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Bahrampour A, Haji-Maghsoudi S. Factors affecting Hemoglobin A1c in the longitudinal study of the Iranian population using mixed quantile regression. Sci Rep 2023; 13:9565. [PMID: 37308493 DOI: 10.1038/s41598-023-36481-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023] Open
Abstract
Diabetes, a major non-communicable disease, presents challenges for healthcare systems worldwide. Traditional regression models focus on mean effects, but factors can impact the entire distribution of responses over time. Linear mixed quantile regression models (LQMMs) address this issue. A study involving 2791 diabetic patients in Iran explored the relationship between Hemoglobin A1c (HbA1c) levels and factors such as age, sex, body mass index (BMI), disease duration, cholesterol, triglycerides, ischemic heart disease, and treatments (insulin, oral anti-diabetic drugs, and combination). LQMM analysis examined the association between HbA1c and the explanatory variables. Associations between cholesterol, triglycerides, ischemic heart disease (IHD), insulin, oral anti-diabetic drugs (OADs), a combination of OADs and insulin, and HbA1c levels exhibited varying degrees of correlation across all quantiles (p < 0.05), demonstrating a positive effect. While BMI did not display significant effects in the lower quantiles (p > 0.05), it was found to be significant in the higher quantiles (p < 0.05). The impact of disease duration differed between the low and high quantiles (specifically at the quantiles of 5, 50, and 75; p < 0.05). Age was discovered to have an association with HbA1c in the higher quantiles (specifically at the quantiles of 50, 75, and 95; p < 0.05). The findings reveal important associations and shed light on how these relationships may vary across different quantiles and over time. These insights can serve as guidance for devising effective strategies to manage and monitor HbA1c levels.
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Affiliation(s)
- Abbas Bahrampour
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Biostatistics and Epidemiology, School of Health, Kerman University of Medical Sciences, Kerman, Iran
- Griffith University, Brisbane, QLD, Australia
| | - Saiedeh Haji-Maghsoudi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Biostatistics and Epidemiology, School of Health, Kerman University of Medical Sciences, Kerman, Iran.
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Tang N, Wu Y, Chen Y, Chen Q, Wu W, Jing J, Cai L. Association between postpartum low-carbohydrate-diet scores and glucose levels in Chinese women. Nutrition 2021; 89:111305. [PMID: 34166894 DOI: 10.1016/j.nut.2021.111305] [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: 12/14/2020] [Revised: 03/22/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Views on the relationship between a low-carbohydrate diet (LCD) and glucose levels are controversial, and no study, to our knowledge, has examined this association in postpartum women. We aimed to explore the association between postpartum LCD scores and glucose levels. METHODS We included 500 postpartum women from a prospective cohort study in Guangzhou, China, during 2017 and 2018. Dietary information during the first month after delivery was assessed via a validated food frequency questionnaire. The overall, animal, and plant LCD scores were determined based on percentages of energy from carbohydrate, protein, and fat. Higher scores reflected higher intakes of fat and protein and lower intakes of carbohydrate. At 6 to 8 wk postpartum, women with previous gestational diabetes mellitus underwent oral glucose tolerance tests (n = 104), and the others had fasting plasma glucose (FPG) tests (n = 396). Multivariable linear, quantile, and logistic regressions were conducted. RESULTS Of the 500 participants, 71 (14.20%) developed impaired fasting glucose. Animal LCD score was positively associated with FPG levels (β = 0.007, P = 0.017), but quantile regression showed that LCD scores were related to FPG only in women with lower FPG levels; they had no significant association in those with higher FPG levels. No significant interaction effect on FPG was found between LCD scores and history of gestational diabetes mellitus (Pinteraction > 0.40). Furthermore, the relationships between the three LCD scores and risk of developing impaired fasting glucose were not statistically significant. CONCLUSIONS Animal LCD score during puerperium may be positively associated with FPG levels in the early postpartum period in Chinese women, but no interactions with history of gestational diabetes mellitus were observed. Stronger associations were observed in women with lower FPG levels.
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Affiliation(s)
- Nu Tang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yang Wu
- Department of Sociology, Jiangxi University of Finance and Economics, Nanchang, China; Center for Asian & Pacific Economic & Social Development, Jiangxi University of Finance and Economics, Nanchang, China
| | - Yajun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qian Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weijia Wu
- Department of Scientific Research, Hainan Women and Children's Medical Center, Haikou, China
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Cai
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China.
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Amir A, Hassan M, Alvi S, Mueed A, Idrees S, Ashraf J, Haleem F, Ali Khan M. Frequency and Characteristics of Metabolic Syndrome in Patients With Ischemic Stroke Admitted to a Tertiary Care Hospital in Karachi. Cureus 2020; 12:e9004. [PMID: 32775084 PMCID: PMC7402533 DOI: 10.7759/cureus.9004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Metabolic syndrome (MetS) is defined as a syndrome of truncal obesity, insulin resistance, hypertension, hypertriglyceridemia, and dyslipidemia. It is well known that MetS increases the risk of cardiovascular disease and adverse events. Each of its components is associated with an increased risk of cardiovascular disease, but data on the association with ischemic stroke are scarce. At the international level, a significant body of research has been conducted on this issue, but the situation is very different in Pakistan. Very little data are present on the subject matter. This study is an endeavor in this direction, generating data, that can be used in early identification and developing treatment services for patients with ischemic stroke having MetS. Aims To determine the frequency of MetS in ischemic stroke patients admitted to a tertiary care hospital in Karachi, Pakistan. Methods This six-month observational and cross-sectional study was conducted at Medical Unit I, Jinnah Postgraduate Medical Centre from July 1, 2019, to December 31, 2019. Patients with a diagnosis of acute ischemic stroke were enrolled. Detailed history, physical examination, and biochemical measurements were noted. The presence of MetS was defined in accordance with the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III)/American Heart Association (AHA) guidelines. Results A total of 224 patients fulfilling the inclusion criteria were inducted into this study. The mean age of presentation was 61.04 ± 14.72 years, and more than two-thirds of the patients were ≥60 years of age. A total of 150 (66.96%) patients with ischemic stroke also had MetS. The male-to-female ratio in this group was 2:1. The most common variables constituting the MetS were truncal obesity, hypertension, and dyslipidemia. The median MetS score was 3. Conclusions MetS is highly prevalent in patients presenting with ischemic stroke irrespective of age or gender. The three most deranged and common components of MetS in these patients are truncal obesity, hypertension, and dyslipidemia.
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Affiliation(s)
- Anum Amir
- Internal Medicine, Civil Hospital, Karachi, PAK
| | - Mujtaba Hassan
- Critical Care, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Souhaib Alvi
- Medicine, Abbassi Shaheed Hospital, Karachi, PAK
| | - Abdul Mueed
- Cardiac Electrocardiography, National Institute of Cardiovascular Diseases, Karachi, PAK
| | | | - Jibran Ashraf
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Farhan Haleem
- Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - M Ali Khan
- Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Mengzi S, Min W, Chong S, Pingping Z, Yaogai L, Liyuan P, Shuo L, Yan Y, Lina J. The cut-off value of impaired fasting glucose should be lower: Based on the associations of fasting blood glucose with blood lipids. Prim Care Diabetes 2020; 14:147-153. [PMID: 31405610 DOI: 10.1016/j.pcd.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 07/05/2019] [Accepted: 07/16/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The previous study served impaired fasting glucose (IFG), a pre-diabetic state which was much greater than that of diabetic patients, have reached no consensus on its cut-off value. In this study, we aimed to explore the cut-off value of IFG via the associations of blood lipids with fasting plasma glucose (FPG). DESIGN A cross-sectional study in Jilin province, China, 2012. SAMPLE 13,093 participants aged 18-79 years in Jilin province were involved in the study. The Lamba-Mu-Sigma (LMS) method and generalized additive model (GAM) were used to explore the associations of different levels of FPG and blood lipids. RESULTS The distributions of FPG, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-c) were significantly different by gender (p<0.01). In general, both LMS and GAM results showed that the TG and HDL-c curves had a steeper tendency when the FPG was greater than 6.0mmol/L. CONCLUSION FPG was positively associated with TG while negatively associated with HDL-c, and the associations were stronger in females. The cut-off value of IFG was suggested to be 6.0mmol/L.
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Affiliation(s)
- Sun Mengzi
- Epidemiology and Biostatistics, School of Public Health, NO. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021 China
| | - Wang Min
- Epidemiology and Biostatistics, School of Public Health, NO. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021 China
| | - Sun Chong
- Epidemiology and Biostatistics, School of Public Health, NO. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021 China
| | - Zheng Pingping
- Epidemiology and Biostatistics, School of Public Health, NO. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021 China
| | - Lv Yaogai
- Epidemiology and Biostatistics, School of Public Health, NO. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021 China
| | - Pu Liyuan
- Epidemiology and Biostatistics, School of Public Health, NO. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021 China
| | - Li Shuo
- Epidemiology and Biostatistics, School of Public Health, NO. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021 China
| | - Yao Yan
- Epidemiology and Biostatistics, School of Public Health, NO. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021 China.
| | - Jin Lina
- Epidemiology and Biostatistics, School of Public Health, NO. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021 China.
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Duan Y, Sun H, Yao Y, Meng Y, Li Y. Distribution of novel and legacy per-/polyfluoroalkyl substances in serum and its associations with two glycemic biomarkers among Chinese adult men and women with normal blood glucose levels. ENVIRONMENT INTERNATIONAL 2020; 134:105295. [PMID: 31726357 DOI: 10.1016/j.envint.2019.105295] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/06/2019] [Accepted: 10/28/2019] [Indexed: 05/23/2023]
Abstract
In recent years, the occurrence of novel per-/polyfluoroalkyl substances (PFASs) such as polyfluoroalkyl ether sulfonates (PFAESs) in human samples have aroused attention due to the change in PFASs production profile, however, the data are still lacking. Furthermore, epidemiological studies have examined the associations of PFAS exposure with glucose homeostasis, but with inconsistent results. Therefore, in this study, fasting serum samples from 252 participants with an age range from 19 to 87 years old were collected in Tianjin, China. A total of 21 target PFASs were determined to analyze the levels and distribution of novel and legacy PFASs in serum and to further evaluate the cross-sectional associations of serum PFAS concentrations with two glycemic biomarkers (i.e., fasting glucose and glycated hemoglobin (HbA1c)). 6:2 chlorinated PFAES (6:2 Cl-PFAES) and trifluoroacetic acid (TFA) were widely detected novel PFASs (greater than90%) with relatively high median concentrations (8.64 ng/mL and 8.46 ng/mL, respectively), which were second only to the two dominant legacy PFASs, i.e., perfluorooctanoic acid (PFOA, 14.83 ng/mL) and perfluorooctane sulfonic acid (14.24 ng/mL). The percentage contributions to the total known PFASs were separately 17.6% and 17.2% for 6:2 Cl-PFAES and TFA. The levels of 6:2 Cl-PFAES were significantly correlated with age and BMI, and the concentrations of TFA were also significantly correlated with age. Furthermore, 1% increase in serum PFOA and perfluorononanoic acid (PFNA) was separately significantly associated with 0.018% [95% confidence interval (CI): 0.004%, 0.033%] and 0.022% (95% CI: 0.007%, 0.037%) increment in fasting glucose levels. Similarly, 1% increase in serum perfluorohexanoic acid, PFNA, and perfluorohexane sulfonic acid was significantly associated with 0.030% (95% CI: 0.010%, 0.051%), 0.018% (95% CI: 0.003%, 0.033%), 0.007% (95% CI: 0.003%, 0.011%) increment in HbA1c levels, respectively. These findings suggested that 6:2 Cl-PFAES and TFA showed greater contributions to PFASs in serum and supported an association of exposure to PFASs with fasting glucose and HbA1c.
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Affiliation(s)
- Yishuang Duan
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China; Institute of Environment and Health, Jianghan University, Wuhan, China
| | - Hongwen Sun
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China.
| | - Yiming Yao
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China
| | - Yue Meng
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China
| | - Yongcheng Li
- Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, College of Environmental Science and Engineering, Nankai University, Tianjin, China
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The Influencing Factors of Serum Lipids among Middle-aged Women in Northeast China. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:1660-1666. [PMID: 30581781 PMCID: PMC6294850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dyslipidemia is a common and serious health problem, especially in middle-aged women. We aimed to reveal quantile-specific associations of serum lipids [triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c) and high density lipoprotein cholesterol (HDL-c)] with influencing factors in middle-aged women. METHODS A sample of 5635 participants were enrolled from Jilin, China, in 2012. Quantile regression (QR) model was performed to identify factors which influenced serum lipids in different quantiles. RESULTS The influencing factors of TG, TC, LDL-c and HDL-c were different. Waist circumference (WC), menopause, smoking, diabetes and hypertension were positively associated with TG in almost all quantiles; Menopause and age were positively associated with TC in almost all quantiles. WC, living in urban areas and alcohol consumption were positively associated with TC in low and middle quantiles, diabetes was positively associated with TC from P50 to P95. The result of LDL-c was similar to TC; BMI was negatively associated with HDL-c from P50 to P90. WC and diabetes were negatively associated with HDL-c from P5 to P90. CONCLUSION Among middle-aged women, menopause, diabetes and WC were the main factors affecting the serum lipids. Postmenopausal women would get more risk in increasing the level of serum lipids.
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