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Bowers K.,National Health Research Institute | Liu G.,Tianjin Womens and Childrens Health Center | Wang P.,Tianjin Womens and Childrens Health Center | Ye T.,Tianjin Womens and Childrens Health Center | And 8 more authors.
Pediatrics | Year: 2011

BACKGROUND: It is hypothesized that a physiological predisposition toward hypertension results from a combination of intrauterine growth restriction or overgrowth and excessive postnatal weight gain. Previous studies were conducted largely in Western countries however the hypothesis may also be relevant in developing countries where metabolic disorders are increasing. OBJECTIVE: We investigated the association of birth weight and postnatal weight gain with hypertension among Chinese children. METHODS: A population based study was conducted among 15 600 children aged 3 to 6 years from Tianjin, China. Weight was expressed as z scores. Postnatal weight gain was defined as changes in z scores from birth to 3 to younger than 4 years, 4 to younger than 5 years, and 5 to 6 years. Hypertension was defined as greater than the 90th percentile of either systolic or diastolic blood pressure. Logistic regression-derived odds ratios and 95% confidence intervals were generated to estimate the association between birth weight and postnatal weight gain with hypertension risk in childhood. RESULTS: Birth weight was positively associated with childhood hypertension in boys and girls (odds ratios [95% confidence interval] comparing extreme quartiles [high versus low] were 5.67 [3.83- 8.39] and 2.58 [3.83- 8.39], respectively). Postnatal weight gain was positively associated with hypertension and the association did not significantly vary by birth size for gestational age. CONCLUSIONS: Greater birth weight or postnatal weight gain was associated with increased childhood hypertension risk, suggesting that intrauterine growth and postnatal weight gain may have implications on health during childhood. Copyright © 2011 by the American Academy of Pediatrics. Source


Li W.,Pennington Biomedical Research Center | Li W.,Tianjin Womens and Childrens Health Center | Katzmarzyk P.T.,Tianjin Womens and Childrens Health Center | Horswell R.,Tianjin Womens and Childrens Health Center | And 5 more authors.
Stroke | Year: 2015

Background and Purpose-Previous studies have evaluated the association of body mass index (BMI) with the risk of all-cause and cardiovascular disease mortality among diabetic patients, and Results were controversial. No studies have focused on the association between BMI and stroke risk among diabetic patients. We aimed to examine the association of BMI with stroke risk among diabetic patients.Methods-We performed a prospective cohort study with 29 554 patients with type 2 diabetes mellitus. Cox proportional hazards regression models were used to estimate the association of different levels of BMI with stroke risk.Results-During a mean follow-up period of 8.3 years, 2883 participants developed stroke (2821 ischemic and 109 hemorrhagic). The multivariable-adjusted (age, sex, race, smoking, income, and type of insurance) hazard ratios associated with different levels of BMI at baseline (18.5-24.9 [reference group], 25-29.9, 30-34.9, 35-39.9, and 40 kg/m) were 1.00, 0.86, 0.83, 0.76, and 0.70 (Ptrend<0.001) for total stroke, 1.00, 0.87, 0.85, 0.78, and 0.72 (Ptrend <0.001) for ischemic stroke, and 1.00, 0.76, 0.72, 0.54, and 0.53 (Ptrend=0.034) for hemorrhagic stroke, respectively. When we used an updated mean or the last visit value of BMI, the inverse association of BMI with stroke risk did not change. This inverse association was consistent among patients of different races, sex, ages, HbA1c levels, never and current smoking, and patients with and without using glucose-lowering, cholesterol-lowering, or antihypertensive agents.Conclusions-The present study demonstrates an inverse association between BMI and stroke risk among patients with type 2 diabetes mellitus. © 2014 American Heart Association, Inc. Source


Zhao W.,Pennington Biomedical Research Center | Katzmarzyk P.T.,Pennington Biomedical Research Center | Horswell R.,Pennington Biomedical Research Center | Wang Y.,Pennington Biomedical Research Center | And 7 more authors.
Circulation | Year: 2014

Background-Several prospective studies have evaluated the association between body mass index (BMI) and death risk among patients with diabetes mellitus; however, the results have been inconsistent. 2014 American Heart Association, Inc.Methods and Results-We performed a prospective cohort study of 19 478 black and 15 354 white patients with type 2 diabetes mellitus. Cox proportional hazards regression models were used to estimate the association of different levels of BMI stratification with all-cause mortality. During a mean follow-up of 8.7 years, 4042 deaths were identified. The multivariable-adjusted (age, sex, smoking, income, and type of insurance) hazard ratios for all-cause mortality associated with BMI levels (18.522.9, 2324.9, 2529.9, 3034.9 [reference group], 3539.9, and ≥40 kg/m2) at baseline were 2.12 (95% confidence interval [CI], 1.802.49), 1.74 (95% CI, 1.462.07), 1.23 (95% CI, 1.081.41), 1.00, 1.19 (95% CI, 1.031.39), and 1.23 (95% CI, 1.051.43) for blacks and 1.70 (95% CI, 1.422.04), 1.51 (95% CI, 1.271.80), 1.07 (95% CI, 0.941.21), 1.00, 1.07 (95% CI, 0.931.23), and 1.20 (95% CI, 1.051.38) for whites, respectively. When stratified by age, smoking status, patient type, or the use of antidiabetic drugs, a U-shaped association was still present. When BMI was included in the Cox model as a time-dependent variable, the U-shaped association of BMI with all-cause mortality risk did not change.Conclusions-The present study indicated a U-shaped association of BMI with all-cause mortality risk among black and white patients with type 2 diabetes mellitus. A significantly increased risk of all-cause mortality was observed among blacks with BMI <30 kg/m2 and ≥35 kg/m2 and among whites with BMI <25 kg/m2 and ≥40 kg/m2 compared with patients with BMI of 30 to 34.9 kg/m2. Source


Zhao W.,Pennington Biomedical Research Center | Guan J.,Pennington Biomedical Research Center | Guan J.,Beijing University of Chinese Medicine | Horswell R.,Pennington Biomedical Research Center | And 5 more authors.
Diabetes Care | Year: 2014

OBJECTIVE: To investigate the relationship between HDL cholesterol (HDL-C) and cancer risk among type 2 diabetic patients. RESEARCH DESIGN AND METHODS: We performed a retrospective cohort study of 14,169 men and 23,176 women with type 2 diabetes. Cox proportional hazards regression models were used to estimate the association of various levels of HDL cholesterol (HDL-C) with cancer risk. RESULTS: During a mean follow-up period of 6.4 years, 3,711 type 2 diabetic patients had a cancer diagnosis. A significant inverse association between HDL-C and the risk of cancer was found among men and women. The multivariable-adjusted hazard ratios (HRs) of cancer at various levels of HDL-C at baseline (<30, 30-39.9, 40- 49.9, 50-59.9, 60-69.9, 70 -79.9, and ≥80 mg/dL) were 1.00, 0.87, 0.95, 1.01, 0.61, 0.45, and 0.37, respectively, in men (P trend = 0.027) and 1.00, 0.98, 0.88, 0.85, 0.84, 0.86, and 0.84, respectively, in women ( Ptrend = 0.025). When stratified by race, BMI, smoking status, or medication use, the inverse association was still present. With an updated mean of HDL-C used in the analysis, the inverse association of HDL-C with cancer risk did not change. The inverse association substantially attenuated after excluding patients who died of or were diagnosed with cancer during the fi rst 2 years of follow-up. CONCLUSIONS: The study suggests an inverse association of HDL-C with cancer risk among men and women with type 2 diabetes, whereas the effect of HDL-C was partially mediated by reverse causation. © 2014 by the American Diabetes Association. Source


Yan Y.-Q.,Institute of Endocrinology | Dong Z.-L.,Tianjin Medical University | Dong L.,Tianjin Womens and Childrens Health Center | Wang F.-R.,Center for Disease Control and Prevention of Xinjiang Autonomous Region | And 5 more authors.
Clinical Endocrinology | Year: 2011

Objective The importance of diagnosis and treatment of thyroid dysfunction during pregnancy has been widely recognized. We therefore established trimester-and method-specific reference intervals for thyroid testing in pregnant women according to the NACB recommended criteria. Several factors can affect the setting of reference intervals, in particular manufacturer's methodology, euthyroid definition and iodine status. Design Cross-sectional dataset analysis. Subjects Five hundred and five normal pregnant women at different stages of gestation were rigorously selected for setting reference intervals. All were healthy, iodine sufficient, euthyroid and negative for both serum thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb). Measurements Thyrotrophin (TSH), total and free thyroxine (TT4 and FT4), total and free triiodothyronine (TT3 and FT3) and anti-TPOAb and anti-TgAb were measured using the Bayer ADVIA Centaur system. Iodine content in drinking water, salt and urine was determined by national standard methods. The 2·5th and 97·5th percentiles were calculated as the reference intervals for thyroid hormone levels during each trimester. Results All participants had long-term consumption of iodized salt and median urinary iodine of 150-200 μg/l during each three trimester. The reference intervals for the first, second and third trimesters were, respectively, TSH 0·03-4·51, 0·05-4·50 and 0·47-4·54 mIU/l and FT4 11·8-21·0, 10·6-17·6 and 9·2-16·7 pmol/l. The manufacturer's method, euthyroid definition and iodine status may influence TSH and FT4 reference intervals. Alterations in thyroid hormone concentrations during pregnancy differed at different stage of gestation and to those of a nonpregnant state. Conclusions The trimester-and method-based reference intervals for thyroid tests during pregnancy are clinically appropriate. Some variables should be controlled when establishing reference intervals. © 2011 Blackwell Publishing Ltd. Source

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