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Zhou Y.,Pudong New Area Center for Disease Control and Prevention | Echouffo-Tcheugui J.B.,Emory University | Gu J.-J.,Health Bureau of Shanghai Pudong New Area | Ruan X.-N.,Pudong New Area Center for Disease Control and Prevention | And 7 more authors.
BMC Nephrology

Background: Few population-based studies have examined the relationship between glycemic status and chronic kidney disease (CKD) in China. We examined the prevalence of CKD across categories of glycemia [diagnosed diabetes, undiagnosed diabetes (fasting plasma glucose [FPG] ≥ 126 mg/dL), prediabetes (FPG 100-126 mg/dL) and normal glycemia (FPG <100 mg/dL)] among Chinese adults and assessed the relative contribution of dysglycemia (prediabetes and/or diabetes) to the burden of CKD. Methods. 5,584 Chinese adults aged 20-79 years were selected from the Pudong New Area of Shanghai through a multistage random sampling. Demographic and lifestyle characteristics, anthropometry and blood pressure were measured. Biochemical assays included FPG, serum creatinine and lipids, urinary creatinine and albumin. Prevalence of albuminuria [urine albumin-to-creatinine ratio (ACR) ≥ 30 mg/g], decreased kidney function and CKD (either decreased kidney function or albuminuria) across levels of glycemia were estimated. Results: The prevalence of albuminuria, decreased kidney function and CKD each increased with higher glycemic levels (P < 0.001). Based on the MDRD Study equation, the unadjusted CKD prevalence was 30.9%, 28.5%, 14.1% and 9.2% in those with diagnosed diabetes, undiagnosed diabetes, prediabetes and normoglycemia, respectively. The corresponding age-, gender- and hypertension-adjusted CKD prevalence were 25.8%, 25.0%, 12.3% and 9.1%, respectively. In a multivariable analysis, the factors associated with CKD were hypertension (Odds ratio [OR] 1.70, 95% confidence interval [CI]: 1.42-2.03), dysglycemia (OR 1.65, 95% CI: 1.39-1.95), female gender (OR 1.48, 95% CI: 1.25-1.75), higher triglycerides (OR 1.14, 95% CI: 1.08-1.20 per mmol/L), higher body mass index (OR 1.08, 95% CI: 1.05-1.10 per kg/m2), and older age (OR 1.02, 95% CI: 1.01 -1.03 per year). The population attributable risks (PARs) associated with diabetes, prediabetes, dysglycemia (diabetes and prediabetes) and hypertension were 18.4%, 19.7%, 30.3% and 44.5% for CKD as defined by the MDRD study equation, and 15.8%, 24.4%, 29.2% and 10.0% with the CKD-EPI equation. Estimates of prevalence and ORs of the relative contribution of various risk factors to CKD obtained with the CKD-EPI equation were similar. Conclusions: As much as 30% of the CKD burden may be associated with dysglycemia among Chinese adults, independent of age, gender and hypertension status. Prevention and control of diabetes and prediabetes should be a high priority in reducing the CKD burden in China. © 2013 Zhou et al.; licensee BioMed Central Ltd. Source

Wu H.-Y.,Centers for Disease Control and Prevention | Zhu Q.-L.,Fudan University | Gu J.-J.,Health Bureau of Shanghai Pudong New Area | Ruan X.-N.,Centers for Disease Control and Prevention | And 10 more authors.
Fudan University Journal of Medical Sciences

Objective To evaluate the relationship between anthropometric indices and measured blood pressures in the residents of Pudong New Area of Shanghai, and to compare the predictive values of the indices in the presence of hypertension in the population. Methods A total of 5 927 eligible residents above 15 years old were selected through a three-stage sampling and interviewed between April and July, 2008. Body height, weight, waist circumference (WC) hip circumference, systolic blood pressure (SBP) and diastolic blood pressures (DBP) were measured at the interview. Data analysis was conducted by SAS 9. 1 and Stata 10.0 software. Receiver operating characteristics (ROC) analysis was applied to estimate the precision of body mass index (BMI), WC, waist to hip circumference ratio (WHR) and waist to height ratio (WHtR) in predicting the presence of hypertension. Results In this sample population, 30.25% subjects were diagnosed with hypertension. The prevalence was slightly higher in the males than in the females and significantly higher in the elder groups (P<0.000 1). Except for the males under 20 years old, the prevalence was observed to increase along with the increasement of BMI, WC, WHR and WHtR (P<0.05), and a significant positive correlation was observed for measured SBP and DBP with these anthropometric indices (P<0.000 1). The subjects with hypertension had higher BMI, WC, WHR and WHtR than normotensive pepole (P<0.000 1). The associations between the indices and hypertension varied across age and sex groups, with odds ratios (ORs) for each 10% increase of the indices ranging from 1. 13 to 1. 46. The associations were observed more pronounced in the younger groups, with P values for the interaction tests between age and the indices less than 0.05. None of the 4 anthropometric indices performed well in predicting the presence of hypertension. The highest area under the ROC curve (AUC) was observed for WHtR (0.701 1 in male and 0.723 9 in female), whereas the lowest (AUC) was obtained for WHR (0.652 0 in male and 0.670 1 in female). Although the best anthropometric index was different in different sex and age groups, WHtR performed better than WC and WHR consistently. Conclusions Age, sex, BMI, WC, WHR and WHtR are closely related with measured BP and the presence of hypertension. However, the anthropometric indices may not function as good predictors of hypertension. Selection of anthropometric indices in screening highrisk individuals for hypertension in the communities should take individual age and sex into consideration simultaneously. Source

Gu J.J.,Health Bureau of Shanghai Pudong New Area | Rafalson L.,DYouville College | Zhao G.M.,Fudan University | Wu H.Y.,Centers for Disease Control and Prevention | And 10 more authors.
Experimental and Clinical Endocrinology and Diabetes

Background: Numerous studies have demonstrated the ability of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) to predict the risk of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). This study aimed to evaluate the predictive value of these anthropometries for metabolic abnormalities and related diseases in Chinese adults. Material & Methods: A cross-sectional study was conducted in 2477 men and 3107 women at 2079 years old who were randomly selected from Pudong New Area of Shanghai, China, through a multistage sampling process. Anthropometric variables and blood pressure were measured according to a standardized protocol, and a fasting blood sample was collected from each subject for biochemical analysis. Results: Prevalence of the metabolic syndrome was observed to increase with increasing BMI, WC, WHR and WHtR in both sexes. Participants with any metabolic abnormality had a higher body size than those without. The associations of anthropometries with each metabolic factor were significant and equal for BMI, WC, WHR and WHtR. Areas under the receiver operating characteristic curves (AUC) ranged from 0.59 to 0.72 across the 4 anthropometries in predicting individual and clusters of metabolic factors. However, none of the 4 anthropometries identified newly-diagnosed T2DM or hypertension with a high sensitivity or specificity. Conclusion: Our findings suggest that the independent use of BMI, WC, WHR, or WHtR may not be an effective tool to predict metabolic factors and related chronic diseases in Chinese adults. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York. Source

Xu W.-H.,Fudan University | Ruan X.-N.,Centers for Disease Control and Prevention | Fu X.-J.,Health Bureau of Shanghai Pudong New Area | Zhu Q.-L.,Fudan University | And 10 more authors.
BMC Public Health

Background. The prevalence of metabolic syndrome (MS) has been increasing in China in recent years. The aim of this study is to estimate and compare the prevalence of MS among Chinese adults in Shanghai, one of the most economic developed areas in China, using definitions proposed by World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel (modified ATP III) and International Diabetes Federation (IDF). Methods. This cross-sectional study included 5,584 adults at age 20-79 randomly selected from Pudong New Area of Shanghai, China, through a three-stage sampling. All participants were interviewed in-person between April and July of 2008 to collect information on demographic and lifestyle characteristics. At the interview, anthropometry and blood pressure were measured and bio-specimens were collected. Results. The prevalence estimates for the MS increased with age for each definition in men and women, but the estimates varied greatly between the definitions and by sex. The prevalence of the MS was higher in men (20.2%) than in women (18.7%) using WHO definition but this sex difference was reversed when using the modified ATP III (28.4% for men vs. 35.1% for women) and the IDF (15.9% for men vs. 26.7% for women) criteria. The most common metabolic disorder in this population was dyslipidaemia, regardless of the definition used. Substantial agreement, estimated using the kappa statistic, was found between the modified ATP III and IDF definition, whereas the lowest agreement was observed between the WHO and ATP III criteria. Conclusions. The MS is highly prevalent among Chinese adults in Pudong New Area of Shanghai and the most prevalent component was dyslipidemia. These findings underscore the importance of prevention and control efforts for the MS in this area and the need for a unified predictive definition for the syndrome for use by clinical practitioners and public health agencies. © 2010 Xu et al; licensee BioMed Central Ltd. Source

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