[Network correlation of circRNA-miRNA and the possible regulatory mechanism in acute myocardial infarction].

Objective: Using microarray technology, to research characteristic circRNA and miRNA expression profile of acute myocardial infarction (AMI), and then explore the role of these circRNA and miRNA in gene regulation. The aim is to explore the mechanism of development of AMI. Methods: The patients hospitalized in the Cardiovascular Research Center of the First Affiliated Hospital of Xinxiang Medical University between November 2016 and January 2017 were included and divided into control group and AMI group according to diagnostic criteria. We collected their whole blood and extracted the total RNA, and the expression profiles of circRNA and microRNA genes in peripheral blood of AMI were analyzed by gene chip. We predicted circRNA which was possible to combine with miRNA, and drew a network diagram, and the differentially expressed circRNA was analyzed by GO and Pathway. Results: There was difference in circRNA expression profile between the control group and the AMI group. The results showed: (1) a total of 1 670 circRNA had differential expressions, and in the analysis of miRNA expression, 13 miRNA had differential expressions (P<0.05, fc≥2); (2) multiple circRNAs-miRNAs were involved in the occurrence of AMI; (3) the analysis of GO and Pathway for differentially expressed circRNAs showed that many pathways, disease and function participated in it. Conclusion: CircRNA, as an important post transcriptional regulator, is closely related to the development of AMI with miRNA.

The relationship between high-density lipoprotein cholesterol levels and arterial stiffness in a Taiwanese population.

BACKGROUND AND AIMS: There are few studies on the association between HDL-C levels and arterial stiffness (AS). HDL-C levels vary in males and females, and it is not clear whether the relationship between HDL-C levels and AS is influenced by gender. The purpose of this study was to investigate gender differences in the association between HDL-C levels and AS in adults. METHODS AND RESULTS: After excluding subjects using lipid-lowering agent, 7254 subjects were enrolled. The AS was assessed by measuring the brachial-ankle pulse wave velocity (baPWV) value. The quartiles of HDL-C were <38, 38-45, 45-53 and >53 mg/dL in men and <48, 48-57, 57-69 and >68 mg/dL in women, respectively. In subjects aged <50 years, none of the HDL-C quartiles were associated with baPWV values. In subjects aged ≥50 years, the highest quartile of HDL-C (beta: -37.57, 95% CI: -61.61 to -13.54) was negatively related to baPWV values. When considering gender difference in subjects aged ≥50 years, the highest quartile of HDL-C (Q4 beta: -57.22, 95% CI: -95.63 to -18.81) was inversely associated with baPWV values in women, but none of the HDL-C quartiles were related to baPWV values in men. CONCLUSIONS: A high HDL-C level was associated with a lower risk of AS in subjects aged ≥50 years in women but not in men, although this relationship was not apparent in subjects aged <50 years. The association between HDL-C level and AS is thus influenced by gender in people aged ≥50 years.

Effects of DNA methyltransferase inhibitor RG108 on methylation in buffalo adult fibroblasts and subsequent embryonic development following somatic cell nuclear transfer.

Buffalo are characteristic livestock of the Guangxi Zhuang Autonomous Region of China, but their low reproductive capacity necessitates the use of somatic cell nuclear transfer (SCNT). We investigated the effects of RG108 on DNA methylation in buffalo adult fibroblasts, and on subsequent SCNT embryo development. RG108 treatment (0, 5, 10, 20, and 100 mM) had no effect on cell morphology, viability, or karyotype (2n = 48), and cell growth followed a typical "S" curve. Immunohistochemistry showed that relative DNA methylation gradually decreased as RG108 concentration increased, and was significantly lower in the 20 and 100 mM groups compared to the 0, 5, and 10 mM treatments (0.94 ± 0.03 and 0.92 ± 0.05 vs 1.0 ± 0.02, 0.98 ± 0.05, and 0.98 ± 0.09, respectively; P < 0.05). Quantitative polymerase chain reaction revealed that DNMT1 gene expression of fibroblasts administered 10, 20, and 100 mM RG108 was significantly lower than those in the 0 and 5 mM groups (0.2 ± 0.05, 0.18 ± 0.07, and 0.3 ± 0.09 vs 1.0 ± 0.12 and 1.4 ± 0.12, respectively; P < 0.05). Treatment with 20 mM RG108 resulted in the lowest expression levels. Fibroblasts incubated with 20 mM RG108 for 72 h were used as donor cells to generate SCNT embryos. A greater number of such embryos developed into blastocysts compared to the non-treated group (28.9 ± 3.9 vs 15.3 ± 3.4%; P < 0.05). RG108 treatment can modify DNA methylation in buffalo adult fibroblasts and promote development of subsequent SCNT embryos.

Cardiac autonomic function and insulin resistance for the development of hypertension: a six-year epidemiological follow-up study.

BACKGROUND AND AIMS: To explore the impact of cardiac autonomic function (CAF) and insulin resistance (IR) on incident hypertension. METHODS AND RESULTS: In 1996, 1638 subjects finished baseline examination, which included anthropometry, blood pressures, CAF, blood biochemistry, plasma insulin, urine examination and electrocardiogram. CAF included standard deviation of normal-to-normal intervals or RR intervals (SDNN), low- and high-frequency power spectrum (LF and HF), and LF/HF ratio at supine for 5 min, the RR interval changes during lying-to-standing maneuver, and the ratio between the longest RR interval during expiration and the shortest RR interval during inspiration (E/I ratio). We used homeostasis model assessment to define beta cell function (HOMA-B) and insulin resistance (HOMA-IR). In total, 992 non-hypertensive participants completed the follow-up assessment in 2003 and 959 participants were included for the final analysis. Incident hypertension was determined by blood pressure status at follow-up. In unadjusted model, both square root of HOMA-IR (OR:3.37, 95%CI: 2.10-6.64) and HOMA-B (OR:0.996, 95%CI: 0.992-0.999) were related to incident hypertension. In multivariate model, square root of HOMA-IR (OR:1.97, 95%CI: 1.05-3.70), but not HOMA-B, was associated with incident hypertension. After further adjustment for baseline CAF, the positive relationship between the square root of HOMA-IR and incident hypertension disappeared. In contrast, LF/HF ratio (OR:1.18, 95%CI: 1.01-1.37), HF power (OR:0.98, 95%CI: 0.96-0.999), and E/I ratio (OR:0.71, 95%CI: 0.54-0.95) were each independently associated with incident hypertension after further adjustment for HOMA measures. CONCLUSION: Sympathovagal imbalance with an apparently decreased parasympathetic tone is an important predictor of incident hypertension independent of IR.

DGAT1, GH, GHR, PRL and PRLR polymorphism in water buffalo (Bubalus bubalis).

The polymorphism of several genes has been shown to affect the milk composition traits in dairy cattle, including DGAT1-exon8 K232A, GH-intron3 MspI, GH-exon5 AluI, GHR-exon8 F279Y, PRL-exon3 RsaI and PRLR-exon3 S18N. However, the polymorphism and effects of these genes on the milk traits of water buffalo are still unclear. In this study, four DNA pooling samples from Murrah, Nili-ravi, Murrah-Nili-Swamp crossbreed and Chinese swamp buffalo were constructed, respectively, and polymorphism of these sites was investigated using PCR-Single-strand conformation polymorphism and sequencing. Twenty-eight inter-specific single-nucleotide polymorphism (SNPs) were found in these six assayed gene fragments between buffalo and dairy cattle, including nine intra-specific SNPs among buffalo groups. All buffalo fixed a K allele genotype in DGAT1-exon8, MspI(+) restriction site(c nucleotide) and AluI(+) site(c nucleotide) at intron3 and exon5 of GH gene, F allele genotype of F279Y mutation in GHR gene, RsaI(-) restriction site at PRL-exon3/exon4 and N allele genotype of S18N mutation at PRLR-exon3. It provides an indirect evidence that water buffalo have fixed alleles with genotypes reported in dairy cattle, which is thought to be responsible for high milk fat, high protein content and low milk yield. Moreover, three new intra-specific SNPs were found including 275th bp (c/t) in DGAT1 of Murrah buffalo, 109th bp (t/a) in PRL-exon3/exon4 and 43rd bp (c/t) in PRLR-exon3 of Chinese swamp buffalo. Information provided in this study will be useful in further studies to improve buffalo breeding for better lactation performances.

Immunisation against inhibin enhances follicular development, oocyte maturation and superovulatory response in water buffaloes.

This study was carried out to test the feasibility of enhancing embryo production in vivo and in vitro by immunoneutralisation against inhibin or follistatin. In Experiment 1, multi-parity buffaloes were assigned into three groups: High group (n=8), which received one primary (2mg) and two booster (1mg) vaccinations (28-day intervals) with a recombinant inhibin α subunit in 1 mL of white oil adjuvant; Low group (n=8), which received half that dose; and Control group (n=7), which received only adjuvant. Immunisation against inhibin stimulated development of ovarian follicles. Following superovulation and artificial insemination, inhibin-immunised buffaloes had more developing follicles than the Control buffaloes. The average number of embryos and unfertilised ova (4.5±0.6, n=6) in the High group was higher (P<0.05) than in the Control group (2.8±0.6, n=5) and was intermediate (4.1±0.7, n=7) in the Low group. The pooled number of transferable embryos of the High and Low groups (3.2±0.5, n=13) was also higher (P<0.05) than that (1.6±0.7, n=5) of the controls. The immunised groups also had higher plasma concentrations of activin, oestradiol and progesterone. In Experiment 2, the addition of anti-inhibin or anti-follistatin antibodies into buffalo oocyte IVM maturation medium significantly improved oocyte maturation and cleavage rates following parthenogenic activation. Treatment with anti-follistatin antibody also doubled the blastocyst yield from activated embryos. These results demonstrated that immunisation against inhibin stimulated follicular development, enhanced oocyte quality and maturation competence, yielded more and better embryos both in vivo and in vitro.

Epidemiological evidence of altered cardiac autonomic function in overweight but not underweight subjects.

BACKGROUND: Little is known about the altered cardiac autonomic function (CAF) across different levels of body mass index (BMI), including underweight, normal weight, overweight and obesity. This study provides a thorough analysis to clarify the CAF change in subjects with underweight, overweight and obesity. METHODS: According to the World Health Organization (WHO) Asia-Pacific BMI cutoffs, a total of 1437 participants were classified as underweight (n=74), normal weight (n=588), overweight (n=313), obesity I (n=390) and obesity II (n=72). CAF was determined by standard deviation of normal-to-normal (SDNN) intervals or RR intervals, power spectrum in low (LF) and high frequency (HF) (LF, 0.04-0.15 Hz; HF, 0.15-0.40 Hz), and LF/HF ratio at supine for 5 min, the ratio between the 30th and the 15th RR interval after standing from the supine position (30/15 ratio) and the average heart-rate change while taking six deep breaths in 1 min (HR(DB)). RESULTS: There were significant differences in age, gender, socioeconomic status, blood pressure, HOMA insulin resistance index, fasting glucose, cholesterol, triglyceride and high-density lipoprotein (HDL)-C, and the prevalence of hypertension, ischemic/left bundle branch block (LBBB) electrocardiography (EKG) pattern, current smoking and alcohol use among subjects with underweight, normal weight, overweight, obesity I and II. Univariate analysis showed that SDNN, HR(DB), HF power and the square root of the LF/HF ratio differed among these five groups. Multivariate analysis showed that obesity I and II were inverse correlates of HR(DB) and HF power. Overweight, obesity I and II were positively associated with the square root of the LF/HF ratio. No BMI status was related to SDNN, 30/15 ratio or LF power. Underweight was not the independent correlate of any CAF indices. CONCLUSIONS: The risk for altered CAF is significant in overweight and obese subjects, independent of cardiovascular risk factors. Underweight is not apparently associated with CAF change.

Gallstone disease associated with increased risk of arterial stiffness in a Taiwanese population.

Arterial stiffness has similar risk factors to gallstone disease (GSD). However, there are few studies on the association between arterial stiffness and GSD. The aim of this study was to determine the relationship between arterial stiffness and GSD in a Taiwanese population. We enroled 6211 subjects from a health examination centre after excluding those who received medications for diabetes, hypertension and hyperlipidemia or had a history of cardiovascular disease, cerebrovascular disease, cancer, cholecystectomy or ankle-brachial index of ⩽ 0.9 or⩾1.3. Increased arterial stiffness was defined as right brachial-ankle pulse wave velocity (baPWV) ⩾1400 cm s-1. The diagnosis of GSD was based on ultrasonographic findings. The prevalence of increased arterial stiffness was 47.2 and 31.9 % in subjects with and without GSD (P<0.001). A multiple linear regression analysis revealed that GSD, age, systolic blood pressure, fasting plasma glucose and current smoking were positively associated with baPWV, whereas male gender, BMI, habitual exercise and HDL-C were negatively related to baPWV after adjusting for other clinical variables. In conclusion, subjects with GSD are associated with an increased risk of arterial stiffness.

Higher serum uric acid level increases risk of prehypertension in subjects with normal glucose tolerance, but not pre-diabetes and diabetes.

Although the association between serum uric acid (SUA) levels and prehypertension has been reported in previous studies, it is unknown whether their relationship is similar in subjects with diabetes, pre-diabetes and normal glucose tolerance (NGT). This study thus aimed to investigate the relationship between SUA and prehypertension in subjects with different glycemic status, including NGT, pre-diabetes and diabetes. A total of 12 010 participants were included after excluding subjects with blood pressure ⩾140/90 mm Hg, history of hypertension, leukaemia, lymphoma, hypothyroidism, medication for hypertension and hyperuricemia and missing data. Subjects were divided into four groups based on SUA quartiles (male Q1: ⩽345.0, Q2: 345.0-392.6, Q3: 392.6-440.2, Q4: ⩾440.2 µmol l(-1) and female Q1: ⩽249.8, Q2: 249.8-285.5, Q3: 285.5-333.1, Q4: ⩾333.1 µmol l(-1)). Diabetes, pre-diabetes and NGT were assessed according to the 2010 American Diabetes Association diagnostic criteria. Normotension and prehypertension were defined according to the JNC-7 (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) criteria. The SUA was significantly higher in prehypertensive subjects as compared with normotensive subjects. SUA, as a continuous variable, was positively associated with prehypertension in subjects with NGT but not pre-diabetes and diabetes. Besides, NGT subjects with the highest quartile of SUA exhibited a higher risk of prehypertension after adjustment for other confounding factors. In pre-diabetes and diabetes groups, none of SUA quartiles was significantly related to prehypertension. SUA was significantly associated with an increased risk of prehypertension in subjects with NGT but insignificantly in subjects with pre-diabetes and diabetes.

Role of adenosine in insulin-stimulated release of leptin from isolated white adipocytes of Wistar rats.

Leptin, the ob gene product that can decrease caloric intake and increase energy expenditure, is functionally released by insulin from adipose tissue. Adenosine is thought to be an important regulator of the action of insulin in adipose tissue. The present study investigated the role of adenosine in the release of leptin by insulin in isolated rat white adipocytes. Release of leptin, measured by radioimmunoassay, from insulin-stimulated samples was seen after 30 min. Adenosine deaminase, at concentrations sufficient to metabolize endogenous adenosine, decreased insulin-stimulated leptin release. Also, the insulin-stimulated leptin release was completely blocked by the adenosine A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX). Mediation of endogenous adenosine in this action of insulin was further supported by the assay of adenosine released into the medium from adipocytes stimulated with insulin. In addition, activation of adenosine A1 receptors by N6-cyclopentyladenosine (CPA) induced an increase in leptin release in a concentration-dependent manner that could be blocked by antagonists, either DPCPX or 8-(p-sulfophenyl)theophylline (8-SPT). In the presence of U73312, a specific inhibitor of phospholipase C (PLC), CPA-stimulated leptin secretion from adipocytes was reduced in a concentration-dependent manner, but it was not affected by U73343, the negative control for U73312. Moreover, chelerythrine and GF 109203X diminished the CPA-stimulated leptin secretion at concentrations sufficient to inhibit protein kinase C (PKC). These results suggest that, in isolated white adipocytes, the released adenosine acts as a helper and/or a positive regulator for insulin in the release of leptin via an activation of adenosine A1 receptors that involves the PLC-PKC pathway.

Plasma glucose-lowering effect of tramadol in streptozotocin-induced diabetic rats.

The effect of tramadol on the plasma glucose level of streptozotocin (STZ)-induced diabetic rats was investigated. A dose-dependent lowering of plasma glucose was seen in the fasting STZ-induced diabetic rats 30 min after intravenous injection of tramadol. This effect of tramadol was abolished by pretreatment with naloxone or naloxonazine at doses sufficient to block opioid mu-receptors. However, response to tramadol was not changed in STZ-induced diabetic rats receiving p-chlorophenylalanine at a dose sufficient to deplete endogenous 5-hydroxytrptamine (5-HT). Therefore, mediation of 5-HT in this action of tramadol is ruled out. In isolated soleus muscle, tramadol enhanced the uptake of radioactive glucose in a concentration-dependent manner. The stimulatory effects of tramadol on glycogen synthesis were also seen in hepatocytes isolated from STZ-induced diabetic rats. The blockade of these actions by naloxone and naloxonazine indicated the mediation of opioid mu-receptors. The mRNA and protein levels of the subtype 4 form of glucose transporter in soleus muscle were increased after repeated treatments for 4 days with tramadol in STZ-induced diabetic rats. Moreover, similar repeated treatments with tramadol reversed the elevated mRNA and protein levels of phosphoenolpyruvate carboxykinase in the liver of STZ-induced diabetic rats. These results suggest that activation of opioid mu-receptors by tramadol can increase the utilization of glucose and/or decrease hepatic gluconeogenesis to lower plasma glucose in diabetic rats lacking insulin.

Klebsiella pneumoniae fascial space infections of the head and neck in Taiwan: emphasis on diabetic patients and repetitive infections.

OBJECTIVES: To assess the epidemiological features, clinical characteristics, treatment, and outcome of head and neck infections caused by Klebsiella pneumoniae. METHODS: We reviewed records of four common aerobic pathogens isolated by the microbiological laboratory of a teaching hospital in Taiwan from July 1995 to December 1999. Patients aged 14 or older with community-acquired fascial space infections of head and neck were identified by review of medical records and included in the study. RESULTS: A total of 100 cases were identified, and K. pneumoniae was the most common pathogen of monomicrobial infections (48%), followed by viridans streptococci (15%). Polymicrobial infections were noted in 35 cases. In comparison with patients with infections not caused by K. pneumoniae, those with monomicrobial K. pneumoniae infections were older (P = 0.04) and had a higher prevalence of diabetes mellitus (P < 0.001), a longer duration of antimicrobial therapy (P = 0.007), a longer hospital stay (P = 0.001), and more repetitive infections (P = 0.001). All but one of K. pneumoniae isolates were susceptible to first generation cephalosporins and aminoglycosides. CONCLUSIONS: K. pneumoniae is an important endemic pathogen of fascial space infections of head and neck in Taiwan, especially among diabetics. Physicians should be aware of the tendency of this organism to cause repetitive infection.

Postural hypotension and postural dizziness in patients with non-insulin-dependent diabetes.

BACKGROUND: Postural hypotension with a decline of 20 mm Hg or more in systolic blood pressure on standing is considered a potentially dangerous hypotensive response. Postural dizziness is often strongly associated with postural hypotension. However, there is conflicting evidence, and previous studies have been confined to the elderly, not specifically to patients with diabetes. Thus, we evaluated the association between postural hypotension and postural dizziness, and determined the factors most likely related to postural hypotension in patients with diabetes. METHODS: The subjects were 204 consecutive noninsulin-dependent patients with diabetes and 408 age- and sex-matched control subjects. Postural hypotension was defined as a decline of 20 mm Hg or more in systolic blood pressure 1 minute after standing. Postural dizziness was any feelings of dizziness, lightheadedness, or faintness that occurred while standing during the examination. RESULTS: The prevalence of postural hypotension and postural dizziness in patients with diabetes was higher than in control subjects. Those patients with both diabetes and postural hypotension were older and had higher supine systolic blood pressures and higher plasma glycosylated hemoglobin and fasting glucose levels. They had higher prevalence of postural dizziness, hypertension, and cerebrovascular disease, and lower standing systolic blood pressures than those without postural hypotension. They also were more often being treated with antihypertensive agents. Only 32.8% of patients with diabetes with postural hypotension suffered from postural dizziness. Postural dizziness, hypertension, cerebrovascular disease, and plasma glycosylated hemoglobin levels were independently associated with postural hypotension in patients with diabetes. CONCLUSIONS: Postural dizziness, glycemic control, hypertension, and cerebrovascular disease were important determinants of postural hypotension in patients with diabetes. Postural hypotension was associated with postural dizziness, but it cannot be determined clinically just from the presence of postural dizziness because the sensitivity for diagnosis of postural hypotension is low.

Serum lipids and lipoprotein(a) concentrations in Chinese NIDDM patients. Relation to metabolic control.

OBJECTIVE: To compare serum blood lipids and lipoprotein(a) [Lp(a)] levels in Chinese non-insulin-dependent diabetes mellitus (NIDDM) patients and nondiabetic control subjects and also to determine the influence of diabetes control on serum Lp(a) concentration in Chinese individuals. RESEARCH DESIGN AND METHODS: We compared the serum blood lipids and Lp(a) levels in NIDDM patients (n = 100) and age- and sex-matched nondiabetic subjects (n = 100) who participated in a case-control study. Comparisons of Lp(a) concentrations were made between a normal control group, a group of diabetic patients with HbA1c < 8.0%, and a group of diabetic patients with HbA1c of 8% or higher. RESULTS: The diabetic patients had higher total triglyceride, apolipoprotein B (apo B), and apo B-to-apo AI ratios, but lower high-density lipoprotein (HDL) cholesterol and apo AI concentrations than nondiabetic controls (P < 0.001, P < 0.01, P < 0.001, P < 0.05, and P < 0.001, respectively). A similar pattern of distribution of Lp(a) levels according to the degree of metabolic control was seen in patients with NIDDM and nondiabetic controls. No correlation was observed between Lp(a) levels and total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, apo AI, apo B, and triglyceride levels in all diabetic patients. No difference in the Lp(a) levels was noted between diabetic patients and nondiabetic subjects, even in poorly controlled diabetic patients. CONCLUSIONS: In conclusion, Lp(a) levels are not elevated in diabetic patients, even in poorly controlled metabolic conditions.

Age and sex effects on HbA1c. A study in a healthy Chinese population.

OBJECTIVE: To evaluate whether glycohemoglobin levels increase with age in both sexes and to determine the effect of BMI on this increment. RESEARCH DESIGN AND METHODS: A cross-sectional survey of 4,580 healthy Chinese men and women, aged 20-85 years, was performed. All subjects who did not have identifiable diseases and who were not on medication known to influence glucose tolerance were recruited from participants at the preventive services of the National Cheng-Kung University Hospital. As an indicator of plasma glucose levels, glycohemoglobin was measured. The subjects were classified according to their age and BMI for both men and women, and any relationships with glycohemoglobin levels were evaluated. RESULTS: In all the BMI groups divided into quartiles, glycohemoglobin levels increased with age. The largest elevation of glycohemoglobin was observed in the 45- to 54-year-old age-group, except in men with a BMI between the lowest and highest quartiles. The group with a BMI above the highest quartile had a higher glycohemoglobin than the group with a BMI below the lowest quartile in men aged < 54 years and women aged 35-64 years. Men had higher average glycohemoglobin levels than women < 55 years of age. CONCLUSIONS: The age factor itself may cause an elevation in glycohemoglobin independent of other age-related factors in Chinese men and women, and there is a sex difference with a lower average glycohemoglobin level in women before menopause. Furthermore, BMI, but not a family predisposition to diabetes or leisure-time physical activity, affects this age-dependent increase in glycohemoglobin levels.

Fasting plasma glucose in screening for diabetes in the Taiwanese population.

OBJECTIVE: To reveal the relationship between fasting and 2-h postload plasma glucose and to examine the appropriate fasting glucose cutoff as the primary screening test for diabetes. RESEARCH DESIGN AND METHODS: We recruited 5,303 subjects from preventive services of the National Cheng Kung University Hospital. Exclusion criteria were age <20 years, pregnancy, known diabetes, and a history of recent surgery, trauma, or illness. All subjects received the 75-g oral glucose tolerance test. The relationship between fasting and 2-h glucose was examined. Sensitivities, specificities, efficiency, and predictive values were assessed at different cutoffs of fasting glucose for prediction of diabetes. RESULTS: The best fit model for the relationship between fasting and 2-h glucose was fasting glucose = 4.914-0.060 x (2-h glucose) + 0.0144 x (2-h glucose)2. From this model, the fasting glucose was 6.0 mmol/l when 2-h glucose was 11.1 mmol/l. A fasting glucose with 6.25 mmol/l gave the same diabetes prevalence as the World Health Organization 2-h glucose criterion. When 7.8 mmol/l was the fasting glucose cutoff, the sensitivity was 28.5%. Lowering the cutoff from 7.8 to 7.0 mmol/l increased the sensitivity by 11.2% and slightly reduced the specificity and positive predictive value. If the cutoffs were 6.25 and 6.0 mmol/l, the sensitivity increased and the specificity and the positive predictive value decreased accordingly. CONCLUSIONS: Our results suggest that fasting glucose as a screening criterion for diabetes could be revised downward to 7.0 mmol/l, because the slight reduction of positive predictive value was more than balanced by an apparent increase of sensitivity and insignificant change of specificity.

Discriminating glucose tolerance status by regions of interest of dual-energy X-ray absorptiometry. Clinical implications of body fat distribution.

OBJECTIVE: To determine whether measuring body fat distribution by dual-energy X-ray absorptiometry (DEXA) can be used to discriminate glucose tolerance status. RESEARCH DESIGN AND METHODS: Using a 75-g oral glucose tolerance test, a total of 1,015 Chinese subjects (559 men and 456 women) were categorized as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or diabetes. Blood pressure and lipid profiles of these subjects were measured. Waist-to-hip ratio (WHR) and DEXA were used to evaluate the varying patterns of body fat distribution among the groups. RESULTS: Body fat distribution, as reflected by WHR and the centrality index, showed significant partial correlation coefficients with glycosylated hemoglobin, blood pressure, and lipid profiles in all subjects. After adjusting for age and BMI, there were significant differences among the three glycemic groups for all the cardiovascular risk factors except for total cholesterol level. The diabetic group had a significantly higher WHR and centrality index, but lower femoral fat percentage than the NGT and IGT groups. The diabetic group also showed higher abdominal fat percentage than the NGT group. Moreover, the IGT group had a higher centrality index than the NGT group. However, no significant differences were found in the percentage of lean tissue mass among the three groups. Using multiple stepwise logistic regression models, the centrality index remained a significant factor for discriminating different glucose tolerance status independent of the percentage total body fat. CONCLUSIONS: Central obesity has shown significant correlation with cardiovascular risk factors among the three different glycemic groups. Centrality index measured by DEXA appears to be the better predictor of glucose intolerance, compared with WHR, abdominal fat, and general obesity (reflected by percentage total body fat or BMI) in a large cohort of the Chinese population.

Relationship between glycosylated hemoglobin, blood pressure, serum lipid profiles and body fat distribution in healthy Chinese.

Obesity-related metabolic disorders have not been adequately addressed due to a failure to distinguish the importance of general obesity or body fat distribution in relation to atherosclerotic risk factors, especially in the less obese populations. To assess the relationship between general obesity (reflected by BMI, total body fat percentage and total adiposity), body fat distribution (reflected by WHR, default regions and ROIs of DEXA) and atherosclerotic risk factors in the Chinese population, a total of 872 healthy subjects (477 male and 395 female) were enrolled in the study. The results indicated that the android pattern of fat distribution, independent of general obesity, was positively correlated with blood pressure, atherogenic indices, fasting and OGTT 2-h plasma glucose, glycosylated hemoglobin (HbA1c), serum concentration of cholesterol, triglyceride, LDL cholesterol and negatively correlated with HDL cholesterol in both genders. The gender differences in patterns of body fat distribution and atherosclerotic risk factors remained significant after adjustments were made for age, BMI and total adiposity, although diminished after further adjustments for body fat distribution. In conclusion, body fat distribution, rather than general obesity, is more correlated with obesity-related atherosclerotic risk factors and sex-associated differences. ROIs measured by DEXA may be a useful method to evaluate sex-associated changes in body fat distribution and atherosclerotic risk factors in the healthy Chinese population.

Factors associated with orthostatic hypotension in the Chinese population in Taiwan.

Factors associated with orthostatic hypotension are heterogeneous, and some of the factors are interrelated and interdependent, which may confound their relationships to orthostatic hypotension. To investigate the factors that were most likely related to orthostatic hypotension, a study of community-dwelling persons (419 men and 309 women) was conducted. Blood pressures and heart rates were measured after the subjects had been recumbent for 5 min and upright for 1 min. A total of 119 persons (16.3%) experienced orthostatic hypotension. Univariate analysis showed that orthostatic hypotension was associated with the following variables: hypertension, diabetes mellitus, cerebrovascular disease, proteinuria, abnormal renal function, or medications use. Those patients with orthostatic hypotension were older in age and had a higher body mass index, seated blood pressure, plasma creatinine, hemoglobin A1c, fasting and 2-h postload glucose levels than those without orthostatic hypotension. Multivariate analysis revealed that diabetes mellitus, hypertension, and age were independently associated factors for orthostatic hypotension. The higher the level of plasma hemoglobin A1c (%) elevation, the higher the likelihood of orthostatic hypotension manifestation. Clinically, elderly persons or patients with hypertension or diabetes mellitus should receive regular monitoring of supine and upright blood pressure in order to detect orthostatic hypotension and prevent its complications.

Hypertension in elderly persons: its prevalence and associated cardiovascular risk factors in Tainan City, southern Taiwan.

BACKGROUND: Hypertension was the eighth leading cause of death in Taiwan in 1996, and the prevalence of hypertension has increased recently. The purpose of the study was to assess the prevalence of hypertension and its associated cardiovascular risk factors in elderly persons in Tainan City, southern Taiwan. METHODS: The study was a cross-sectional, population-based study. We used the stratified cluster sampling method to enroll subjects aged 65 years and above, 1435 persons in total, into our study. Questionnaire interview, body weight, body height, and blood pressure measurement were completed for 876 participants (response rate of 70.2%) at each subject's home by home visit. RESULTS: Hypertension was defined according to the criteria of the Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The crude prevalence of hypertension was 60.4% (men 59.1%, women 61.9%); previously diagnosed hypertension was 31.1% (men 29.4%, women 33.1%); and newly diagnosed hypertension was 29.3% (men 29.7%, women 28.8%). The hypertensive group had a higher body mass index (BMI) than the normotensive group. There were no lifestyle differences such as smoking, drinking, eating a vegetarian diet, reading health information, and undergoing a health examination in the past year between the hypertensive and normotensive groups. However, the hypertensive group had a higher prevalence of regular exercise than did the normal blood pressure group on univariate analysis. Only BMI and family history of hypertension had a significantly positive association with hypertension on multiple logistic regression analysis. CONCLUSIONS: The crude prevalence of hypertension was 60.4% in elderly persons in Tainan City. Subjects who had family history of hypertension and higher BMI had a higher risk of hypertension, so they should be screened for high blood pressure regularly.