Fresh fruit consumption and risk of incident albuminuria among rural Chinese adults: A village-based prospective cohort study.

BACKGROUND: Recent studies showed that increased fresh fruit consumption is significantly associated with lower risks of diabetes, hypertension, and cardiovascular disease (CVD); other studies suggested that albuminuria is associated with diabetes, hypertension, and CVD. Therefore, we hypothesized that lower fresh fruit consumption is associated with higher risk of incident albuminuria among Chinese adults in rural areas, where fresh fruit consumption level is very low and prevalence of albuminuria is high. METHODS: We tested the hypothesis in a village-based cohort study of 3574 participants aged ≥ 30 years from the Handan Eye Study conducted from 2006 to 2013. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥ 30 mg/g. RESULTS: Overall, 35.4% of the participants never or rarely consumed fresh fruits, and 33.9, 21.6, and 9.1% consumed fresh fruits 1-3 times/month, 1-2 times/week, and ≥ 3 times/week, respectively. During a median follow-up period of 5.6 years, albuminuria developed in 17.6% (n = 629) of the participants. Compared with participants who consumed fresh fruits ≥ 3 times/week, the multivariable adjustment odds ratios (ORs) for incident albuminuria associated with fruit consumption 1-2 times/week, 1-3 times/month, and no or rare consumption were 1.58 (95% confidence intervals (CI), 1.05-2.40), 1.74 (95% CI, 1.17-2.58), and 1.78 (95% CI, 1.20-2.64), respectively. After excluding participants with diabetes, the association remained significant. CONCLUSIONS: Lower fresh fruit consumption was significantly associated with higher risk of incident albuminuria, and fresh fruit consumption frequency could be an essential intervention target to prevent albuminuria in rural China.

Comparisons of different metabolic syndrome definitions and associations with coronary heart disease, stroke, and peripheral arterial disease in a rural Chinese population.

OBJECTIVES: We estimated the prevalence of metabolic syndrome (MetS) and compared associations of different MetS definitions with coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD) in a rural Chinese population. METHODS: Among 4,748 residents (2,145 men and 2,603 women) aged 30+ years in rural China from 2006 to 2007, the prevalence of MetS was estimated by using five different definitions: modified World Health Organization (WHO), Chinese Diabetes Society (CDS), the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) for Asian-Americans, International Diabetes Federation (IDF), and Joint Interim Statement (JIS). Multivariable logistic regression analyses were implemented to estimate the association between MetS and the prevalence of CHD, stroke and PAD, respectively. RESULTS: Prevalence of MetS in men was 11.5% (WHO), 14.8% (CDS), 32.4% (NCEP-ATP III), 27.5% (IDF) and 39.7% (JIS) and in women was 15.7% (WHO), 20.7% (CDS), 54.2% (NCEP-ATP III), 51.5% (IDF) and 54.2% (JIS), respectively. Respective ORs (95% CI) for associating MetS with CHD in men were 1.79 (1.02-3.17), 1.25 (0.69-2.26), 1.61 (1.01-2.58), 1.84 (1.14-2.96), and 1.53 (0.96-2.43). Corresponding ORs (95% CI) for stroke in men were 2.18 (95% CI 1.20 to 3.97), 2.20 (95% CI 1.25 to 3.89), 1.71 (95% CI 1.02 to 2.84), 1.30 (95% CI 0.77 to 2.23), and 1.61 (95% CI 0.97 to 2.68), respectively. In women, CHD and stroke were significantly associated with MetS using all five definitions of MetS. In addition, PAD was associated with all five MetS definitions in men, but not in women. Only hyperglycemia and BMI were significantly associated with PAD in women. CONCLUSIONS: In this rural Chinese population, the JIS, IDF and CDS criteria may not be more suitable than WHO and updated NCEP-ATPIII definitions for screening high-risk individuals and estimating the risk of CHD and stroke from MetS, especially in men.

Prevalence and risk factors of posterior vitreous detachment in a Chinese adult population: the Handan eye study.

BACKGROUND: To describe the prevalence and associations of posterior vitreous detachment (PVD) in a rural adult Chinese population. METHODS: All eligible subjects were requested to carry out a comprehensive eye examination; PVD was a pre-specified outcome variable and was determined via biomicroscopical examination (slit-lamp biomicroscopy) with a +90-D preset lens after mydriasis. Prevalence was standardized to China population census (2000). RESULTS: 5890 (86.2%) subjects completed the examination of slit-lamp biomicroscopy with a +90-D lens. PVD was present in 160 participants (2.7%); the standardized prevalence was 2.0% (95% confidence interval [CI], 1.6-2.3%). PVD developed increasingly with age (P for trend < 0.001) for both men and women. Using a multivariate regression model, older people were found to run a higher risk of developing PVD than younger people, and women were found to have a higher risk than men (OR, 2.9; 95% CI, 1.5-5.9). Diabetes, hypertension, smoking, drinking, and intraocular pressure (IOP) were not significantly associated with PVD. CONCLUSIONS: About one in fifty people is found to have PVD in this population-based study. Age and female are independently associated with PVD occurrence.

Metabolic syndrome, C-reactive protein and microalbuminuria in a rural Chinese population: a cross-sectional study.

BACKGROUND: Microalbuminuria is an early marker of chronic kidney disease (CKD). Previous studies have shown that either metabolic syndrome (MetS) or chronic inflammation is related to renal impairment. The aim of this study was to investigate the association between MetS, C-reactive protein (CRP) and microalbuminuria in a rural Chinese population. METHODS: This was a cross-sectional study using data from the Handan Eye Study. MetS was defined according to the Chinese Diabetes Society (CDS) criteria. CRP levels ≥ 3 mg/L were classified as high CRP. Microalbuminuria was defined as a urinary albumin/creatinine ratio (ACR) of 30-300 mg/g. RESULTS: We included 4191 subjects aged ≥ 30 years in this analysis. The prevalence of MetS and microalbuminuria in the group was 25.7% and 15.6%, respectively. The odds ratio (OR) of microalbuminuria in subjects with MetS was 1.25 (95% confidence interval (CI): 1.03 - 1.51) compared with those without microalbuminuria. In multivariate logistic regression analysis, high blood pressure (OR 1.36, 95% CI: 1.10 - 1.67) and high fasting blood glucose (OR 1.44, 95% CI: 1.17 - 1.76) were independently associated with microalbuminuria. Subjects with high CRP and MetS had a 1.46-fold greater risk of having microalbuminuria compared with those with low CRP without MetS (95% CI: 1.06 - 2.01). CONCLUSIONS: In this rural Chinese population aged ≥30 years, MetS and microalbuminuria were independently related and the combination of high CRP and MetS was associated with an increased risk of microalbuminuria.

Inequities in Cataract Surgery and Postsurgical Quality-of-Life Outcomes in Handan, China.

PURPOSE: This study aimed to describe the rate of cataract surgical coverage (CSC) and the quality-of-life (QoL) outcomes after cataract surgery in rural China. DESIGN: Cross-sectional study. METHODS: A clustered, random sampling procedure was used to select 7557 Chinese patients aged 30 years and older from Handan, China. Comprehensive eye examinations, including standardized refraction and classification of lens characteristics, were offered to all eligible subjects. Visual impairment was defined as any individual with presenting visual acuity of less than 20/60 in the better-seeing eye. The main outcome measures were CSC rate and a summary measure assessing QoL in visually impaired (VI) participants. RESULTS: Of 5592 participants older than 40 years, there were 41 cataract patients operated on and 54 VI cataract patients not operated on. The CSC rate among individuals with VI was 43.2%. Older age was significantly negatively associated with a history of cataract surgery (adjusted odds ratio, 0.44 per 10-year increase in age; 95% confidence interval, 0.26-0.74). Women were less likely to have had cataract surgery compared with men, although not significantly (adjusted odds ratio, 0.44; 95% confidence interval, 0.17-1.12). The QoL summary measure was significantly better in the cataract group operated on than that not operated on (P < 0.01). CONCLUSIONS: There is a large unmet need for cataract surgery in rural Handan, China. Those who had surgery were more likely to have better QoL outcomes than those who did not. There is a potential need to promote cataract surgery and develop age- and sex-sensitive interventions in rural China.

Association of dilated retinal arteriolar caliber with early age-related macular degeneration: the Handan Eye Study.

BACKGROUND: To identify factors associated with early age-related macular degeneration (AMD) in a rural Chinese population, with emphasis on retinal vessel caliber. METHODS: The study population comprised the 6,830 participants of the Handan Eye Study. All participants underwent digital retinal photography of both eyes. Trained graders assessed the presence of AMD lesions. Arteriolar and venular diameters were measured with a specific computer-assisted program and were summarized as the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE). RESULTS: The data for the 199 individuals with evaluable retinal photographs and early AMD and 400 age-matched individuals randomly selected from the group without AMD were analyzed. After adjusting for participants' age, sex, smoking status, hypertension, diabetes, BMI, and CRVE, the multivariate adjusted model showed that a higher CRAE was significantly associated with early AMD (OR = 1.34; 95% CI: 1.05-1.71; p = 0.020) and the presence of soft distinct drusen (OR = 1.32 (95% CI: 1.02-1.71, p = 0.037). There were no significant associations between CRVE and early AMD. CONCLUSIONS: Dilated retinal arteriolar caliber is associated with early AMD and soft distinct drusen in this population. We found no significant associations between CRAE and other characteristics of the retina related to AMD or between retinal venal caliber and early AMD. More research is needed to determine whether the difference between these results and those previously published stem from the rural living conditions of the participants or other factors.

Metabolic syndrome and chronic kidney disease in a rural Chinese population.

BACKGROUND: Metabolic syndrome is a common risk factor for cardiovascular disease. Chronic kidney disease (CKD) is a worldwide public health problem. We investigated the association between metabolic syndrome and CKD in a rural Chinese population. METHODS: This was a cross-sectional study using data from the Handan Eye Study. RESULTS: 4944 of participants aged ≥ 30 y were included in this analysis. Participants with metabolic syndrome had a higher prevalence of CKD (20.9% vs.15.8%, P<0.001) than those without. As the number of metabolic syndrome components increased, so did the prevalence of CKD (P<0.001). The multivariate-adjusted odds ratio (OR) of chronic kidney disease in participants with metabolic syndrome was 1.293 (95% CI 1.093-1.529) compared with those without. In multivariate logistic regression analysis, high blood pressure (OR 1.348; 95% CI 1.122-1.619) and high fasting glucose (OR 1.501; 95% CI 1.235-1.794) were independently associated with the risk for CKD. Compared with participants without any component, multivariate adjusted OR for CKD was 1.316 (95%CI 1.004-1.723), 1.397(95%CI 1.038-1.882), 1.672 (95%CI 1.183-2.363) for those with 2, 3, 4 or 5 components, respectively. CONCLUSION: In this rural Chinese population aged ≥ 30 y, metabolic syndrome was associated with CKD.

Prevalence of chronic kidney disease in a rural Chinese adult population: the Handan Eye Study.

BACKGROUND: Chronic kidney disease (CKD) is a worldwide public health problem. The purpose of this study was to investigate the prevalence of CKD and associated factors in a rural adult population in Northern China. METHODS: This was a cross-sectional study using data from the Handan Eye Study. A total of 5,105 subjects aged >or=30 years were included in this analysis. Spot urine albumin-to-creatinine ratio was determined. Glomerular filtration rate was estimated with the modified Modification of Diet in Renal Disease equation. CKD was defined by the guidelines proposed by the Kidney Disease Outcomes Quality Initiative. The associations between age, gender, diabetes, hypertension, and kidney damage were examined. RESULTS: Albuminuria and reduced renal function were detected in 16.8 and 0.4% of subjects, respectively. The age-standardized prevalence of albuminuria, reduced renal function and CKD was 14.9% (95% confidence interval (CI) 13.9-15.9), 0.38% (95% CI 0.21-0.55) and 15.2% (95% CI 14.2-16.2), respectively. The prevalence of CKD was greater in women than in men (16.7 vs. 12.9%, respectively, p < 0.001). The increased prevalence of CKD with increasing age was observed in both genders. Older age, female gender, diabetes and hypertension were independently associated with albuminuria. Older age was independently associated with reduced renal function. CONCLUSION: The prevalence of CKD in the rural Chinese population is relatively high. Factors associated with CKD are similar to those of urban areas in China and developed countries. CKD is a major public health problem in rural China.

C-reactive protein, gamma-glutamyltransferase and type 2 diabetes in a Chinese population.

BACKGROUND: We studied the association of C-reactive protein (CRP), gamma-glutamyltransferase (GGT) and type 2 diabetes in Chinese. METHOD: A population-based cross-sectional study. RESULTS: CRP and GGT levels were significantly higher in participants with diabetes than in those without (P<0.001). Higher CRP levels were positively associated with prevalent type 2 diabetes after adjustment for age, sex, smoking, alcohol consumption, physical activity, family history of diabetes, body mass index, waist circumference, waist/hip ratio, education, systolic blood pressure, triglycerides, high density lipoprotein cholesterol, use of antihypertensive drugs, aspirin and lipid-lowering agents, with multivariable odds ratios (OR) of 1.55 (95% confidence interval (CI), 1.05-2.27, P trend=0.005, comparing quartile 4 to quartile 1). However, after further adjustment for GGT, the association was completely attenuated (fourth quartile OR 1.23, 95% CI, 0.83-1.82, P trend=0.127). Moreover, the association of CRP and prevalent type 2 diabetes was stronger in subjects with GGT values above the median than in those with GGT values below the median. Increasing serum GGT quartiles were positively associated with prevalent type 2 diabetes after adjustment for potential confounding variables (P for trend <0.001). CONCLUSION: CRP may not be an independent risk factor for type 2 diabetes, at least in Chinese people.

Association of C-reactive protein and metabolic syndrome in a rural Chinese population.

OBJECTIVE: To explore the relationship between C-reactive protein (CRP) and metabolic syndrome (MetS) in a rural Chinese population. DESIGN AND METHODS: We performed a population-based cross-sectional study. RESULTS: The median CRP was 0.90 mg/L. After exclusion of subjects with a CRP value >10 mg/L, The median CRP with 0, 1, 2, 3, 4, and 5 components of MetS were 0.61, 0.61, 0.73, 1.07, 1.51, and 1.16 mg/L (P=0.029 for linear trend) in men, and were 0.37, 0.45, 0.62, 1.10, 1.52, and 2.17 mg/L (P=0.002 for linear trend) in women, respectively. After adjustment for potential confounders, compared with those without components of MetS, those with 1, 2, 3, 4, and 5 components of MetS had ORs of 1.39, 1.08, 1.84, 2.65, and 1.21 for elevated CRP in men and 1.91, 2.06, 3.10, 4.06, and 6.01 in women, respectively. CONCLUSION: In this rural Chinese population, the CRP concentration was lower than that of Caucasians and strongly related to the MetS, especially in women.

The epidemiology of age-related eye diseases in Mainland China.

While many papers have been published regarding age-related eye diseases in Mainland China in the past two decades, the variable quality of those reports limit the conclusions that can be drawn. Many of these studies assessed blindness and low vision rates, and these estimates are likely accurate. However, due to lack of standardization of techniques for assessing cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy, estimates of the burden of these diseases on the population are less reliable. Owing to the rapid economic development of China in the last decade, resources to address eyecare problems are more likely to be available. Therefore, an accurate assessment of the burden of various eye diseases is needed in order to improve blindness prevention planning and program development.

[Vitreous hemorrhage and vitreoschisis].

PURPOSE: To identify the morphologic characteristics of vitreous especially vitreoschisis in vitreous hemorrhage, aiming at discussing the mechanism and clinical importance of vitreoschisis. METHODS: Eighty-eight cases (97 eyes) of vitreous hemorrhage were observed among which 32 cases (38 eyes) resulting from PDR, 28 cases (30 eyes) resulting from retinal vasculitis and 28 cases (29 eyes) resulting from retinal vein occlusion. All cases had B-scan examination, some had color Doppler examination. Images were compared with the finding in vitre-ctomy. RESULTS: Vitreoschisis occurred in 18 cases (47.4%) in PDR group, 10 cases (33%) in retinal vasculitis group and 4 cases (13.8%) in retinal vein occlusion group. CONCLUSIONS: Vitreoschisis may occur in different kind of vitreous hemorrhage. Recognition of vitreoschisis may aid to complete vitrectomy and reduce some complication after surgery.