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Zhang Y, Ding Y, Yu C, Sun D, Pei P, Du H, Yang L, Chen Y, Schmidt D, Avery D, Chen J, Chen J, Chen Z, Li L, Lv J. Predictive value of 8-year blood pressure measures in intracerebral hemorrhage risk over 5 years. Eur J Prev Cardiol 2024:zwae147. [PMID: 38629743 DOI: 10.1093/eurjpc/zwae147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/21/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
AIMS The relationships between long-term blood pressure (BP) measures and intracerebral hemorrhage (ICH), as well as their predictive ability on ICH, were unclear. We aimed to investigate the independent associations of multiple BP measures with subsequent 5-year ICH risk, as well as the incremental value of these measures over a single-point BP measurement in ICH risk prediction. METHODS We included 12,398 participants from the China Kadoorie Biobank (CKB) who completed three surveys every four to five years. The following long-term BP measures were calculated: mean, minimum, maximum, standard deviation, coefficient of variation, average real variability, and cumulative BP exposure (cumBP). Cox proportional hazard models were used to examine the associations between these measures and ICH. The potential incremental value of these measures in ICH risk prediction was assessed using Harrell's C statistics, continuous net reclassification improvement (cNRI), and relative integrated discrimination improvement (rIDI). RESULTS The hazard ratios (95% confidence intervals) of incident ICH associated with per SD increase in cumSBP and cumDBP were 1.62 (1.25, 2.10) and 1.59 (1.23, 2.07), respectively. When cumBP was added to the conventional 5-year ICH risk prediction model, the C-statistic change was 0.009 (-0.001, 0.019), the cNRI was 0.267 (0.070, 0.464), and the rIDI was 18.2% (5.8%, 30.7%). Further subgroup analyses revealed a consistent increase in cNRI and rIDI in men, rural residents, and participants without diabetes. Other long-term BP measures showed no statistically significant associations with incident ICH and generally did not improve model performance. CONCLUSION The nearly 10-year cumBP was positively associated with an increased 5-year risk of ICH and could significantly improve risk reclassification for the ICH risk prediction model that included single-point BP measurement.
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Affiliation(s)
- Yiqian Zhang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Yinqi Ding
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education
| | - Dianjianyi Sun
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Dan Schmidt
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Daniel Avery
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Jianwei Chen
- Liuyang Centers for Disease Control and Prevention, Liuyang, Changsha, Hunan, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Liming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University
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Abdi A, Kohansal K, Khalili D, Azizi F, Hadaegh F. The difference between 2-hour post-challenge and fasting plasma glucose associates with the risk of cardiovascular disease in a normoglycemic population: the Tehran lipid and glucose study. Nutr Metab (Lond) 2024; 21:10. [PMID: 38389086 PMCID: PMC10882815 DOI: 10.1186/s12986-024-00782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Elevated fasting plasma glucose (FPG) and 2-hour post-challenge glucose (2hPG) levels are known to be independent risk factors for cardiovascular disease (CVD). However, there is limited data on the association of the difference between these measures and the risk of CVD. This study aims to investigate this association in normoglycemic Iranian adults, particularly in those with low-normal FPG levels. METHODS This prospective cohort study included 4,594 30-65-year-old participants from the Tehran Lipid and Glucose Study. Using multivariable Cox proportional hazards regression models adjusting for age, sex, body mass index, hypertension, hypercholesterolemia, smoking, education level and FPG, hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated for the association between 2hPG-FPG, both as continuous and categorical variables, and the CVD risk. Analyses of receiver operating characteristic curves were undertaken to determine the optimal 2hPG-FPG cut-off value. RESULTS During a median of 17.9 years of follow-up, 459 CVD events occurred. A one-unit increase in 2hPG-FPG was significantly associated with an elevated risk of cardiovascular disease in both normoglycemic (HR 1.10, 95% CI (1.01-1.19)) and low-normal FPG individuals (HR 1.16, 95% CI (1.04-1.30)); this association resisted adjustment for Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) among normoglycemic individuals. However, those with 2hPG levels greater than FPG levels had a non-significant increased risk of incident CVD compared to those with 2hPG levels of less than or equal to FPG, with corresponding HR values of 1.18 (95% CI: 0.95-1.46) in normoglycemic and 1.32 (95% CI: 0.98-1.79) in low-normal FPG, respectively. For incident CVD, the optimal cut-off value for the 2hPG-FPG was found to be 1.06 mmol/L, which was applicable for both normoglycemic and low FPG populations; using this criterion, the corresponding risks for incident CVD were 1.36 (95% CI: 1.12-1.64) and 1.57 (95% CI: 1.22-2.03), respectively. CONCLUSIONS The difference between 2hPG and FPG levels within the normoglycemic range is related to an increased risk of CVD, an issue that was independent of HOMA-IR. A cut-off point for 2hPG-FPG > 1.06 mmol/L may stratify persons at higher risk. These findings were particularly notable in those with low-normal FPG.
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Affiliation(s)
- Amir Abdi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, P.O. Box: 19395-4763, Iran
- Student Research Committee, School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Karim Kohansal
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, P.O. Box: 19395-4763, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, P.O. Box: 19395-4763, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, P.O. Box: 19395-4763, Iran.
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3
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Bragg F, Kartsonaki C, Guo Y, Holmes M, Du H, Yu C, Pei P, Yang L, Jin D, Chen Y, Schmidt D, Avery D, Lv J, Chen J, Clarke R, Hill MR, Li L, Millwood IY, Chen Z. The role of NMR-based circulating metabolic biomarkers in development and risk prediction of new onset type 2 diabetes. Sci Rep 2022; 12:15071. [PMID: 36064959 PMCID: PMC9445062 DOI: 10.1038/s41598-022-19159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/25/2022] [Indexed: 11/08/2022] Open
Abstract
Associations of circulating metabolic biomarkers with type 2 diabetes (T2D) and their added value for risk prediction are uncertain among Chinese adults. A case-cohort study included 882 T2D cases diagnosed during 8-years' follow-up and a subcohort of 789 participants. NMR-metabolomic profiling quantified 225 plasma biomarkers in stored samples taken at recruitment into the study. Cox regression yielded adjusted hazard ratios (HRs) for T2D associated with individual biomarkers, with a set of biomarkers incorporated into an established T2D risk prediction model to assess improvement in discriminatory ability. Mean baseline BMI (SD) was higher in T2D cases than in the subcohort (25.7 [3.6] vs. 23.9 [3.6] kg/m2). Overall, 163 biomarkers were significantly and independently associated with T2D at false discovery rate (FDR) controlled p < 0.05, and 138 at FDR-controlled p < 0.01. Branched chain amino acids (BCAA), apolipoprotein B/apolipoprotein A1, triglycerides in VLDL and medium and small HDL particles, and VLDL particle size were strongly positively associated with T2D (HRs 1.74-2.36 per 1 SD, p < 0.001). HDL particle size, cholesterol concentration in larger HDL particles and docosahexaenoic acid levels were strongly inversely associated with T2D (HRs 0.43-0.48, p < 0.001). With additional adjustment for plasma glucose, most associations (n = 147 and n = 129 at p < 0.05 and p < 0.01, respectively) remained significant. HRs appeared more extreme among more centrally adipose participants for apolipoprotein B/apolipoprotein A1, BCAA, HDL particle size and docosahexaenoic acid (p for heterogeneity ≤ 0.05). Addition of 31 selected biomarkers to an established T2D risk prediction model modestly, but significantly, improved risk discrimination (c-statistic 0.86 to 0.91, p < 0.001). In relatively lean Chinese adults, diverse metabolic biomarkers are associated with future risk of T2D and can help improve established risk prediction models.
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Affiliation(s)
- Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christiana Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Michael Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, 102308, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Donghui Jin
- Hunan Centre for Disease Control and Prevention, Furong Mid Road, Changsha, Hunan, China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Dan Schmidt
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Daniel Avery
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michael R Hill
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, BDI Building, Old Road Campus, Oxford, OX3 7LF, UK.
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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4
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Song C, Lv J, Yu C, Zhu M, Yu C, Guo Y, Yang L, Chen Y, Chen Z, Jiang T, Ma H, Jin G, Shen H, Hu Z, Li L. Adherence to Healthy Lifestyle and Liver cancer in Chinese: a prospective cohort study of 0.5 million people. Br J Cancer 2022; 126:815-821. [PMID: 34853434 PMCID: PMC8888610 DOI: 10.1038/s41416-021-01645-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/02/2021] [Accepted: 11/17/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Little prospective evidence exists about whether a combination of healthy lifestyle factors is related to a considerable reduction of liver cancer risk. METHODS Based on the prospective China Kadoorie Biobank (CKB) cohort with a total of 492,640 Chinese adults, we examined the associations of five lifestyle factors with risk of liver cancer. Low-risk lifestyle factors were defined as non-smoking, non-drinking, median or higher level of physical activity, a healthy diet, and waist-to-hip ratio (WHR) < 0.90 for men and <0.85 for women. RESULTS During a median of 10.12 years of follow-up, 2529 liver cancer events were observed. There was a significant decrease in liver cancer risk with the increasing of the healthy lifestyle index scores (P < 0.001). Participants with a favourable lifestyle (4 or 5 healthy lifestyle factors) had a 43% reduced liver cancer risk compared with those with an unfavourable lifestyle (0 or 1 healthy lifestyle factor) (HR, 0.57 [95% CI, 0.47-0.68]). The cumulative protective effect of a healthy lifestyle on liver cancer appeared to be more dramatic for patients with hepatitis B surface antigen (HBsAg) positive, the individuals at high risk of liver cancer. CONCLUSIONS Individuals adhering to a favourable lifestyle was associated with a considerable absolute risk reduction of liver cancer.
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Affiliation(s)
- Ci Song
- Department of Epidemiology, China International Cooperation Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China
| | - Chengxiao Yu
- Department of Epidemiology, China International Cooperation Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215008, China
| | - Meng Zhu
- Department of Epidemiology, China International Cooperation Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tao Jiang
- Department of Epidemiology, China International Cooperation Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Hongxia Ma
- Department of Epidemiology, China International Cooperation Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Guangfu Jin
- Department of Epidemiology, China International Cooperation Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Hongbing Shen
- Department of Epidemiology, China International Cooperation Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China
| | - Zhibin Hu
- Department of Epidemiology, China International Cooperation Center on Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, China.
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China.
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, 100191, China.
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5
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Wang M, Gan W, Kartsonaki C, Guo Y, Lv J, Chen Z, Li L, Yang L, Yu M. Menopausal status, age at natural menopause and risk of diabetes in China: a 10-year prospective study of 300,000 women. Nutr Metab (Lond) 2022; 19:7. [PMID: 35123520 PMCID: PMC8818141 DOI: 10.1186/s12986-022-00643-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/22/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Menopause characteristics have been implicated in future health consequences, yet little is known about its relevance to diabetes. We examined the associations of menopausal status and age at natural menopause with diabetes risk in Chinese women. METHODS We used prospective data of the China Kadoorie Biobank study that recruited 302,522 women aged 30-79 years in 2004-2008 from 10 areas across China. During average 10.8 years of follow-up, 11,459 incident diabetes cases were recorded among 281,319 women without prior diabetes diagnosis at baseline. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for incident diabetes associated with menopausal status and age at natural menopause. RESULTS Overall, the mean (SD) age at natural menopause was 48.2 (4.4) years among 141,789 post-menopausal women. Naturally peri-, or post-menopausal women were at higher risk of diabetes, with HRs of 1.17 (95% CI 1.06-1.29) and 1.15 (1.06-1.25) compared with pre-menopausal women, adjusting for several potential confounders. Among women who had natural menopause, the HR of diabetes was 1.14 (1.01-1.30), 1.01 (0.93-1.09), 1.10 (1.04-1.16), and 1.10 (1.01-1.20) for menopause at ages less than 40, 40-44, 50-53, and 54 years or older, respectively, relative to 45-49 years. CONCLUSIONS In this study, we found that women with naturally peri-, or post-menopausal status had higher risk of developing diabetes. Besides, among the post-menopausal women, both earlier and later age at natural menopause were associated with increased risk of diabetes.
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Affiliation(s)
- Meng Wang
- grid.433871.aDepartment of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051 China
| | - Wei Gan
- grid.4991.50000 0004 1936 8948Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Old Road Campus, Roosevelt Drive, Oxfordshire, Oxford, OX3 7FZ UK
| | - Christiana Kartsonaki
- grid.4991.50000 0004 1936 8948Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Old Road Campus, Roosevelt Drive, Oxfordshire, Oxford, OX3 7FZ UK
| | - Yu Guo
- grid.506261.60000 0001 0706 7839Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, 100864 China
| | - Jun Lv
- grid.11135.370000 0001 2256 9319Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Zhengming Chen
- grid.4991.50000 0004 1936 8948Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Old Road Campus, Roosevelt Drive, Oxfordshire, Oxford, OX3 7FZ UK
| | - Liming Li
- grid.11135.370000 0001 2256 9319Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Ling Yang
- grid.4991.50000 0004 1936 8948Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Old Road Campus, Roosevelt Drive, Oxfordshire, Oxford, OX3 7FZ UK
| | - Min Yu
- grid.433871.aDepartment of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051 China
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6
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Bragg F, Kartsonaki C, Guo Y, Holmes M, Du H, Yu C, Pei P, Yang L, Jin D, Chen Y, Schmidt D, Avery D, Lv J, Chen J, Clarke R, Hill M, Li L, Millwood I, Chen Z. Circulating Metabolites and the Development of Type 2 Diabetes in Chinese Adults. Diabetes Care 2022; 45:477-480. [PMID: 34848488 PMCID: PMC7612375 DOI: 10.2337/dc21-1415] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/09/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess prospective associations of circulating metabolites with the risk of type 2 diabetes (T2D) among Chinese adults. RESEARCH DESIGN AND METHODS A case-cohort study within the 8-year prospective China Kadoorie Biobank comprised 882 participants with incident T2D and 789 subcohort participants. Nuclear magnetic resonance metabolomic profiling quantified 225 metabolites in stored baseline plasma samples. Cox regression related individual metabolites with T2D risk, adjusting for potential confounders and fasting time. RESULTS After correction for multiple testing, 163 metabolites were significantly associated with the risk of T2D (P < 0.05). There were strong positive associations of VLDL particle size, the ratio of apolipoprotein B to apolipoprotein A-1, branched-chain amino acids, glucose, and triglycerides with T2D, and inverse associations of HDL-cholesterol, HDL particle size, and relative n-3 and saturated fatty acid concentrations. CONCLUSIONS In Chinese adults, metabolites across diverse pathways were independently associated with T2D risk, providing valuable etiological insights and potential to improve T2D risk prediction.
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Affiliation(s)
- Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Yu Guo
- Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases, Beijing, China
| | - Michael Holmes
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Huaidong Du
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.,Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Donghui Jin
- Hunan Centre for Disease Control and Prevention, Changsha, Hunan, China
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Dan Schmidt
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Daniel Avery
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.,Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Michael Hill
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Liming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.,Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Iona Millwood
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
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7
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Wang Y, Yu L, Wang Y, Zhou J, Wu Y, Liu T, Wang N, Fu C. Postload Plasma Glucose but Not Fasting Plasma Glucose Had a Greater Predictive Value for Cardiovascular Disease in a Large Prospective Cohort Study in Southwest China. Front Cardiovasc Med 2022; 8:815357. [PMID: 35141297 PMCID: PMC8818731 DOI: 10.3389/fcvm.2021.815357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Uncertainty remains regarding the relevance of glycemia, though below the threshold for diabetes, for the risk of cardiovascular disease (CVD) among the Southwest Chinese. We aimed to examine the associations of the first-onset CVD with fasting plasma glucose (FPG) and 2-h postload glucose (2h-PG) in Southwest China. METHODS The current study examined data from the Guizhou Population Health Cohort Study (GPHCS) of 9,280 participants aged 18 to 95 years recruited from 12 areas since 2010 in Guizhou Province, Southwest China. Participants were followed-up until December, 2020. Primary outcomes were the first onset of a composite of or one of major CVD events, including ischaemic stroke, haemorrhagic stroke and myocardial infarction. FPG, 2h-PG, other metabolic factors and some demographic factors were collected at baseline. Cox proportional hazards models were used to estimate the risk of CVD associated with FPG and 2h-PG. Sensitive analysis and stratified analysis were conducted among participants across different modifiable risk factors and demographic features. RESULTS During a median of 6.58 years of follow-up, of 7,593 participants with available data for analysis, 174 experienced at least one CVD events, 158 developed stroke (including 126 ischemic stroke and 39 Ischemic stroke events), and 24 developed myocardial infarction. The risk of major CVD events was significantly increased with elevated 2h-PG but not FPG. Compared with participants in the lowest tertile of 2h-PG, those in the highest tertile had a 1.87-fold (95%CI: 1.26-2.77) increased risk for overall CVD, a 1.82-fold (95%CI: 1.20-2.75) increased risk for overall Stroke, and a 1.82-fold (95%CI: 1.20-2.75) increased risk for ischemic stroke, respectively, after adjustment for age, sex, smoking, ethnic group, education level, systolic blood pressure (SBP), triglycerides (TG), body mass index (BMI) and waist circumference (WC). However, there was no relation of glycemia of haemorrhagic stroke or myocardial infarction (P > 0.05). The effect sizes in the associations of CVD with 2h-PG become enhanced among those within normal range of glycemia, SBP, TG, BMI, as well as those without hypertension, dyslipidemia.and obesity. CONCLUSIONS 2h-PG, in contrast to FPG, is a significant indicator in predication of CVD in Southwest Chinese. Elevated 2h-PG, though below the below the threshold for diabetes, remains independently increased the risk of CVD.
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Affiliation(s)
- Yingying Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Lisha Yu
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Yiying Wang
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Jie Zhou
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Yanli Wu
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Tao Liu
- Guizhou Province Center for Disease Prevention and Control, Chronic Disease Prevention and Cure Research Institute, Guiyang, China
| | - Na Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Chaowei Fu
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
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Qin C, Lv J, Yu C, Guo Y, Bian Z, Gao M, Du H, Yang L, Chen Y, Shen L, Zhou S, Chen J, Chen Z, Li L. Dietary patterns and cardiometabolic diseases in 0.5 million Chinese adults: a 10-year cohort study. Nutr J 2021; 20:74. [PMID: 34479555 PMCID: PMC8418004 DOI: 10.1186/s12937-021-00730-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The effect of the overall diet quality on cardiometabolic diseases has been well studied in the Western population. However, evidence is still in need regarding dietary patterns depicting unique Chinese dietary habits and their associations with cardiometabolic diseases. METHODS A prospective cohort recruited around 0.5 million Chinese residents aged 30-79 years from 10 diverse survey sites during 2004-08. Dietary patterns were obtained using factor analysis based on the habitual consumption of 12 food groups collected at baseline. Among 477,465 eligible participants free of prior heart disease, stroke and cancer, linkages to multiple registries and health insurance database recorded 137,715 cardiovascular diseases (CVD) and 17,412 diabetes cases (among 451,846 non-diabetic participants) until 31 December 2017. Adjusted hazard ratios (HRs) were estimated to compare the risks of cardiometabolic diseases across quintiles of dietary pattern scores using the Cox regression. RESULTS Two dietary patterns were derived: the traditional northern pattern, characterised by wheat, other staples, egg and dairy products; and the modern pattern, featured with fresh fruit, meat, poultry, fish, dairy products and soybean. Adherence to either dietary pattern was associated with lower risks of major cardiometabolic diseases in a dose-response relationship way. After multivariate adjustment, participants adhering to the traditional northern pattern the most had an 8% (95%CI: 5-11%) lower risk of CVD in comparison with those adhering the least. Corresponding risk reductions were 12% (11-32%) for haemorrhagic stroke (HS), 14% (8-19%) for ischaemic stroke (IS), and 15% (6-24%) for diabetes, respectively. When comparing extreme quintiles of the modern pattern, the adjusted HR of HS was 0.67 (95%CI: 0.59-0.77). Corresponding HRs were 0.89 (0.86-0.92) for CVD, 0.88 (0.77-0.99) for MCE, 0.85 (0.80-0.89) for IS, and 0.89 (0.81, 0.97) for diabetes. CONCLUSION Among Chinese adults, both traditional northern and modern dietary patterns were associated with lower risks of cardiovascular disease and diabetes beyond other risk factors.
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Affiliation(s)
- Chenxi Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
- Peking University Institute of Environmental Medicine, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Meng Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China
| | - Huaidong Du
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Ling Yang
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Yiping Chen
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Leijia Shen
- The Second hospital of Tongxiang, Tongxiang, Zhejiang Province, China
| | - Songgen Zhou
- Wuzhen Town Health Centres, Tongxiang, Zhejiang Province, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Nuffield Department of Population Health, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Road, Beijing, 100191, China.
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9
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Zhang Y, Gu S, Wang C, Liu D, Zhang Q, Yang M, Zhou Z, Zuo H. Association between fasting blood glucose levels and stroke events: a large-scale community-based cohort study from China. BMJ Open 2021; 11:e050234. [PMID: 34408054 PMCID: PMC8375728 DOI: 10.1136/bmjopen-2021-050234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/03/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Diabetes mellitus has been associated with stroke. However, the association between fasting blood glucose (FBG) and stroke risk in a general population remains not clear. The purpose of our study was to examine the FBG levels on subsequent stroke risk in a community-based cohort in China. DESIGN Prospective cohort study, employing Cox proportional hazard model to analyse the association of FBG levels with stroke risk. SETTING A community-based cohort study included adults participating in a baseline survey conducted in 2013 in Changshu, eastern China. PARTICIPANTS 16 113 participants were recruited with a multistage sampling method, excluding participants with severe disability, severe cancer, severe psychiatric disturbance or previous stroke before enrolment. PRIMARY OUTCOME MEASURES Stroke events. RESULTS During a median follow-up of 5.5 years, 417 incident cases of stroke were identified. The adjusted HR for total and ischaemic stroke for participants in the fourth quartile of FBG compared with the first quartile was 1.44 (95% CI 1.07 to 1.94) and 1.57 (95% CI 1.11 to 2.21), respectively. FBG levels of ≥7.0 mmol/L were associated with an increased risk of stroke based on two clinical classifications (American Diabetes Association: 1.68 (1.24 to 2.27); WHO: 1.62 (1.21, 2.13)). In stratified analyses, risk associations existed in women (HR: 1.92, 95% CI 1.22 to 3.01) and postmenopausal women (HR: 1.68, 95% CI 1.06 to 2.68) for the fourth quartile versus the first. More importantly, the meta-analysis observed a positive association between FBG levels and stroke risk (pooled HR: 1.70, 95% CI 1.27 to 2.29; n=7)). CONCLUSIONS Higher FBG level was independently associated with an increased risk of stroke in Chinese adults, especially significant in women.
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Affiliation(s)
- Ya Zhang
- School of Public Health, Soochow University Medical College, Suzhou, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Shujun Gu
- Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Cuicui Wang
- School of Public Health, Soochow University Medical College, Suzhou, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Dong Liu
- School of Public Health, Soochow University Medical College, Suzhou, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Qiuyi Zhang
- Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Man Yang
- Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Zhengyuan Zhou
- Changshu Center for Disease Control and Prevention, Suzhou, China
| | - Hui Zuo
- School of Public Health, Soochow University Medical College, Suzhou, China
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
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Wang B, Zhao Z, Liu S, Wang S, Chen Y, Xu Y, Xu M, Wang W, Ning G, Li M, Wang T, Bi Y. Impact of diabetes on subclinical atherosclerosis and major cardiovascular events in individuals with and without non-alcoholic fatty liver disease. Diabetes Res Clin Pract 2021; 177:108873. [PMID: 34051282 DOI: 10.1016/j.diabres.2021.108873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022]
Abstract
AIMS To investigate the impact of diabetes on subclinical atherosclerosis and cardiovascular disease (CVD) in individuals with and without non-alcoholic fatty liver disease (NAFLD). METHODS The prospective cohort study included 8451 Chinese adults free of baseline CVD in 2010. NAFLD was diagnosed based on hepatic ultrasonography. Fibrosis-4 index as a non-invasive marker was used to evaluate the degree of fibrosis. Subclinical atherosclerosis was evaluated by carotid intima-media thickness, brachial-ankle pulse wave velocity, ankle-brachial index, and carotid plaque. At follow-up during 2014-2016, the composite of incident fatal or nonfatal CVD were ascertained. RESULTS Of the 8451 participants, 2557 (30.3%) had NAFLD at baseline. Diabetes was associated with arterial stiffness and carotid plaque in participants with NAFLD (P < 0.001). Similar associations were observed in participants without NAFLD. During a mean 4.6 years of follow-up, 432 incident CVD events occurred. The multivariable-adjusted hazard ratio (HR) for CVD events associated with diabetes was 1.27 (95% CI 0.90-1.81) in participants with NAFLD and 1.73 (95% CI 1.32-2.26) in those without NAFLD (P for interaction = 0.21). Among participants with NAFLD who had pre-existing diabetes, those with ≥5 years of diabetes duration had an adjusted HR of 2.02 (95% CI 1.12-3.62) for CVD as compared to those with <2 years of duration. When categorizing participants with NAFLD by fibrosis severity, diabetes conferred an increased risk of CVD in those with potential advanced fibrosis. CONCLUSIONS Among participants with NAFLD, diabetes was associated with prevalent atherosclerosis, and a long duration of diabetes was associated with an increased risk of developing CVD. The effects of diabetes on cardiovascular outcomes did not appreciably differ by NAFLD status.
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Affiliation(s)
- Bin Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanshan Liu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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11
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Bragg F, Halsey J, Guo Y, Zhang H, Yang L, Sun X, Pei P, Chen Y, Du H, Yu C, Clarke R, Lv J, Chen J, Li L, Chen Z. Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 7:100085. [PMID: 34327415 PMCID: PMC8315364 DOI: 10.1016/j.lanwpc.2020.100085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Controversy persists about the relationship of blood pressure with cardiovascular diseases (CVD) in diabetes and associated disease burden. We assessed these associations among Chinese adults with type 2 diabetes (T2D). METHODS In 2004-08, the China Kadoorie Biobank recruited >512,000 adults aged 30-79 years from 10 localities across China, including 26,315 with T2D (based on self-report or plasma glucose measurement) but no prior CVD, followed-up for ~9 years. Cox regression yielded adjusted HR for major CVD and all-cause mortality associated with 10 mmHg higher usual (longer-term average) SBP. Attributable fractions were estimated to assess cardiovascular mortality burden due to uncontrolled hypertension (SBP ≥130 mmHg or DBP ≥80 mmHg). FINDINGS Overall, 75.7% of participants had self-reported (24.8%) or screen-detected (50.9%) (SBP ≥130 mmHg or DBP ≥80 mmHg) hypertension. Among individuals with self-reported hypertension, 82.3% were treated, of whom 9.3% achieved control. There were positive log-linear associations of blood pressure with CVD, with no evidence of a threshold down to ~120 mmHg for usual SBP. Each 10 mmHg higher usual SBP was associated with HR of 1.28 (95% CI 1.25-1.30), 1.18 (1.15-1.21), 1.17 (1.15-1.19) and 1.45 (1.38-1.52) for cardiovascular death (n=1807), major coronary event (n=1190), ischaemic stroke (n=4362) and intracerebral haemorrhage (n=469), respectively. There was an apparent J-shaped association with all-cause mortality (n=4503). In this diabetes population, uncontrolled hypertension accounted for 39% of cardiovascular deaths. INTERPRETATION Uncontrolled hypertension is common in Chinese adults with T2D, resulting in substantial excess risks of CVD. Improved hypertension management could avoid a large number of cardiovascular-related deaths. FUNDING Kadoorie Foundation, Wellcome Trust, MRC, BHF, CR-UK, MoST, NNSF.
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Affiliation(s)
- Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Jim Halsey
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Hua Zhang
- Qingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Xiaohui Sun
- Qingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - Canqing Yu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Jun Lv
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Junshi Chen
- China National Center For Food Safety Risk Assessment, Beijing 100022, China
| | - Liming Li
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
| | - for the China Kadoorie Biobank (CKB) collaborative group (members listed in Supplementary appendix)
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Chinese Academy of Medical Sciences, Beijing 102308, China
- Qingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, China
- School of Public Health, Peking University Health Science Center, Beijing, China
- China National Center For Food Safety Risk Assessment, Beijing 100022, China
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Dai N, Shi Q, Hua Y, Guo Y, Bian Z, Li L, Chen Z, Lu Y. Internal fat mediates the impact of age on diabetes onset in chinese people between 30 and 44 years old. ENDOCRINOL DIAB NUTR 2020; 67:594-601. [PMID: 32224148 PMCID: PMC7674848 DOI: 10.1016/j.endinu.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022]
Abstract
AIMS We sought to measure the effect of controlling body fat indexes on decreasing the incidence of type 2 diabetes mellitus (T2DM) mathematically. METHODS Study samples were selected from a well-established cohort in Suzhou, China between 2004 and 2008, comprising 6364 males and 9678 females. The questionnaire contained socio-demographic characteristics, smoking, alcohol consumption, diet, physical activity, personal and family medical history and current medication. Multiple linear regression, Cox regression and mediation analyses were performed to determine the relationship among age, body fat indexes and T2DM onset. RESULTS All the three body fat indexes [the body mass index (BMI), waist-to-hip ratio (WHR) and body fat percentage] showed a significant positive association (P<0.05) with age and T2DM. Significant indirect effects (IE) were detected for age, which were mediated respectively through WHR [IE=1.10, 95%CI: 1.07-1.13; P<0.001], the BMI (IE=1.15, 95%CI: 1.11-1.18; P<0.001), and body fat percentage (IE=1.09, 95%CI: 1.07-1.12; P<0.001). The combined body fat index score demonstrated a significant association with age (P<0.001) and a stronger relationship with the onset of diabetes (P<0.001) along with a significant mediating effect (IE=1.17; 95%CI: 1.13-1.22; P<0.001). The total effect of age on T2DM was 1.60 (95%CI: 1.21-2.10; P=0.0008). As a result, the three body fat indexes jointly mediated 33.97% of the age impact on diabetes onset. CONCLUSIONS This pilot study revealed important roles for body fat indexes in mediating the age pathway to the onset of diabetes. Controling body fat in the appropriate range could reduce 33.97% of the risk of T2DM onset with increasing age.
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Affiliation(s)
- Ningbin Dai
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Qianwen Shi
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Yujie Hua
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Liming Li
- Department of Epidemiology, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yan Lu
- Suzhou Center for Disease Control and Prevention, Suzhou, China.
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Wang M, Muraki I, Liu K, Shirai K, Tamakoshi A, Hu Y, Iso H. Diabetes and Mortality From Respiratory Diseases: The Japan Collaborative Cohort Study. J Epidemiol 2020; 30:457-463. [PMID: 31839642 PMCID: PMC7492709 DOI: 10.2188/jea.je20190091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/28/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Little evidence is available about the association between diabetes and respiratory disease mortality among Japanese populations. We aimed to explore the association between diabetes and the risk of respiratory diseases mortality through a nationwide prospective study in Japan. METHODS We followed 95,056 participants (39,925 men and 55,131 women) for a median 17.1 years. The information about diabetes status, sociodemographic characteristics, and lifestyles was collected at baseline. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of mortality from respiratory diseases associated with baseline diabetes status. RESULTS We identified 2,838 deaths from total respiratory diseases (1,759 respiratory infection, 432 chronic obstructive pulmonary disease, and 647 other respiratory diseases). The association between diabetes and total respiratory disease mortality was statistically significant among women (HR 1.81; 95% CI, 1.39-2.37) but of borderline statistical significance in men (P for interaction <0.01). Besides, there were significant associations between diabetes and mortality from respiratory infection among both men and women (HR 1.39; 95% CI, 1.10-1.76 and HR 2.30; 95% CI, 1.71-3.11, respectively; P for interaction <0.001). However, we failed to detect any statistically significant association between diabetes and COPD mortality. Moreover, the subgroup analysis revealed that the association between diabetes and total respiratory disease mortality was stronger in never smokers when compared with ever smokers (P for interaction = 0.02). CONCLUSIONS Significant association was observed between diabetes and the risk of total respiratory disease mortality, in particular from respiratory infection. Prevention and control of respiratory diseases, especially respiratory infection, should be paid more attention among people with diabetes in clinical and public health practice.
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Affiliation(s)
- Mengying Wang
- School of Public Health, Peking University, Beijing, China
| | - Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keyang Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Faculty of Medicine Hokkaido University, Sapporo, Japan
| | - Yonghua Hu
- School of Public Health, Peking University, Beijing, China
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Chen J, Xu L, He Q, Wu S, Hu D, Lu K. Correlation Between Ideal Cardiovascular Health Metrics and Plasma hs-CRP Levels in a North China Population: One Four-Year Follow-Up Study. Int J Gen Med 2020; 13:617-625. [PMID: 32982379 PMCID: PMC7505702 DOI: 10.2147/ijgm.s266602] [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: 06/07/2020] [Accepted: 08/07/2020] [Indexed: 12/03/2022] Open
Abstract
Background This prospective cohort study aimed to evaluate the potential association of ideal cardiovascular health metrics with the plasma levels of highly sensitive C-reactive protein (hs-CRP) among people in North China. Methods A total of 80,968 participants were included in this study at baseline. Data relating to seven health metrics and plasma hs-CRP levels were collected at baseline and the end of follow-up. The change in health metrics of each individual was compared and recorded. The potential association of gain or loss of each health metric, as well as the change in the total number of health metrics that each individual had during follow-up, with the risk of increased hs-CRP level, were explored by multiple Cox proportional hazards models. Results A total of 72,321 participants (94.51%) completed the follow-up, and the average follow-up time was 4.1 years. Ideal body mass index (BMI), physical activity, smoking status and total cholesterol all had significant impacts on hs-CRP levels, with ideal BMI having the largest impact. Losing ideal BMI during follow-up raised the probability of hs-CRP increase during the follow-up time by 1.72 (95% CI, 1.59–1.86) times for men and 2.05 (95% CI, 1.76–2.39) times for women. The effects of ideal salt intake and blood pressure on hs-CRP levels were uncertain. Changes in the total number of ideal metrics for each individual had a significant cumulative effect on hs-CRP. The hazard ratio of loss of four to six health metrics during follow-up on the risk of hs-CRP increase was 1.69 (95% CI, 1.38–2.06) for men and 1.52 (95% CI, 1.13–2.04) for women. Conclusion Loss or gain of ideal cardiovascular health metrics is associated with significant fluctuations in plasma hs-CRP levels. The cardiovascular benefits brought by the ideal health metrics are mediated at least in part by reducing systemic inflammation in the body.
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Affiliation(s)
- Jia Chen
- Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Liuyue Xu
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Quan He
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Hebei United University, Tangshan 100816, People's Republic of China
| | - Dayi Hu
- Heart Center, Peking University People's Hospital, Beijing 100044, People's Republic of China
| | - Kai Lu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
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15
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Simeni Njonnou SR, Boombhi J, Etoa Etoga MC, Tiodoung Timnou A, Jingi AM, Nkem Efon K, Mbono Samba Eloumba EA, Ntsama Essomba MJ, Kengni Kebiwo O, Tsitsol Meke AN, Talbit Ndjonya S, Dehayem Yefou M, Sobngwi E. Prevalence of Diabetes and Associated Risk Factors among a Group of Prisoners in the Yaoundé Central Prison. J Diabetes Res 2020; 2020:5016327. [PMID: 32047824 PMCID: PMC7003275 DOI: 10.1155/2020/5016327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Diabetes is a public health problem worldwide, associated with increased morbidity and mortality. According to the International Diabetes Federation (IDF) 2017 data, around 425 million people worldwide suffer from diabetes. This number is expected to increase to 629 million in 2045. Various occidental studies reported the increased prevalence and lower control of diabetes among prisoners. However, there is no data on the characteristics of inmates with diabetes in sub-Saharan Africa. METHODS A cross-sectional study among incarcerated detainees from the Yaoundé Central Prison was conducted from January to July 2017. Diabetes was defined according to the American Diabetes Association (ADA) criteria. Analyzed variables included phenotypic characteristics, lifestyle, the reason for detention, the sentence severity, and the length of detention. RESULTS We recruited 437 inmates (344 men) with an average age of 37.0 (95% CI: 35.9-38.3) years. The most frequent age group was 20 to 39 years with 281 (64.7%) inmates, and the mean prison stay was 29.1 (95% CI: 25.7-32.8) months. The prevalence of diabetes in the Yaoundé Central Prison was 9.4%. The main cardiovascular risk factors were a sedentary lifestyle (91.1%), hypertension (39.6%), smoking (31.6%), and alcohol consumption (28.1%). Hypertension (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (p = 0.005), obesity (. CONCLUSION Diabetes prevalence in the Yaoundé Central Prison was high, at 9.4%, compared to that in the general population. It was associated with other classical cardiovascular risk factors and factors linked to the sentence (minor and major crimes). This trial is registered with CE00617/CRERSHC/2016.
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Affiliation(s)
- Sylvain Raoul Simeni Njonnou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jérôme Boombhi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé General Hospital, Yaoundé, Cameroon
| | - Martine Claude Etoa Etoga
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Aimée Tiodoung Timnou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ahmadou Musa Jingi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Kevin Nkem Efon
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Prison, Yaoundé, Cameroon
| | | | - Marie-Josiane Ntsama Essomba
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Odette Kengni Kebiwo
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Alice Ninon Tsitsol Meke
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Stéphane Talbit Ndjonya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Mesmin Dehayem Yefou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Eugène Sobngwi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Yaoundé Central Hospital, Yaoundé, Cameroon
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16
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Bennett DA, Du H, Bragg F, Guo Y, Wright N, Yang L, Bian Z, Chen Y, YU C, Wang S, Meng F, Lv J, Chen J, Li L, Clarke R, Chen Z. Physical activity, sedentary leisure-time and risk of incident type 2 diabetes: a prospective study of 512 000 Chinese adults. BMJ Open Diabetes Res Care 2019; 7:e000835. [PMID: 31908799 PMCID: PMC6936425 DOI: 10.1136/bmjdrc-2019-000835] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 01/19/2023] Open
Abstract
Objective Aim to examine the independent and joint associations of physical activity (PA) and sedentary leisure-time (SLT) with risk of diabetes and assess the extent to which these associations were mediated by adiposity. Research design and methods The prospective China Kadoorie Biobank recruited ~512 000 adults from 10 diverse areas across China. Self-reported PA was estimated based on type, frequency and duration of specific types of PA, covering four domains (occupation, leisure, household and commuting). SLT was defined as hours per day spent watching television, reading or playing card games. Stratified Cox proportional hazards models were used to estimate adjusted HRs (aHRs) for PA and SLT associated with incident diabetes. Analyses were stratified by age-at-risk (5-year intervals), sex and region and adjusted for household income, education, alcohol consumption, smoking, fresh fruit intake, self-reported general health status, family history of diabetes and body mass index (BMI) status. Analyses of total PA, occupational and non-occupational PA and SLT were mutually adjusted for each other, as appropriate. Results After ~9 years of follow-up, there were 14 940 incident diabetes cases among 460 736 participants without prior diabetes or cardiovascular diseases at baseline. The mean (SD) age at baseline was 51 (10.6) years, 59% were women and 43% resided in urban areas. Overall, the mean BMI was 23.5 (3.3) kg/m2, which differed by ~0.5 kg/m2 among individuals in the highest compared with the lowest PA and SLT groups. PA was inversely associated the risk of diabetes 16% (aHR: 0.84, 95% CI 0.81 to 0.88) lower in top than bottom fifth. After further adjustment for BMI this was attenuated to 0.99 (95% CI 0.98 to 1.00). SLT was positively associated with diabetes and each 1 hour per day higher usual level was associated with aHR of 1.13 (95% CI 1.09 to 1.17) for diabetes, attenuated to 1.05 (95% CI 1.01 to 1.09) after further adjustment for BMI. Conclusions Among Chinese adults, higher levels of PA and lower levels of SLT were associated with lower risks of diabetes with no evidence of effect modification by each other. These associations appeared to arise mainly through adiposity.
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Affiliation(s)
- Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Neil Wright
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Canqing YU
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Sisi Wang
- Non-Communicable Disease Prevention and Control Department, Liuzhou CDC, Liuzhou, Guangxi, China
| | - Fanwen Meng
- Non-Communicable Disease Prevention and Control Department, Liuzhou CDC, Liuzhou, Guangxi, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment (CFSA), Beijing, China
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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17
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Gan W, Bragg F, Walters RG, Millwood IY, Lin K, Chen Y, Guo Y, Vaucher J, Bian Z, Bennett D, Lv J, Yu C, Mahajan A, Clarke RJ, Li L, Holmes MV, McCarthy MI, Chen Z. Genetic Predisposition to Type 2 Diabetes and Risk of Subclinical Atherosclerosis and Cardiovascular Diseases Among 160,000 Chinese Adults. Diabetes 2019; 68:2155-2164. [PMID: 31399431 PMCID: PMC6804628 DOI: 10.2337/db19-0224] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
In observational studies, type 2 diabetes is associated with two- to fourfold higher risk of cardiovascular diseases (CVD). Using data from the China Kadoorie Biobank (CKB), we examined associations of genetically predicted type 2 diabetes with CVD among ∼160,000 participants to assess whether these relationships are causal. A type 2 diabetes genetic risk score (comprising 48 established risk variants) was associated with the presence of carotid plaque (odds ratio 1.17 [95% CI 1.05, 1.29] per 1 unit higher log-odds of type 2 diabetes; n = 6,819) and elevated risk of ischemic stroke (IS) (1.08 [1.02, 1.14]; n = 17,097), nonlacunar IS (1.09 [1.03, 1.16]; n = 13,924), and major coronary event (1.12 [1.02, 1.23]; n = 5,081). There was no significant association with lacunar IS (1.03 [0.91, 1.16], n = 3,173) or intracerebral hemorrhage (ICH) (1.01 [0.94, 1.10], n = 6,973), although effect estimates were imprecise. These associations were consistent with observational associations of type 2 diabetes with CVD in CKB (P for heterogeneity >0.3) and with the associations of type 2 diabetes with IS, ICH, and coronary heart disease in two-sample Mendelian randomization analyses based on summary statistics from European population genome-wide association studies (P for heterogeneity >0.2). In conclusion, among Chinese adults, genetic predisposition to type 2 diabetes was associated with atherosclerotic CVD, consistent with a causal association.
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Affiliation(s)
- Wei Gan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, U.K
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Robin G. Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Iona Y. Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, U.K
| | - Kuang Lin
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, U.K
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Julien Vaucher
- Department of Internal Medicine, University Hospital of Lausanne, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Derrick Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Jun Lv
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Canqing Yu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, U.K
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K
| | - Robert J. Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Liming Li
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Michael V. Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, U.K
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, U.K
- Corresponding authors: Michael V. Holmes,
| | - Mark I. McCarthy
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, U.K
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, U.K
- Mark I. McCarthy, , and
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, U.K
- Zhengming Chen,
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18
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Islet Function Changes Among the Elderly Population. Arch Med Res 2019; 50:468-475. [DOI: 10.1016/j.arcmed.2019.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/27/2019] [Accepted: 10/29/2019] [Indexed: 12/22/2022]
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19
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Kizza J, Lewington S, Mappin‐Kasirer B, Turnbull I, Guo Y, Bian Z, Chen Y, Yang L, Chen Z, Clarke R. Cardiovascular risk factors and Parkinson's disease in 500,000 Chinese adults. Ann Clin Transl Neurol 2019; 6:624-632. [PMID: 31019987 PMCID: PMC6469341 DOI: 10.1002/acn3.732] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/08/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The objectives of this study were to compare the risks of Parkinson's disease among those with versus those without prior stroke or heart disease at baseline in a prospective study of 0.5 million adults in China, and to examine associations of cardiovascular disease risk factors (cigarette smoking, hypertension, diabetes, obesity) with risk of Parkinson's disease. METHODS During an average of 11.5 years of follow-up of 503,497 middle-aged participants in the China Kadoorie Biobank study, 603 incident cases were hospitalized with a diagnosis of Parkinson's disease. Cox proportional hazards models were used to assess associations of history of heart disease or stroke with Parkinson's disease in all participants, and of cardiovascular disease risk factors with Parkinson's disease in a subset without prior cardiovascular disease. RESULTS In this population the incidence rate of Parkinson's disease (mean [SD] age of cases, 61 [10] years) was 13.3 (95% confidence interval: 12.3-14.4) per 100,000 person-years. Incidence increased with age, and was higher in men than in women, and in urban than in rural residents. Prior stroke was associated with about twofold higher risk of Parkinson's disease (hazard ratio 1.94; 1.39-2.69). After adjustment for confounders in those without prior cardiovascular disease, a 5 kg/m2 higher body mass index was associated with 17% (1.17; 1.03-1.34: P = 0.019) higher risk of Parkinson's disease, but neither hypertension, diabetes, nor current cigarette smoking was significantly associated with Parkinson's disease. INTERPRETATION Prior stroke and adiposity were each associated with higher risks of Parkinson's disease, but none of the other cardiovascular disease risk factors were significantly associated with Parkinson's disease in this population.
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Affiliation(s)
- Jennifer Kizza
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Benjamin Mappin‐Kasirer
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Iain Turnbull
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Yu Guo
- Chinese Academy of Medical SciencesBeijingChina
| | - Zheng Bian
- Chinese Academy of Medical SciencesBeijingChina
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU)Nuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
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20
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Pang Y, Kartsonaki C, Turnbull I, Guo Y, Clarke R, Chen Y, Bragg F, Yang L, Bian Z, Millwood IY, Hao J, Han X, Zang Y, Chen J, Li L, Holmes MV, Chen Z. Diabetes, Plasma Glucose, and Incidence of Fatty Liver, Cirrhosis, and Liver Cancer: A Prospective Study of 0.5 Million People. Hepatology 2018; 68:1308-1318. [PMID: 29734463 PMCID: PMC6220764 DOI: 10.1002/hep.30083] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/03/2018] [Indexed: 12/18/2022]
Abstract
The prevalence of diabetes is increasing rapidly in China. However, evidence is limited about its effects on chronic liver diseases and liver cancer. We examined the associations of diabetes with chronic liver diseases and liver cancer and of random plasma glucose (RPG) with these liver diseases among participants without diabetes in Chinese adults and the possible interaction by hepatitis B virus (HBV) infection. The prospective China Kadoorie Biobank recruited 512,891 adults. During 10 years of follow-up, 2,568 liver cancer, 2,082 cirrhosis, 1,298 hospitalized nonalcoholic fatty liver disease (NAFLD), and 244 hospitalized alcoholic liver disease (ALD) cases were recorded among 503,993 participants without prior history of cancer or chronic liver diseases at baseline. Cox regression was used to estimate hazard ratios (HRs) for each disease by diabetes status (previously diagnosed or screen-detected) and, among those without previously diagnosed diabetes, by levels of RPG. Overall 5.8% of participants had diabetes at baseline. Compared to those without diabetes, individuals with diabetes had adjusted HRs of 1.49 (95% confidence interval 1.30-1.70) for liver cancer, 1.81 (1.57-2.09) for cirrhosis, 1.76 (1.47-2.16) for NAFLD, and 2.24 (1.42-3.54) for ALD. The excess risks decreased but remained elevated in those with longer duration. Among those without previously diagnosed diabetes, RPG was positively associated with liver diseases, with adjusted HRs per 1 mmol/L higher RPG of 1.04 (1.03-1.06) for liver cancer, 1.07 (1.05-1.09) for cirrhosis, 1.07 (1.05-1.10) for NAFLD, and 1.10 (1.05-1.15) for ALD. These associations did not differ by HBV infection. CONCLUSION In Chinese adults, diabetes and higher blood glucose levels among those without known diabetes are associated with higher risks of liver cancer and major chronic liver diseases.
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Affiliation(s)
- Yuanjie Pang
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Iain Turnbull
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Yu Guo
- Chinese Academy of Medical SciencesBeijingChina
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Zheng Bian
- Chinese Academy of Medical SciencesBeijingChina
| | - Iona Y. Millwood
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | | | - Xianyong Han
- Yongqinglu Community Health Service CenterQingdaoChina
| | - Yajing Zang
- Qingdao Center for Disease Prevention and ControlQingdaoChina
| | - Junshi Chen
- National Center for Food Safety Risk AssessmentBeijingChina
| | - Liming Li
- Chinese Academy of Medical SciencesBeijingChina
- School of Public HealthPeking University
| | - Michael V. Holmes
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- National Institute for Health Research Oxford Biomedical Research CentreOxford University HospitalOxfordUK
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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21
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Liu S, Ding T, Liu H, Jian L. GPER was Associated with Hypertension in Post-Menopausal Women. Open Med (Wars) 2018; 13:338-343. [PMID: 30155521 PMCID: PMC6110139 DOI: 10.1515/med-2018-0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To explore the relationship between G protein-coupled estrogen receptor (GPER) and hypertension in post-menopausal women. Methods Using a matched case-control design, clinical and laboratory data were collected. Conditional logistic regression with stratified analysis was conducted to identify the association between GPER and hypertension. Results The GPER level was significantly lower in the case group than in the control group (126.3 ± 21.6 vs. 133.6 ± 27.3, P=0.000). The GPER levels of the hypertension cases with and those without menopause were significant (120.5 ± 11.8 and 127.2 ± 12.1, P=0.000). No significant difference in the GPER level between the controls with and those without menopause was observed (P=0.241). Logistic regression revealed that the GPER quartile was related to hypertension (odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.13–0.93, P=0.018) after adjusting for potential confounding factors. Stratified analysis revealed that the GPER quartile was not associated with hypertension in premenopausal women, and the fourth GPER quartile showed a predictive association with hypertension (OR: 0.43, 95% CI: 0.29–0.90) in menopausal women. Conclusions GPER level is associated with hypertension and is a protective factor for hypertension in menopausal women but not premenopausal women. Further research is required due to study limitations.
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Affiliation(s)
- Shichao Liu
- Department of Cardiovascular, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province 450014 China
| | - Tongbin Ding
- Department of Cardiovascular, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province 450014 China
| | - Hang Liu
- Department of Cardiovascular, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province 450014 China
| | - Liguo Jian
- Department of Cardiovascular, the Second Affiliated Hospital of Zhengzhou University, NO. 2, Jing-ba Road, Jinshui District, Zhengzhou City, Henan Province 4500014 China
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22
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Metabolic and lifestyle risk factors for acute pancreatitis in Chinese adults: A prospective cohort study of 0.5 million people. PLoS Med 2018; 15:e1002618. [PMID: 30067849 PMCID: PMC6070164 DOI: 10.1371/journal.pmed.1002618] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/20/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Little prospective evidence exists about risk factors and prognosis of acute pancreatitis in China. We examined the associations of certain metabolic and lifestyle factors with risk of acute pancreatitis in Chinese adults. METHODS AND FINDINGS The prospective China Kadoorie Biobank (CKB) recruited 512,891 adults aged 30 to 79 years from 5 urban and 5 rural areas between 25 June 2004 and 15 July 2008. During 9.2 years of follow-up (to 1 January 2015), 1,079 cases of acute pancreatitis were recorded. Cox regression was used to estimate adjusted hazard ratios (HRs) for acute pancreatitis associated with various metabolic and lifestyle factors among all or male (for smoking and alcohol drinking) participants. Overall, the mean waist circumference (WC) was 82.1 cm (SD 9.8) cm in men and 79.0 cm (SD 9.5) cm in women, 6% had diabetes, and 6% had gallbladder disease at baseline. WC was positively associated with risk of acute pancreatitis, with an adjusted HR of 1.35 (95% CI 1.27-1.43; p < 0.001) per 1-SD-higher WC. Individuals with diabetes or gallbladder disease had HRs of 1.34 (1.07-1.69; p = 0.01) and 2.42 (2.03-2.88; p < 0.001), respectively. Physical activity was inversely associated with risk of acute pancreatitis, with each 4 metabolic equivalent of task (MET) hours per day (MET-h/day) higher physical activity associated with an adjusted HR of 0.95 (0.91-0.99; p = 0.03). Compared with those without any metabolic risk factors (i.e., obesity, diabetes, gallbladder disease, and physical inactivity), the HRs of acute pancreatitis for those with 1, 2, or ≥3 risk factors were 1.61 (1.47-1.76), 2.36 (2.01-2.78), and 3.41 (2.46-4.72), respectively (p < 0.001). Among men, heavy alcohol drinkers (≥420 g/week) had an HR of 1.52 (1.11-2.09; p = 0.04, compared with abstainers), and current regular smokers had an HR of 1.45 (1.28-1.64; p = 0.02, compared with never smokers). Following a diagnosis of acute pancreatitis, there were higher risks of pancreatic cancer (HR = 8.26 [3.42-19.98]; p < 0.001; 13 pancreatic cancer cases) and death (1.53 [1.17-2.01]; p = 0.002; 89 deaths). Other diseases of the pancreas had similar risk factor profiles and prognosis to acute pancreatitis. The main study limitations are ascertainment of pancreatitis using hospital records and residual confounding. CONCLUSIONS In this relatively lean Chinese population, several modifiable metabolic and lifestyle factors were associated with higher risks of acute pancreatitis, and individuals with acute pancreatitis had higher risks of pancreatic cancer and death.
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23
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Downing NS, Li J. Ischaemic heart disease in China: the time to address rising mortality rates. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 3:4-5. [PMID: 28927183 DOI: 10.1093/ehjqcco/qcw049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nicholas S Downing
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02116, USA
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, People's Republic of China
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24
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Pang Y, Kartsonaki C, Guo Y, Chen Y, Yang L, Bian Z, Bragg F, Millwood IY, Shen L, Zhou S, Liu J, Chen J, Li L, Holmes MV, Chen Z. Diabetes, plasma glucose and incidence of colorectal cancer in Chinese adults: a prospective study of 0.5 million people. J Epidemiol Community Health 2018; 72:919-925. [PMID: 29970599 PMCID: PMC6161653 DOI: 10.1136/jech-2018-210651] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/22/2018] [Accepted: 05/27/2018] [Indexed: 01/15/2023]
Abstract
Background Diabetes is associated with higher risk of colorectal cancer (CRC). Uncertainty remains about the relevance of duration of diabetes and about the association of blood glucose with CRC risk among individuals without diabetes. Methods The prospective China Kadoorie Biobank recruited 512 713 participants in 2004–2008 from 10 diverse areas in China. After 10 years of follow-up, 3024 incident cases of CRC (1745 colon, 1716 rectal) were recorded among 510 136 participants without prior cancer at baseline. Cox regression was used to estimate adjusted HRs for CRC associated with diabetes (previously diagnosed or screen-detected) and, among those without previously diagnosed diabetes, with levels of random plasma glucose (RPG). Results Overall 5.8% of participants had diabetes at baseline. Individuals with diabetes had an adjusted HR of 1.18 (95% CI 1.04 to 1.33) for CRC, with similar risk for colon and rectal cancer (1.19 [1.01 to 1.39] vs 1.14 [0.96 to 1.35]). The HRs decreased with longer duration of diabetes (p for trend 0.03). Among those without previously diagnosed diabetes, RPG was positively associated with CRC, with adjusted HRs per 1 mmol/L higher baseline RPG of 1.04 (1.02 to 1.05) for CRC, again similar for colon and rectal cancer (1.03 [1.01to 1.05] and 1.04 [1.02 to 1.06], respectively). The associations of diabetes and RPG appeared stronger in men than in women, but the differences were non-significant (p for heterogeneity 0.3 and 0.2). Discussion Among Chinese adults, diabetes and higher blood glucose levels among those without known diabetes are associated with higher risk of CRC.
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Affiliation(s)
- Yuanjie Pang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iona Y Millwood
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Jiben Liu
- Yongqing Road Community Health Center, Qingdao, China
| | - Junshi Chen
- National Center for Food Safety Risk Assessment, Beijing, China
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, China.,School of Public Health, Peking University, Beijing, China
| | - Michael V Holmes
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Center, Oxford University Hospital, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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25
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Pan XF, He M, Yu C, Lv J, Guo Y, Bian Z, Yang L, Chen Y, Wu T, Chen Z, Pan A, Li L. Type 2 Diabetes and Risk of Incident Cancer in China: A Prospective Study Among 0.5 Million Chinese Adults. Am J Epidemiol 2018; 187:1380-1391. [PMID: 29304221 PMCID: PMC6153481 DOI: 10.1093/aje/kwx376] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/09/2017] [Accepted: 12/14/2017] [Indexed: 12/20/2022] Open
Abstract
Using data from the China Kadoorie Biobank Study, we conducted a prospective investigation on the association between type 2 diabetes mellitus (T2DM) and cancer risk in Chinese adults. A total of 508,892 participants (mean age = 51.5 (standard deviation, 10.7) years) without prior cancer diagnosis at baseline (2004-2008) were included. We documented 17,463 incident cancer cases during follow-up through December 31, 2013. Participants with T2DM had increased risks of total and certain site-specific cancers; hazard ratios were 1.13 (95% confidence interval (CI): 1.07, 1.19) for total cancer, 1.51 (95% CI: 1.29, 1.76) for liver cancer, 1.86 (95% CI: 1.43, 2.41) for pancreatic cancer, and 1.21 (95% CI: 1.01, 1.47) for female breast cancer. The associations were largely consistent when physician-diagnosed and screen-detected T2DM were analyzed separately, except for colorectal cancer (for physician-diagnosed T2DM, HR = 0.91 (95% CI: 0.73, 1.13), and for screen-detected T2DM, HR = 1.44 (95% CI: 1.18, 1.77)). In participants without a prior diagnosis of T2DM, higher random blood glucose levels were positively associated with risks of total cancer, liver cancer, and female breast cancer (all P's for trend ≤ 0.02). In conclusion, T2DM is associated with an increased risk of new-onset cancer in China, particularly cancers of the liver, pancreas, and female breast.
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Affiliation(s)
- Xiong-Fei Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health
| | - Meian He
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Tangchun Wu
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Chinese Academy of Medical Sciences, Beijing, China
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26
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Liu X, Bragg F, Yang L, Kartsonaki C, Guo Y, Du H, Bian Z, Chen Y, Yu C, Lv J, Wang K, Zhang H, Chen J, Clarke R, Collins R, Peto R, Li L, Chen Z. Smoking and smoking cessation in relation to risk of diabetes in Chinese men and women: a 9-year prospective study of 0·5 million people. Lancet Public Health 2018; 3:e167-e176. [PMID: 29548855 PMCID: PMC5887081 DOI: 10.1016/s2468-2667(18)30026-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND In developed countries, smoking is associated with increased risk of diabetes. Little is known about the association in China, where cigarette consumption has increased (first in urban, then in rural areas) relatively recently. Moreover, uncertainty remains about the effect of smoking cessation on diabetes in China and elsewhere. We aimed to assess the associations of smoking and smoking cessation with risk of incident diabetes among Chinese adults. METHODS The prospective China Kadoorie Biobank enrolled 512 891 adults (59% women) aged 30-79 years during 2004-08 from ten diverse areas (five urban and five rural) across China. Participants were interviewed at study assessment clinics, underwent physical measurements, and had a non-fasting blood sample taken. Participants were separated into four categories according to smoking history: never-smokers, ever-regular smokers, ex-smokers, and occasional smokers. Incident diabetes cases were identified through linkage with diabetes surveillance systems, the national health insurance system, and death registries. All analyses were done separately in men and women and Cox regression was used to yield adjusted hazards ratios (HRs) for diabetes associated with smoking. FINDINGS 68% (n=134 975) of men ever smoked regularly compared with 3% (n=7811) of women. During 9 years' follow-up, 13 652 new-onset diabetes cases were recorded among 482 589 participants without previous diabetes. Among urban men, smokers had an adjusted HR of 1·18 (95% CI 1·12-1·25) for diabetes. HRs increased with younger age at first smoking regularly (1·12, 1·20, and 1·27 at ≥25 years, 20-24 years, and <20 years, respectively; p for trend=0·00073) and with greater amount smoked (1·11, 1·15, 1·42, and 1·63 for <20, 20-29, 30-39 and ≥40 cigarettes per day; p for trend<0·0001). Among rural men, similar, albeit more modest, associations were seen. Overall, HRs were more extreme at higher levels of adiposity. Among men who stopped by choice, there was no excess risk within 5 years of cessation, contrasting with those who stopped because of illness (0·92 [0·75-1·12] vs 1·42 [1·23-1·63]). Among the few women who ever smoked regularly, the excess risk of diabetes was significant (1·33 [1·20-1·47]). INTERPRETATION Among Chinese adults, smoking was associated with increased risk of diabetes, with no significant excess risk following voluntary smoking cessation. FUNDING Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, Ministry of Science and Technology, National Natural Science Foundation of China, and China Scholarship Council.
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Affiliation(s)
- Xin Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Christiana Kartsonaki
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Kang Wang
- Shibei Centre for Disease Control and Prevention, Qingdao, China
| | - Hua Zhang
- Qingdao Centre for Disease Control and Prevention, Qingdao, China
| | - Junshi Chen
- National Center for Food Safety Risk Assessment, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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27
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Bragg F, Tang K, Guo Y, Iona A, Du H, Holmes MV, Bian Z, Kartsonaki C, Chen Y, Yang L, Sun Q, Dong C, Chen J, Collins R, Peto R, Li L, Chen Z. Associations of General and Central Adiposity With Incident Diabetes in Chinese Men and Women. Diabetes Care 2018; 41:494-502. [PMID: 29298802 PMCID: PMC6548563 DOI: 10.2337/dc17-1852] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/05/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assess associations of general and central adiposity in middle age and of young adulthood adiposity with incident diabetes in adult Chinese and estimate the associated population burden of diabetes. RESEARCH DESIGN AND METHODS The prospective China Kadoorie Biobank enrolled 512,891 adults 30-79 years of age from 10 localities across China during 2004-2008. During 9.2 years of follow-up, 13,416 cases of diabetes were recorded among 482,589 participants without diabetes at baseline. Cox regression yielded adjusted hazard ratios (HRs) for incident diabetes associated with measures of general (e.g., BMI and BMI at 25 years) and central (e.g., waist circumference [WC]) adiposity. RESULTS The mean (SD) BMI was 23.6 kg/m2 (3.4 kg/m2), and 3.8% had a BMI ≥30 kg/m2. Throughout the range examined (19-32 kg/m2), BMI showed a positive log-linear relationship with diabetes, with adjusted HRs per SD higher usual BMI greater in men (1.98; 95% CI 1.93-2.04) than in women (1.77; 1.73-1.81) (P for heterogeneity <0.001). For WC, HRs per SD were 2.13 (95% CI 2.07-2.19) in men and 1.91 (1.87-1.95) in women (P for heterogeneity <0.001). Mutual adjustment attenuated these associations, especially those of BMI. BMI at age 25 years was weakly positively associated with diabetes (men HR 1.09 [95% CI 1.05-1.12]; women 1.04 [1.02-1.07] per SD), which was reversed after adjustment for baseline BMI. In China, the increase in adiposity accounted for ∼50% of the increase in diabetes burden since 1980. CONCLUSIONS Among relatively lean Chinese adults, higher adiposity-general and central-was strongly positively associated with the risk of incident diabetes. The predicted continuing increase in adiposity in China foreshadows escalating rates of diabetes.
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Affiliation(s)
- Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.
| | - Kun Tang
- Department of Global Health, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Andri Iona
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, U.K
| | - Huaidong Du
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, U.K
| | - Michael V Holmes
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, U.K
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, U.K
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, U.K
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.,Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, U.K
| | - Qiang Sun
- Pengzhou Centre for Disease Control and Prevention, Sichuan, People's Republic of China
| | - Caixia Dong
- Gansu Centre for Disease Control and Prevention, Gansu, People's Republic of China
| | - Junshi Chen
- National Center for Food Safety Risk Assessment, Beijing, People's Republic of China
| | - Rory Collins
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Richard Peto
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,School of Public Health, Peking University, Beijing, People's Republic of China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, U.K.
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28
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Yang L, Li L, Peters SAE, Clarke R, Guo Y, Chen Y, Bian Z, Sherliker P, Yin J, Tang Z, Wang C, Wang X, Zhang L, Woodward M, Chen Z. Age at Menarche and Incidence of Diabetes: A Prospective Study of 300,000 Women in China. Am J Epidemiol 2018; 187:190-198. [PMID: 28605451 PMCID: PMC5860078 DOI: 10.1093/aje/kwx219] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 04/12/2017] [Indexed: 01/19/2023] Open
Abstract
Previous studies of predominantly Western populations have reported inconsistent associations between age at menarche and risk of diabetes. We examined this relationship among Chinese women, who generally experience menarche at a later age than Western women. In 2004–2008, China Kadoorie Biobank recruited 302,632 women aged 30–79 years from 10 areas across China, and recorded 5,391 incident cases of diabetes during 7 years of follow-up among 270,345 women without baseline diabetes, cardiovascular disease or cancer. Cox regression models yielded adjusted hazard ratios for incident diabetes associated with age at menarche. Overall, the mean age at menarche was 15.4 years, and decreased across successive generations. Age at menarche was linearly and inversely associated with incident diabetes, with adjusted hazard ratio of 0.96 (95% confidence interval (CI): 0.94, 0.97) per year delay. Hazard ratios were greater in younger generations (for women born in the 1960s–1970s, hazard ratio (HR) = 0.93, 95% CI: 0.90, 0.97; for women born in the 1950s, HR = 0.95, 95% CI: 0.93, 0.98; and for women born in the 1920s–1940s, HR = 0.97, 95% CI: 0.95, 0.99). Further adjustment for adulthood body mass index significantly attenuated the association (HR = 0.99, 95% CI: 0.97, 1.00), especially among those born before 1950 (HR = 1.00, 95% CI: 0.97, 1.02). Much of the inverse association between age at menarche and incident diabetes was mediated through increased adiposity associated with early menarche, especially in older generations.
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Affiliation(s)
- Ling Yang
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit and Epidemiological Studies Unit
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
- Department of Public Health, School of Public Health, Peking University, Beijing, China
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit and Epidemiological Studies Unit
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Paul Sherliker
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Clinical Trial Service Unit and Epidemiological Studies Unit
| | - Jiyuan Yin
- Heilongjiang Center for Disease Control and Prevention
| | | | - Chunmei Wang
- Tongxiang CDC NCDs Prevention and Control Department, Tongxiang, Zhejiang, China
| | - Xiaohuan Wang
- Hainan CDC NCDs Prevention and Control Department, Haikou, Hainan, China
| | - Libo Zhang
- Liuyang CDC NCDs Prevention and Control Department, Liuyang, Hunan, China
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, University of Sydney, Australia
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit
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Lv J, Yu C, Guo Y, Bian Z, Yang L, Chen Y, Li S, Huang Y, Fu Y, He P, Tang A, Chen J, Chen Z, Qi L, Li L. Gallstone Disease and the Risk of Type 2 Diabetes. Sci Rep 2017; 7:15853. [PMID: 29158491 PMCID: PMC5696516 DOI: 10.1038/s41598-017-14801-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/13/2017] [Indexed: 01/06/2023] Open
Abstract
Gallstone disease (GSD) is related to several diabetes risk factors. The present study was to examine whether GSD was independently associated with type 2 diabetes in the China Kadoorie Biobank study. After excluding participants with prevalent diabetes and prior histories of cancer, heart disease, and stroke at baseline, 189,154 men and 272,059 women aged 30-79 years were eligible for analysis. The baseline prevalence of GSD was 5.7% of the included participants. During 4,138,687 person-years of follow-up (median, 9.1 years), a total of 4,735 men and 7,747 women were documented with incident type 2 diabetes. Compared with participants without GSD at baseline, the multivariate-adjusted hazard ratios (HRs) for type 2 diabetes for those with GSD were 1.09 (95% CI: 0.96-1.24; P = 0.206), 1.21 (95% CI: 1.13-1.30; P < 0.001), and 1.17 (95% CI: 1.10-1.25; P < 0.001) in men, women, and the whole cohort respectively. There was no statistically significant heterogeneity between men and women (P = 0.347 for interaction). The association between GSD and type 2 diabetes was strongest among participants who reported ≥5 years since the first diagnosis and were still on treatment at baseline (HR = 1.48; 95% CI: 1.16-1.88; P = 0.001). The present study highlights the importance of developing a novel prevention strategy to mitigate type 2 diabetes through improvement of gastrointestinal health.
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Affiliation(s)
- Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Institute of Environmental Medicine, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Shanpeng Li
- Qingdao Center for Disease Control & Prevention, Qingdao, Shandong, China
| | - Yuelong Huang
- Hunan Center for Disease Control & Prevention, Changsha, Hunan, China
| | - Yan Fu
- Hainan Center for Disease Control & Prevention, Haikou, Hainan, China
| | - Pan He
- Huixian Center for Disease Control & Prevention, Huixian, Henan, China
| | - Aiyu Tang
- Suzhou Center for Disease Control & Prevention, Suzhou, Jiangsu, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America.
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America.
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
- Chinese Academy of Medical Sciences, Beijing, China.
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Abstract
This study aimed to observe the change in nonhigh-density lipoprotein cholesterol (non-HDL-C) levels and analyzed its related factors in adults with prediabetes (impaired fasting glucose and/or impaired glucose tolerance).This case-controlled study included 56 adults with normal glucose tolerance (NGT) and 74 adults with prediabetes. The cases and controls were age and gender-matched. Anthropometric measurements including height, weight, waist circumference, and blood pressure were performed. All patients underwent an oral glucose tolerance test (OGTT) after 8 hours of fasting, and the levels of glucose, insulin, lipids, and uric acid were measured.The levels of non-HDL-C (3.63 ± 0.92 vs 3.27 ± 1.00 mmol/L) were significantly higher in prediabetic subjects than in NGT subjects (P < .05). Non-HDL-C positively correlated with HOMA-IR (r = 0.253, P = .004), triglyceride (r = 0.204, P = .020), and uric acid (r = 0.487, P = .000). After multivariate analysis, uric acid continued to be significantly associated with non-HDL-C (β = 0.006, P = .000).Non-HDL-C is elevated in adults with prediabetes. A relationship between non-HDL-C and uric acid was observed.
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31
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Wu H, Meng X, Wild SH, Gasevic D, Jackson CA. Socioeconomic status and prevalence of type 2 diabetes in mainland China, Hong Kong and Taiwan: a systematic review. J Glob Health 2017; 7:011103. [PMID: 28702177 PMCID: PMC5481892 DOI: 10.7189/jogh.07.011103] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND China is estimated to have had the largest number of people with diabetes in the world in 2015, with extrapolation of existing data suggesting that this situation will continue until at least 2030. Type 2 diabetes has been reported to be more prevalent among people with low socioeconomic status (SES) in high-income countries, whereas the opposite pattern has been found in studies from low- and middle-income countries. We conducted a systematic review to describe the cross-sectional association between SES and prevalence of type 2 diabetes in Chinese in mainland China, Hong Kong and Taiwan. METHODS We conducted a systematic literature search in Medline, Embase and Global Health electronic databases for English language studies reporting prevalence or odds ratio for type 2 diabetes in a Chinese population for different SES groups measured by education, income and occupation. We appraised the quality of included studies using a modified Newcastle-Ottawa Scale. Heterogeneity of studies precluded meta-analyses, therefore we summarized study results using a narrative synthesis. RESULTS Thirty-three studies met the inclusion criteria and were included in the systematic review. The association between education, income and occupation and type 2 diabetes was reported by 27, 19 and 12 studies, respectively. Most, but not all, studies reported an inverse association between education and type 2 diabetes, with odds ratios (OR) and 95% confidence interval (CI) ranging from 0.39 (CI not reported) to 1.52 (95% CI 0.91 - 2.54) for the highest compared to the lowest education level. The association between income and type 2 diabetes was inconsistent between studies. Only a small number of studies identified a significant association between occupation and type 2 diabetes. Retired people and people working in white collar jobs were reported to have a higher risk of type 2 diabetes than other occupational groups even after adjusting for age. CONCLUSIONS This first systematic review of the association between individual SES and prevalence of type 2 diabetes in China found that low education is probably associated with an increased prevalence of type 2 diabetes, while the association between income and occupation and type 2 diabetes is unclear.
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Affiliation(s)
- Hongjiang Wu
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Xiangrui Meng
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Danijela Gasevic
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Caroline A Jackson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK
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Aghajanpour M, Nazer MR, Obeidavi Z, Akbari M, Ezati P, Kor NM. Functional foods and their role in cancer prevention and health promotion: a comprehensive review. Am J Cancer Res 2017; 7:740-769. [PMID: 28469951 PMCID: PMC5411786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 02/21/2017] [Indexed: 06/07/2023] Open
Abstract
Following cardiovascular disease, cancer is the second leading cause of death in most affluent countries. The 13.3 million new cases of cancer in 2010 were predicted to cost US$ 290 billion, but the total costs were expected to increases to US$ 458 billion in the year 2030 on basis of World Economic Forum in 2011. More than half of all cancer cases and deaths worldwide are consider being preventable. From its inception, the disease control priorities series has focused attention on delivering efficacious health interventions that can result in dramatic reductions in mortality and disability at relatively modest cost. The approach has been multidisciplinary, and the recommendations have been evidence-based, scalable, and adaptable in multiple settings. Better and more equitable health care is the shared responsibility of governments and international agencies, public and private sectors, and societies and individuals, and all of these partners have been involved in the development of the series. Functional foods are foods and food components that supply health benefits beyond basic nutrition. It's-believed these functional foods do more than simply provide nutrients because they help to maintaining health and thereby reducing the risk of disease. There are some reported evidences showing association between functional foods and cancer. For example, S-ally cysteine of garlic and lycopene from tomatoes in combination form suppressed the development of chemically induced gastric cancer by modulation of apoptosis-associated proteins (reduced Bcl-2/Bax ratio and up-regulation of Bim and caspases 8 and 3) at considerably lower intakes than when these substances were given in isolation. Similarly, vitamin D3 with genistein in combination form precipitated a growth inhibition of prostate cancer cells at much lower concentration than when these substances were provided individually. There are very few studies conducted worldwide to see the effects of functional foods on health or cancer or related states. This review, presents the complex patterns of cancer incidence and death around the world and evidence on effective and cost-effective ways to control cancers. The evaluation of cancer will indicate where cancer treatment is ineffective and wasteful, and offer alternative cancer care packages that are cost-effective and suited to low-resource settings. In the present paper, cancer prevention by functional foods is reviewed and the possible mechanisms of action are described.
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Affiliation(s)
- Mohammad Aghajanpour
- Otolaryngologist, Department of Otolaryngology Head and Neck Surgery, Lorestan University of Medical SciencesKhorramabad, Iran
| | - Mohamad Reza Nazer
- MPH, Associated Professor, Department of Infectious Diseases, Lorestan University of Medical SciencesKhorramabad, Iran
| | - Zia Obeidavi
- Medical Student, Student Research Committee, Lorestan University of Medical SciencesKhorramabad, Iran
| | - Mohsen Akbari
- Young Researchers and Elite Club, Kermanshah Branch, Islamic Azad UniversityKermanshah, Iran
| | - Parya Ezati
- Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, Urmia UniversityUrmia, Iran
| | - Nasroallah Moradi Kor
- Young Researchers and Elite Club, Kerman Branch, Islamic Azad UniversityKerman, Iran
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33
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Pang Y, Kartsonaki C, Guo Y, Bragg F, Yang L, Bian Z, Chen Y, Iona A, Millwood IY, Lv J, Yu C, Chen J, Li L, Holmes MV, Chen Z. Diabetes, plasma glucose and incidence of pancreatic cancer: A prospective study of 0.5 million Chinese adults and a meta-analysis of 22 cohort studies. Int J Cancer 2017; 140:1781-1788. [PMID: 28063165 PMCID: PMC5396360 DOI: 10.1002/ijc.30599] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/27/2016] [Accepted: 12/20/2016] [Indexed: 12/12/2022]
Abstract
Diabetes is associated with an increased risk of pancreatic cancer (PC) in Western populations. Uncertainty remains, however, about the relevance of plasma glucose for PC among people without diabetes and about the associations of diabetes and high blood glucose with PC in China where the increase in diabetes prevalence has been very recent. The prospective China Kadoorie Biobank (CKB) study recruited 512,000 adults aged 30‐79 years from 10 diverse areas of China during 2004‐2008, recording 595 PC cases during 8 years of follow‐up. Cox regression yielded adjusted hazard ratios (HRs) for PC associated with diabetes (previously diagnosed or screen‐detected) and, among those without previously diagnosed diabetes, with levels of random plasma glucose (RPG). These were further meta‐analysed with 22 published prospective studies. Overall 5.8% of CKB participants had diabetes at baseline. Diabetes was associated with almost twofold increased risk of PC (adjusted HR = 1.87, 95% CI 1.48‐2.37), with excess risk higher in those with longer duration since diagnosis (p for trend = 0.01). Among those without previously diagnosed diabetes, each 1 mmol/L higher usual RPG was associated with a HR of 1.12 (1.04‐1.21). In meta‐analysis of CKB and 22 other studies, previously diagnosed diabetes was associated with a 52% excess risk (1.52, 1.43‐1.63). Among those without diabetes, each 1 mmol/L higher blood glucose was associated with a 15% (1.15, 1.09‐1.21) excess risk. In Chinese and non‐Chinese populations, diabetes and higher blood glucose levels among those without diabetes are associated with an increased risk of PC. What's new? Diabetes is associated with increased risk of pancreatic cancer (PC) in Western populations, but uncertainty remains about the relevance of plasma glucose among people without diabetes. In this first prospective study investigating the association of diabetes with PC risk in China, where the increase in diabetes prevalence has been very recent, diabetes was associated with an almost twofold increased risk of PC, with random plasma glucose being positively associated with PC risk among participants without prior diagnosis of diabetes. In meta‐analysis, the results were consistent with previous evidence in Western populations, highlighting diabetes as a potential aetiological factor of PC.
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Affiliation(s)
- Yuanjie Pang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom
| | - Andri Iona
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom
| | - Iona Y Millwood
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom
| | - Jun Lv
- School of Public Health, Peking University, Beijing, 100191, China
| | - Canqing Yu
- School of Public Health, Peking University, Beijing, 100191, China
| | - Junshi Chen
- National Center for Food Safety Risk Assessment, Beijing, 100021, China
| | - Liming Li
- Chinese Academy of Medical Sciences, Beijing, 100730, China.,School of Public Health, Peking University, Beijing, 100191, China
| | - Michael V Holmes
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.,Medical Research Council Population Health Research Unit (MRC PHRU) at the University of Oxford, Oxford, United Kingdom
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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34
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Bragg F, Holmes MV, Iona A, Guo Y, Du H, Chen Y, Bian Z, Yang L, Herrington W, Bennett D, Turnbull I, Liu Y, Feng S, Chen J, Clarke R, Collins R, Peto R, Li L, Chen Z. Association Between Diabetes and Cause-Specific Mortality in Rural and Urban Areas of China. JAMA 2017; 317:280-289. [PMID: 28114552 PMCID: PMC6520233 DOI: 10.1001/jama.2016.19720] [Citation(s) in RCA: 316] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE In China, diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes. OBJECTIVES To assess the proportional excess mortality associated with diabetes and estimate the diabetes-related absolute excess mortality in rural and urban areas of China. DESIGN, SETTING, AND PARTICIPANTS A 7-year nationwide prospective study of 512 869 adults aged 30 to 79 years from 10 (5 rural and 5 urban) regions in China, who were recruited between June 2004 and July 2008 and were followed up until January 2014. EXPOSURES Diabetes (previously diagnosed or detected by screening) recorded at baseline. MAIN OUTCOMES AND MEASURES All-cause and cause-specific mortality, collected through established death registries. Cox regression was used to estimate adjusted mortality rate ratio (RR) comparing individuals with diabetes vs those without diabetes at baseline. RESULTS Among the 512 869 participants, the mean (SD) age was 51.5 (10.7) years, 59% (n = 302 618) were women, and 5.9% (n = 30 280) had diabetes (4.1% in rural areas, 8.1% in urban areas, 5.8% of men, 6.1% of women, 3.1% had been previously diagnosed, and 2.8% were detected by screening). During 3.64 million person-years of follow-up, there were 24 909 deaths, including 3384 among individuals with diabetes. Compared with adults without diabetes, individuals with diabetes had a significantly increased risk of all-cause mortality (1373 vs 646 deaths per 100 000; adjusted RR, 2.00 [95% CI, 1.93-2.08]), which was higher in rural areas than in urban areas (rural RR, 2.17 [95% CI, 2.07-2.29]; urban RR, 1.83 [95% CI, 1.73-1.94]). Presence of diabetes was associated with increased mortality from ischemic heart disease (3287 deaths; RR, 2.40 [95% CI, 2.19-2.63]), stroke (4444 deaths; RR, 1.98 [95% CI, 1.81-2.17]), chronic liver disease (481 deaths; RR, 2.32 [95% CI, 1.76-3.06]), infections (425 deaths; RR, 2.29 [95% CI, 1.76-2.99]), and cancer of the liver (1325 deaths; RR, 1.54 [95% CI, 1.28-1.86]), pancreas (357 deaths; RR, 1.84 [95% CI, 1.35-2.51]), female breast (217 deaths; RR, 1.84 [95% CI, 1.24-2.74]), and female reproductive system (210 deaths; RR, 1.81 [95% CI, 1.20-2.74]). For chronic kidney disease (365 deaths), the RR was higher in rural areas (18.69 [95% CI, 14.22-24.57]) than in urban areas (6.83 [95% CI, 4.73-9.88]). Among those with diabetes, 10% of all deaths (16% rural; 4% urban) were due to definite or probable diabetic ketoacidosis or coma (408 deaths). CONCLUSIONS AND RELEVANCE Among adults in China, diabetes was associated with increased mortality from a range of cardiovascular and noncardiovascular diseases. Although diabetes was more common in urban areas, it was associated with greater excess mortality in rural areas.
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Affiliation(s)
- Fiona Bragg
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael V Holmes
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford
| | - Andri Iona
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford
| | - Yu Guo
- Chinese Academy of Medical Sciences, 9 Dongdan San Tiao, Beijing 100730, China
| | - Huaidong Du
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford
| | - Zheng Bian
- Chinese Academy of Medical Sciences, 9 Dongdan San Tiao, Beijing 100730, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford
| | - William Herrington
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Derrick Bennett
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iain Turnbull
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yongmei Liu
- Qingdao CDC, 175 Shandong Road, Qingdao 266033, China
| | - Shixian Feng
- Henan Provincial CDC, 105 NongYeDong Road, Zhengzhou 450016, Henan, China
| | - Junshi Chen
- National Center for Food Safety Risk Assessment, 37 Guangqu Road, Beijing 100021, China
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard Peto
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, 9 Dongdan San Tiao, Beijing 100730, China
- School of Public Health, Peking University, Beijing 100191, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Liu F, Yang X, Li J, Cao J, Chen J, Li Y, Liu X, Zhao L, Shen C, Yu L, Huang J, Gu D. Association of fasting glucose levels with incident atherosclerotic cardiovascular disease: An 8-year follow-up study in a Chinese population. J Diabetes 2017; 9:14-23. [PMID: 26840038 DOI: 10.1111/1753-0407.12380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/28/2015] [Accepted: 01/20/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Identification of the population at high risk of developing atherosclerotic cardiovascular disease (ASCVD) is critical for its prevention. The aim of the present study was to evaluate the use of fasting blood glucose (FBG) to predict ASCVD. METHODS In all, 18 610 participants, aged 35-74 years at enrollment, were included in this prospective study. Baseline information was collected using a standardized questionnaire, physical examinations, and laboratory tests. During follow-up, disease status and vital information were updated. Cox proportional hazards regression analysis was used to estimate associations, with normal FBG (70-99 mg/dL) as the reference group. Anthropometric measurements, socioeconomic status, and conventional cardiovascular risk factors were included in the multivariate-adjusted model. RESULTS After 7.8 years follow-up (145 223 person-years), there were 519 cases of ASCVD. The multivariate-adjusted hazard ratios (HR), with 95% confidence intervals (CI), for ASCVD in patients with low FBG (<70 mg/dL), impaired fasting glucose (IFG; 100-125 mg/dL), and diabetes (≥126 mg/dL, use of antidiabetic medication and/or self-report) were 1.35 (0.84, 2.15), 1.02 (0.81, 1.27), and 1.68 (1.26, 2.23), respectively. Although IFG was associated with the development of diabetes (multivariate-adjusted HR 3.67; 95% CI 3.20, 4.21), it was only associated with incident ASCVD in the univariate model (HR 1.52; 95% CI 1.23, 1.88). The association of diabetes with coronary heart disease was more pronounced than that with stroke. Gender and residential differences were also identified. CONCLUSIONS In the present study, IFG was associated with the development of diabetes but not incident ASCVD. Prevention strategies to reduce the development of diabetes in people with IFG are critical to improve cardiovascular health.
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Affiliation(s)
- Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueli Yang
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Cao
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jichun Chen
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Li
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China
| | - Liancheng Zhao
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ling Yu
- Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China
| | - Jianfeng Huang
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongfeng Gu
- Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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36
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Bragg F, Li L, Yang L, Guo Y, Chen Y, Bian Z, Chen J, Collins R, Peto R, Wang C, Dong C, Pan R, Zhou J, Xu X, Chen Z. Risks and Population Burden of Cardiovascular Diseases Associated with Diabetes in China: A Prospective Study of 0.5 Million Adults. PLoS Med 2016; 13:e1002026. [PMID: 27379518 PMCID: PMC4933372 DOI: 10.1371/journal.pmed.1002026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/15/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In China, diabetes prevalence is rising rapidly, but little is known about the associated risks and population burden of cardiovascular diseases. We assess associations of diabetes with major cardiovascular diseases and the relevance of diabetes duration and other modifiable risk factors to these associations. METHODS AND FINDINGS A nationwide prospective study recruited 512,891 men and women aged 30-79 y between 25 June 2004 and 15 July 2008 from ten diverse localities across China. During ~7 y of follow-up, 7,353 cardiovascular deaths and 25,451 non-fatal major cardiovascular events were recorded among 488,760 participants without prior cardiovascular disease at baseline. Cox regression yielded adjusted hazard ratios (HRs) comparing disease risks in individuals with diabetes to those without. Overall, 5.4% (n = 26,335) of participants had self-reported (2.7%) or screen-detected (2.7%) diabetes. Individuals with self-reported diabetes had an adjusted HR of 2.07 (95% CI 1.90-2.26) for cardiovascular mortality. There were significant excess risks of major coronary event (2.44, 95% CI 2.18-2.73), ischaemic stroke (1.68, 95% CI 1.60-1.77), and intracerebral haemorrhage (1.24, 95% CI 1.07-1.44). Screen-detected diabetes was also associated with significant, though more modest, excess cardiovascular risks, with corresponding HRs of 1.66 (95% CI 1.51-1.83), 1.62 (95% CI 1.40-1.86), 1.48 (95% CI 1.40-1.57), and 1.17 (95% CI 1.01-1.36), respectively. Misclassification of screen-detected diabetes may have caused these risk estimates to be underestimated, whilst lack of data on lipids may have resulted in residual confounding of diabetes-associated cardiovascular disease risks. Among individuals with diabetes, cardiovascular risk increased progressively with duration of diabetes and number of other presenting modifiable cardiovascular risk factors. Assuming a causal association, diabetes now accounts for ~0.5 million (489,676, 95% CI 335,777-681,202) cardiovascular deaths annually in China. CONCLUSIONS Among Chinese adults, diabetes is associated with significantly increased risks of major cardiovascular diseases. The increasing prevalence and younger age of onset of diabetes foreshadow greater diabetes-attributable disease burden in China.
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Affiliation(s)
- Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Chinese Academy of Medical Sciences, Beijing, China
- * E-mail: (LL); (ZC)
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Richard Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Chunmei Wang
- Tongxiang Centre for Disease Control and Prevention, Zhejiang, China
| | - Caixia Dong
- Gansu Centre for Disease Control and Prevention, Gansu, China
| | - Rong Pan
- Liuzhou Centre for Disease Control and Prevention, Liuzhou, China
| | - Jinyi Zhou
- Jiangsu Centre for Disease Control and Prevention, Jiangsu, China
| | - Xin Xu
- Liuyang Centre for Disease Control and Prevention, Hunan, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail: (LL); (ZC)
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Gan W, Walters RG, Holmes MV, Bragg F, Millwood IY, Banasik K, Chen Y, Du H, Iona A, Mahajan A, Yang L, Bian Z, Guo Y, Clarke RJ, Li L, McCarthy MI, Chen Z. Evaluation of type 2 diabetes genetic risk variants in Chinese adults: findings from 93,000 individuals from the China Kadoorie Biobank. Diabetologia 2016; 59:1446-1457. [PMID: 27053236 PMCID: PMC4901105 DOI: 10.1007/s00125-016-3920-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/22/2016] [Indexed: 01/19/2023]
Abstract
AIMS/HYPOTHESIS Genome-wide association studies (GWAS) have discovered many risk variants for type 2 diabetes. However, estimates of the contributions of risk variants to type 2 diabetes predisposition are often based on highly selected case-control samples, and reliable estimates of population-level effect sizes are missing, especially in non-European populations. METHODS The individual and cumulative effects of 59 established type 2 diabetes risk loci were measured in a population-based China Kadoorie Biobank (CKB) study of 93,000 Chinese adults, including >7,100 diabetes cases. RESULTS Association signals were directionally consistent between CKB and the original discovery GWAS: of 56 variants passing quality control, 48 showed the same direction of effect (binomial test, p = 2.3 × 10(-8)). We observed a consistent overall trend towards lower risk variant effect sizes in CKB than in case-control samples of GWAS meta-analyses (mean 19-22% decrease in log odds, p ≤ 0.0048), likely to reflect correction of both 'winner's curse' and spectrum bias effects. The association with risk of diabetes of a genetic risk score, based on lead variants at 25 loci considered to act through beta cell function, demonstrated significant interactions with several measures of adiposity (BMI, waist circumference [WC], WHR and percentage body fat [PBF]; all p interaction < 1 × 10(-4)), with a greater effect being observed in leaner adults. CONCLUSIONS/INTERPRETATION Our study provides further evidence of shared genetic architecture for type 2 diabetes between Europeans and East Asians. It also indicates that even very large GWAS meta-analyses may be vulnerable to substantial inflation of effect size estimates, compared with those observed in large-scale population-based cohort studies. ACCESS TO RESEARCH MATERIALS Details of how to access China Kadoorie Biobank data and details of the data release schedule are available from www.ckbiobank.org/site/Data+Access .
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Affiliation(s)
- Wei Gan
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital Campus, Old Road, Headington, Oxford, OX3 7LJ, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Robin G Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Michael V Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Fiona Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Karina Banasik
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital Campus, Old Road, Headington, Oxford, OX3 7LJ, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Andri Iona
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Anubha Mahajan
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital Campus, Old Road, Headington, Oxford, OX3 7LJ, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, People's Republic of China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, People's Republic of China
| | - Robert J Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, People's Republic of China
- School of Public Health, Peking University Health Sciences Center, Beijing, People's Republic of China
| | - Mark I McCarthy
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital Campus, Old Road, Headington, Oxford, OX3 7LJ, UK.
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford, UK.
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
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Millwood IY, Bennett DA, Walters RG, Clarke R, Waterworth D, Johnson T, Chen Y, Yang L, Guo Y, Bian Z, Hacker A, Yeo A, Parish S, Hill MR, Chissoe S, Peto R, Cardon L, Collins R, Li L, Chen Z. A phenome-wide association study of a lipoprotein-associated phospholipase A2 loss-of-function variant in 90 000 Chinese adults. Int J Epidemiol 2016; 45:1588-1599. [PMID: 27301456 PMCID: PMC5100610 DOI: 10.1093/ije/dyw087] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 12/20/2022] Open
Abstract
Background: Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been implicated in development of atherosclerosis; however, recent randomized trials of Lp-PLA2 inhibition reported no beneficial effects on vascular diseases. In East Asians, a loss-of-function variant in the PLA2G7 gene can be used to assess the effects of genetically determined lower Lp-PLA2. Methods:PLA2G7 V279F (rs76863441) was genotyped in 91 428 individuals randomly selected from the China Kadoorie Biobank of 0.5 M participants recruited in 2004–08 from 10 regions of China, with 7 years’ follow-up. Linear regression was used to assess effects of V279F on baseline traits. Logistic regression was conducted for a range of vascular and non-vascular diseases, including 41 ICD-10 coded disease categories. Results:PLA2G7 V279F frequency was 5% overall (range 3–7% by region), and 9691 (11%) participants had at least one loss-of-function variant. V279F was not associated with baseline blood pressure, adiposity, blood glucose or lung function. V279F was not associated with major vascular events [7141 events; odds ratio (OR) = 0.98 per F variant, 95% confidence interval (CI) 0.90-1.06] or other vascular outcomes, including major coronary events (922 events; 0.96, 0.79-1.18) and stroke (5967 events; 1.00, 0.92-1.09). Individuals with V279F had lower risks of diabetes (7031 events; 0.91, 0.84-0.98) and asthma (182 events; 0.53, 0.28-0.98), but there was no association after adjustment for multiple testing. Conclusions: Lifelong lower Lp-PLA2 activity was not associated with major risks of vascular or non-vascular diseases in Chinese adults. Using functional genetic variants in large-scale prospective studies with linkage to a range of health outcomes is a valuable approach to inform drug development and repositioning.
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Affiliation(s)
- Iona Y Millwood
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Derrick A Bennett
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Robin G Walters
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Dawn Waterworth
- GlaxoSmithKline (GSK) Medicines Research Centre, GSK, Stevenage, UK, Research Triangle Park, NC, USA and King of Prussia, PA, USA
| | - Toby Johnson
- GlaxoSmithKline (GSK) Medicines Research Centre, GSK, Stevenage, UK, Research Triangle Park, NC, USA and King of Prussia, PA, USA
| | - Yiping Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China and
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China and
| | - Alex Hacker
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Astrid Yeo
- GlaxoSmithKline (GSK) Medicines Research Centre, GSK, Stevenage, UK, Research Triangle Park, NC, USA and King of Prussia, PA, USA
| | - Sarah Parish
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Michael R Hill
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Stephanie Chissoe
- GlaxoSmithKline (GSK) Medicines Research Centre, GSK, Stevenage, UK, Research Triangle Park, NC, USA and King of Prussia, PA, USA
| | - Richard Peto
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Lon Cardon
- GlaxoSmithKline (GSK) Medicines Research Centre, GSK, Stevenage, UK, Research Triangle Park, NC, USA and King of Prussia, PA, USA
| | - Rory Collins
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China and.,Department of Epidemiology & Biostatistics, Peking University Health Science Centre, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
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Liu Y, Cotillard A, Vatier C, Bastard JP, Fellahi S, Stévant M, Allatif O, Langlois C, Bieuvelet S, Brochot A, Guilbot A, Clément K, Rizkalla SW. A Dietary Supplement Containing Cinnamon, Chromium and Carnosine Decreases Fasting Plasma Glucose and Increases Lean Mass in Overweight or Obese Pre-Diabetic Subjects: A Randomized, Placebo-Controlled Trial. PLoS One 2015; 10:e0138646. [PMID: 26406981 PMCID: PMC4583280 DOI: 10.1371/journal.pone.0138646] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 08/31/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Preventing or slowing the progression of prediabetes to diabetes is a major therapeutic issue. OBJECTIVES Our aim was to evaluate the effects of 4-month treatment with a dietary supplement containing cinnamon, chromium and carnosine in moderately obese or overweight pre-diabetic subjects, the primary outcome being change in fasting plasma glucose (FPG) level. Other parameters of plasma glucose homeostasis, lipid profile, adiposity and inflammatory markers were also assessed. METHODS In a randomized, double-blind, placebo-controlled study, 62 subjects with a FPG level ranging from 5.55 to 7 mmol/L and a body mass index ≥ 25 kg/m(2), unwilling to change their dietary and physical activity habits, were allocated to receive a 4-month treatment with either 1.2 g/day of the dietary supplement or placebo. Patients were followed up until 6 months post-randomization. RESULTS Four-month treatment with the dietary supplement decreased FPG compared to placebo (-0.24 ± 0.50 vs +0.12 ± 0.59 mmol/L, respectively, p = 0.02), without detectable significant changes in HbA1c. Insulin sensitivity markers, plasma insulin, plasma lipids and inflammatory markers did not differ between the treatment groups. Although there were no significant differences in changes in body weight and energy or macronutrient intakes between the two groups, fat-free mass (%) increased with the dietary supplement compared to placebo (p = 0.02). Subjects with a higher FPG level and a milder inflammatory state at baseline benefited most from the dietary supplement. CONCLUSIONS Four-month treatment with a dietary supplement containing cinnamon, chromium and carnosine decreased FPG and increased fat-free mass in overweight or obese pre-diabetic subjects. These beneficial effects might open up new avenues in the prevention of diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT01530685.
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Affiliation(s)
- Yuejun Liu
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique—Hôpitaux de Paris, Heart and Nutrition Department, Pitié-Salpêtrière Hospital, and Human Nutrition Research Center—Ile de France, 75013, Paris, France
- INSERM, UMR S U1166, Nutriomics, 75013, Paris, France
- Sorbonne University, Pierre and Marie Curie University, Paris 06, UMR_S 1166 I, Nutriomics Team, Paris, France
| | - Aurélie Cotillard
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique—Hôpitaux de Paris, Heart and Nutrition Department, Pitié-Salpêtrière Hospital, and Human Nutrition Research Center—Ile de France, 75013, Paris, France
- INSERM, UMR S U1166, Nutriomics, 75013, Paris, France
- Sorbonne University, Pierre and Marie Curie University, Paris 06, UMR_S 1166 I, Nutriomics Team, Paris, France
| | - Camille Vatier
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique—Hôpitaux de Paris, Heart and Nutrition Department, Pitié-Salpêtrière Hospital, and Human Nutrition Research Center—Ile de France, 75013, Paris, France
- INSERM, UMR S U1166, Nutriomics, 75013, Paris, France
| | - Jean-Philippe Bastard
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique—Hôpitaux de Paris, Heart and Nutrition Department, Pitié-Salpêtrière Hospital, and Human Nutrition Research Center—Ile de France, 75013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Biochemistry and Hormonology Department, Tenon Hospital, 75970, Paris, France
| | - Soraya Fellahi
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique—Hôpitaux de Paris, Heart and Nutrition Department, Pitié-Salpêtrière Hospital, and Human Nutrition Research Center—Ile de France, 75013, Paris, France
- Assistance Publique-Hôpitaux de Paris, Biochemistry and Hormonology Department, Tenon Hospital, 75970, Paris, France
| | | | - Omran Allatif
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique—Hôpitaux de Paris, Heart and Nutrition Department, Pitié-Salpêtrière Hospital, and Human Nutrition Research Center—Ile de France, 75013, Paris, France
- INSERM, UMR S U1166, Nutriomics, 75013, Paris, France
| | | | | | | | | | - Karine Clément
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique—Hôpitaux de Paris, Heart and Nutrition Department, Pitié-Salpêtrière Hospital, and Human Nutrition Research Center—Ile de France, 75013, Paris, France
- INSERM, UMR S U1166, Nutriomics, 75013, Paris, France
- Sorbonne University, Pierre and Marie Curie University, Paris 06, UMR_S 1166 I, Nutriomics Team, Paris, France
| | - Salwa W. Rizkalla
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique—Hôpitaux de Paris, Heart and Nutrition Department, Pitié-Salpêtrière Hospital, and Human Nutrition Research Center—Ile de France, 75013, Paris, France
- INSERM, UMR S U1166, Nutriomics, 75013, Paris, France
- Sorbonne University, Pierre and Marie Curie University, Paris 06, UMR_S 1166 I, Nutriomics Team, Paris, France
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Ciampolini M. Conditioned Intake and Fattening/Diabetes. OPEN JOURNAL OF PREVENTIVE MEDICINE 2015; 05:468-478. [DOI: 10.4236/ojpm.2015.512053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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41
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Contractor A, Sarkar BK, Arora M, Saluja K. Addressing Cardiovascular Disease Burden in low and Middle Income Countries (LMICs). CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0405-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bragg F, Li L, Smith M, Guo Y, Chen Y, Millwood I, Bian Z, Walters R, Chen J, Yang L, Collins R, Peto R, Lu Y, Yu B, Xie X, Lei Y, Luo G, Chen Z. Associations of blood glucose and prevalent diabetes with risk of cardiovascular disease in 500 000 adult Chinese: the China Kadoorie Biobank. Diabet Med 2014; 31:540-51. [PMID: 24344928 PMCID: PMC4114560 DOI: 10.1111/dme.12392] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/04/2013] [Accepted: 12/12/2013] [Indexed: 12/14/2022]
Abstract
AIMS To examine the relationship of self-reported diabetes, and of random blood glucose levels among individuals without known diabetes, with the prevalence of cardiovascular disease in Chinese adults. METHODS We examined cross-sectional data from the China Kadoorie Biobank of 0.5 million people aged 30-79 years recruited from 10 diverse regions of China in the period 2004-2008. Logistic regression was used to estimate the odds ratios of prevalent cardiovascular disease associated with self-reported diabetes, and with measured random blood glucose levels among participants with no history of diabetes, adjusting simultaneously for age, sex, area, education, smoking, alcohol, blood pressure and physical activity. RESULTS A total of 3.2% of participants had self-reported diabetes (men 2.9%; women 3.3%) and 2.8% had screen-detected diabetes (men 2.6%; women 2.8%), i.e. they had no self-reported history of diabetes but a blood glucose level suggestive of a diagnosis of diabetes. Compared with individuals without a history of diabetes, the odds ratios associated with self-reported diabetes were 2.18 (95% CI 2.06-2.30) and 1.88 (95% CI 1.75-2.01) for prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively. Among participants without self-reported diabetes there was a positive association between random blood glucose and ischaemic heart disease and stroke/transient ischaemic attack prevalence (P for trend <0.0001). Below the diabetic threshold (<11.1 mmol/l) each additional 1 mmol/l of random blood glucose was associated with 4% (95% CI 2-5%) and 5% (95% CI 3-7%) higher odds of prevalent ischaemic heart disease and stroke/transient ischaemic attack, respectively. CONCLUSIONS In this adult Chinese population, self-reported diabetes was associated with a doubling of the odds of prevalent cardiovascular disease. Below the threshold for diabetes there was still a modest, positive association between random blood glucose and prevalent cardiovascular disease.
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Affiliation(s)
- F. Bragg
- Clinical Trial Service Unit and Epidemiological Studies Unit
(CTSU) Nuffield Department of Population Health University of OxfordUK
| | - L. Li
- Department of Public Health Beijing UniversityBeijing China
- Correspondence to: Zhengming Chen.
E‐mail: or Liming Li. E‐mail:
| | - M. Smith
- Clinical Trial Service Unit and Epidemiological Studies Unit
(CTSU) Nuffield Department of Population Health University of OxfordUK
| | - Y. Guo
- Chinese Academy of Medical Sciences Beijing China
| | - Y. Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit
(CTSU) Nuffield Department of Population Health University of OxfordUK
| | - I. Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit
(CTSU) Nuffield Department of Population Health University of OxfordUK
| | - Z. Bian
- Chinese Academy of Medical Sciences Beijing China
| | - R. Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit
(CTSU) Nuffield Department of Population Health University of OxfordUK
| | - J. Chen
- China National Center for Food Safety Risk
Assessment Beijing China
| | - L. Yang
- Clinical Trial Service Unit and Epidemiological Studies Unit
(CTSU) Nuffield Department of Population Health University of OxfordUK
| | - R. Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit
(CTSU) Nuffield Department of Population Health University of OxfordUK
| | - R. Peto
- Clinical Trial Service Unit and Epidemiological Studies Unit
(CTSU) Nuffield Department of Population Health University of OxfordUK
| | - Y. Lu
- Suzhou Centre for Disease Control and
Prevention Suzhou China
| | - B. Yu
- Nangang Centre for Disease Control and
Prevention Harbin China
| | - X. Xie
- Liuyang Centre for Disease Control and
Prevention Liuyang China
| | - Y. Lei
- Maiji Centre for Disease Control and Prevention Tianshui China
| | - G. Luo
- Pengzhou Centre for Disease Control and
Prevention Pengzhou China
| | - Z. Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit
(CTSU) Nuffield Department of Population Health University of OxfordUK
- Correspondence to: Zhengming Chen.
E‐mail: or Liming Li. E‐mail:
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