The associations between urinary metals and metal mixtures and kidney function in Chinese community-dwelling older adults with diabetes mellitus.

BACKGROUND: Previous studies have found associations between single toxic metals, such as arsenic and cadmium, and kidney function in adults with diabetes. However, studies with regards to other metals and metal mixtures are still limited. OBJECTIVE: Our study aimed to investigate the associations between urinary concentrations of 5 selected metals and metal mixtures and kidney function using a sample of older adults with diabetes mellitus in Chinese communities. METHODS: In a sample of older adults (n = 5186), 592 eligible subjects were included in this study. Urinary concentrations of 5 metals, i.e., arsenic (As), cadmium (Cd), vanadium (V), cobalt (Co), and thallium (Tl), were measured by inductively coupled plasma mass spectrometer (ICP-MS). Estimated glomerular filtration rate (eGFR) was calculated and dichotomized into indicator of chronic kidney disease (CKD). Logistic analysis and Bayesian kernel machine regression (BKMR) were used to explore the associations between single metals and metal mixtures and CKD, respectively. RESULTS: Urinary levels of As and V were positively correlated with CKD (OR=2.37, 95% CI: 1.31-4.30 for As; OR=2.24, 95% CI: 1.25-4.03 for V), when compared the 4th quartile with the 1st quartile. After adjustment for potential confounders, the significant association between As and CKD still existed (OR=2.73, 95% CI: 1.23-6.07). BKMR analyses showed strong linear positive associations between As and V and CKD. Higher urinary levels of the mixture were significantly associated with higher odds of CKD in a dose-response pattern. As and V showed the highest posterior inclusion probabilities. CONCLUSION: Urine As and V were positively associated with CKD in older adults with diabetes mellitus, separately and in a mixture. The metals mixture showed a linear dose-response association with the odds of CKD. The analyses of mixtures, rather than of single metals, may provide a real-world perspective on the relationship between metals and kidney function.

The association of marital status with cognitive function and the role of gender in Chinese community-dwelling older adults: a cross-sectional study.

BACKGROUND: Evidence of the association between marital status and cognitive function in Chinese older adults is limited. AIMS: To examine the relationship between marital status and cognitive function and to explore the role of gender amongst older adults from three Chinese communities. METHODS: A total of 1376 participants aged 60 years or over were included in this cross-sectional study. Cognitive function was assessed using the Chinese version of the mini-mental state examination (MMSE). Marital status and other variables were collected using a standardized questionnaire. Multiple linear regression models were used to examine associations between marital statuses and cognitive function amongst the target population. The moderating role of gender in these potential associations has also been explored. RESULTS: In univariate linear regression models, compared to being married, both being widowed (ß [95% CI]: -1.46[-2.78 to - 0.13]) and being single (ß [95% CI]: - 4.88[-6.43 to - 3.38]) were associated with lower MMSE scores. After adjustment for confounding factors, the significant association of being widowed with MMSE scores disappeared (ß [95% CI: - 0.08[- 1.04 to 0.86]), but the association of being single with MMSE scores still existed (ß [95% CI]: - 1.87[- 3.17 to - 0.58]). Furthermore, the association of being single with MMSE scores was statistically significant in men (ß [95% CI]: - 5.25[- 7.17 to - 3.33]) but not in women (ß [95% CI: 0.88[- 0.87 to 2.64]). DISCUSSION AND CONCLUSIONS: Being single was associated with poorer cognitive function compared with their married counterparts in older Chinese men but not in women. More preventive measurements should be implemented for single men to reduce or delay cognitive decline. This is particularly important in the context of an aging population in China.

Levels and determinants of urinary phthalate metabolites in Chinese community-dwelling older adults.

BACKGROUND: Biomonitoring studies have demonstrated extensive exposure of infants, children, and pregnant women to phthalates, but data on phthalate exposure and their determinants in Chinese older adults remain insufficient. This study aims to assess urinary phthalate metabolite levels, individual and cumulative exposure risk, and their determinants in Chinese community-dwelling older adults. METHODS: A total of 987 individuals aged 60 years or over were included in this study. The urinary levels of seven phthalate metabolites were measured using high-performance liquid chromatography-tandem mass spectrometry. The estimated daily intake (EDI), hazard quotient (HQ), and hazard index (HI) of phthalates were calculated based on urinary metabolite levels. The associations between phthalate metabolite levels and potential determinants were examined using multiple linear regressions. RESULTS: Detection rates of seven phthalate metabolites from the study population ranged from 63.83% to 99.39%. The highest median concentration was 43.64 µg/L (42.59 µg/g creatinine) for mono-butyl phthalate (MBP). The highest median EDI was 1.55 µg/kg-bw/day for diethyl phthalate (DBP). Nearly 5% of participants had high HI values exceeding 1, mainly attributed to DBP and di-2-ethylhexyl phthalate (DEHP). Furthermore, we found that females, higher body mass index (BMI), smoking, having two or more chronic diseases, and vegetable-based diets were significantly associated with higher levels of parts of phthalate metabolites. More interestingly, higher urine levels of high-molecular-weight (HMW) phthalate metabolites and lower urine levels of low-molecular-weight (LMW) phthalate metabolites were found in rural older adults than in urban older adults. CONCLUSIONS: Chinese community-dwelling older adults are extensively exposed to phthalates, especially to DBP and DEHP. More attention should be paid to urban-rural differences in exposure to HMW and LMW phthalates and to phthalate exposure among older adults with overweight/obesity, females, and individuals who are current heavy smokers, have two or more chronic diseases, and consume vegetable-based diets.

[Clinical features of invasive candidiasis and risk factors for Candida bloodstream infection in children: a multicenter study in Urumqi, China].

OBJECTIVE: To investigate the clinical features of invasive candidiasis in children and the risk factors for Candida bloodstream infection. METHODS: A retrospective study was performed on 134 children with invasive candidiasis and hospitalized in 5 tertiary hospitals in Urumqi, China, between January 2010 and December 2015. The Candida species distribution was investigated. The clinical data were compared between the patients with and without Candida bloodstream infection. The risk factors for Candida bloodstream infection were investigated using multivariate logistic regression analysis. RESULTS: A total of 134 Candida strains were isolated from 134 children with invasive candidiasis, and non-albicans Candida (NAC) accounted for 53.0%. The incidence of invasive candidiasis in the PICU and other pediatric wards were 41.8% and 48.5% respectively. Sixty-eight patients (50.7%) had Candida bloodstream infection, and 45 patients (33.6%) had Candida urinary tract infection. There were significant differences in age, rate of use of broad-spectrum antibiotics, and incidence rates of chronic renal insufficiency, heart failure, urinary catheterization, and NAC infection between the patients with and without Candida bloodstream infection (P<0.05). The multivariate logistic regression analysis showed that younger age (1-24 months) (OR=6.027) and NAC infection (OR=1.020) were the independent risk factors for Candida bloodstream infection. CONCLUSIONS: The incidence of invasive candidiasis is similar between the PICU and other pediatric wards. NAC is the most common species of invasive candidiasis. Candida bloodstream infection is the most common invasive infection. Younger age (1-24 months) and NAC infection are the risk factors for Candida bloodstream infection.

[Leptin gene C2549A polymorphism in minority Hui and Uygur children with obesity].

OBJECTIVE: To investigate the relationship of leptin gene polymorphism with obesity in ethnic minority Hui and Uygur children in China. METHODS: Sixty-eight ethnic minority (35 Hui and 33 Uygur) children with obesity and 69 age-matched minority (36 Hui and 33 Uygur) children without obesity were recruited from six primary schools in the sub-urban areas of Urumqi. Venous blood was sampled from all subjects after fasting for 12 hours. Leptin gene C2549A polymorphism was determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism methods. Blood concentrations of lipids, leptin and insulin were measured with biochemical methods and radioimmunoassys, respectively. RESULTS: In the 137 children tested, the prevalence of AA, AC and CC genotype was 9.5%, 33.6% and 56.9%, respectively. A allele frequency was significantly different between the two ethnic (i.e. Hui and Uygur) groups (P<0.05). A allele frequency and AA+ AC genotype frequency were not significantly different between obese and non-obese children in both ethnic groups (P>0.05). Blood leptin levels were not significantly different between obese and non-obese children with an AA+AC or CC genotype in both ethnic groups (P>0.05). CONCLUSIONS: Leptin gene polymorphisms exist in Hui and Uygur children. The C2549A polymorphism is not significantly associated with the prevalence of obesity in both Hui and Uygur children.

[Epidemiological characteristics of metabolic syndrome among Kazakh children aged from 6 to 13 in Xinjiang, China].

OBJECTIVE: This study was designed to evaluate the epidemiology and clinical characteristics on metabolic syndrome (MetS) among overweight and obese children aged from 6 to 13 years old in Kazakh ethnic populations. METHODS: Based on the data including body mass index (BMI), waist circumference (WC) and blood pressure measured from the 'Kazakh ethnic child Health examination study in Yili', 5360 Kazakh children aged 6 - 13 were screened for overweight and obesity in Xinjiang, using the Chinese BMI cutoffs for schoolchildren (7 - 18 years) and WHO growth reference for school-aged children and adolescents (6 year). Simultaneously a group of children with normal BMI were selected as the control group. Fasting plasma glucose (FPG), insulin (FINS), serum high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were examined. HOMA-IR index was calculated to estimate the individual insulin resistance. Children under study were older than or equal to 10 years and met the criteria according to the definition of metabolic syndrome, prophylaxis and treatment on Chinese children and adolescents, proposed by the Society of Pediatrics in China or NCEP-ATPIII definition as MetS. Risk factors related to cardiovascular diseases were analyzed according to the criteria by the Society of Pediatrics among those aged from 6 to 10 years old children. Connection between waist-to-height ratio (WHtR) and biochemical indexes was explored. RESULTS: Prevalence rates of MetS according to the criteria from Society of Pediatrics in China were: 0%, 9.57%, 19.64% in the normal weight, overweight and obese children, respectively. The rates diagnosed by NCEP-ATPIII definition were 0.64%, 2.61%, 16.07% respectively. The detective rates of individual MetS component among obese children were: 78.95% for abdominal obesity, 29.82% for elevated BPs, 26.32% for high TG, 22.81% for low HDL-C, 0.88% for FPG. High TG (31.15%), abdominal obesity (23.77%) and low HDL-C (22.95%) appeared as the leading three abnormal indices among the overweight children. With increased BMI, the clustering of MetS components were also remarkably increasing. The detective rates of cardiovascular-related risk factors among overweight or obesity children from 6 to 10 years old were:abdominal obesity or obesity, low HDL-C, high TG, impaired FPG, elevated BPs. Differences were seen between overweight or obesity children and normal weight children on the detective rates of high TG, low HDL-C, abdominal obesity or obesity. WHtR was related with FINS, HOMA-IR index and LDL-C. CONCLUSION: MetS seemed epidemic among obese Hazakh children. Abdominal obesity, elevated BPs and high TG were the leading three abnormal factors among obese children. Compare to NCEP-ATPIII, abnormal biochemical indices on overweight Kazakh children seemed to be more sensitive, proposed by the Society of Pediatrics in China.

Characterization of erythromycin-resistant Streptococcus pneumoniae isolates causing invasive diseases in Chinese children.

BACKGROUND: Erythromycin-resistant Streptococcus pneumoniae isolates that causing invasive pneumococcal diseases (IPD) in Chinese children remain uncharacterized. This study aims to identify the resistance genes associated with erythromycin resistance and to determine the genetic relationships of IPD isolates in Chinese children. METHODS: A total of 171 S. pneumoniae strains were isolated from 11 medical centers in China from 2006 to 2008. All the isolates were characterized via serotyping and antibiotic susceptibility determination. The erythromycin-resistant isolates were further characterized via ermB and mefA gene detection, multi-locus sequence typing analysis, and pulsed-field gel electrophoresis. RESULTS: A total of 164 (95.9%) isolates showed resistance to erythromycin, of which 162 strains with high high-level resistance (MIC ≥ 256 µg/ml). A total of 104 (63.4%) isolates carry the ermB gene alone, whereas 59 (36.0%) harbor both ermB and mefA genes. Of the 59 strains, 54 were of serotypes 19A and 19F and were identified as highly clonal and related to the Taiwan(19F)-14 clone. CONCLUSIONS: The erythromycin resistance rate in IPD isolates is significantly high and is predominantly mediated by the ermB gene. Isolates that carry both ermB and mefA genes are predominantly of serotypes 19A and 19F.

[Correlation between obesity index and blood pressure in Kazak childhood from Yili, Xinjiang].

OBJECTIVE: To investigate the correlations between obesity index such as waist circumference, hip circumference, skin-fold thickness, body mass index, waist to hip ratio, waist to height ratio etc, and blood pressure among Kazak children living in Yili of Xinjiang. METHODS: In May-June 2009, 2438 Kazak children aged 7 to 14 at primary schools in Yili of Xinjiang, were investigated. Waist circumference, hip circumference, skin-fold thickness, systolic and diastolic blood pressure were measured to calculate the body mass index, waist to hip ratio and waist to height ratio. Analysis on the differences in age and gender, blood pressure (BP) between hypertensive or normal BP group under the standard set for children. SPSS 17.0 software was used for statistical analysis on its correlation. RESULTS: The total prevalence of hypertension was 5.7% in Kazak ethnic school-age children in Yili, with 4.4% in the boys and 7.0% in girls. Data from waist circumference, hip circumference, waist-height-ratio, waist-hip ratio, systolic and diastolic blood pressure showed gender and age differences (P = 0.000). Average systolic blood pressure was correlated to waist circumference, hip circumference, skin-fold thickness, body mass index and waist to hip ratio (P = 0.000), with hip circumference the most (man: r = 0.618, female: r = 0.655). The average diastolic blood pressure was correlated to waist circumference, hip circumference, skin-fold thickness, body mass index and waist to hip ratio (P = 0.000), with hip having the strongest relation (r = 0.489 for male and r = 0.548 for females). Significant differences were seen between Hypertension group and normal blood pressure group on waist circumference, hip circumference, skin-fold thickness, body mass index and waist-hip ratio (P < 0.05). CONCLUSION: In Yili of Xinjiang, the prevalence of hypertension was at the low level in Kazak ethnic school-aged children when comparing to data from national and foreign standards. Indicators related to obesity as waist circumference, hip circumference, body mass index and waist to hip ratio were positively correlated with blood pressure, with hip in particular.

[Childhood benign acanthosis nigricans and metabolic abnormality].

OBJECTIVE: To observe the relationship of childhood benign acanthosis nigricans to anthropometric and metabolic indexes, with the aim of studying the association between childhood benign acanthosis nigricans and metabolic diseases. METHODS: A retrospective analysis was performed on the clinical data of 29 children who presented with benign acanthosis nigricans between February 2007 and October 2011. Thirty-two age, sex- and ethnic-matched normal children were selected as control group. The two groups were compared according to obesity (body mass index, waist-to-hip ratio, body fat content and body fat percentage) and metabolic indexes (blood glucose, insulin level and blood lipids). RESULTS: Body mass index, body fat content, body fat percentage, waist-to-hip ratio, fasting blood glucose, insulin level and triglyceride in the 29 patients with benign acanthosis nigricans were higher than in the control group (P<0.05), but the level of high-density lipoprotein in the 29 patients was lower than in the control group (P<0.05). Of the 29 patients, 16 had impaired glucose tolerance and 3 were diagnosed with diabetes (1 case with type 1, two cases with type 2). CONCLUSIONS: Childhood benign acanthosis nigricans is closely associated with obesity, insulin resistance and dyslipidemia.

[Blood pressure levels of 2438 Hasakh children in the Yili region of Xinjiang Province].

OBJECTIVE: To study blood pressure levels, the prevalence of hypertension and factors associated with the development of hypertension in Hasakh children in the Yili region of Xinjiang Province. METHODS: A total of 2438 Hasakh school children from the Yili region of Xinjiang Province were sampled by stratified random cluster sampling method between May and June 2009. Height, weight, waist circumference, hip circumference, skinfold thickness and blood pressure were measured. Body mass index (BMI) was calculated. RESULTS: Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 94±13 mm Hg and 60±9 mm Hg respectively in the 2438 children, and both averages were lower than in the Han children. Hypertension was noted in 138 children (5.66%). The prevalence of hypertension in girls (6.97%, 84/1206) was higher than in boys (4.38%, 54/1232) (P<0.05). The prevalence of hypertension and blood pressone were positively correlated with BMI, waist circumference, hip circumference, skinfold thickness circumference, gender and age. CONCLUSIONS: Average blood pressure levels in Hasakh children in the Yili region of Xinjiang Province are lower than in domestic age-matched Han children. The prevalence of hypertension in girls is higher than in boys. Obesity is highly correlated with the development of hypertension.