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Hou X.G.,Shandong University | Wang C.,Shandong University | Ma Z.Q.,China National Heavy Duty Truck Group Corporation Hospital | Yang W.F.,Jining Lukang Hospital | And 28 more authors.
Biomedical and Environmental Sciences | Year: 2014

Objective To study the optimal waist circumference (WC) cut-off values for identifying metabolic risk factors in middle-aged and elderly subjects in Shandong Province of China. Methods A total of 2 873 men and 5 559 women were included in this cross-sectional study. Metabolic syndrome (MetS) was diagnosed according to the definition of Chinese Diabetes Society in 2004. The relation between WC and MetS was analyzed by multivariate logistic regression analysis. The optimal WC cut-off values were identified using the area under the ROC curve and the different diagnostic criteria for central obesity were compared. Results The WC was the risk factor for MetS independent of BMI, blood glucose, blood lipid, and blood pressure. The optimal WC cut-off value was 83.8 cm and 91.1 cm for identifying MetS in women and men, respectively. Compared with 80 cm and 85 cm for women and men, 85 cm and 90 cm had a higher Youden index for identifying all metabolic risk factors and MetS in women and men. Conclusion The appropriate WC cut-off value is 85 cm and 90 cm for identifying central obesity and MetS in women and men in Shandong Province of China. © 2014 The Editorial Board of Biomedical and Environmental Sciences.


Sun Y.,Shandong University | Li W.J.,Shandong University | Hou X.G.,Shandong University | Wang C.,Shandong University | And 27 more authors.
Chinese Medical Journal | Year: 2014

Background Insulin resistance (IR) plays an important pathophysiological role in the development of diabetes, dyslipidemia, hypertension, and cardiovascular disease. Moreover, IR can occur even in non-obese people without diabetes. However, direct detection of IR is complicated. In order to find a simple surrogate marker of IR early in nonobese people, we investigate the association of commonly-used biochemical markers (liver enzymes and lipid profiles) with IR in urban middle-aged and older non-obese Chinese without diabetes. Methods This cross-sectional study included 1 987 subjects (1 473 women). Fasting blood samples were collected for measurement of glucose, insulin, liver enzymes, lipid profiles and creatinine. Subjects whose homeostasis model of assessment-IR (HOMA-IR) index values exceeded the 75th percentile (2.67 for women and 2.48 for men) of the population were considered to have IR. The area under the receiver operating characteristic curve (ROC) was used to compare the power of potential markers in identifying IR. Results Triglycerides (TG) and ratio of TG to high-density lipoprotein cholesterol (TG/HDL-C) discriminated IR better than other indexes for both sexes; areas under the receiver operating characteristic (ROC) curves (AUC) values were 0.770 (95% confidence interval 0.733-0.807) and 0.772 (0.736-0.809), respectively, for women and 0.754 (0.664-0.844) and 0.756 (0.672-0.840), respectively, for men. To identify IR, the optimal cut-offs for TG and TG/HDL-C ratio were 1.315 mmol/L (sensitivity 74.3%, specificity 71.0%) and 0.873 (sensitivity 70.1%, specificity 73.4%), respectively, for women, and 1.275 mmol/L (sensitivity 66.7%, specificity 74.4%) and 0.812 (sensitivity 75.8%, specificity 69.2%), respectively, for men. Conclusion TG and TG/HDL-C ratio could be used to identify IR in urban middle-aged and older non-obese Chinese without diabetes.


Wang C.,Shandong University | Liang K.,Shandong University | Zhang X.,Shantui Community Health Center | Li C.,Second Peoples Hospital of Jining | And 18 more authors.
International Urology and Nephrology | Year: 2014

Background The role of obesity as a determinant of kidney dysfunction has not reached an agreement and the underlying reason may be due to the heterogeneity of obese phenotypes. The aim of the study was to explore the associations of different obese phenotypes with the change of estimated glomerular filtration rate (eGFR) and the roles of obesity and metabolic abnormalities in this association. Methods eGFR was calculated in 8,586 participants (≥40 years old). eGFR 60-90 mL/min/1.73 m2 was defined as the mildly reduced eGFR. Multiple logistic regression analysis was used to determine odds ratios (ORs) for mildly reduced eGFR in the metabolically healthy obese (MHO), metabolically abnormal non-obese (MANO) and metabolically abnormal obese (MAO) groups, using the metabolically healthy non-obese (MHNO) subjects as the reference group. Meanwhile, the associations of body mass index (BMI), waist circumference (WC) and metabolic abnormalities (including hypertension, hyperglycemia and dyslipidemia) with the risk of mildly reduced eGFR were also investigated. Results The proportion of MHNO, MHO, MANO and MAO subjects was 8.3, 17.1, 10.1 and 64.5 %, respectively. Increased ORs were observed in MANO (OR 1.51, P = 0.014) and MAO (OR 1.47, P = 0.015) groups, after adjusting for age, gender, smoking, drinking, BMI and WC. When further adjusting for metabolic abnormalities, MANO (OR 1.24, P = 0.247) and MAO (OR 1.17, P = 0.366) subjects would not present increased risk of mildly reduced eGFR any more. Oppositely, fasting insulin (OR 1.03, P < 0.001), hyperglycemia (OR 1.25, P = 0.002) and dyslipidemia (OR 1.25, P = 0.002), but not hypertension, BMI and WC, significantly increased the risk of mildly reduced eGFR. Conclusions Metabolic abnormalities, but not simple obesity, may contribute to the mildly reduced eGFR in middle-aged and elderly Chinese. © 2014 Springer Science+Business Media Dordrecht.


Hou X.,Shandong University | Wang C.,Shandong University | Zhang X.,Shantui Community Health Center | Zhao X.,Shantui Community Health Center | And 26 more authors.
PloS one | Year: 2014

OBJECTIVE: To investigate the relationship between lipid profiles [including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C)] and a mild decline in the estimated glomerular filtration rate (eGFR) in subjects with normal serum lipid levels.DESIGN AND METHODS: In this study, we included 2647 participants who were ≥ 40 years old and had normal serum lipid levels. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the GFR. A mildly reduced eGFR was defined as 60-90 mL/min/1.73 m(2). First, multiple linear regression analysis was used to estimate the association of lipid profiles with the eGFR. Then, the levels of each lipid component were divided into four groups, using the 25th, 50th and 75th percentiles as cut-off points. Finally, multiple logistic regression analysis was used to investigate the association of different lipid components with the risk of mildly reduced eGFR.RESULTS: In the group with a mildly reduced eGFR, TG and LDL-C levels were significantly increased, but HDL-C levels were significantly decreased. After adjusting for age, gender, body mass index (BMI), systolic blood pressure (SBP), glycated hemoglobin (HbA1c), smoking and drinking, only TC and TG were independently related to the eGFR. Additionally, only TG showed a linear relationship with an increased risk of a mildly reduced eGFR, with the highest quartile group (TG: 108-150 mg/dl [1.22-1.70 mmol/L]) having a significantly increased risk after adjusting for the above factors.CONCLUSIONS: Triglyceride levels are closely associated with a mildly reduced eGFR in subjects with normal serum lipid levels. Dyslipidemia with lower TG levels could be used as new diagnostic criteria for subjects with mildly reduced renal function.


Wang C.,Shandong University | Song J.,Shandong University | Ma Z.,China National Heavy Duty Truck Group Corporation Hospital | Yang W.,Lukang Hospital of Jining | And 17 more authors.
PLoS ONE | Year: 2014

Objective: To investigate how the glucose variability between fasting and a 2-h postload glucose state (2-h postload plasma glucose [2hPG]-fasting plasma glucose [FPG]) is associated with chronic kidney disease (CKD) in middle-aged and elderly Chinese patients previously diagnosed with type 2 diabetes. Design and Methods: This cross-sectional study included 1054 previously diagnosed type 2 diabetes patients who were 40 years of age and older. First, the subjects were divided into two groups based on a glycated hemoglobin (HbA1c) value of 7%. Each group was divided into two subgroups, with or without CKD. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the glomerular filtration rate (GFR). CKD was defined as eGFR< 60 mL/min/1.73 m2 . Multiple linear regression analysis was used to estimate the association between the 2hPG-FPG and eGFR. The 2hPG-FPG value was divided into four groups increasing in increments of 36 mg/dl (2.0 mmol/L): 0-72, 72-108, 108-144 and ≥144 mg/dl, based on the quartiles of patients with HbA1c levels ≥7%; then, binary logistic regression analysis was used to investigate the association between 2hPG-FPG and the risk of CKD. Results: In the patients with HbA1c levels ≥7%, the 2hPG-FPG was significantly associated with decreased eGFR and an increased risk of CKD independent of age, gender, body mass index (BMI), systolic blood pressure (BP), diastolic BP, smoking, and drinking, as well as fasting insulin, cholesterol, triglyceride, and HbA1c levels. The patients with 2hPG-FPG values ≥144 mg/dl showed an increased odds ratio (OR) of 2.640 (P = 0.033). Additionally, HbA1c was associated with an increased risk of CKD in patients with HbA1c values ≥7%. Conclusions: The short-term glucose variability expressed by 2hPG-FPG is closely associated with decreased eGFR and an increased risk of CKD in patients with poor glycemic control (HbA1c≥7%). © 2014 Wang et al.


PubMed | Shantui Community Health Center, China National Heavy Duty Truck Group Corporation Hospital, Lukang Hospital of Jining, Shandong University and Second Peoples Hospital of Jining
Type: | Journal: Journal of diabetes research | Year: 2015

To investigate changes in the glycated hemoglobin A1c (A1c) level and those in cell function and insulin resistance in newly diagnosed and drug naive type 2 diabetes patients and to evaluate the relationship between them.A total of 818 newly diagnosed diabetic individuals who were 40 years of age were recruited. The subjects were grouped by A1c values (<6.5%, 6.5-7%, 7-8%, 8-9%, and 9%). The homeostasis model assessment (HOMA) was used to evaluate pancreatic cell function (HOMA-) and insulin resistance (HOMA-IR). ANOVA, t-tests, and binary logistic regression analysis were used for data analysis.Compared with subjects with A1c values <6.5%, individuals with an A1c of 6.5-7% exhibited an increased HOMA- index. However, the HOMA- index was significantly decreased at A1c values 7% and further decreased by 9.3% and by 23.7%, respectively, at A1c values of 7-8% and 8-9%. As A1c increased to 9%, a 62% reduction in cell function was observed, independently of age, gender, body mass index (BMI), blood pressure (BP), blood lipids, and hepatic enzyme levels. Meanwhile, insulin resistance was significantly increased with an increase in A1c values.Elevated A1c values ( 7%) were associated with substantial reductions in cell function.


PubMed | China National Heavy Duty Truck Group Corporation Hospital, Shantui Community Health Center, Lukang Hospital of Jining, Shandong University and Second Peoples Hospital of Jining
Type: Journal Article | Journal: PloS one | Year: 2014

To investigate the relationship between lipid profiles [including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C)] and a mild decline in the estimated glomerular filtration rate (eGFR) in subjects with normal serum lipid levels.In this study, we included 2647 participants who were 40 years old and had normal serum lipid levels. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the GFR. A mildly reduced eGFR was defined as 60-90 mL/min/1.73 m(2). First, multiple linear regression analysis was used to estimate the association of lipid profiles with the eGFR. Then, the levels of each lipid component were divided into four groups, using the 25th, 50th and 75th percentiles as cut-off points. Finally, multiple logistic regression analysis was used to investigate the association of different lipid components with the risk of mildly reduced eGFR.In the group with a mildly reduced eGFR, TG and LDL-C levels were significantly increased, but HDL-C levels were significantly decreased. After adjusting for age, gender, body mass index (BMI), systolic blood pressure (SBP), glycated hemoglobin (HbA1c), smoking and drinking, only TC and TG were independently related to the eGFR. Additionally, only TG showed a linear relationship with an increased risk of a mildly reduced eGFR, with the highest quartile group (TG: 108-150 mg/dl [1.22-1.70 mmol/L]) having a significantly increased risk after adjusting for the above factors.Triglyceride levels are closely associated with a mildly reduced eGFR in subjects with normal serum lipid levels. Dyslipidemia with lower TG levels could be used as new diagnostic criteria for subjects with mildly reduced renal function.


Yan F.,Shandong University | Liu J.,Shandong University | Zhao X.,Shantui Community Health Center | Hu X.,Second Peoples Hospital of Jining | And 8 more authors.
Journal of Women's Health | Year: 2015

Background: This study aimed to assess the prevalence of metabolic syndrome (MetS) and the association of years since menopause with MetS and Insulin Resistance (IR) in Chinese women. Method: A total of 4436 Chinese subjects aged 40-80 years participated in the study; 790 were premenopausal women, and 3646 were postmenopausal women. IR was arbitrarily defined as a homeostasis model assessment-IR index (HOMA-IR) value above the 75th percentile of normal glucose tolerance (NGT). MetS was defined according to the International Diabetes Federation consensus definition. To test whether there was an association between the number of years since menopause and MetS, multivariate logistic analysis was conducted. Premenopausal women were used as a comparison group in regression analyses. Results: After adjustment for age, body mass index (BMI), and γ-glutamyltransferase (GGT), more years since menopause was highly associated with an increased risk of MetS (p for trend <0.05) ; the number of years since menopause was not correlated with fasting insulin and HOMA-IR. Postmenopausal women with 10 to 14 years since menopause had the highest risk (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.52-2.89, p<.05) of MetS, high triglycerides (TG; OR, 1.80; 95% CI, 1.34-2.42, p<.05) and high glucose (OR, 1.52; 95% CI, 1.14-2.05, p<.05) and low high-density lipoprotein cholesterol (HDL-C; OR, 1.38; 95% CI, 1.18-2.32, p<.05). Postmenopausal women with more than 15 years since menopause had the highest risk of abdominal obesity (OR, 1.69; 95% CI, 1.05-2.71, p<.05). Conclusion: In China, more years since menopause was highly associated with an increased risk of MetS. Menopausal history may help identify women with increased risk of developing MetS. © Copyright 2015, Mary Ann Liebert, Inc. 2015.


PubMed | Shantui Community Health Center, China National Heavy Duty Truck Group Corporation Hospital, Lukang Hospital of Jining, Shandong University and Second Peoples Hospital of Jining
Type: Journal Article | Journal: PloS one | Year: 2014

To investigate whether fluctuations between the fasting and 2-h postload glucose ([2-hPBG]-fasting blood glucose [FBG]) states are associated with glomerular hyperfiltration (GHF) in middle-aged and elderly Chinese patients with newly diagnosed diabetes.In this study, we included 679 newly diagnosed diabetes patients who were 40 years old. All the subjects were divided into two groups; those with HbA1c<7% and 7%. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the glomerular filtration rate (GFR). GHF was defined as an eGFR the 90th percentile. First, a multiple linear regression analysis was used to estimate the association of 2-hPBG-FBG with eGFR. Then, a generalized additive model was used to explore the possible nonlinear relationship between 2-hPBG-FBG and eGFR. Next, the 2-hPBG-FBG values were divided into four groups as follows: 0-36, 36-72, 72-108 and 108 mg/dl. Finally, a multiple logistic regression analysis was used to investigate the association of 2-hPBG-FBG with the risk of GHF.For the group with HbA1c<7%, the eGFR and the percentage of GHF were significantly higher compared with the group with HbA1c 7%. After adjusting for age, gender, body mass index (BMI), systolic blood pressure (BP), diastolic BP, fasting insulin, cholesterol, triglycerides, smoking, drinking and glycated hemoglobin (HbA1c), 2-hPBG-FBG was significantly associated with increased eGFR and an increased risk of GHF (the GHF risk increased by 64.9% for every 36.0 mg/dl [2.0 mmol/L] 2-hPBG-FBG increase) only in those patients with HbA1c<7%. Additionally, 2-hPBG-FBG and eGFR showed a nonlinear association (P<0.001).Increased fluctuations between the fasting and 2-h postload glucose states are closely associated with increased eGFR and an increased risk of GHF in newly diagnosed diabetes patients with HbA1c<7%.


Liang K.,Shandong University | Sun Y.,Shandong University | Li W.-J.,Shandong University | Zhang X.-P.,Shantui Community Health Center | And 9 more authors.
Diabetes Technology and Therapeutics | Year: 2014

Background: Europeans and Americans are gradually accepting the hemoglobin A1c (HbA1c) threshold of 6.5% for diagnosing diabetes proposed by the American Diabetes Association, but the cutoff of HbA1c for the Chinese population is unclear. We evaluated the diagnostic efficiency of HbA1c for diagnosing newly diagnosed diabetes and prediabetes in community-based Chinese adults 40 years of age or older. Subjects and Methods: In this study 8,239 subjects (5,496 women) 40-90 years of age underwent HbA1c and oral glucose tolerance test measurement after an overnight fast. Diabetes and prediabetes were defined by the World Health Organization criteria. The area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic efficiency of HbA1c, and the optimal cutoff was defined as the point on the receiver operating characteristic curve with the largest Youden index. Spearman correlation was used for correlation analysis. Results: The prevalence of newly diagnosed diabetes and prediabetes was 10.7% (880/8,239) and 19.0% (1,564/8,239), respectively. Fasting plasma glucose and postprandial plasma glucose were positively correlated with HbA1c level (r=0.725 and r=0.673, both P<0.001, respectively). For diagnosing diabetes, the AUC was 0.857 (95% confidence interval, 0.841-0.873), and the optimal cutoff for HbA1c was 6.3%, with the largest Youden index being 0.581. For diagnosing prediabetes, the AUC was 0.681 (95% confidence interval, 0.666-0.697), and the optimal cutoff for HbA1c was 5.9%, with the largest Youden index being 0.280. Conclusions: An HbA1c threshold of 6.3% was highly valuable for diagnosing newly diagnosed diabetes, and a value of 5.9% was weakly valuable for diagnosing prediabetes in community-based Chinese adults 40 years of age or older. © Mary Ann Liebert, Inc. 2014.

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