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Grant-Alfieri A, Herman WH, Watkins DJ, Batterman S, Karvonen-Gutierrez C, Park SK. Associations of serum persistent organic pollutant concentrations with incident diabetes in midlife women: The Study of Women's Health Across the Nation Multi-Pollutant Study. ENVIRONMENTAL RESEARCH 2024; 260:119582. [PMID: 38992756 DOI: 10.1016/j.envres.2024.119582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/30/2024] [Accepted: 07/07/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs), and polychlorinated biphenyls (PCBs) are persistent organic pollutants (POPs) that can negatively impact metabolic health through pathways including endocrine disruption. Few studies have evaluated diabetes risk associated with PBDEs. Little is known about the joint effect of exposure to POP mixtures on diabetes risk. OBJECTIVES We investigated the relationship between POPs, individually and as mixtures, and diabetes development over 18 years (1999-2016) in midlife women. METHODS We measured lipid-standardized serum concentrations of 34 PCBs, 19 OCPs, and 14 PBDEs in 1040 midlife women aged 45-56 years from the Study of Women's Health Across the Nation. We tested the association between POPs measured in 1999/2000 and incident diabetes using Cox proportional hazards models. We evaluated diabetes risk associated with the overall POP mixture using Quantile-Based G-Computation (QBGC). RESULTS For most mixture components, single pollutant and mixtures analyses indicated null associations with diabetes risk, however results were inconsistent. After adjustment, hazard ratios (HRs) of developing diabetes (95% CI) associated with upper exposure tertiles (T2/T3) compared with the first tertile (T1), were 1.7 (1.0, 2.8) at T2 and 1.5 (0.84, 2.7) at T3 for hexachlorobenzene and 1.9 (1.1, 3.3) at T2 and 1.6 (0.88, 2.9) at T3 for PCB 123. A doubling of PBDE 47 was associated with 1.11 (1.00, 1.24) times the risk of T2D. QBGC identified no association for the overall joint effect of the POP mixture on diabetes (HR = 1.04 [0.53, 2.07]). CONCLUSION Exposure to a mixture of PCBs, OCPs, and PBDEs was not associated with incident diabetes in midlife U.S. women, although some individual POPs demonstrated significant yet inconsistent associations with diabetes. Non-linear and non-monotonic dose-response dynamics deserve further exploration. More research is needed on the diabetogenic effects of PBDEs.
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Affiliation(s)
- Amelia Grant-Alfieri
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - William H Herman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Deborah J Watkins
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Stuart Batterman
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Sung Kyun Park
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Klisic A, Karakasis P, Patoulias D, Khalaji A, Ninić A. Are Oxidative Stress Biomarkers Reliable Part of Multimarker Panel in Female Patients with Type 2 Diabetes Mellitus? Metab Syndr Relat Disord 2024. [PMID: 38848276 DOI: 10.1089/met.2024.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Background: Oxidative stress and inflammation are the key features of metabolic diseases, including type 2 diabetes mellitus (T2D). However, studies that explored redox homeostasis parameters in relation to T2D show discrepant results. Accordingly, we aimed to examine the potential reliability of oxidative stress biomarkers [i.e., determined by malondialdehyde (MDA), advanced oxidation protein products (AOPP) and catalase (CAT)] in addition to traditional cardiometabolic parameters in relation to T2D in female cohort. Methods: A total of 214 women (of them 40.6% T2D) were consecutively recruited in the study. Principal component analysis with varimax rotation was performed to determine the adequate number of factors consisting of anthropometric, traditional cardiometabolic and redox status markers. Results: MDA and AOPP concentrations were lower, but CAT activity was higher in T2D group as compared with controls (P < 0.001, P = 0.002, P < 0.001). Traditional markers related factor (i.e., with positive loading of waist circumference, triglycerides, uric acid, high sensitivity C-reactive protein and negative loadings of high-density lipoprotein cholesterol) was found to be independently related with T2D in multivariate binary regression analysis, whereas oxidative stress related factor (i.e., with positive loading of MDA and AOPP) lost its independent prediction after adjustment for confounding factors (i.e., age, menopausal status, antihypertensive, and hypolipemic therapies). Increased Traditional markers related factor was associated with more than three times higher probability for T2D onset (OR = 3.319, p < 0.001). Conclusion: Oxidative stress biomarkers, i.e., MDA, AOPP, and CAT are not superior over traditional cardiometabolic markers in relation to T2D in female population. Future studies with both gender included are needed to confirm such results.
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Affiliation(s)
- Aleksandra Klisic
- University of Montenegro-Faculty of Medicine, Podgorica, Montenegro
- Center for Laboratory Diagnostics, Primary Health Care Center, Podgorica, Montenegro
| | - Paschalis Karakasis
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Greece
| | - Dimitrios Patoulias
- Outpatient Department of Cardiometabolic Medicine, Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", Thessaloniki, Greece
| | - Amirmohammad Khalaji
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ana Ninić
- Department for Medical Biochemistry, University of Belgrade-Faculty of Pharmacy, Belgrade, Serbia
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Lin W. The Association between Body Mass Index and Glycohemoglobin (HbA1c) in the US Population's Diabetes Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:517. [PMID: 38791732 PMCID: PMC11121031 DOI: 10.3390/ijerph21050517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
Obesity, indicated by Body Mass Index (BMI), is a risk factor for type 2 diabetes. However, its association with glycated hemoglobin (HbA1c), a crucial indicator of blood-sugar control, may vary across different populations and disease statuses. Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 were analyzed. Participants aged 18-79 years with complete information on BMI, diabetes status, and HbA1c were included (n = 4003). Linear regression models were used to assess the association between BMI and HbA1c, adjusting for demographic confounders, smoking status, alcohol consumption, and healthcare access. Among participants without diabetes, BMI was positively associated with HbA1c levels (coefficient: 0.015, 95% CI: 0.01, 0.02; p-value < 0.05), after adjusting for potential confounders. However, this association was not significant among those with diabetes (coefficient: -0.005, 95% CI: -0.05, 0.04; p-value > 0.1). Our findings suggest a differential relationship between BMI and HbA1c in individuals with and without diabetes. While BMI remains a significant predictor of HbA1c in non-diabetic individuals, its significance diminishes in those with diabetes.
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Affiliation(s)
- Wenxue Lin
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19122, USA
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Man S, Deng Y, Ma Y, Yang X, Wang X, Fu J, Yu C, Lv J, Du J, Wang B, Li L. Association between weight change, waist circumference change, and the risk of nonalcoholic fatty liver disease in individuals with metabolically healthy overweight or obesity and metabolically unhealthy overweight or obesity. Obes Res Clin Pract 2024; 18:109-117. [PMID: 38443283 DOI: 10.1016/j.orcp.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND This study aimed to explore and compare the effect of weight change, and waist circumference (WC) change, on the risk of nonalcoholic fatty liver disease (NAFLD) in individuals with metabolically healthy overweight or obesity (MHOW/O) and metabolically unhealthy overweight or obesity (MUOW/O) in a health check-up cohort in China. METHODS 5625 adults with overweight or obesity, and free from NAFLD at baseline were included. Metabolically healthy was defined as not having any components of metabolic syndrome. Weight/WC changes were calculated as the relative difference between the first and second visits of check-up. NAFLD was assessed based on abdominal ultrasound. RESULTS During a median follow-up of 2.1 (IQR: 1.1-4.3) years, 1849 participants developed NAFLD. In MHOW/O participants, the multivariable adjusted HRs (95 % CIs) for NAFLD in weight change ≤ -5.0 %, and - 4.9-- 1.0 % were 0.36 (0.23-0.59), 0.59 (0.43-0.80), respectively, compared to the weight stable group (-0.9% to 0.9 %). The corresponding HRs (95 % CIs) for the association between WC change (≤ 6.0 %, - 5.9 to -3.0 %) and NAFLD in MHOW/O participants were 0.41 (0.27-0.62), and 0.74 (0.54-1.01), respectively, compared to the WC stable group (-2.9-2.9 %). Similar patterns were observed in MUOW/O participants. A more marked gradient of cumulative incidence of NAFLD across weight/WC change categories was observed in MHOW/O than in MUOW/O individuals. CONCLUSIONS A more evident association between weight/WC loss and risk of NAFLD was observed in MHOW/O than in MUOW/O individuals. Our findings indicate the practical significance of encouraging all individuals with overweight and obesity to achieve a clinically relevant level of weight/WC loss to prevent NAFLD, even among metabolic healthy groups.
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Affiliation(s)
- Sailimai Man
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Meinian Institute of Health, Beijing 100083, China; Peking University Health Science Center Meinian Public Health Institute, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Yuhan Deng
- Meinian Institute of Health, Beijing 100083, China; Chongqing Research Institute of Big Data, Peking University, Chongqing 400000, China
| | - Yuan Ma
- Meinian Institute of Health, Beijing 100083, China; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiaochen Yang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China
| | - Xiaona Wang
- Beijing MJ Health Check-up Center, Beijing 100000, China
| | - Jingzhu Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Peking University Health Science Center Meinian Public Health Institute, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Peking University Health Science Center Meinian Public Health Institute, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Peking University Health Science Center Meinian Public Health Institute, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
| | - Jing Du
- Beijing Centre for Disease Prevention and Control, Beijing 100013, China.
| | - Bo Wang
- Meinian Institute of Health, Beijing 100083, China; Peking University Health Science Center Meinian Public Health Institute, Beijing 100191, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China.
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China; Peking University Health Science Center Meinian Public Health Institute, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China.
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Ouyang A, Hu K, Chen L. Trends and risk factors of diabetes and prediabetes in US adolescents, 1999-2020. Diabetes Res Clin Pract 2024; 207:111022. [PMID: 37981123 DOI: 10.1016/j.diabres.2023.111022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
AIMS To assess the national trends in prevalence of diabetes and prediabetes and their major risk factors among adolescents in the US. METHODS We analyzed data on 6,936 adolescents aged 12 to 19 years from the National Health and Nutrition Examination Surveys (NHANES) between 1999 and 2020. Diabetes was defined by self-reported physician-diagnosis (diagnosed) and by fasting plasma glucose and HbA1c levels (undiagnosed). Prediabetes was identified by fasting plasma glucose and HbA1c levels. Logistic regression was performed to estimate the associations of major risk factors with diabetes and prediabetes. RESULTS The prevalence of prediabetes in adolescents increased from 11.5% in 1999-2002 to 36.3% in 2015-2020. The prevalence of diabetes increased from 0.82% (0.62% of diagnosed and 0.20% of undiagnosed) in 1999-2002 to 1.14% (0.76% of diagnosed and 0.38% of undiagnosed) in 2015-2020, but the increase was not statistically significant (P value = 0.69). Obesity was significantly associated with higher odds of diabetes and prediabetes while boys and Mexican Americans had a significantly higher risk of prediabetes than their counterparts. CONCLUSIONS The prevalence of prediabetes among adolescents in the US has more than tripled from 1999 to 2020. Obese adolescents are at the greatest risk for diabetes and prediabetes.
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Affiliation(s)
- Anthony Ouyang
- Thomas S. Wootton High School, 2100 Wootton Pkwy, Rockville, MD 20850, USA
| | - Kathy Hu
- Episcopal School of Baton Rouge, 3200 Woodland Ridge Blvd, Baton Rouge, LA 70816, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA 90095, USA.
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Fan B, Tang T, Zheng X, Ding H, Guo P, Ma H, Chen Y, Yang Y, Zhang L. Sleep disturbance exacerbates atherosclerosis in type 2 diabetes mellitus. Front Cardiovasc Med 2023; 10:1267539. [PMID: 38107260 PMCID: PMC10722146 DOI: 10.3389/fcvm.2023.1267539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/10/2023] [Indexed: 12/19/2023] Open
Abstract
Background Short sleep duration and poor sleep quality are important risk factors for atherosclerosis. The use of smart bracelets that measure sleep parameters, such as sleep stage, can help determine the effect of sleep quality on lower-extremity atherosclerosis in patients with type 2 diabetes. Objective To investigate the correlation between sleep disorders and lower-extremity atherosclerosis in patients with type 2 diabetes. Methods After admission, all patients were treated with lower-extremity arterial ultrasound and graded as having diabetic lower-extremity vascular lesions according to the results. A smart bracelet was used to obtain the patient sleep data. The correlation between sleep patterns and diabetic lower-extremity atherosclerosis, diabetic foot, and various metabolic indices was verified. Results Between August 2021 and April 2022, we screened 100 patients with type 2 diabetes, with 80 completing sleep monitoring. Univariate ordered logistic regression analysis indicated that patients with a sleep score below 76 (OR = 2.707, 95%CI: 1.127-6.488), shallow sleep duration of 5.3 h or more (OR=3.040, 95 CI: 1.005-9.202), wakefulness at night of 2.6 times or more (OR = 4.112, 95%CI: 1.513-11.174), and a deep sleep continuity score below 70 (OR = 4.141, 95%CI: 2.460-615.674) had greater risk of high-grade lower limb atherosclerosis. Multivariate ordinal logistic regression analysis revealed that the risk of high-grade lower limb atherosclerosis was higher in patients with 2.6 or more instances of nighttime wakefulness (OR = 3.975, 95%CI: 1.297-12.182) compared with those with fewer occurrences. The sleep duration curve of patients with different grades of diabetic lower-extremity atherosclerosis was U-shaped. According to the results of the one-way analysis of variance, the higher the deep sleep continuity score, the lower the Wagner scale score for diabetic foot (P < 0.05). Conclusions Sleep disorders (long, shallow sleep duration, frequent wakefulness at night, and poor continuity of deep sleep) can worsen lower limb atherosclerosis in patients with type 2 diabetes. This finding can provide a new method for medical professionals to prevent and treat diabetic lower-extremity vascular lesions.
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Affiliation(s)
- Bingge Fan
- Department of Endocrinology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ting Tang
- Department of War and Rescue Medicine Field Internal Medicine Teaching and Research Office, NCO School, Army Medical University, Shijiazhuang, China
| | - Xiao Zheng
- Department of Orthopedics, The Affiliated Hospital, NCO School of Army Medical University, Shijiazhuang, China
| | - Haixia Ding
- Department of Endocrinology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Peng Guo
- Department of Orthopedics, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongqing Ma
- Second Department of General Surgery, The Forth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yu Chen
- Department of Cardiology, Bethune International Peaceful Hospital, Shijiazhuang, China
| | - Yichao Yang
- Department of Gastroenterology, Baoding First Central Hospital, Baoding, China
| | - Lihui Zhang
- Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Geng S, Chen X, Bai K, Ding J, Li H, Shi S. Association of the Clínica Universidad de Navarra-Body Adiposity Estimator With Type 2 Diabetes: A Retrospective Cohort Study. Int J Public Health 2023; 68:1606063. [PMID: 37810434 PMCID: PMC10551821 DOI: 10.3389/ijph.2023.1606063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives: Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) is considered to be a more accurate indicator of body fat estimation. We aimed to investigate the association of CUN-BAE with the risk of type 2 diabetes mellitus (T2DM) and to compare the strength of the association between CUN-BAE, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and T2DM. Methods: The data were obtained from the annual health checkup database of residents in Xinzheng, China. From January 2011 to December 2021, 80,555 subjects aged ≥45 years met the inclusion criteria. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for CUN-BAE, BMI, WC, and WHtR in T2DM. Results: During a mean follow-up of 6.26 years, T2DM occurred in 12,967 subjects. The multivariable-adjusted HRs (95% CIs) of T2DM (highest vs. reference group) were 1.994 (1.811-2.196) for CUN-BAE, 1.751 (1.665-1.842) for WC, 1.715 (1.631-1.804) for WHtR, and 1.510 (1.436-1.588) for BMI, respectively. In addition, the risk of T2DM increased with baseline CUN-BAE (HR: 1.374; 95% CI: 1.328, 1.421), WC (HR: 1.236; 95% CI: 1.215, 1.256), WHtR (HR: 1.228; 95% CI: 1.208, 1.248), and BMI (HR: 1.175; 95% CI: 1.156, 1.195). Conclusion: Compared to BMI, WC or WHtR, CUN-BAE may more adequately reflect the adverse effects of adiposity on the risk of T2DM.
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Affiliation(s)
| | | | | | | | | | - Songhe Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, China
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Alghadir AH, Gabr SA, Iqbal A. Mineral elements and adiposity-related consequences in adolescents with intellectual disabilities. BMC Mol Cell Biol 2023; 24:29. [PMID: 37730529 PMCID: PMC10512604 DOI: 10.1186/s12860-023-00490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Patients with intellectual disabilities are shown to have a limited capacity for cooperation, communication,and other biological consequences, which significantly require a specialized interest in healthcare professionals worldwide. AIM In this respect, the present study was designed to evaluate the levels mineral elements, and their correlation with oxidative stress markers and adiposity markers; leptin (L), adiponectin (A), and L/A ratio in adolescents with intellectual disabilities. METHODS A total of 350 schoolchildren aged (12-18 years) were randomly invited to participate in this prospective, observational study. Only 300 participants agreed to participate in this study. According to Intelligence quotients scores (IQ) measured by WISC-III, the participants were classified into two groups; the healthy control group (no = 180; IQ = 90-114); and the moderate intellectual disability (MID) group (no = 120; IQ = 35-49). Adiposity markers; body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), physical activity scores, adipokines biomarkers; leptin, adiponectin, L/A ratio, oxidative stress, and plasma mineral elements were evaluated by prevalidated questionnaires, inductively coupled plasma-mass spectrometry (ICP-MS), colorimetric, and immunoassay techniques. RESULTS Intellectual disability of moderate type was reported in 40% of the studied populations most of them are men aged 12-18 years (66.6% for men vs. 33.3 for females). Obesity was shown to be associated with the degree of intellectual disability of the students. There was a significant (P = 0.001) increase in the BMI, WHR, and WHtR scores as obesity markers with poor physical activity (P = 0.01) in students with poor disability compared to healthy controls (HC). The levels of leptin (P = 0.001), adiponectin (P = 0.01), and L/A ratio (P = 0.01) as adiposity biomarkers were significantly increased in students with MID compared to healthy controls. Also, oxidative stress measured by malondialdehyde (MDA) (P = 0.01) and total antioxidant capacity (TAC) (P = 0.01) were significantly increased in students with MID compared to healthy control subjects. In addition, mineral elements were shown to be linked with intellectual disability. The data showed that the levels of Fe, Mn, Zn, Hg, Pb, Ca, Cr, Mg, and Ni significantly (P = 0.001) increased, and the levels of Al, Na, K, Cu, and Zn/Cu ratio significantly (P = 0.001) decreased in subjects with MID compared to healthy controls. Correlation analysis concluded that changes in mineral elements significantly correlated with adiposity markers, oxidative stress, and the scores of intellectual disability (WISC III-IQ score). CONCLUSION The intellectual disability of moderate type (MID) was associated with abnormal changes in the levels of essential mineral elements and adipokines and increased levels of cellular oxidative stress. Thus, evaluating plasma mineral elements and adipokines levels could be a potential diagnostic parameter for diagnosing MID.
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Affiliation(s)
- Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Sami A Gabr
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Amir Iqbal
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia.
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Nieto-Martinez R, Mechanick JI, González-Rivas JP, Ugel E, Iglesias R, Clyne M, Grekin C. Revised Case Finding Protocol for Dysglycemia in Chile: A Call for Action in Other Populations. Endocr Pract 2023:S1530-891X(23)00399-3. [PMID: 37270107 DOI: 10.1016/j.eprac.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Guidelines recommend case finding for dysglycemia (prediabetes and type 2 diabetes [T2D]) in adults or youth older than 10 years with overweight/obesity, but increased adiposity has not been associated with dysglycemia in some Hispanic populations. This study aims to determine the prevalence of dysglycemia in this population using simplified criteria independent of BMI and age to request an oral glucose tolerance test (OGTT). METHODS Cross-sectional retrospective analysis of medical records from a clinical center in Chile (2000-2007). OGTT was obtained from any patient with one cardiometabolic risk factor (CMRF) independent of age and BMI. RESULTS In total, 4,969 adults (mean age ± SD) 45.7 ± 15.9 years and 509 youths 16.6 ± 3.0 years were included. The prevalence (%, 95%CI) of prediabetes doubled that of T2D in youths (14.1%, 1.4-17.4 vs. 6.3%, 4.5-8.7) and tripled it in adults (36.0%, 34.7-37.4 vs. 10.7%, 9.8-11.5). In underweight and normal-weight adults, 22% (12.0-36.7) and 29.2% (26.4-32.1) had prediabetes, whereas 4.9% (1.3-16.1) and 8.8% (7.2-10.7) had T2D, respectively. In normal-weight youths, 10.5% (6.7-15.9) and 2.9% (1.2-6.6) had prediabetes and T2D, respectively. In adults, but not in youths, most dysglycemia categories were related to overweight/obesity. CONCLUSION This study supports a public health policy to identify more people at risk for cardiovascular disease by implementing a revised case-finding protocol for dysglycemia using OGTT in even normal-weight patients over 6 years of age when there is at least one CMRF. Re-analysis of case-finding protocols for cardiometabolic risk in other populations is warranted.
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Affiliation(s)
- Ramfis Nieto-Martinez
- Precision Care Clinic Corp, Saint Cloud, FL, USA; Department of Global Health and Population. Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela.
| | - Jeffrey I Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan P González-Rivas
- Department of Global Health and Population. Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela; International Clinical Research Center, St Anne's University Hospital (ICRC-FNUSA), Brno, Czech Republic
| | - Eunice Ugel
- Department of Global Health and Population. Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela; Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - Rocio Iglesias
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Megan Clyne
- Department of Physiology and Biophysics, School of Medicine, Georgetown University, Washington DC, USA
| | - Carlos Grekin
- Nutrition and Diabetes Unit. Clínica Red Salud Vitacura, Santiago, Chile; Nutrition and Diabetes Service. Santiago Military Hospital, Chile; Universidad de Los Andes, Santiago de Chile, Chile.
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Denton JJ, Cedillo YE. Investigating family history of diabetes as a predictor of fasting insulin and fasting glucose activity in a sample of healthy weight adults. Acta Diabetol 2023; 60:535-543. [PMID: 36637530 DOI: 10.1007/s00592-023-02030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
AIMS Type 2 diabetes is a major public health problem for the global community. Having a family history of diabetes significantly increases risk for diabetes development and understanding how family history contributes to diabetes risk could lead to more effective prevention efforts for at-risk individuals. In a previous study, we showed family history of diabetes is a significant predictor of fasting insulin in healthy weight children. The present study aimed to use the National Health and Nutrition Examination Survey (NHANES 2017) to apply similar multiple regression models to a population of healthy weight adults to determine if family history is a significant predictor of fasting glucose and fasting insulin. METHODS Fasting glucose (mg/dL) and fasting insulin (pmol/L) were used as dependent variables in each model, respectively, with family history of diabetes as the independent variable. Covariates for each model included age, gender, race/ethnicity, waist circumference, and macronutrient intake. RESULTS The model significantly predicted the variance of fasting glucose [(F(11,364) = 34.80, p < 0.001, R2 = 0.2342] and fasting insulin [F(11,343) = 17.58, p < 0.001, R2 = 0.1162]. After adjusting for covariates, family history was a significant predicator of fasting glucose (p = 0.0193) as well as age, gender, non-Hispanic black ethnicity, waist circumference, and fat intake. Significant predictors of fasting insulin included gender and waist circumference, but not family history (p = 0.8264). In addition, fasting glucose was higher in individuals with a family history of diabetes (p = 0.033). CONCLUSIONS These results add to the understanding of how family history influences the biomarkers that contribute to diabetes development. Knowledge of how family history of diabetes relates to fasting insulin and fasting glucose activity in healthy weight individuals can be used to design personalized screening and early prevention strategies.
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Affiliation(s)
- Jessica J Denton
- University of Alabama at Birmingham, School of Health Professions Building, Room 448, 1720 2nd Ave S., Birmingham, Alabama, 35294, USA.
| | - Yenni E Cedillo
- University of Alabama at Birmingham, Webb Building, Room 544, 1720 2nd Ave S., Birmingham, Alabama, 35294, USA
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Xiao X, Yu X, Zhu H, Zhai X, Li S, Ma W, Ouyang M, Liu K, Eshak ES, Cao J. Arm Circumference, Arm-to-Waist Ratio in Relation to Cardiovascular and All-Cause Mortality among Patients with Diabetes Mellitus. Nutrients 2023; 15:nu15040961. [PMID: 36839318 PMCID: PMC9959583 DOI: 10.3390/nu15040961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Abstract
Among patients with diabetes mellitus, limited studies have investigated the relationship between anthropometric parameters and cardiovascular disease (CVD), with all-cause mortality. We examined the associations of arm circumference (AC), arm-to-waist ratio (AC/WC), and CVD, with all-cause mortality among patients with diabetes. This is a cohort study of 5497 diabetic individuals aged 20 or over who were recruited in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014. Cox proportional hazards regression models were used to analyze the associations between AC, AC/WC, and CVD, with all-cause mortality. We also conducted stratified analyses and explored the possible non-linear relation by restricted cubic splines. During a median follow-up of 7.2 years, there were 271 and 1093 cases of CVD and all-cause death. The multivariable adjusted hazard ratios (HRs) with 95% confidence intervals (Cis) of CVD mortality in Q2, Q3, and Q4 groups compared with Q1 group were 0.37 (0.22, 0.62), 0.24 (0.12, 0.48), 0.18 (0.07, 0.46) for AC, and 0.18 (0.07, 0.46), 0.34 (0.20, 0.60), 0.28 (0.15, 0.53) for AC/WC. Similar results were observed in the analysis for all-cause mortality risk. AC and AC/WC were both inversely associated with CVD and all-cause mortality among individuals with diabetes. It is important to pay attention to these anthropometric parameters of diabetic patients.
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Affiliation(s)
- Xinyu Xiao
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Xinyi Yu
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Huiping Zhu
- School of Public Health, Capital Medical University, Beijing 100069, China
| | - Xiaobing Zhai
- Center for Artificial Intelligence Driven Drug Discovery, Faculty of Applied Sciences, Macao Polytechnic University, Macau SAR, China
| | - Shiyang Li
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Wenzhi Ma
- School of Public Health, Wuhan University, Wuhan 430071, China
| | - Meishou Ouyang
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Osaka, Japan
| | - Keyang Liu
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Osaka, Japan
| | - Ehab S. Eshak
- Department of Public Health, Faculty of Medicine, Minia University, Minia 61511, Egypt
- Advanced Clinical Epidemiology, Medical data Science Unit, Public Health, Department of Social Medicine, Graduate School of Medicine, 2-2 Yamadaoka, Osaka University, Suita-shi 565-0871, Osaka, Japan
- Public Health, School of Health, Calvin University, Grand Rapids, MI 49546, USA
| | - Jinhong Cao
- School of Management, Hubei University of Traditional Chinese Medicine, Wuhan 430065, China
- Research Center for the Development of Traditional Chinese Medicine, Hubei Province Project of Key Research Institute of Humanities and Social Sciences at Universities, Wuhan 430065, China
- Correspondence:
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12
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Qin Y, Qiao Y, Wang D, Li M, Yang Z, Li L, Yan G, Tang C. Visceral adiposity index is positively associated with fasting plasma glucose: a cross-sectional study from National Health and Nutrition Examination Survey 2017-2020. BMC Public Health 2023; 23:313. [PMID: 36774500 PMCID: PMC9922465 DOI: 10.1186/s12889-023-15231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Visceral adiposity index (VAI) has been recognized as a reliable indicator for visceral adiposity. However, it remains largely unexplored on its association with fasting plasma glucose (FPG). The current study aims to explore the association between VAI and FPG using a representative dataset. METHODS A cross-sectional study was carried out based on the dataset from National Health and Nutrition Examination Survey (NHANES) 2017-2020. Univariate and Multiple linear regression analysis were performed to explore the relationship between VAI and FPG. Generalized additive model (GAM) and smooth curve fitting analysis were performed to explore the nonlinear relationship between VAI and FPG. Receiver operating characteristic (ROC) analysis was used to evaluate the predictive value of VAI for FPG elevation. RESULTS A total of 4437 participants with complete data were finally included in the research. Individuals were divided into 4 quartiles according to the calculated VAI value: Q1 (VAI<0.69), Q2 (0.69 ≤ VAI < 1.18), Q3 (1.18 ≤ VAI < 2.02) and Q4 (VAI ≥ 2.02). FPG significantly increased with the increasing VAI quartile. Multiple linear regression analysis showed VAI was independently positively associated with FPG after adjusting confounding factors. As a continuous variable, an increase of one unit in VAI was correlated with 0.52 mmol/L (95% CI: 0.41-0.63, p < 0.0001) higher FPG level. As a categorical variable, 4th VAI quartile group was related to 0.71 mmol/L (95% CI: 0.47-0.95, p < 0.001) higher FPG level compared with 1st VAI group. GAM and smooth curve fitting analysis identified the non-linear relationship between VAI and FPG, and 4.02 was identified as the inflection point using two-piecewise linear regression. The positive association between VAI and FPG existed when VAI was lower (β = 0.73, p < 0.0001) and higher than 4.02 (β = 0.23, p = 0.0063). ROC analysis indicated VAI has a good predictive value for FPG elevation (AUC = 0.7169, 95% CI: 0.6948-0.7389), and the best threshold of VAI was 1.4315. CONCLUSION VAI was an independently risk indicator for FPG, and VAI was nonlinearly positively associated with FPG. VAI had a good predictive value for elevated FPG. VAI might become a useful indicator for risk assessment and treatment of hyperglycemia in clinical practice.
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Affiliation(s)
- Yuhan Qin
- grid.263826.b0000 0004 1761 0489Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 Jiangsu China
| | - Yong Qiao
- grid.263826.b0000 0004 1761 0489Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 Jiangsu China
| | - Dong Wang
- grid.263826.b0000 0004 1761 0489Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 Jiangsu China
| | - Mingkang Li
- grid.263826.b0000 0004 1761 0489Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 Jiangsu China
| | - Zhanneng Yang
- grid.263826.b0000 0004 1761 0489Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 Jiangsu China
| | - Linqing Li
- grid.263826.b0000 0004 1761 0489Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 Jiangsu China
| | - Gaoliang Yan
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.
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Li Z, Daniel S, Fujioka K, Umashanker D. Obesity among Asian American people in the United States: A review. Obesity (Silver Spring) 2023; 31:316-328. [PMID: 36695056 PMCID: PMC10108164 DOI: 10.1002/oby.23639] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Standard measures of obesity, i.e., body weight and BMI, suggest that Asian American people have a lower obesity prevalence than other racial groups in the United States. However, Asian American people face a unique challenge in their pattern of adiposity with central obesity, which raises the risk for multiple comorbidities, such as type 2 diabetes, metabolic syndrome, and cardiovascular disease, at a lower BMI compared with other populations. Several organizations recommend lower BMI cutoffs for obesity in Asian people (BMI ≥25.0 or ≥27.5 kg/m2 ) instead of the standard ≥30.0 kg/m2 threshold. The risks of obesity and related comorbidities in this population are further influenced by diet, physical activity, perceptions of health, and access to information and therapies. Asian-specific parameters for assessing obesity should become a standard part of clinical practice. Asian American people should equally be offered subgroup-specific tailored interventions owing to heterogeneity of this population. Access to medications and surgery should be improved, in part by updating US indications for therapies to reflect race-specific obesity thresholds and through inclusion of Asian American people of all subtypes with lower BMI values in clinical trials.
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Affiliation(s)
- Zhaoping Li
- Center for Human Nutrition, UCLA, Los Angeles, California, USA
| | | | - Ken Fujioka
- Scripps Clinic Del Mar, San Diego, California, USA
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Li S, Wang Y, Ying Y, Gong Q, Lou G, Liu Y, Liu S, Li H. Independent and Joint Associations of BMI and Waist Circumference With the Onset of Type 2 Diabetes Mellitus in Chinese Adults: Prospective Data Linkage Study. JMIR Public Health Surveill 2023; 9:e39459. [PMID: 36630180 PMCID: PMC9878373 DOI: 10.2196/39459] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 11/19/2022] [Accepted: 11/26/2022] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND General obesity and abdominal obesity, typically measured by BMI and waist circumference (WC), respectively, are associated with an increased risk of type 2 diabetes mellitus (T2DM). However, the magnitude of the association of these two obesity indicators and their joint association with the onset of T2DM remain controversial. OBJECTIVE The aim of this study was to investigate the associations between these two obesity indicators and T2DM among the Chinese population to contribute scientific evidence for appropriate T2DM interventions. METHODS A cohort of 3001 eligible participants was selected from the Ningbo Adult Chronic Disease Surveillance Project running since 2015. Based on BMI, individuals were categorized into groups of underweight or normal, overweight, and obesity. Based on WC, individuals were categorized in groups of normal, precentral obesity, and central obesity. Follow-up was performed by linking data of the baseline data set with the diabetes registry data set and the vital registry data set (both from the Ningbo Municipal Integrated Noncommunicable Disease Collaborative Management System), mainly using the participants' identity numbers. Follow-up was completed when a participant was diagnosed with T2DM. The associations were estimated with multivariate Cox proportional hazard regression. RESULTS In the cohort, 90 of 3001 participants developed T2DM (incidence density: 6.483/1000 person-years) with a median 4.72 years of follow-up. After controlling for age, sex, hypertension, dyslipidemia, smoking status, and family history of diabetes, the multivariate adjusted hazard ratios (HRs) across underweight/normal, overweight, and obesity BMI categories were 1.000, 1.653 (95% CI 1.030-2.654), and 2.375 (95% CI 1.261-4.473), respectively. The multivariate adjusted HRs across the normal, precentral obesity, and central obesity WC categories were 1.000, 1.215 (95% CI 0.689-2.142), and 1.663 (95% CI 1.016-2.723), respectively. Compared with the reference group (normal WC with an underweight/normal BMI), the multivariate adjusted HR for participants with both central obesity according to WC and obesity according to BMI was 2.489 (95% CI 1.284-4.825). CONCLUSIONS Both elevated BMI and WC at baseline increased the risk of T2DM. Compared with WC, BMI as an obesity indicator was more strongly associated with the onset of T2DM.
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Affiliation(s)
- Sixuan Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Yong Wang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Yanyan Ying
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Qinghai Gong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Ge Lou
- Center for Disease Control and Prevention of Chaoyang District, Beijing, China
| | - Yang Liu
- Shanghai Pudong New Area Center for Disease Control and Prevention, Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Shiwei Liu
- Chinese Center for Disease Control and Prevention, Bejing, China
| | - Hui Li
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
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15
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Chen N, Hu LK, Sun Y, Dong J, Chu X, Lu YK, Liu YH, Ma LL, Yan YX. Associations of waist-to-height ratio with the incidence of type 2 diabetes and mediation analysis: Two independent cohort studies. Obes Res Clin Pract 2023; 17:9-15. [PMID: 36586764 DOI: 10.1016/j.orcp.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/11/2022] [Accepted: 12/18/2022] [Indexed: 12/31/2022]
Abstract
AIM To assess the relationship between waist-to-height ratio (WHtR) and the incidence of type 2 diabetes (T2D)/impaired fasting glucose (IFG) and to explore to what extent these associations are mediated by blood pressure, lipids and other indicators related to liver and kidney metabolism. MATERIALS AND METHODS This study was based on a functional community cohort included 6109 participants which were divided into two sub-cohorts. One sub-cohort included participants with normal fasting glucose (n = 5563), another included IFG individuals at baseline (n = 546). Cox regression models were used to evaluate the relationships of WHtR with T2D/IFG. Four-year time-dependent receiver operating characteristic (ROC) curve and area under curve (AUC) were calculated to estimate the discriminatory power of WhtR and other anthropometric indices on T2D. Mediation analysis was performed to estimate which risk factors mediate the association between WHtR and T2D. RESULTS Significant positive associations were found between WHtR and the incidence of T2D/IFG in both sub-cohort. WhtR was a useful predictor of T2D (P < 0.05). Mediation analysis showed that HOMA-IR (0.45 %), SBP (5.10 %), triglycerides (11.02 %), creatinine (9.36 %) and combined kidney indicators (17.48 %) partly mediated the effect of WHtR on T2D in men. For women, this association was partly mediated by SBP (13.86 %), HDL (24.54 %), ALT (6.29 %), UA (22.58 %) and combined kidney indicators (39.51 %). CONCLUSIONS WHtR was an independent risk factor for the development of T2D and IFG. This association was partly mediated by HOMA-IR, SBP, lipids and other liver and kidney metabolism indicators.
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Affiliation(s)
- Ning Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Li-Kun Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yue Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Jing Dong
- Health Management Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xi Chu
- Health Management Center, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ya-Ke Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yu-Hong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Lin-Lin Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yu-Xiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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Waist Circumference-Years Construct Analysis and the Incidence of Type 2 Diabetes: China Health and Nutrition Survey, 1997-2015. Nutrients 2022; 14:nu14214654. [PMID: 36364916 PMCID: PMC9654573 DOI: 10.3390/nu14214654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Few studies have combined the degree and duration of abdominal obesity into a waist circumference-years construct for analysis. The purpose of this study was to investigate the effect of waist circumference-years on the incidence of type 2 diabetes. Methods: A total of 6616 adults from the China Health and Nutrition Survey (CHNS) were enrolled in this study from 1997. The waist circumference-years construct was represented as the sum of the upper and lower area between the waist circumference baseline (men: ≥90 cm, women: ≥85 cm) and the waist circumference line. The correlations in the study were analyzed using logistic regression. Results: The incidence of type 2 diabetes increased with increasing waist circumference-years, with an adjusted risk increase of 38% (95% CI: 31−47%) for each additional 50 waist circumference-years, and this rate was similar across gender and age groups. The area under the curve of waist circumference-years (0.743) was greatest in the receiver operating characteristic curve (ROC) analysis compared to baseline waist circumference (0.731) and the waist-height ratio (0.728) (p < 0.05). Conclusion: The waist circumference-years construct is closely associated with an increased risk of type 2 diabetes and may be a stronger predictor of type 2 diabetes risk than baseline waist circumference or the waist-height ratio.
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17
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Conte C. Waist circumference and dysglycaemia: new insights and additional questions, but do not miss the opportunity to measure it! Intern Emerg Med 2022; 17:1859-1861. [PMID: 36040676 DOI: 10.1007/s11739-022-03088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via di Val Cannuta 247, 00166, Rome, Italy.
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni, 20900, Milan, Italy.
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Zhen J, Liu S, Zhao G, Peng H, Samaranayake N, Xu A, Li C, Wu J, Cheung BMY. Association of waist circumference with haemoglobin A1c and its optimal cutoff for identifying prediabetes and diabetes risk in the Chinese population. Intern Emerg Med 2022; 17:2039-2044. [PMID: 36002618 PMCID: PMC9522717 DOI: 10.1007/s11739-022-03072-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/29/2022] [Indexed: 12/19/2022]
Abstract
Haemoglobin A1c (HbA1c) is a marker of glycaemic control in type 2 diabetes mellitus (T2DM). Increased waist circumference (WC) is known to be associated with T2DM. Therefore, we investigated the relationship of WC with HbA1c and explored its optimal cutoff for identifying prediabetes and diabetes risk. This study included 2339 participants between 18 and 84 years of age [mean (SD) age, 43.5 (11.9) years] with valid data on WC, HbA1c and related variables in the Shenzhen-Hong Kong United Network on Cardiovascular Disease study. Participants on anti-diabetic medications were excluded. Multiple linear regression was used to investigate the relationship between HbA1c and WC. Cutoff values of WC indicating an HbA1c level of 5.7% and 6.5% were also assessed using optimal binning. There was a significant linear relationship between WC and HbA1c in the overall population (B = 0.261, P < 0.001), men (B = 0.206, P < 0.001) and women (B = 0.311, P < 0.001). After adjustment for smoking, alcohol consumption, physical activity, hypertension, hypercholesterolaemia and age, the association remained significant in the overall population (B = 0.201, P < 0.001), men (B = 0.186, P < 0.001) and women (B = 0.182, P < 0.001). The optimal cutoff values of WC indicating an HbA1c level of 5.7% and 6.5% was 83 cm (entropy = 0.943) and 85 cm (entropy = 0.365) in men, and 78 cm (entropy = 0.922) and 86 cm (entropy = 0.256) in women. The linear relationship between WC and HbA1c in this study suggests that addressing central obesity issue is beneficial to people with T2DM or at risk of T2DM. WC cutoff values of 85 cm for men and 86 cm for women are appropriate for recommendation to undergo diabetes screening.
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Affiliation(s)
- Juanying Zhen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Shuyun Liu
- Department of Neurology, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Guoru Zhao
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Research Center for Neural Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Nithushi Samaranayake
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Aimin Xu
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Chao Li
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China.
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | - Jun Wu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China.
| | - Bernard Man Yung Cheung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
- Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Li Y, Liu X, Tu R, Hou J, Zhuang G. Mendelian Randomization Analysis of the Association of SOCS3 Methylation with Abdominal Obesity. Nutrients 2022; 14:nu14183824. [PMID: 36145200 PMCID: PMC9503364 DOI: 10.3390/nu14183824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
This study was conducted to evaluate the potential causality association of SOCS3 methylation with abdominal obesity using Mendelian randomization. A case-control study, including 1064 participants, was carried out on Chinese subjects aged 18 to 79. MethylTargetTM was used to detect the methylation level for each CpG site of SOCS3, and SNPscan® was applied to measure the single-nucleotide polymorphism (SNP) genotyping. The logistic regression was used to assess the relationship of SOCS3 methylation level and SNP genotyping with abdominal obesity. Three types of Mendelian randomization methods were implemented to examine the potential causality between SOCS3 methylation and obesity based on the SNP of SOCS3 as instrumental variables. SOCS3 methylation levels were inversely associated with abdominal obesity in five CpG sites (effect estimates ranged from 0.786 (Chr17:76356054) to 0.851 (Chr17:76356084)), and demonstrated positively association in 18 CpG sites (effect estimates ranged from 1.243 (Chr17:76354990) to 1.325 (Chr17:76355061)). The causal relationship between SOCS3 methylation and abdominal obesity was found using the maximum-likelihood method and Mendelian randomization method of penalized inverse variance weighted (MR-IVW), and the β values (95% CI) were 5.342 (0.215, 10.469) and 4.911 (0.259, 9.564), respectively. The causality was found between the SOCS3 methylation level and abdominal obesity in the Chinese population.
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Affiliation(s)
- Yuqian Li
- Departmentof Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an 710061, China
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou 450052, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450052, China
| | - Runqi Tu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450052, China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450052, China
| | - Guihua Zhuang
- Departmentof Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Centre, Xi’an 710061, China
- Correspondence: ; Tel.: +86-29-826-551-03
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Chen A, Zhou W, Hou J, Nevill A, Ding Y, Wan Y, Jester R, Qin X, Hu Z, Chen R. Impact of Older Age Adiposity on Incident Diabetes: A Community-Based Cohort Study in China. Diabetes Metab J 2022; 46:733-746. [PMID: 35487506 PMCID: PMC9532176 DOI: 10.4093/dmj.2021.0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/30/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Obesity classifications vary globally and the impact of older age adiposity on incident diabetes has not been well-studied. METHODS We examined a random sample of 2,809 participants aged ≥60 years in China, who were free of diabetes at baseline and were followed up for up to 10 years to document diabetes (n=178). The incidence of diabetes was assessed in relation to different cut-off points of body mass index (BMI) and waist circumference (WC) in multiple adjusted Cox regression models. RESULTS The diabetic risk in the cohort increased linearly with the continuous and quartile variables of BMI and WC. The BMI-World Health Organization (WHO) and BMI-China criteria analysis did not show such a linear relationship, however, the BMI-Asian/Hong Kong criteria did; adjusted hazards ratio (HR) was 0.42 (95% confidence interval [CI], 0.20 to 0.90) in BMI <20 kg/m2, 1.46 (95% CI, 0.99 to 2.14) in 23-≤26 kg/m2, and 1.63 (95% CI, 1.09 to 2.45) in ≥26 kg/m2. The WC-China criteria revealed a slightly better prediction of diabetes (adjusted HRs were 1.79 [95% CI, 1.21 to 2.66] and 1.87 [95% CI, 1.22 to 2.88] in central obese action levels 1 and 2) than the WC-WHO. The combination of the BMI-Asian/Hong Kong with WC-China demonstrated the strongest prediction. There were no gender differences in the impact of adiposity on diabetes. CONCLUSION In older Chinese, BMI-Asian/Hong Kong criteria is a better predictor of diabetes than other BMI criterion. Its combination with WC-China improved the prediction of adiposity to diabetes, which would help manage bodyweight in older age to reduce the risk of diabetes.
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Affiliation(s)
- Anthony Chen
- Faculty of Sciences and Technology, Middlesex University, London, UK
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Weiju Zhou
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Jian Hou
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Alan Nevill
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Yuanlin Ding
- School of Public Health, Guangdong Medical University, Dongguan, China
- Corresponding authors: Yuanlin Ding https://orcid.org/0000-0003-4057-6488 School of Public Health, Guangdong Medical University, No.1 Xingcheng Road, Songshan Lake Science and Technology Park, Dongguan, Guandong 523808, China E-mail:
| | - Yuhui Wan
- School of Public Health, Anhui Medical University, Hefei, China
| | - Rebecca Jester
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
- School of Nursing and Midwifery, RCSI Medical University, Adliya, Bahrain, China
| | - Xia Qin
- School of Health Administration, Anhui Medical University, Hefei, China
| | - Zhi Hu
- School of Health Administration, Anhui Medical University, Hefei, China
- Zhi Hu https://orcid.org/0000-0001-5454-0422 School of Health Administration, Anhui Medical University, Anhui Medical University, No.81 Meishan Road, Hefei, Anhui 230032, China E-mail:
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
- Ruoling Chen https://orcid.org/0000-0002-3033-8753 Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, WV1 1DT, UK E-mail:
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Xu C, Cao Z, Yang H, Hou Y, Wang X, Wang Y. Association Between the EAT-Lancet Diet Pattern and Risk of Type 2 Diabetes: A Prospective Cohort Study. Front Nutr 2022; 8:784018. [PMID: 35096931 PMCID: PMC8795697 DOI: 10.3389/fnut.2021.784018] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The EAT-Lancet Commission has promulgated a sustainable dietary guideline and recommended that it was designed to improve the human health and support environmental sustainability. Objective: This research was designed to explore the association between this healthy diet pattern (EAT-Lancet diet pattern, EAT-LDP) and risk of type 2 diabetes (T2D). Methods: Between 2006 and 2010, a total of 59,849 participants from the UK Biobank without diabetes, cardiovascular disease, or cancers were included at baseline. The EAT-LDP score was constructed on the sum of 14 food components and then categorized into three tertiles. Multivariable Cox proportional hazards regression models were conducted to explore the association between EAT-LDP score and the risk of incident T2D. A mediation analysis was also implemented to disentangle the role of body mass index (BMI) and waist circumference in the relationship between EAT-LDP score and T2D. Results: During a median follow-up of 10 years, 2,461 incident T2D cases were recorded. In analyses that compared tertile 3 of the EAT-LDP score (highest) with tertile 1 (lowest), the hazard ratio (HR) for T2D was 0.81 (95% CI: 0.72–0.90) after adjusting for sociodemographic status and health-related factors. Participants who reported a one-point increase in the diet score were associated with a 6% decrease in risk of T2D (HR: 0.94, 95% CI: 0.91–0.97). A significant indirect association was observed between the EAT-LDP score and T2D (β: 0.66, 95% CI: 0.65–0.67), indicating that 44% of the association of EAT-LDP score with T2D was mediated by BMI. Additionally, 40% of the association of EAT-LDP score with T2D was mediated by waist circumference was also observed. Conclusions: Our findings indicate that a higher adherence to EAT-LDP contributes to lower risk of T2D. Further independent validation is needed to be conducted before applying the EAT-LDP to inform dietary guidelines.
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Affiliation(s)
- Chenjie Xu
- School of Public Health, Hangzhou Normal University, Hangzhou, China
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhi Cao
- Department of Big Data in Health Science, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongxi Yang
- Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Yabing Hou
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaohe Wang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
- *Correspondence: Xiaohe Wang
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
- Yaogang Wang
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22
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Xiao JY, Zhang WS, Jiang CQ, Jin YL, Zhu F, Cheng KK, Lam TH, Xu L. Obesity indicators as mediators of association between daytime napping and type 2 diabetes mellitus: the Guangzhou Biobank Cohort Study. BMC Public Health 2022; 22:56. [PMID: 35012516 PMCID: PMC8744231 DOI: 10.1186/s12889-021-12451-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To examine the mediating effect of obesity indicators on the association between daytime napping and type 2 diabetes mellitus (T2DM) qualitatively and quantitatively using baseline data from the Guangzhou Biobank Cohort Study. METHODS Twenty-nine thousand three hundred fifty-five participants aged 50+ years were included in this cross-sectional study. Mediation analysis was used to assess the mediating effect of body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) on the association between daytime napping and T2DM after adjustment for sex, age, education, occupation, smoking status, alcohol use and physical activity. RESULTS The mean (standard deviation) age of participants was 61.5 ( 7.1) years. The prevalence of T2DM and daytime napping was 12.5% and 65.2%, respectively. After adjustment for potential confounders, WC, WHR and WHtR showed partial mediating effects on the association between daytime napping and T2DM, with the proportion (95% confidence interval) of mediation effect being 10.17% (8.14-14.43%), 14.91% (11.95-21.24%) and 9.36% (7.49-13.29%), respectively. No mediating effect of BMI or HC on the association between daytime napping and T2DM was found. CONCLUSIONS Our results showed significant mediating effects of WC, WHR and WHtR on the association between daytime napping and T2DM, suggesting that waist circumference management could be important in daytime nappers.
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Affiliation(s)
- Jing Yi Xiao
- School of Public Health, Sun Yat-sen University, No. 74 Zhongshan 2nd Road, Guangzhou, Guangdong Province, China
| | - Wei Sen Zhang
- Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | | | - Ya Li Jin
- Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | - Feng Zhu
- Guangzhou Twelfth People's Hospital, Guangzhou, 510620, China
| | - Kar Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tai Hing Lam
- School of Public Health, the University of Hong Kong, Hong Kong, Hong Kong
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, No. 74 Zhongshan 2nd Road, Guangzhou, Guangdong Province, China. .,School of Public Health, the University of Hong Kong, Hong Kong, Hong Kong.
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23
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He K, Zhang W, Hu X, Zhao H, Song R, Bai K, Shi W, Shi S, Shi Z, Yan M. Stronger Associations of Body Mass Index and Waist Circumference with Diabetes than Waist-Height Ratio and Triglyceride Glucose Index in the Middle-Aged and Elderly Population: A Retrospective Cohort Study. J Diabetes Res 2022; 2022:9982390. [PMID: 35257014 PMCID: PMC8898128 DOI: 10.1155/2022/9982390] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/13/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It remains controversial whether body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), or triglyceride glucose (TyG) index has a stronger association with diabetes. The aims of the study were to compare the magnitude of associations of four indicators with diabetes risk. METHODS Data collected from annual health examination dataset in the Xinzheng during 2011 and 2019. A total of 41,242 participants aged ≥ 45 years were included in this study. Cox proportional hazard regression models were used to examine associations between the four indicators and diabetes risk. RESULTS After 205,770 person-years of follow up, diabetes developed in 2,472 subjects. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes (highest vs reference group) were 1.92 (1.71-2.16) for BMI, 1.99 (1.78-2.23) for WC, 1.65 (1.47-1.86) for WHtR, and 1.66 (1.47-1.87) for TyG, respectively. In addition, the risk of diabetes increased with baseline BMI (HR: 1.30; 95% CI: 1.25, 1.35) and TyG (HR: 1.25; 95% CI: 1.20, 1.30), but the lowest HR was 0.78 (95% CI 0.65-0.92) when WC was approximately 72 cm, and 0.85 (95% CI 0.72-0.99) when WHtR was approximately 0.47 in women. In joint analyses, the highest risk was observed in participants with a high BMI combined with a high WC (HR: 2.26; 95% CI: 1.98, 2.58). CONCLUSIONS In middle-aged and elderly Chinese population, BMI and WC were more strongly associated with diabetes than WHtR or TyG, especially the combined effect of BMI and WC.
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Affiliation(s)
- Kun He
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wenli Zhang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xueqi Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hao Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Rui Song
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Kaizhi Bai
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Wenlong Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Songhe Shi
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhan Shi
- Department of Pharmacy, Zhengzhou People's Hospital, Zhengzhou, Henan, China
| | - Mingshu Yan
- College of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Cai X, Luo D, Liu S, Li R, Lu Y, Li M, Qiu S. Four-year changes in central fatness, risk of diabetes, and metabolic control in older adults: a cohort study with mediation analysis. Korean J Intern Med 2022; 37:230-240. [PMID: 34905814 PMCID: PMC8747920 DOI: 10.3904/kjim.2020.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/26/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Older adults are vulnerable to central obesity, while the association of changes in central fatness with risk of diabetes and metabolic control has not been investigated among this particular population. This study was aimed to address these issues. METHODS A total of 1,815 adults aged ≥ 60 years without diabetes at baseline were followed for 4 years. Incident diabetes was ascertained based on plasma glucose, hemoglobin A1c, medical history, and/or the use of anti-diabetic drugs. Central fatness was assessed by waist circumference (WC), waist-height ratio (WHtR), and body roundness index (BRI). Logistic regression analyses were used to assess the association of changes in central fatness with risk of diabetes, along with dose-response and mediation analyses. RESULTS During the 4-year follow-up, 177 participants developed diabetes. The risk of diabetes was increased by 42%, 41%, and 40% per 1 standard deviation increases in WC, WHtR, and BRI, respectively, in multivariable-adjusted models (all p < 0.01). Moreover, these relationships were all linearly-shaped (all pnonlinearity ≥ 0.11). Increases in WC, WHtR, and BRI correlated with increases in hemoglobin A1c, triglycerides-and-glucose index, triglycerides, white blood cell, and C-reactive protein (all p ≤ 0.04). Yet only changes in hemoglobin A1c and triglycerides-and-glucose index were identified as the possible mediators for risk of diabetes, with their mediating effect being about 35% and 21%, respectively. CONCLUSION Increases in central fatness were related to elevated risk of diabetes, and this association might be partly explained by the worsening of glycemic control and insulin resistance in older adults.
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Affiliation(s)
- Xue Cai
- Institute of Diabetes, Zhongda Hospital, Southeast University, Nanjing,
China
- School of Nursing, Peking University, Beijing,
China
| | - Dan Luo
- School of Nursing, Peking University, Beijing,
China
| | - Shuling Liu
- School of Nursing, Peking University, Beijing,
China
| | - Ruxue Li
- School of Nursing, Peking University, Beijing,
China
| | - Yanhui Lu
- School of Nursing, Peking University, Beijing,
China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing,
China
| | - Shanhu Qiu
- Institute of Diabetes, Zhongda Hospital, Southeast University, Nanjing,
China
- Department of Endocrinology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen,
China
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25
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Guo Z, Liu L, Yu F, Cai Y, Wang J, Gao Y, Ping Z. The causal association between body mass index and type 2 diabetes mellitus-evidence based on regression discontinuity design. Diabetes Metab Res Rev 2021; 37:e3455. [PMID: 33860627 DOI: 10.1002/dmrr.3455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/23/2021] [Accepted: 03/06/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to investigate and determine the precise causal association between body mass index (BMI) and type 2 diabetes mellitus (T2DM) using a regression discontinuity design (RDD). METHODS The cross-sectional data of 8550 participants were from the China Health and Nutrition Survey (CHNS) in 2015. Influencing factors with statistically significant were selected with logistic regression analysis, and a risk prediction model was established to obtain the risk of individuals suffering from T2DM. RDD was performed with BMI as the grouping variable and the risk of individuals suffering from T2DM as the outcome variable. RESULTS The predictive factors in the T2DM risk prediction model were age, gender, BMI, habitation, education, physical activity level, preference for sugary beverages, walking, self-evaluation health status and history of hypertension. The AUC (area under receiver operating characteristic curve) of the T2DM risk prediction model was 0.849 (95% CI: 0.833, 0.866). BMI was an independent risk factor for T2DM (OR = 1.109, p < 0.001); at BMI = 31 kg/m2 , the risk of T2DM increased sharply by 5.03% (p = 0.006). CONCLUSIONS There was a positive causal association between BMI and T2DM; when BMI = 31 kg/m2 , the risk of individuals suffering from T2DM was sharply increased.
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Affiliation(s)
- Zhaoyan Guo
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Li Liu
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Fangfang Yu
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yaning Cai
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Junyi Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yang Gao
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhiguang Ping
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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Chen Y, Wang Y, Xu K, Zhou J, Yu L, Wang N, Liu T, Fu C. Adiposity and Long-Term Adiposity Change Are Associated with Incident Diabetes: A Prospective Cohort Study in Southwest China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111481. [PMID: 34769995 PMCID: PMC8582792 DOI: 10.3390/ijerph182111481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 02/08/2023]
Abstract
In order to estimate the associations of different adiposity indicators and long-term adiposity changes with risk of incident type 2 diabetes (T2DM), we conducted a 10-year prospective cohort study of 7441 adults in Guizhou, China, from 2010 to 2020. Adiposity was measured at baseline and follow-up. Cox proportional hazard models were used to estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs). A total of 764 new diabetes cases were identified over an average follow-up of 7.06 years. Adiposity indicators, body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), and long-term adiposity changes (both weight change and WC change) were significantly associated with an increased risk of T2DM (adjusted HRs: 1.16–1.48). Significant non-linear relationships were found between weight/WC change and incident T2DM. Compared with subjects with stable WC from baseline to follow-up visit, the subjects with WC gain ≥9 cm had a 1.61-fold greater risk of T2DM; those with WC loss had a 30% lower risk. Furthermore, the associations were stronger among participants aged 40 years or older, women, and Han Chinese. Preventing weight or WC gain and promoting maintenance of normal body weight or WC are important approaches for diabetes prevention, especially for the elderly, women, and Han Chinese.
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Affiliation(s)
- Yun Chen
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China; (Y.C.); (K.X.); (N.W.)
| | - Yiying Wang
- Guizhou Center for Disease Control and Prevention, Guiyang 550004, China; (Y.W.); (J.Z.); (L.Y.)
| | - Kelin Xu
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China; (Y.C.); (K.X.); (N.W.)
| | - Jie Zhou
- Guizhou Center for Disease Control and Prevention, Guiyang 550004, China; (Y.W.); (J.Z.); (L.Y.)
| | - Lisha Yu
- Guizhou Center for Disease Control and Prevention, Guiyang 550004, China; (Y.W.); (J.Z.); (L.Y.)
| | - Na Wang
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China; (Y.C.); (K.X.); (N.W.)
| | - Tao Liu
- Guizhou Center for Disease Control and Prevention, Guiyang 550004, China; (Y.W.); (J.Z.); (L.Y.)
- Correspondence: (T.L.); (C.F.); Tel.: +86-21-3356-3933 (C.F.)
| | - Chaowei Fu
- School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai 200032, China; (Y.C.); (K.X.); (N.W.)
- Correspondence: (T.L.); (C.F.); Tel.: +86-21-3356-3933 (C.F.)
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Bhori M, Rastogi V, Tungare K, Marar T. A review on interplay between obesity, lipoprotein profile and nutrigenetics with selected candidate marker genes of type 2 diabetes mellitus. Mol Biol Rep 2021; 49:687-703. [PMID: 34669123 DOI: 10.1007/s11033-021-06837-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/12/2021] [Indexed: 12/06/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus, a rapidly growing epidemic, and its frequently related complications demand global attention. The two factors commonly attributed to the epidemic are genetic factors and environmental factors. Studies indicate that the genetic makeup at an individual level and the environmental aspects influence the occurrence of the disease. However, there is insufficiency in understanding the mechanisms through which the gene mutations and environmental components individually lead to T2DM. Also, discrepancies have often been noted in the association of gene variants and type 2 diabetes when the gene factor is examined as a sole attribute to the disease. STUDY In this review initially, we have focused on the proposed ways through which CAPN10, FABP2, GLUT2, TCF7L2, and ENPP1 variants lead to T2DM along with the inconsistencies observed in the gene-disease association. The article also emphasizes on obesity, lipoprotein profile, and nutrition as environmental factors and how they lead to T2DM. Finally, the main objective is explored, the environment-gene-disease association i.e. the influence of each environmental factor on the aforementioned specific gene-T2DM relationship to understand if the disease-causing capability of the gene variants is exacerbated by environmental influences. CONCLUSION We found that environmental factors may influence the gene-disease relationship. Reciprocally, the genetic factors may alter the environment-disease relationship. To precisely conclude that the two factors act synergistically to lead to T2DM, more attention has to be paid to the combined influence of the genetic variants and environmental factors on T2DM occurrence instead of studying the influence of the factors separately.
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Affiliation(s)
- Mustansir Bhori
- School of Biotechnology and Bioinformatics, D. Y. Patil Deemed To Be University, Navi Mumbai, 400614, India
| | - Varuni Rastogi
- School of Biotechnology and Bioinformatics, D. Y. Patil Deemed To Be University, Navi Mumbai, 400614, India
| | - Kanchanlata Tungare
- School of Biotechnology and Bioinformatics, D. Y. Patil Deemed To Be University, Navi Mumbai, 400614, India.
| | - Thankamani Marar
- School of Biotechnology and Bioinformatics, D. Y. Patil Deemed To Be University, Navi Mumbai, 400614, India
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Moya M, Pérez-Fernandez V. Estimating trunk fat in children according to sex using basic somatic readings: an opportunity for improving evaluation among girls. BMC Pediatr 2021; 21:446. [PMID: 34629070 PMCID: PMC8504037 DOI: 10.1186/s12887-021-02918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The fat mass estimators waist-to-height ratio (WHtR) and relative fat mass-pediatric (RFMp) complement the widely accepted body mass index (BMI) in obesity evaluation. AIMS OF THE STUDY Conduct an easy appraisal of trunk fat and the cardiometabolic risk associated with pediatric obesity. METHODS A total of 472 children (39% boys in the total sample) were classified as underweight, normal weight, overweight or obese (nutritional groups, NGs) according to BMI Z-score after initial anthropometric data were obtained and ad hoc exclusion criteria were applied. WHtR and RFMp (% of total fat) were calculated for each group, associations were assessed through multiple linear regression (MLR), and differences between sexes were evaluated (medians, IQR). RESULTS The mean age (mean (95% CI)) was 10.8 y (10.1-11.1). The values in the total sample were as follows: WHtR, 0.5 (0.49-0.51) and RFMp%, 32.3 (31.7-33.0). In the overweight group, the values were as follows: WHtR, 0.51 (0.50-0.52) and RFMp(%), 34.2 (33.3-35.1). In the obese group, the values were as follows: WHtR, 0.56 (0.55-0.57) and RFMp(%), 37.8 (36.9-38.6). The associations were as follows (NG; independent variables): In the NG, adjusted R2 values were between 0.74 and 0.78. In the total sample, the beta coefficient was 3.36 (P < 0.001) for RFMp for girls; for waist circumference (WC), the beta coefficient was 2.97 (P < 0.001), and for WHtR the beta coefficients were - 0.01 (p < 0.001) and 0.03 (p < 0.001),for girls and for WC respectively. The sex differences were as follows: BMI exhibited no differences in the NG (Mann-Whitney U). WHtR (median (IQR)) differed (M vs. F) in the total sample (0.49 (0.45-0.54) vs. 0.52 (0.45-0.56), p < 0.004); in the overweight group (0.51 (0.48-0.53) vs. 0.54 (0.51-0.55), p < 0.001); and in the obese group (0.55 (0.52-0.57) vs. 0.57 (0.54-0.60), p < 0.004). RFMp (%) differed in the total group (29.21 (24.27-32.92) vs. 36.63 (30.2-39.51), p < 0.001); in the overweight group (31.24 (28.35-32.35) vs. 37.95 (35.75-38.82), p < 0.001) and in the obese group (35.89 (32.05-36.15) vs. 40.63 (38.27-42.42), p < 0.001). CONCLUSIONS WHtR and RFMp are simple and reliable indices that do not require centile charts. Their values, including waist circumference, can be used to estimate the different trunk fat components in boys and girls better than BMI, especially if individuals are overweight or obese. RFMp proved to be more reliable as it considers sex. Both should be included in routine anthropometric readings.
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Affiliation(s)
- Manuel Moya
- Universidad Miguel Hernández, Health Sciences Campus of S. Juan, UMH Campus de S. Juan, Edificio Balmis, room S01 P002; Av Ramón y Cajal s/n. 03550 San Juan, Alicante, Spain
| | - Virginia Pérez-Fernandez
- Department of Surgery, Pediatrics and Obs & Gynecology, Facultad de Medicina, Universidad de Murcia, LAIB Building, Av. Buenavista s/n 30120 El Palmar, Murcia, Spain
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Abe M, Fujii H, Funakoshi S, Satoh A, Kawazoe M, Maeda T, Tada K, Yokota S, Yamanokuchi T, Yoshimura C, Mimata R, Takahashi K, Ito K, Yasuno T, Kuga T, Mukoubara S, Akiyoshi K, Kawanami D, Masutani K, Arima H. Comparison of Body Mass Index and Waist Circumference in the Prediction of Diabetes: A Retrospective Longitudinal Study. Diabetes Ther 2021; 12:2663-2676. [PMID: 34448106 PMCID: PMC8479044 DOI: 10.1007/s13300-021-01138-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/04/2021] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Both body mass index (BMI) and waist circumference (WC) are associated with diabetes risk, and the difference between them in predictive ability for diabetes is still contentious. We conducted a population-based study to investigate and compare the association of them with diabetes by sex. METHODS This study included a total of 4754 subjects aged 40-80 years with no diabetes at baseline between 2008 and 2017. Using multivariate Cox proportional hazards models, we calculated hazard ratios for diabetes according to tertiles of BMI or WC. Harrell's C statistics was applied to assess and compare the predictive ability of the models using BMI and WC. RESULTS Both BMI and WC showed the significant positive trends with diabetes risk. In men, the extreme tertiles (BMI > 25.1 kg/m2 and WC > 88.0 cm) provided 1.58-fold or 2.04-fold higher risk compared with the first tertiles (< 22.6 kg/m2 and < 81.2 cm). In women, BMI > 24.4 kg/m2 showed 3.28-fold higher risk than the first tertile (< 21.6 kg/m2), whereas WC ≥ 78.2 cm was more than twice as likely to suffer from diabetes as WC < 78.2 cm. BMI and WC showed a comparative performance in predicting diabetes in both sexes (P value 0.447 in men, and 0.337 in women). CONCLUSION Both BMI and WC showed a positive association with diabetes and offered a comparative predictive performance for diabetes in both sexes. The cut-off points, BMI 25.1 kg/m2 and WC 88.0 cm in men and BMI 24.4 kg/m2 and WC 78.2 cm in women, might contribute to the effective prevention strategies for diabetes.
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Affiliation(s)
- Makiko Abe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hideyuki Fujii
- Division of Endocrinology and Diabetes Mellitus, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shunsuke Funakoshi
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Atsushi Satoh
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Miki Kawazoe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiki Maeda
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuhiro Tada
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Soichiro Yokota
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshitaka Yamanokuchi
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Chikara Yoshimura
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryosuke Mimata
- Department of Anesthesiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Koji Takahashi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kenji Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tetsuhiko Yasuno
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takeshi Kuga
- Department of Internal Medicine, Mitsutake Hospital, Iki, Japan
| | - Shigeki Mukoubara
- Department of Internal Medicine, Nagasaki Prefecture Iki Hospital, Iki, Japan
| | - Kozaburo Akiyoshi
- Department of Anesthesiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Daiji Kawanami
- Division of Endocrinology and Diabetes Mellitus, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
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Yin XY, Chen P, Zhu HW, Yin XL, Ye G, Chi YY, Kang ZP, Sun HY, Hou WL, Guan LY, Zhu ZH, Tang Z, Wang J, Zhang GY, Jia QF, Hui L. The type 2 diabetes mellitus susceptibility gene CDKAL1 polymorphism is associated with depressive symptom in first-episode drug-naive schizophrenic patients. Hum Psychopharmacol 2021; 36:e2790. [PMID: 33856697 DOI: 10.1002/hup.2790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with schizophrenia have an increased prevalence of type 2 diabetes mellitus that has shown a significant association with the rs7754840 polymorphism in the gene encoding the cyclin-dependent kinase 5 (CDK5) regulatory subunit-associated protein 1-like 1 (CDKAL1). OBJECTIVE To examine whether this polymorphism was involved in the susceptibility in first-episode drug-naive schizophrenic patients (FDSP), and further influenced their clinical symptoms. METHODS This polymorphism was genotyped in 239 FDSP and 368 healthy controls. The clinical symptoms in FDSP were assessed using the Positive and Negative Syndrome Scale (PANSS) five-factor models. RESULTS There was no significant difference in the allelic and genotypic frequencies of this polymorphism between two groups (both p > 0.05) after adjusting for covariates. However, the PANSS depressive score significantly differed by genotype in FDSP after adjusting for covariates (F = 5.25, p = 0.006). This significant difference also persisted after Bonferroni correction (p < 0.05). FDSP with C/C genotype had significantly higher PANSS depressive score than those with C/G genotype (p = 0.007) and those with G/G genotype (p = 0.005). Moreover, further stepwise multivariate regression analysis showed the significant association between the rs7754840 polymorphism and PANSS depressive score in FDSP (β = -1.07, t = -2.75, p = 0.007). CONCLUSIONS Our findings demonstrated that although the CDKAL1 rs7754840 polymorphism did not contribute to the susceptibility to FDSP, it might be implicated in depressive symptoms in this patient group.
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Affiliation(s)
- Xu Yuan Yin
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Peng Chen
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Hai Wen Zhu
- Department of Laboratory Medicine, Suzhou Municipal Hospital North, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, Jiangsu, PR China
| | - Xiao Li Yin
- Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Gang Ye
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Yu Yan Chi
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Zhao Peng Kang
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Hong Yan Sun
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Wen Long Hou
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Lu Yang Guan
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Zhen Hua Zhu
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Zhen Tang
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Jing Wang
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Guang Ya Zhang
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Qiu Fang Jia
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
| | - Li Hui
- Research Center of Biological Psychiatry, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Soochow Unversity, Suzhou, Jiangsu, PR China
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Comparison of Indices of Carbohydrate Quality and Food Sources of Dietary Fiber on Longitudinal Changes in Waist Circumference in the Framingham Offspring Cohort. Nutrients 2021; 13:nu13030997. [PMID: 33808767 PMCID: PMC8003409 DOI: 10.3390/nu13030997] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/01/2023] Open
Abstract
The long-term impact of carbohydrate quality on abdominal weight gain is not fully understood. We aimed to examine the prospective relation of a carbohydrate quality index (CQI; defined by four criteria: dietary fiber, glycemic index, whole grain-to-total grain ratio, and solid-to-total carbohydrate ratio), total, cereal grain, vegetable, and fruit fiber, carbohydrate-to-total fiber ratio, and carbohydrate-to-cereal fiber ratio with changes in waist circumference (WC). Subjects were middle-aged to older, mostly white, participants in the Framingham Offspring cohort (n = 3101 subjects), with mean baseline age 54.9 ± 0.2 years (mean ± SE) and body mass index (BMI) 27.2 ± 0.1 kg/m2. Food frequency questionnaire (FFQ), health, and lifestyle data were collected approximately every four years over a median total follow-up of 18 years. Repeated measure mixed models were used to estimate adjusted mean change in WC per four-year interval across quartiles of carbohydrate variables. In the most adjusted model, a higher CQI was marginally associated with a smaller increase in WC (2.0 ± 0.1 vs. 2.4 ± 0.1 cm in highest vs. lowest quartile, p-trend = 0.04). Higher ratios of carbohydrate-to-fiber and carbohydrate-to-cereal fiber were associated with greater increases in WC per four-year interval (2.6 ± 0.1 vs. 2.0 ± 0.1 cm, p-trend < 0.001, and 2.5 ± 0.1 vs. 2.1 ± 0.1 cm in highest versus lowest categories, p-trend = 0.007, respectively); whereas higher intake of total fiber (1.8 ± 0.1 vs. 2.7 ± 0.1 cm, p-trend < 0.001), cereal fiber (2.0 ± 0.1 vs. 2.5 ± 0.1 cm, p-trend = 0.001), and fruit fiber (2.0 ± 0.1 vs. 2.7 ± 0.1 cm, p-trend < 0.001) were associated with smaller increases in WC compared to lower intakes. There was a significant interaction between total fiber and total carbohydrate (as % of total energy intake). After stratification, the association between fiber intake and change in WC was not maintained in the context of a high carbohydrate diet. Better carbohydrate quality, primarily higher fiber intake and lower carbohydrate-to-fiber ratios, may help attenuate increases in abdominal adiposity over time.
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Leung AYM, Sun Q, Kwan RYC, Lam SC, Deng R. Moderating effect of age on the relationships between pre-frailty and body measures. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:515-525. [PMID: 32746506 DOI: 10.1111/hsc.13114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
This study aims to investigate the relationship between body measures and the presence of two frailty-related phenotypes, and the moderating effect of age on this relationship. This is a secondary data analysis of the baseline data of an interventional study. The participants were residents of seven districts in Hong Kong, aged 55 or older, able to ambulate independently and to function well cognitively. Pre-frailty refers to the presence of two frailty-related phenotypes: low physical activity or poor handgrip strength or both. Included in the study were 199 individuals with a mean age of 73.43 (SD 7.54). Regression models showed that body weight (OR = 0.95, 95% CI 0.92-0.99, p < .05) was significantly associated with pre-frailty, as was body height (OR = 0.88, 95% CI 0.83-0.94, p < .001). Age is a significant moderator of the relationship between pre-frailty and body weight and body height. The effect of body weight (beta = -0.044, p < .05) and height (beta = -0.16, p < .001) on pre-frailty was significant and negative in the younger age groups. The findings indicate that raw body measures (i.e. body weight, body height) are more predictive of pre-frailty than BMI in older Chinese people. However, in the old-old group, these measures are not significant predictors of pre-frailty in Chinese community-dwelling adults. Practitioners should consider adopting body measures as predictors of pre-frailty in the younger-old population.
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Affiliation(s)
- Angela Yee Man Leung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Qian Sun
- Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
- Faculty of Social Security, School of Public Administration, Hebei University of Business and Economics, Shijiazhuang, China
| | - Rick Yiu Cho Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Simon Ching Lam
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Renli Deng
- Nursing Department, The 5th Affiliated Hospital of Zunyi Medical University, Zhuhai, China
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Xia M, Liu K, Feng J, Zheng Z, Xie X. Prevalence and Risk Factors of Type 2 Diabetes and Prediabetes Among 53,288 Middle-Aged and Elderly Adults in China: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:1975-1985. [PMID: 33976558 PMCID: PMC8104985 DOI: 10.2147/dmso.s305919] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes is a metabolic disorder that causes a heavy burden on healthcare systems worldwide. The aim of this study was to determine the prevalence of type 2 diabetes and prediabetes and its associated factors among eight communities in Nanchong, China. METHODS This was an observational cross-sectional study conducted throughout eight communities in Nanchong, China. The participants were 53,288 individuals aged 45 years or older. The participants' characteristics, comorbidities, health behaviors, family history, and dietary intake were assessed. Multinomial logistic regression models were fitted to identify factors associated with type 2 diabetes and prediabetes. RESULTS The prevalence of diabetes and prediabetes was 13.9% (95% confidence interval [CI], 13.6-14.2) and 3.1% (95% CI, 2.9-3.2) of the population, respectively. After adjusting for other risk factors, advanced age, overweight, obesity, abdominal obesity, comorbidities, smoking, a family history of diabetes, and Chinese cooking vegetable intake were associated with an increased risk of type 2 diabetes and prediabetes. CONCLUSION The prevalence of type 2 diabetes in the Chinese population is rising compared with data from the past. The risk factors of type 2 diabetes and prediabetes identified in this study will aid the identification of individuals at a high-risk of diabetes and the implementation of effective health promotion programs and campaigns. CLINICAL TRIAL REGISTRY NUMBER ChiCTR-HOC-17013200.
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Affiliation(s)
- Mengdi Xia
- Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital) and Nanchong Key Laboratory of Basic Science & Clinical Research on Chronic Kidney Disease, Nanchong, Sichuan, People’s Republic of China
| | - Kaixiang Liu
- Department of Nephrology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, People’s Republic of China
| | - Jie Feng
- Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital) and Nanchong Key Laboratory of Basic Science & Clinical Research on Chronic Kidney Disease, Nanchong, Sichuan, People’s Republic of China
| | - Zaiqiong Zheng
- Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital) and Nanchong Key Laboratory of Basic Science & Clinical Research on Chronic Kidney Disease, Nanchong, Sichuan, People’s Republic of China
| | - Xisheng Xie
- Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital) and Nanchong Key Laboratory of Basic Science & Clinical Research on Chronic Kidney Disease, Nanchong, Sichuan, People’s Republic of China
- Correspondence: Xisheng Xie Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital), South Renmin Road 97, Shunqing District, Nanchong, Sichuan Province, 637000, People’s Republic of ChinaTel +86 158 8170 0265 Email
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Shang L, Li R, Zhao Y, Sun H, Tang B, Hou Y. Association Between Chinese Visceral Adiposity Index and Incident Type 2 Diabetes Mellitus in Japanese Adults. Diabetes Metab Syndr Obes 2021; 14:3743-3751. [PMID: 34466009 PMCID: PMC8402978 DOI: 10.2147/dmso.s322935] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity is a well-known risk factor for type 2 diabetes mellitus (T2DM). Studies have shown that the Chinese visceral adiposity index (CVAI), a novel visceral adiposity indicator, is positive associated with the risk of T2DM in the Chinese population. This study aimed to investigate the correlation between CVAI and incident T2DM in a Japanese population. METHODS We performed a secondary analysis of open-access data from a retrospective cohort study. This study included 15,464 participants who received regular medical examinations at Murakami Memorial Hospital. All participants underwent a questionnaire survey, physical examination, and blood biochemical testing at baseline. The main outcome was new-onset T2DM during follow-up. Cox regression analysis and Kaplan-Meier analysis were used to analyze the risk of CVAI on T2DM, and we conducted smooth curve fitting. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of CVAI, body mass index (BMI), and waist circumference (WC) for incident T2DM. RESULTS During a median follow-up time of 5.39 years, 373 new-onset T2DM events were observed. Kaplan-Meier curves showed that the incidence of T2DM increased as the CVAI increased (log-rank χ 2 = 187.1076 and 129.6067 in males and females, respectively, both P <0.001). After adjustment for covariates, per 1 increase of CVAI was associated with a 1.0133-fold and 1.0246-fold higher risk of incident T2DM in males and females, respectively (both P <0.001). Those individuals in the top CVAI quartile group had the highest risk of new-onset T2DM (HR = 3.1568 and 5.8415 in males and females, respectively, both P <0.05). A nonlinear relationship was identified by the smooth fitting curve between CVAI and T2DM events in both genders. ROC analysis indicated that CVAI had better predictive power than BMI and WC in both genders. CONCLUSION Our results demonstrate that CVAI was significantly associated with an increased risk of new-onset T2DM in Japanese adults.
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Affiliation(s)
- Luxiang Shang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong, People’s Republic of China
| | - Rui Li
- Shandong Provincial Center for Disease Control and Prevention, Jinan, Shandong, People’s Republic of China
| | - Yang Zhao
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Huaxin Sun
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Baopeng Tang
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
| | - Yinglong Hou
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong, People’s Republic of China
- Correspondence: Yinglong Hou Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, Shandong, 250014, People’s Republic of ChinaTel +86 531-89269317 Email
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Min J, Hu X, Zhang J, Zeng T, Wang Y, Tian S, Liu G, Zhong X, Qiu K, Peng M, Chen L. Short-Term Changes in Metabolically Healthy Overweight/Obesity Status Impact the Susceptibility to Type 2 Diabetes in Chinese Adults. Diabetes Metab Syndr Obes 2021; 14:2561-2571. [PMID: 34135608 PMCID: PMC8200172 DOI: 10.2147/dmso.s313475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Changes in transition from metabolically healthy overweight/obesity (MHO) to metabolically unhealthy overweight/obesity (MUO) are associated with the risk for cardiometabolic complications. This study aims to investigate the effects of short-term dynamic changes in body mass index (BMI) and metabolic status on the risk of type 2 diabetes (T2D) and to identify biological predictors for the MHO-to-MUO transition. PATIENTS AND METHODS A total of 4604 subjects from the REACTION study were included for a 3-year follow-up. Subjects were categorized based on their BMI and metabolic syndrome status. Overweight/obesity was defined as BMI ≥ 24 kg/m2. Metabolically healthy was defined as having two or fewer of the metabolic syndrome components proposed by the Chinese Diabetes Society. Thus, subjects were divided into four groups: metabolically healthy normal weight (MHNW), MHO, metabolically unhealthy normal weight (MUNW), and MUO. RESULTS Compared with MHNW, MHO was not predisposed to an increased risk for T2D (OR 1.08, 95% CI 0.64-1.83, P = 0.762). However, a 3-year transition probability of 20.6% was identified for subjects who shifted from MHO to MUO; this conversion increased the risk of T2D by 3-fold (OR 3.04, 95% CI 1.21-7.68, P = 0.018). The fatty liver index independently predicted the MHO-to-MUO transition with an OR 3.14 (95% CI 1.56-7.46, P = 0.002) when comparing the fourth quartile to the first quartile. CONCLUSION This study reveals that metabolic changes affect the short-term susceptibility to T2D in the overweight/obese Chinese population, and the fatty liver index is an efficient clinical parameter for identifying those with a metabolic deterioration risk.
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Affiliation(s)
- Jie Min
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Xiang Hu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Jiaoyue Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Tianshu Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Ying Wang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Shenghua Tian
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Geng Liu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Xueyu Zhong
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Kangli Qiu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Miaomiao Peng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
- Correspondence: Lulu Chen Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, 430022, People’s Republic of ChinaTel +86 27 8572 6082Fax +86 27 8535 6365 Email
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Song LL, Wang X, Yang ZJ, Kong XM, Chen XP, Zhang B, Yang WY. Factors associated with improvement in waist-to-height ratio among newly diagnosed type 2 diabetes patients treated with acarbose or metformin: A randomized clinical trial study. World J Diabetes 2020; 11:514-526. [PMID: 33269063 PMCID: PMC7672790 DOI: 10.4239/wjd.v11.i11.514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The waist-to-height ratio (WHtR) is a promising anthropometric measure used to evaluate cardiovascular risk in diabetes and metabolic syndrome patients. The metformin and acarbose in Chinese as the initial hypoglycaemic treatment trial demonstrated that acarbose and metformin reduced the WHtR after 24 wk of treatment.
AIM To investigate the factors associated with a decrease in the WHtR in newly diagnosed Chinese type 2 diabetes patients receiving acarbose or metformin monotherapy.
METHODS At 24 wk, 343 patients in the acarbose treatment and 333 patients in the metformin treatment were included in this analysis. On the basis of the reduction in the WHtR, these participants were divided into the following two groups: Low ΔWHtR group and high ΔWHtR group. Metabolic and related parameters associated with a high ΔWHtR were investigated using univariate and multivariate logistic regression analyses.
RESULTS A significant decrease in the WHtR was observed in both treatment groups (acarbose: -0.015, 95% confidence interval [CI]: -0.018 to -0.012, P < 0.001; metformin: -0.013, 95%CI: -0.016 to -0.010, P < 0.001). In both the acarbose and metformin groups, the WHtR of the women was more likely to be reduced than that of the men. In the acarbose group, a lower baseline area under the curve of glucagon-like peptide 1 (AUCGLP-1) was associated with a high ΔWHtR (odds ratio [OR] = 0.796, P < 0.001), while a higher baseline AUCGLP-1 was associated with a high ΔWHtR in the patients treated with metformin (OR = 1.133, P = 0.025). Regarding the changes from baseline, an increase in AUCGLP-1 was associated with a high ΔWHtR in the acarbose (OR = 1.121, P = 0.016) but not metformin group. A higher reduction in high-density lipoprotein cholesterol/non-high-density lipoprotein cholesterol was also associated with a high ΔWHtR in the acarbose arm (OR = 20.735, P = 0.001). In the metformin arm, a higher reduction in fasting plasma glucose (OR = 0.843, P = 0.039) and total cholesterol was associated with a high ΔWHtR (OR = 0.743, P = 0.013).
CONCLUSION A lower glucagon-like peptide 1 level and higher increase in glucagon-like peptide 1 are associated with a high reduction in the WHtR in newly diagnosed Chinese diabetes patients receiving treatment with acarbose.
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Affiliation(s)
- Lu-Lu Song
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xin Wang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhao-Jun Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiao-Mu Kong
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiao-Ping Chen
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wen-Ying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
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