HDL-C, longitudinal change and risk of mortality in a Chinese cohort study.

BACKGROUND AND AIMS: High-density lipoprotein cholesterol (HDL-C) concentration and variability are both important factors of cardiovascular disease (CVD) and mortality. We aimed to explore the associations of HDL-C and longitudinal change in HDL-C with risk of mortality. METHODS AND RESULTS: We recruited a total of 69,163 participants aged ≥40 years and had medical examination records of HDL-C during 2010-2014 from the Yinzhou District, Ningbo, China. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models. We observed a non-linear association of HDL-C with risks of non-accidental and CVD mortality. Compared with the moderate concentration group (1.4-1.6 mmol/L), HDL-C <1 mmol/L was associated with a higher risk of non-accidental mortality (HR: 1.13 (95% CI: 1.01-1.27)) and both HDL-C <1 mmol/L and ≥2 mmol/L were associated with a higher risk of CVD mortality (HRs: 1.23 (95% CI: 1.01-1.50) and 1.37 (95% CI: 1.03-1.82), respectively). Compared with the stable group ([-0.1, +0.1 mmol/L]), a large decrease ([-0.5, -0.3 mmol/L]) and very large decrease (<-0.5 mmol/L) in HDL-C were associated with a higher risk of non-accidental mortality (HRs: 1.40 (95% CI: 1.21-1.63) and 1.78 (95% CI: 1.44-2.20), respectively). Similar results were observed for CVD mortality and cancer mortality. CONCLUSION: Extremely low or high HDL-C and a large decrease or very large decrease in HDL-C were associated with a higher risk of cause-specific mortality. Monitoring of HDL-C may have utility in identifying individuals at higher risk of mortality.

Low LDL-C levels are associated with risk of mortality in a Chinese cohort study.

BACKGROUND AND AIMS: Although low-density lipoprotein cholesterol (LDL-C) has been considered as a risk factor of atherosclerotic cardiovascular disease, limited studies can be available to evaluate the association of LDL-C with risk of mortality in the general population. This study aimed to examine the association of LDL-C level with risk of mortality using a propensity-score weighting method in a Chinese population, based on the health examination data. METHODS: We performed a retrospective cohort study with 65,517 participants aged 40 years or older in Ningbo city, Zhejiang. LDL-C levels were categorized as five groups according to the Chinese dyslipidemia guidelines in adults. To minimize potential biases resulting from a complex array of covariates, we implemented a generalized boosted model to generate propensity-score weights on covariates. Then, we used Cox proportional hazard regression models with all-cause and cause-specific mortality as the dependent variables to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS: During the 439,186.5 person years of follow-up, 2403 deaths occurred. Compared with the median LDL-C group (100-130 mg/dL), subjects with extremely low LDL-C levels (group 1) had a higher risk of deaths from all-cause (HR = 2.53, 95% CI:1.80-3.53), CVD (HR = 1.84, 95% CI: 1.28-2.61), ischemic stroke (HR = 2.29, 95% CI:1.32-3.94), hemorrhagic stroke (HR = 3.49, 95% CI: 1.57-7.85), and cancer (HR = 2.12, 95% CI: 1.04-4.31) while the corresponding HRs in LDL-C group 2 were relatively lower than that in group 1. CONCLUSIONS: Low LDL-C levels were associated with an increased risk of all-cause, CVD, ischemic stroke, hemorrhagic stroke, and cancer mortality in the Chinese population.

Effect of COVID-19 on hospital visits in Ningbo, China: an interrupted time-series analysis.

OBJECTIVE: Unprecedented rigorous public health measures were implemented during the coronavirus disease 2019 (COVID-19) epidemic, but it is still unclear how the intervention influenced hospital visits for different types of diseases. We aimed to evaluate the impact of the intervention on hospital visits in Yinzhou District, Ningbo, Zhejiang province, China. METHODS: We conducted an interrupted time-series analysis from 1 January 2017 to 6 September 2020 based on the Yinzhou Health Information System in Ningbo, Zhejiang province. The beginning of the intervention was on 23 January 2020, and thus, there were 160 weeks before the intervention and 32 weeks after the implementation of the intervention. Level changes between expected and observed hospital visits in the post-intervention period were estimated using quasi-Poisson regression models. RESULTS: Compared with the expected level, there was an estimated decrease of -22.60% (95% confidence interval (CI): -27.53%, -17.36%) in the observed total hospital visits following the intervention. Observed hospital visits for diseases of the respiratory system were found to be decreased dramatically (-62.25%; 95% CI: -65.62%, -58.60%). However, observed hospital visits for certain diseases were estimated to be increased, including diseases of the nervous system (+11.17%; 95% CI: +3.21%, +19.74%); diseases of pregnancy, childbirth and the puerperium (+27.01%; 95% CI: +17.89%, +36.85%); certain conditions originating in the perinatal period (+45.05%; 95% CI: +30.24%, +61.56%); and congenital malformation deformations and chromosomal abnormalities (+35.50%; 95% CI: +21.24%, +51.45%). CONCLUSIONS: Our findings provided scientific evidence that cause-specific hospital visits evolve differently following the intervention during the COVID-19 epidemic.

Short-term associations between ambient fine particulate matter pollution and hospital visits for chronic obstructive pulmonary disease in Yinzhou District, China.

Ambient particulate matter is one of the main risk factors of chronic obstructive pulmonary disease (COPD) in developing countries. However, the studies were scant in China concerning the health effects of the fine particulate matter (PM2.5; particulate matter ≤ 2.5 µm in diameter) on hospital visits for COPD. We applied a generalized additive model (GAM) to calculate relative risks (RRs) with 95% confidence intervals (CIs) for the associations between hospital visits for COPD and an interquartile range (24.50 µg/m3) increment of ambient PM2.5 concentrations in Yinzhou District between 2016 and 2018. The ambient PM2.5 concentration was positively associated with hospital visits for COPD at a distributed lag of 0-7 days (RR = 1.073, 95% CI, 1.016, 1.133). In the stratified analysis, we found that the association between ambient PM2.5 and COPD was stronger during the warm season (April to September) than that during the cold season (October to March), but we did not observe statistically significant differences in age groups (< 60 years and ≥ 60 years) or gender groups (male and female) related to the effects of PM2.5. The associations between ambient PM2.5 and COPD became partially attenuated after the adjustment for gaseous pollutants in subgroups. Our findings could provide evidence that regulations for controlling both PM2.5 and gaseous pollutants should be implemented to protect the overall population.

[Iodine nutritional status of child islanders in relation with iodized salt intake].

OBJECTIVE: To evaluate the iodine nutritional status and its relation to iodized salt intake in child islanders. METHODS: A comparing study was carried out in 4 townships selected by random sampling from Dinghai (iodized salt) and Daishan(non-iodized salt) of Zhoushan island and total 592 of children were included in the study. The Mann-Whitney test was used to compare the urinary iodine concentration and dietary iodine intake of two groups. The correlation of urinary iodine concentration and dietary iodine intake were examined by Spearman correlation test. Ordinal regression was used to analyse the dependent variables of urinary iodine concentration. RESULTS: The urinary iodine concentration of non-iodized salt district was lower than that in iodized salt district (87 microg/L compared with 150 microg/L, u=7.296, P=0.000) ,whereas the amount of daily iodine intake in the two groups was 34.5 microg/d and 62.3 microg/d (u=6.925, P=0.000). The urinary iodine concentration of 58.6 % children in non-iodized salt district was below 100 microg/L. Age and iodized-salt intake were significant factors in the final regression model (P<0.05) with the OR of 1.119 and 3.238, respectively. CONCLUSION: The daily dietary iodine intake for children in Zhoushan island is insufficient, the iodized salt prophylaxis is necessary.

[A case-control study on the relationship between nutrition and gastric cancer in islanders].

OBJECTIVE: To study the association between nutritional factors and gastric cancer in islanders. METHODS: A population-based case-control study on diet and gastric cancer was carried out in Zhoushan islands, China. 103 cases of gastric cancer newly diagnosed in 2001 and 133 controls frequency-matched by age, sex, and islands of residence among residents in Zhoushan were included in the study. Dietary intake was estimated using a constructed food frequency questionnaire. Total calories and 15 nutrients were calculated according to the food composition table and their adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated by gender using unconditional logistic regression models. RESULTS: Increased risks of gastric cancer were associated with protein (ORQ4 vs. Q1=10.3; P for linear trend=0.01), saturated fat (ORQ4 vs. Q1=3.24), and cholesterol (ORQ4 vs. Q1=2.76) particularly among males. Among females, carbohydrate was a significant high-risk nutrient (ORQ4 vs. Q1=14.8; P for linear trend=0.024). In both sexes, all cases reported a significantly higher daily intake of natrium mainly from salts than controls. An inversed association with the risk of gastric cancer was seen in vitamin A and vitamin C. CONCLUSION: The findings from this study provided information about the role of specific nutrients in the etiology of gastric cancer. High intakes of protein, saturated fat, cholesterol, sodium and poor intakes of vitamin A and C could increase the risk of gastric cancer.

[A comparative study on iodine nutritional status of adult islanders in Zhoushan].

OBJECTIVE: To measure the iodine nutritional status on adult islanders and to evaluate the advantages and disadvantages of iodized salt prophylactic programs. METHODS: A comparative study was carried out in 8 rural townships selected from Dinghai (iodized salt district) and Daishan (non-iodized salt district) of Zhoushan islands by random sampling method. Mann-Whitney test was used to compare the urinary iodine concentration and dietary iodine intake of the two groups. Spearman correlation test was used to look for the correlation of urinary iodine concentration and dietary iodine intake in the two groups respectively. RESULTS: The amounts of daily iodine intake excluding the iodine intake from iodized salt in the two groups were 128 micro g and 147 micro g respectively but the difference was not statistically significant (u = 1.847, P = 0.065). The urinary iodine concentration of non-iodized salt group was 90 micro g/L, lower than 194 micro g/L in iodized salt group (u = 14.673, P = 0.000). There was no significant correlation between daily iodine intake and urinary iodine concentration (r(s) = 0.052, P = 0.095). CONCLUSIONS: In Zhoushan islands, the daily iodine intake did not meet the daily need (150 micro g/day) suggesting that iodized salt supplement was necessary. However, side effect due to overdose should be brought into attention.

Tetrodotoxin-associated snail poisoning in Zhoushan: a 25-year retrospective analysis.

Outbreaks of paralytic snail poisoning have recently occurred in Asia, especially in China. The epidemiological characteristics of this disease from an outbreak in Zhoushan City, China, were recorded. Forty-two outbreaks of paralytic snail poisoning, involving 309 cases of illness, occurred from 1977 to 2001. Sixteen people (5.2%) died, 48 people (15.5%) required intubations, and 140 people (45.3%) required emergency hospital treatment as a result of these outbreaks. Outbreaks involved multiple marine snail species and occurred primarily during the summer (from June to August) on 11 islands with high population densities. Peak numbers of outbreaks and amounts of snail toxicity occurred from 1978 to 1979, from 1985 to 1987, and from 1992 to 1994. Toxicity varied depending on specimen, region, and season. The toxin involved was identified as tetrodotoxin. The data obtained in this study suggest that snails should not be eaten unless they are certified to be nontoxic.

[Study on the relationship between smoking, alcohol intake and hyperlipidemia in fishermen].

OBJECTIVE: To identify the relationship between smoking, alcohol intake and hyperlipidemia in fishermen. METHODS: 115 fishermen were randomly recruited and divided into case and control groups according to the result of blood lipoprotein. A questionnaire was used to record general information and the history of smoking and alcohol intake. Statistics were gathered to compare the difference of lipoprotein and apolipoprotein level between exposure and control groups and to calculate the OR value of smoking and alcohol intake. RESULTS: The OR of smoking was 3.417 (95% CI: 1.132 - 10.308), with significant dosage-effect relationship between smoking index and hyperlipidemia. The serum low density lipoprotein-cholesterol (LDL-C) and apolipoprotein (apo) B levels in smoking group was higher than that of control group. The OR value of alcohol intake at early age (early than 20) were 3.275 (95% CI: 1.249 - 8.580) and 4.016 (95% CI: 1.475 - 10.952) respectively. The LDL-C, apoB, the serum total cholesterol (TC)/high density lipoprotein-cholesterol (HDL-C) levels in alcohol abuse group were higher than that of control group. CONCLUSION: Smoking and alcohol abuse were important risk factors of hyperlipidemia, through changing the level of LDL-C and apoB. There was synergistic action between smoking and alcohol abuse in the development of hyperlipidemia.