5 mg/dL to 116.4 mg/dL, 2-hour postprandial BG by 92.2 mg/dL to 149.0 mg/dL and bodyweight by 0.4 kg to 67.5 kg. Subgroup analyses for type 2 diabetes and IGT populations were also conducted. In diabetic patients, HbA(1c) was reduced by 1.4%, FBG by 42.1 mg/dL and 2-hour postprandial BG by 98.9 mg/dL. Marked reductions were also achieved in the IGT population (0.9% for HbA(1c), 11.8 mg/dL for FBG and 42.9 mg/dL for 2-hour postprandial BG) despite lower baseline glucose levels in this group than in patients with type 2 diabetes. Bodyweight slightly increased in the IGT population. Only 12 acarbose-related adverse events, none of which was serious, were reported. The attending physicians assessed treatment efficacy as 'good' or 'very good' for 92.4%, tolerability as 'good' or 'very good' for 91.1%, and patient acceptance as 'good' or 'very good' for 89.8% of all study participants.

CONCLUSION

Acarbose was efficacious, safe and well accepted by Chinese patients with type 2 diabetes and subjects with IGT under day-to-day treatment conditions, both as monotherapy and in combination with other antihyperglycaemic medication.

Epidemic obesity and type 2 diabetes in Asia

The proportions of people with type 2 diabetes and obesity have increased throughout Asia, and the rate of increase shows no sign of slowing. People in Asia tend to develop diabetes with a lesser degree of obesity at younger ages, suffer longer with complications of diabetes, and die sooner than people in other regions. Childhood obesity has increased substantially and the prevalence of type 2 diabetes has now reached epidemic levels in Asia. The health consequences of this epidemic threaten to overwhelm health-care systems in the region. Urgent action is needed, and advocacy for lifestyle changes is the first step. Countries should review and implement interventions, and take a comprehensive and integrated public-health approach. At the level of primary prevention, such programmes can be linked to other non-communicable disease prevention programmes that target lifestyle-related issues. The cost of inaction is clear and unacceptable.

Hematocrit, independent of chronic kidney disease, predicts adverse cardiovascular outcomes in chinese patients with type 2 diabetes

OBJECTIVE

Anemia and chronic kidney disease (CKD) are risk factors for cardiovascular diseases in diabetes. We examined the association between hematocrit, stratified by the presence of CKD, and cardiovascular events in a cohort of Chinese subjects with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 3,983 patients who underwent assessment for diabetes complications were recruited. Subjects were categorized into five groups. Group I included subjects with hematocrit below the normal sex-specific range. The cutoff points for groups II-V were selected to represent the distribution of the hematocrit for each sex. CKD was defined by the estimated glomerular filtration rate <60 ml/min per 1.73 m(2). Cardiovascular events were defined as cardiovascular mortality and morbidity, including new onset of myocardial infarction, acute coronary syndrome, revascularization, heart failure, and stroke requiring hospitalization.

RESULTS

A total of 294 subjects (7.4%) developed cardiovascular events during the median of 36.4 months. The rate of cardiovascular events was highest in subjects with low hematocrit (group I, 18.6%) compared with group V (3.4%, P < 0.001). The multivariate-adjusted hazard ratio for cardiovascular events diminished with increasing hematocrit (group I, 1.0; group II, 0.73 [95% CI 0.51-1.04]; group III, 0.57 [0.39-0.83]; group IV, 0.61 [0.39-0.95]; and group V, 0.36 [0.17-0.79]). After stratifying by the presence of CKD, the previously observed reduction in the risk of developing cardiovascular events with increasing hematocrit was abolished in the cohort with CKD but persisted in the non-CKD cohort.

CONCLUSIONS

In Chinese subjects with type 2 diabetes, low levels of hematocrit and the presence of CKD are associated with increased risk of developing adverse cardiovascular events.

Parity and the metabolic syndrome in older Chinese women: the Guangzhou Biobank Cohort Study

OBJECTIVE

To examine whether parity or gravidity contributes to the development of the metabolic syndrome (MS).

METHODS

The first phase of the Guangzhou Biobank Cohort Study recruited 7352 women and 3065 men aged 50-93 years in 2003-4. Data on the number of live births and pregnancies, other reproduction-associated factors and socioeconomic and lifestyles factors were collected by standardized interview. The MS components were determined through physical examination and measurement of fasting blood samples. MS was identified if waist circumference was >or= 90 cm for men or >or= 80 cm for women, plus any two of: (a) raised triglyceride (TG) level (1.7 mmol/l) or specific treatment for this lipid abnormality; (b) reduced high density lipoprotein (HDL)-cholesterol (< 1.03 mmol/l in males or < 1.29 mmol/l in females) or specific treatment for this lipid abnormality; (c) raised blood pressure (BP, systolic BP >or= 130 mmHg or diastolic BP >or= 85 mmHg) or hypertension therapy; and (d) raised fasting glucose (>or= 5.6 mmol/l) or previously diagnosed type 2 diabetes.

RESULTS

Before adjustment for potential confounders, we found associations between the number of births and lifestyle and socioeconomic factors in both sexes. However, in women, but not in men, body mass index (BMI), waist-hip ratio, triglyceride and glucose were positively associated with the number of birth after adjusting for a range of potential confounders. The age-adjusted prevalence of the MS increased with the number of births and pregnancies in women, but the gradient for birth was steeper than that for pregnancies [odds ratio change per birth 1.16, 95% confidence interval (CI) 1.11-1.22, P < 0.001; odds ratio change per pregnancy 1.11, 95% CI 1.06-1.16, P < 0.001], although attenuating the association adjustment did not affect the significance of these findings. There was no association in men with regard to the number of their partners' live births given the same analysis and similar shared living background with the women.

CONCLUSION

Higher parity or gravidity was associated with a consistent increase in the risk of MS in Chinese women. As the association persisted after adjustment for lifestyle factors and there was no association between the risk of MS and the number of births associated with the partners of the males, the association in women may represent a biological response to pregnancy.

Prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong, and Taiwan

This article reviews and describes trends and differences in prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong and Taiwan based on literatures published in the MEDLINE Advanced database (January 1966-October 2005) in both Chinese and English languages. Chinese populations in Hong Kong and Taiwan have significant higher prevalence rates of diabetes than their Mainland counterparts, with odds ratios 1.5 (95% confidence intervals: 1.4, 1.7) and 2.0 (95% confidence intervals: 1.8, 2.2), respectively in 1995-2003 adjusted for age and diagnostic criteria. Using stratified diagnostic criteria; the odds ratios in Hong Kong and Taiwan were consistently higher than Mainland China for the periods of 1985-1994 and 1995-2003. A large proportion, i.e. 68.6% (95% confidence intervals: 67.4%, 69.7%) of diabetic patients remains undiagnosed in Mainland China as compared to 52.6% (95% confidence intervals: 49.8%, 55.5%) undiagnosed in Hong Kong and Taiwan. The prevalence rates of diabetes and impaired glucose tolerance of the Chinese populations rise in older age groups. In tandem with economic development and change toward lifestyle that is lack of physical activity and rich in high-fat diet, prevalence of diabetes of the Chinese populations are on the rise. If the undiagnosed individuals left uncontrolled, they are subject to higher risks of developing diabetes and its complications. These will increase the burdens of diabetes medically and financially.

Hypertension and kidney disease in Asia

PURPOSE OF REVIEW

Communicable diseases were traditionally the major cause of public health concern in Asian countries, most of which were less developed. With industrialization and associated lifestyle changes during the past few decades, however, noncommunicable diseases similar to those that affect Western societies have emerged in Asian countries. The purpose of the review was to examine recent evidence about the burden and factors associated with hypertension and chronic kidney disease (CKD) in Asian countries.

RECENT FINDINGS

Hypertension has become one of the leading causes of mortality in Asia. Although its prevalence continues to rise, it remains under-diagnosed and under-treated. CKD is becoming increasingly common mainly due to an increase in risk factors such as high blood pressure, diabetes, and obesity. Treatment of advanced CKD is overwhelmingly burdensome in a resource poor environment. Barriers to early detection of CKD in Asians include the fact that equations to estimate the glomerular filtration rate have not been validated in this population, and the uncertainty about appropriate glomerular filtration rate cutoff values to define CKD.

SUMMARY

Concerted efforts are needed to develop and implement cost-effective strategies for prevention and treatment of hypertension and CKD in Asian countries. More research is needed on these conditions in these populations.

Use of body mass index to identify obesity-related metabolic disorders in the Chinese population

OBJECTIVE

To identify the body mass index (BMI; in kg/m2) cutoff that predicts the risk for obesity-related metabolic disorders for the Chinese population.

DESIGN

Community-based cross-sectional survey.

SETTING

Rural regions of Jiangxi and Anhui provinces and an urban community of Jing'an District of Shanghai, China.

SUBJECTS

Five hundred and twenty-nine non-pregnant, non-lactating urban and rural adults, aged 20-64 years without diagnosed diabetes.

RESULTS

Subjects were divided into two groups: with or without obesity-related metabolic disorders, which was defined as having at least one of the following: hypertension, insulin resistance, high plasma triacylglycerol, low-density lipoprotein-cholesterol or glucose. Gender-specific multiple logistic regression analysis demonstrated a significant dose-response relationship between BMI and obesity-related metabolic disorders, after adjusting for potential confounders. The lowest BMI interval associated with significant risk for both men and women (odds ratios of 2.67 and 3.46, respectively) was that of 22.5-24.4. Receiver-operating characteristic (ROC) curve analysis indicated that a BMI cutoff of 23 had the best combination of sensitivity and specificity and the shortest distance in the ROC curve, with positive and negative predictive values of 0.6-0.7 in both genders.

CONCLUSIONS

A BMI cutoff of 23 might be appropriate for use in identification of high risk of obesity-related metabolic disorders and serve as a public health action threshold in the Chinese population.

SPONSORSHIP

Center of a Livable Future, John Hopkins Bloomberg School of Public Health.

Prevalence of decreased kidney function in Chinese adults aged 35 to 74 years

BACKGROUND

Chronic kidney disease (CKD) is a major public health burden in Western countries but little is known about its impact in developing countries. We estimated the prevalence and absolute burden of CKD in the general adult population in China.

METHODS

A cross-sectional survey was conducted in a nationally representative sample of 15,540 Chinese adults aged 35 to 74 years in 2000 and 2001. Serum creatinine was measured using the modified kinetic Jaffe reaction method at a central laboratory calibrated to the Cleveland Clinic Foundation laboratory. Glomerular filtration rate (GFR) was estimated using the simplified equation developed by the Modification of Diet in Renal Disease study. CKD was defined as an estimated GFR <60 mL/min/1.73m2.

RESULTS

Overall, the age-standardized prevalences of GFR 60 to 89, 30 to 59, and <30 mL/min/1.73m2 were 39.4%, 2.4%, and 0.14%, respectively, in Chinese adults aged 35 to 74 years. The overall prevalence of CKD (GFR <60 mL/min/1.73m2) was 2.53%, representing 11,966,653 persons (1.31% or 3,185,330 men and 3.82% or 8,781,323 women). The age-specific prevalence of CKD was 0.71%, 1.69%, 3.91%, and 8.14% among persons 35 to 44, 45 to 54, 55 to 64, and 65 to 74 years old, respectively. The age-standardized prevalence of CKD was similar in urban (2.60%) and rural (2.52%) residents but was higher in south China (3.05%) than in north China (1.78%) residents.

CONCLUSION

Although the prevalence of CKD in China was relatively low, the population absolute burden is substantial. These data warrant a national program aimed at detection, prevention, and treatment of CKD in China.

Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001

OBJECTIVE

The purpose of this study was to estimate the prevalence of diabetes and impaired fasting glucose (IFG) and their association with risk factors in the Korean population.

RESEARCH DESIGN AND METHODS

The Korean National Health and Nutrition Survey 2001 was a nationally representative survey with a stratified multistage sampling design. Data from a comprehensive questionnaire, a physical examination, and blood tests were obtained from 5,844 Korean adults (2,513 men and 3,331 women) aged >20 years.

RESULTS

The age-adjusted prevalence of diabetes in this Korean population was 7.6%, and the age-adjusted prevalences of previously diagnosed diabetes and newly diagnosed diabetes were 4.4 and 3.3%, respectively (fasting plasma glucose > or = 7.0 mmol/l). Overall, these results indicate that 8.1% or 1.4 million Korean men and 7.5% or 1.3 million Korean women have diabetes. The age-adjusted prevalence of IFG was 23.9%, using the new American Diabetes Association criteria (fasting plasma glucose 5.6-6.9 mmol/l). Diabetes prevalence increased with age and peaked in the oldest age-group; however, IFG prevalence did not show the same trend. Diabetes was found to be associated with age, BMI, blood pressure, triglyceride, HDL cholesterol, education levels, alcohol consumption, exercise, and a family history of diabetes.

CONCLUSIONS

This study shows that diabetes and IFG are common in Korea, and about one-half of diabetes cases remain undiagnosed. These results emphasize the need to develop an urgent public program to improve the detection, prevention, and treatment of diabetes.

A Community-based Picture of Type 2 Diabetes Mellitus in Vietnam

There has been a significant increase in the prevalence of type 2 diabetes mellitus (T2DM) in Vietnam. We found that Vietnamese with T2DM had a normal body mass index (BMI), but high levels of total body fat and abdominal fat. Based on published reports together with our own findings, we believe that a sedentary lifestyle and an abundance of starchy foods and also Western style energy-rich foods are factors associated with disease. The staple food of the Vietnamese is still polished-rice which has high glycemic index values. In addition, a Westernized diet, and the chronic consumption of high-glycemic index foods together with a sedentary lifestyle result in insulin resistance and diabetes. The average BMI of T2DM patients is <or= 23 kg/m(2), greater than that 20 years ago. In addition,these patients have high levels of body fat, especially abdominal fat, measured as the waist to hip ratio (WHR >or= 0.90). We therefore, tentatively suggest a BMI of 23 kg/m(2) together with a WHR of 0.90 for males and 0.85 for females as new cutoff values for the risk of T2DM in Vietnamese. These findings have important implications for primary prevention because they indicate that screening and intervention should focus on high-risk populations.

Prevalence of Type 2 diabetes in urban and rural Chinese populations in Qingdao, China

AIMS

To determine the prevalence of diabetes in the Chinese adult population in rural and urban areas of Qingdao city.

METHODS

A population-based cross-sectional study of diabetes was performed in 12 436 (5346 men) Chinese adults (20-74 years old) from 2001 to 2002. Fasting capillary whole blood glucose test (FCG) was performed in all participants and a 2-h 75-g oral glucose tolerance test in those with FCG > or = 6.1 mmol/l following initial screening. The 1999 World Health Organization diagnostic criteria for diabetes were used.

RESULTS

The age-standardized prevalence of diabetes was 6.1% (4.1% for undiagnosed and 2.1% for previously known diabetes) in adults aged 20-74 years. Diabetes prevalence increased with age up to the oldest age group (70-74); in subjects over 50 years of age, the prevalence reached 10%. Men tended to have a higher prevalence of known diabetes than women, whereas the prevalence of undiagnosed diabetes was lower in men than in women (4.6% vs. 3.3%, d.f. = 1, P = 0.001). Diabetes was more prevalent in the urban than in the rural population (6.9% vs. 5.6%, d.f. = 1, P < 0.001). However, the proportion of undiagnosed diabetes was higher in the rural than in the urban areas (70.5% vs. 58.0%, d.f. = 1, P < 0.001).

CONCLUSIONS

The prevalence of Type 2 diabetes in Qingdao city is moderately high, but much higher than reported in 1996. The large proportion of undiagnosed cases of diabetes indicates the lack of public awareness of diabetes and shortage of medical facilities. In view of the huge population in China, the results of this study emphasize the need to improve the early detection and prevention of diabetes in China to prevent the emerging diabetes epidemic.

The Cardiovascular Continuum in Asia-A New Paradigm for the Metabolic Syndrome

Atherosclerosis, myocardial infarction, and heart failure are cardiovascular complications in a continuum that begins with risk factors such as hypertension, diabetes, and dyslipidemia. These particular cardiovascular risk factors commonly occur together in obese individuals as components of the metabolic syndrome. In Asia, there is a trend toward an increase in the prevalence of the metabolic syndrome and cardiovascular disease. Abdominal adiposity is arguably the key factor underlying the development of insulin resistance and the metabolic syndrome. It is now known that adipose tissues secrete adipokines, and in obese subjects, there is a chronic low-grade inflammation. The inflammation and the associated endothelial dysfunction are reversible in the early stages. The Asian diet is low in animal fat but high in carbohydrates. Recent studies suggest that low-carbohydrate diets are more effective than low fat diets in inducing weight loss, suggesting that excessive carbohydrate rather than fat is the cause of obesity. Strategies to combat cardiovascular disease should now focus on tackling the epidemic of obesity and developing innovative and effective lifestyle and pharmacological interventions.

Prevalence of physical activity among Chinese adults: results from the International Collaborative Study of Cardiovascular Disease in Asia

OBJECTIVES

Determining physical activity levels in the community provides a context for the development and implementation of programs aimed at increasing these activity levels. Therefore, we assessed overall, work-related, and leisure-time physical activity in a representative sample of Chinese adults, aged 35 to 74 years, using data from the International Collaborative Study of Cardiovascular Disease in Asia.

METHODS

Being physically active was defined as participating in 30 or more minutes of moderate or vigorous activity daily. Work-related and leisure-time physical activities were defined as being physically active and participating in any moderate or vigorous activity at work or during leisure time, respectively.

RESULTS

In rural and urban China, 78.1% and 21.8% of residents, respectively, were physically active; 75.8% and 16.5%, respectively, participated in work-related activity; and 28.9% and 7.9%, respectively, participated in leisure-time physical activity. In both rural and urban settings, younger adults, men, and southern residents were more likely to be physically active and to participate in work-related and leisure-time physical activity than older adults, women, and northern residents.

CONCLUSIONS

Intervention strategies to promote leisure-time physical activity, especially among urban residents, should be considered a major health priority in China.

Prevalence of the metabolic syndrome and overweight among adults in China

BACKGROUND

The metabolic syndrome and obesity are major risk factors for cardiovascular disease. Little information exists on the prevalence of the metabolic syndrome in China. We aimed to provide up-to-date estimates of the prevalence of the metabolic syndrome and overweight in the general adult population in China.

METHODS

We did a cross-sectional survey in a nationally representative sample of 15,540 Chinese adults aged 35-74 years in 2000-01. Metabolic syndrome was defined according to guidelines from the US National Cholesterol Education Program. Overweight was defined as body-mass index of 25.0 kg/m2 or greater.

FINDINGS

The age-standardised prevalence of metabolic syndrome was 9.8% (95% CI 9.0-10.6) in men and 17.8% (16.6-19.0) in women. The age-standardised prevalence of overweight was 26.9% (25.7-28.1) in men and 31.1% (29.7-32.5) in women. The prevalence of the metabolic syndrome and overweight was higher in northern than in southern China, and higher in urban than rural residents.

INTERPRETATION

Our results indicate that a large proportion of Chinese adults have the metabolic syndrome and that overweight has become an important public health problem in China. These findings emphasise the urgent need to develop national strategies for the prevention, detection, and treatment of overweight and the metabolic syndrome, to reduce the societal burden of cardiovascular disease in China.

Collaborative healthcare research: some ethical considerations

This article reviews some of the ethical aspects of collaborative research. Scientific collaboration has known potential benefits but it's a challenging task to successfully accomplish a collaborative venture on ethically sound grounds. Current trends in international healthcare research collaboration reflect limited benefits for the majority of world population. Research collaboration between scientists of academia and industry usually has financial considerations. Successful cross-cultural and international collaborations have to overcome many regional and global barriers. Despite these difficulties, many scientific collaborations usually begin with an informal meeting or contact. With advancement in global communications, scientists have greater responsibility towards the world community while considering the impact of their collaborative partnerships. I review the basic factors that are required for forging a collaborative partnership and responsible attitudes to sustain the relationship. Finally I conclude that scientists in healthcare research can play important roles beyond collaborations and contribute to bringing harmony, resolving differences across the nations and countries in today's troubled world.

Sexual behaviour and dysfunction and help-seeking patterns in adults aged 40-80 years in the urban population of Asian countries

OBJECTIVE

To study sexual activity, the prevalence of sexual dysfunction and related help-seeking behaviour among middle-aged and elderly people in Asia.

SUBJECTS AND METHODS

A random population survey was carried out in 2001-2002 among urban residents aged 40-80 years in China, Taiwan, South Korea, Japan, Thailand, Singapore, Malaysia, Indonesia and The Philippines, with interviews based on a standardized questionnaire covering demographic details, health, relationships, and sexual behaviours, attitudes and beliefs. An intercept method of sampling was used in all countries except Japan, where questionnaires were mailed to a sample drawn from telephone directories. Sexual dysfunction was defined as persistent sexual problems.

RESULTS

The questionnaire was completed by 6700 people (3350 men and 3350 women), giving a response rate of 27%. Across all countries, 82% of men and 64% of women had engaged in sexual intercourse during the year preceding the interview. Most of the respondents considered satisfactory sex an essential means of maintaining a relationship. More than 20% of men and 30% of women complained of having at least one sexual dysfunction, although there were marked variations among the countries. The sexual dysfunctions most frequently reported were early ejaculation (20%; 95% confidence interval, CI, 18-21) and erectile dysfunction (15%, 14-17) among men; and a lack of sexual interest (27%, 25-29), lubrication difficulties (24%, 22-25), and an inability to reach orgasm (23%, 22-25) among women. Of the 948 men and 992 women who were sexually active and reported sexual dysfunctions, 45% did sought no help or advice and only 21% sought medical care.

CONCLUSION

Men and women in Asian countries continue to show sexual interest and activity into middle age and beyond. Although sexual dysfunction is prevalent in this age group, several sociocultural and economic factors appear to be preventing individuals from seeking medical help for these problems.

Effects of impaired fasting glucose and impaired glucose tolerance on predicting incident type 2 diabetes in a Chinese population with high post-prandial glucose

AIMS

To ascertain which impaired glucose homeostasis at baseline is predictive of conversion to type 2 diabetes in both men and women in a high-risk non-diabetic population.

METHODS

The screening survey for type 2 diabetes was conducted in 1994, and a follow-up study of 627 high-risk non-diabetic individuals at baseline was carried out in 1999 in Beijing area. A total of 70 men and 76 women developed diabetes during the 5-year follow-up.

RESULTS

After adjustment for age, body mass index, smoking, systolic blood pressure, family history of diabetes, total cholesterol, triglycerides, antihypertensive medication, occupation, education, urine albumin excretion rate, and fasting insulin, the odds ratios for incidence of diabetes were 1.00, 2.04 (95% CI 0.84-4.97), 7.82 (2.66-23.00), 9.38 (3.30-26.69) in men with normal glucose, isolated IFG, isolated IGT, and both IFG and IGT, respectively. In women, the corresponding odds ratios were 1.00, 2.19 (0.91-5.30), 1.62 (0.72-3.67), and 8.79 (2.98-25.93), respectively.

CONCLUSIONS

This study shows that combined IFG and IGT at baseline is a strong risk predictor for the development of diabetes in both men and women. Isolated IGT is also a predictor of diabetes in Chinese men.

Body fat distribution and risk of diabetes among Chinese women

OBJECTIVE

To assess the relationship between measures of central and overall obesity and risk of diabetes.

DESIGN

Nested case-control study.

SETTING

Shanghai, China.

PARTICIPANTS

A total of 57 130 women were screened for diabetes at enrollment for the Shanghai Women's Health Study (SWHS), a population-based cohort study of Chinese women aged 40-70 y. In this study, 345 women diagnosed with diabetes and 2760 age-matched controls (eight controls per case), randomly selected from women who tested negative for urine glucose, were included.

RESULTS

Risk of diabetes increased significantly with increasing levels of obesity, particularly with measures of central obesity. Compared to those in the lowest quartile, women in the highest quartile of body mass index (BMI) (>/=26.57) and waist to hip ratio (WHR) (>/=0.855) had a 2.57-fold (95% CI 1.75-3.77) and a 6.05-fold (95% CI 4.05-9.04) increased risk of diabetes, respectively. The risk of diabetes was elevated with increasing WHR at all levels of BMI, while the positive association between BMI and diabetes was observed primarily among women with a low WHR. However, test for multiplicative interaction was not statistically significant.

CONCLUSIONS

Our data indicated that central obesity is a stronger risk factor for diabetes than overall obesity, suggesting that WHR may be a better indicator of risk of diabetes than BMI among Chinese women.