Association of serum uric acid levels with osteoporosis and bone turnover markers in a Chinese population.

Recent evidence shows that uric acid is protective against some neurological diseases, but can be detrimental in many metabolic and cardiovascular disorders. In this study, we examined the association between serum uric acid levels and bone metabolism in Chinese males and postmenopausal females. A total of 943 males and 4256 postmenopausal females were recruited in Shanghai. The levels of serum uric acid and bone turnover markers (BTMs) were detected along with other biochemical traits. In addition, the fat distribution was calculated through MRI and image analysis software, and bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry. For postmenopausal females, the prevalence of osteoporosis was significantly lower in the hyperuricemia group compared with the normouricemic group (P=4.65E-06). In females, serum uric acid level was significantly associated with osteoporosis, with odds ratio (OR) and 95% confidence interval (95% CI) of 0.844 [0.763; 0.933] (P=0.0009) after adjusting for age, body mass index, HbA1c, lean mass, visceral and subcutaneous fat areas, albumin, 25-hydroxyvitamin D3 [25(OH)D3], and parathyroid hormone (PTH). In females, serum uric acid level was positively correlated with the BMD of the femoral neck (ß±SE: 0.0463±0.0161; P=0.0042), total hip (ß±SE: 0.0433±0.0149; P=0.0038) and L1-4 (ß±SE: 0.0628±0.0165; P=0.0001) after further adjusting for age, BMI, HbA1c, lean mass, VFA, SFA, albumin, 25(OH)D3 and PTH. Regarding BTMs, serum uric acid level was negatively correlated with N-terminal procollagen of type I collagen (PINP) in females (ß±SE: -0.1311±0.0508; P=0.0100). In summary, our results suggest that uric acid has a protective effect on bone metabolism independent of body composition in Chinese postmenopausal females.

Association of bone turnover markers with glucose metabolism in Chinese population.

The association between type 2 diabetes (T2DM) and bone metabolism has been discussed previously but is controversial. In this study we aimed to evaluate the association of bone turnover markers with glucose metabolism in Chinese population, in which 919 males and 4171 postmenopausal females in a region of Shanghai were recruited. Anthropometric and biochemical traits related to glucose and bone metabolism were analyzed. Participants were classified according to their glucose tolerance as normal glucose tolerance (NGT), impaired glucose regulation (IGR) or T2DM. Males and females were analyzed separately, and then associations between bone turnover markers (BTMs) and glucose metabolism were evaluated. The results showed that in females, the serum levels of N-terminal osteocalcin (N-MID), N-terminal procollagen of type I collagen (PINP) and ß-cross-linked C-telopeptide of type I collagen (ß-CTX) were significantly decreased in the T2DM group compared to the NGT group (P<0.01). When age, body mass index, serum lipids, fat percentage, visceral fat area, subcutaneous fat area, anti-diabetic medicines, PINP, N-MID and ß-CTX were included in one logistic model, N-MID (OR [95% CI]: 0.954 [0.932; 0.976]; P=0.0001) was significantly associated with T2DM in females. In females, N-MID was associated with insulin sensitivity and HOMA-ß. PINP was significantly associated with HOMA-ß, GUTT-ISI, Stumvoll first-phase insulin secretion index (STU-1) and Stumvoll second-phase insulin secretion index (STU-2), but ß-CTX was associated only with HOMA-ß (ß±SE: 0.1331±0.0311; P=1.95×10-5) and GUTT-ISI (ß±SE: 0.0727±0.0229; P=0.0015). In males, N-MID was significantly correlated with HOMA-ß (ß±SE: 0.3439±0.0633; P=7.75×10-8), GUTT-ISI (ß±SE: 0.1601±0.0531; P=0.0027) and STU-1 (ß±SE: 0.2529±0.1033; P=0.0146). Significant associations were also detected between ß-CTX and HOMA-ß (ß±SE: 0.2736±0.0812; P=0.0009). This study reveals that BTMs are highly associated with T2DM, insulin sensitivity and beta cell function in both Chinese males and postmenopausal females.

Prevalence of unruptured cerebral aneurysms in Chinese adults aged 35 to 75 years: a cross-sectional study.

BACKGROUND: The reported prevalence of unruptured cerebral aneurysms (UCAs) varies widely. OBJECTIVE: To measure the prevalence of UCAs by using 3-dimensional time-of-flight magnetic resonance angiography in adults aged 35 to 75 years. DESIGN: Cross-sectional study done between June 2007 and June 2011. SETTING: Two communities chosen at random from 2 districts (1 urban and 1 suburban) in Shanghai, China. PARTICIPANTS: 4813 adults aged 35 to 75 years. MEASUREMENTS: Three-dimensional time-of-flight magnetic resonance angiography, interpreted by 3 observers blinded to the participants' information, was used to identify the location and size of UCAs and to estimate the overall, age-specific, and sex-specific prevalence. RESULTS: 369 UCAs were found in 336 participants (130 men and 206 women); 4477 participants had no evidence of UCAs. The prevalence was 7.0% overall (95% CI, 6.3% to 7.7%), with 5.5% for men (CI, 4.6% to 6.4%) and 8.4% for women (CI, 7.3% to 9.5%). The overall prevalence of UCAs was higher in women than in men (P < 0.001) and peaked at ages 55 to 64 years in men and women. The UCAs were mostly located in the internal carotid artery (81%), and 90.2% had a maximum diameter less than 5 mm. Mean diameter was larger in women than in men (3.7 mm vs. 3.2 mm; P < 0.009). LIMITATION: Participants were from 2 communities selected from 2 districts in Shanghai, and adults older than 75 years were not studied. CONCLUSION: The overall prevalence of UCAs was 7.0% in Chinese adults aged 35 to 75 years, and most lesions had a diameter less than 5 mm. PRIMARY FUNDING SOURCE: National Natural Science Foundation of China.

Metabolic disorders increase the risk to incident cardiovascular disease in middle-aged and elderly Chinese.

OBJECTIVE: The association of metabolic syndrome (MetS) with cardiovascular diseases (CVD) has not been adequately explored in middle-aged and elderly Chinese. This study aimed to investigate MetS' prevalence and its impact on the CVD incidence in this specific population group. METHODS: A data set of a community-based prospective cohort study was analyzed. A total of 2300 subjects aged 40-94 years were followed up for the CVD events. MetS defined according to the JCDCG criteria was assessed at baseline, and the middle-aged and elderly groups were classified by the WHO definition. RESULTS: As compared with the middle-aged group, the prevalence of MetS increased by 0.6 times (34.6% vs. 21.3%) and the incidence density of CVD increased by 4.9 times in the elderly group (52.3/1000 person-year vs. 8.9/1000 person-year). Furthermore, the multivariate Cox regression revealed that the risk to CVD incidence was independently related to increased waist circumference in the middle-aged group (HR=2.23, P<0.01) and to elevated blood glucose in the elderly group (HR=1.39, P<0.01). CONCLUSION: MetS was highly prevalent in middle-aged and elderly Chinese. MetS significantly increased the risk to CVD incidence in the elderly. All individuals with metabolic disorders should receive active clinical care to reduce the incidence of CVD.

Liver enzymes concentrations are closely related to prediabetes: findings of the Shanghai Diabetes Study II (SHDS II).

OBJECTIVE: To investigate the relationship of liver enzymes with hyperglycemia in a large population in Shanghai and identify the association between liver enzymes and insulin resistance. METHODS: A total of 3 756 participants were enrolled. Each participant underwent an oral glucose tolerance test and completed a questionnaire. Anthropometric indices were recorded and serum samples were collected for measurement. RESULTS: Liver enzymes concentrations were independently associated with i-IGT, IFG+IGT, and diabetes. With the increase of ALT and GGT concentrations, ORs for i-IGT, IFG+IGT, and diabetes increased gradually. By comparing patients in the highest quartile of GGT concentrations or ALT concentrations with those in the lowest quartile (Q1), ORs for i-IGT, IFG+IGT, or diabetes was significant after adjustment. Both ALT and GGT concentrations were linearly correlated with HOMA-IR and independently associated with HOMA-IR [ALT OR (95% CI): 2.56 (1.51-4.34) P=0.00; GGT OR (95% CI): 2.66 (1.53-4.65) P=0.00]. CONCLUSION: Serum ALT and GGT concentrations were closely related to pre-diabetes and diabetes in the Shanghai population and positively associated with insulin resistance.

Non-alcoholic fatty liver disease's prevalence and impact on alanine aminotransferase associated with metabolic syndrome in the Chinese.

BACKGROUND AND AIM: Non-alcoholic fatty liver disease (NAFLD) is becoming a major public health hazard in China. The present study aimed to estimate the prevalence of NAFLD, NAFLD with abnormal serum alanine aminotransferase (ALT) levels, and determine the potential associations of ALT levels with the components of metabolic syndrome (MetS) in the absence or presence of NAFLD in Chinese adults. METHODS: A population-based cross-sectional survey was conducted with 2226 participants. Physical examinations, laboratory tests and hepatic ultrasounds were performed. Individuals were further stratified into higher or lower ALT subgroups with the upper quartiles of ALT in this population. The MetS was identified according to the criteria of the Chinese Joint Committee for Developing Chinese Guidelines (JCDCG). RESULTS: The standardized prevalence of NAFLD was 23.3% (NAFLD with abnormal ALT levels, 3.1%), 26.5% (NAFLD with abnormal ALT levels, 5.1%) in males, and 19.7% (NAFLD with abnormal ALT levels, 0.9%) in females. Multivariate logistic analysis revealed that higher ALT was significantly associated with elevated triglyceride (TG) in the non-NAFLD participants, independent of age, smoking status, drinking status, and other MetS-related measures with odds ratios (95% confidence intervals) of 3.4 (1.6-7.1) and 2.3 (1.4-3.7) in males and females, respectively. On the other hand, the higher ALT was statistically associated with elevated TG and hyperglycemia in the NAFLD cases with odds ratios of 2.2 to 2.5 (P<0.05). CONCLUSIONS: The prevalence of NAFLD has become epidemic in Shanghai adults. NAFLD combined with ALT levels may be used to identify the individuals at the different risk levels of metabolic disorders.

Comparison of body mass index with body fat percentage in the evaluation of obesity in Chinese.

OBJECTIVE: To evaluate the present Chinese body mass index (BMI) criteria with body fat percentage (BF%) in determining obesity in Chinese population. METHODS: A total of 4 907 subjects (age: 20-90 yrs) were enrolled in the baseline survey of a longitudinal epidemiological study, and 2 638 of them were reevaluated in 5.5 years later. The Chinese BMI and WHO BF% were used to define obesity, respectively. RESULTS: The diagnostic agreement between the Chinese BMI and WHO BF% definitions for obesity was poor for both men (kappa: 0.210, 95% CI: 0.179-0.241) and women (kappa: 0.327, 95% CI: 0.296-0.358). However, BMI had a good correlation with BF% both in men (r: 0.785, P<0.01) and women (r: 0.864, P<0.01). The age and sex-adjusted relative risks (RR) for incidence of type 2 diabetes (T2DM) were significantly higher in subjects with intermediate BF% (BF%:20.1%-25% for men, 30.1%-35% for women) (RR: 2.35, 95% CI: 1.23-4.48) and high BF%(BF%>25% for men and > 35% for women)(RR: 2.89, 95% CI: 1.43-5.81), or in subjects with high BMI (BMI>or=28 kg/m(2)) (RR: 2.46, 95% CI: 1.31-4.63) when compared to those with low BF% (BF%

[Prevalence of and risk factors associated with diabetic retinopathy in pre-diabetic and diabetic population in Shanghai community].

OBJECTIVE: To determine the prevalence and risk factors of diabetic retinopathy (DR) in the Diabetes Mellitus (DM) and impaired glucose regulation (IGR) population in Shanghai Community. METHODS: DR screening after the epidemiologic study of metabolic syndrome in Huayang and Caoyang Community, Shanghai was conducted among 1300 patients with DM or IGR during June 2005 and March 2006, Digital non-mydriatic fundus photography was performed for each eye in all subjects. Other factors, including diabetes related history, BMI, WHR, fasting plasma glucose, HbA1c, serum lipid and blood pressure were also assessed. 642 patients, 312 males and 330 females, aged 65 +/- 13, with complete data were enrolled into the analysis. RESULTS: The prevalence of DR was 19.9% in the diabetic population, and the prevalence of mild, moderate, severe non-proliferative retinopathy and proliferative retinopathy was 12.0%, 5.1%, 2.3% and 0.5%, respectively; the prevalence of DR in IGR reached 8.0%. Logistic regression analysis revealed that HbA1c level and diabetes duration were both independently associated with diabetic retinopathy. CONCLUSION: The prevalence of DR was high in both DM and IGR population. Bad blood glucose control and long diabetes duration both increased occurrence of DR.

[Serum lipid profile changes of the adults in Shanghai communities].

OBJECTIVE: To explore the adult lipid profile of Huayang community from 1998 to 2000 and Caoyang communities in 2001. METHODS: Representative serum samples of 5628 adults (aged 20 - 95 years) were obtained in Huayang and Caoyang communities during 1998.9 and 2001.11. Standard epidemiology questionnaire, physical check-ups and serum lipids data were analyzed. RESULTS: After standardization to Chinese census statistics of 2000, the age-and sex-standardized means of total cholesterol, HDL-C, LDL-C and triglycerides of the two communities (Huayang vs. Caoyang) were 5.01 mmol/L vs. 4.43 mmol/L, 1.28 mmol/L vs. 1.32 mmol/L, 3.37 mmol/L vs. 2.99 mmol/L, 1.97 mmol/L vs. 1.60 mmol/L respectively, and the age- and sex- standardized prevalence of dyslipidemia was 52.9% vs. 25.1%, and the prevalence for borderline dyslipidemia was 76.0% vs. 56.2%, respectively. The decreasing order of dyslipidemia prevalence of the two communities was: elevated TG, decreased HDL-C, elevated LDL-C and TC. The standardized proportions of optimal HDL-C level were only 15.7% and 16.1% in Huayang and Caoyang respectively which was much lower than these of TG, LDL and TC. CONCLUSIONS: The standardized prevalence of adult dyslipidemia and borderline dyslipidemia in the two communities were high. Dyslipidemia of the two communities was TG and decreased.

[Epidemiological characteristics of major abnormal electrocardiogram in adults from Shanghai].

OBJECTIVE: To understand the prevalence, characteristics and risk factors of major abnormal electrocardiogram (MA-ECG) in adults living in Shanghai. METHODS: The cross-sectional dataset of prevalence survey on diabetes and metabolic syndrome in adults, aged 20-74 years, from Shanghai, in 2007-2008, was analyzed. Demographic information, personal and, family histories of diseases were collected. Physical examination and laboratory tests were done. Subjects underwent examination on resting 12-leads electrocardiogram (ECG), ECG records were coded according to the Minnesota criteria and classified as MA-ECG or non-MA-ECG. RESULTS: A total number of 5364 subjects (2003 men, 3361 women) were finally included in this analysis. (1) The standardized prevalence of MA-ECG was 7.3% (7.0% in men, 7.7% in women). In both genders, the age-specific prevalence of MA-ECG significantly increased with age (Ptrend < 0.01). The age-specific prevalence of MA-ECG in youths, middle aged and the elderly were 2.3%, 7.7%, and 17.3% in men, and 3.3%, 8.8% and 16.4% in women, respectively (both Ptrend < 0.01). (2) The three most common MA-ECG forms were arrhythmia (28.8%), bundle branch block (26.5%) and ST segment depression (20.0%) in men, while there appeared ST segment depression (44.6%), arrhythmia (23.0%) and combined MA-ECG (11.8%) in women. (3) Data from multivariate logistic regression analysis showed that other than age, coronary heart disease (CHD) was the only independent risk factor of MA-ECG in men, with its corresponding OR being 2.33 - 2.39; while in women, menopause (OR value: 1.72 - 1.85) and hypertension (OR value: 1.33 - 1.34) were main factors related to MA-ECG. CONCLUSION: MA-ECG was prevalent in the middle aged and the elderly, with, arrhythmia and ST segment depression the most frequent forms of MA-ECG. Age, CHD and hypertension were the main risk factors of MA-ECG in the adults from Shanghai.

Serum vaspin level in relation to postprandial plasma glucose concentration in subjects with diabetes.

BACKGROUND: Vaspin is a newly-identified adipocytokine related to obesity and insulin sensitivity. However, its pathophysiologic role in humans remains largely unknown. The aim of our study was to investigate the relationship between serum vaspin level and glucose metabolism or obesity in Chinese adults. METHODS: A total of 123 subjects, including 84 subjects with normal glucose tolerance (NGT) and 39 subjects with diabetes, were enrolled in this study. Anthropometric parameters, abdominal fat areas, plasma glucose concentration, serum insulin, lipids, and vaspin level were measured in each participant. RESULTS: Serum vaspin concentration was significantly higher in diabetic patients than that in NGT subjects (592 (438 - 695) pg/ml vs 380 (294 - 517) pg/ml, P = 0.020) in women. In all participants, age, fasting plasma glucose concentration (FPG), 2-hour post-load plasma glucose (PG2h), hemoglobin A1c (HbA1c) and high-density lipoprotein cholesterol (HDL-c) significantly increased from the lower tertile to the higher tertile of vaspin. Univariate linear regression analyses revealed that vaspin level was only positively correlated with age (beta = 0.340, P = 0.002) in NGT subjects. And vaspin was positively associated with FPG (beta = 0.365, P = 0.023), PG2h (beta = 0.526, P = 0.001), HbA1c (beta = 0.388, P = 0.016), and HDL-c (beta = 0.353, P = 0.027), while negatively with homeostasis model assessment of beta cell function (HOMA-beta) (beta = -0.361, P = 0.024) in diabetic patients. In stepwise multivariate regression analyses, age was independently associated with circulating vaspin in NGT subjects, whereas PG2h was an independent predictor of vaspin in diabetic patients. In addition, there was no significant difference of serum vaspin level between men and women. And no significant correlations between vaspin and body fat indexes were detected. CONCLUSIONS: Serum vaspin level is higher in diabetic patients than that in NGT subjects in women. Age predicts serum vaspin level in NGT subjects, while PG2h is independently associated with vaspin in diabetic patients.

Relationship of plasma creatinine and lactic acid in type 2 diabetic patients without renal dysfunction.

BACKGROUND: As one of most widely-used biguanides, metformin can induce the lactic acidosis in patients with renal failure though its incidence is very low. However, lactic acidemia induced by metformin was reported in patients without renal dysfunction. It is unclear that whether lactatemia exists in diabetic patients with normal renal function in Chinese or not and its influencing factors. This study aimed to clarify the influencing factors of lactic acid, and identify a practiced clinical marker to predict the hyperlactacidemia in diabetics with normal renal function. METHODS: The clinical data and venous blood samples of 1024 type 2 diabetic patients treated with (n = 426) or without metformin (n = 599) were collected. The lactic acid was assayed by enzyme-electrode method. The biochemical indexes included creatinine (Cr) and hepatase were measured with enzymatic procedures. The lactic acid concentrations of different Cr subgroups were compared, and the correlation and receiver operating characteristic curve analysis were used. RESULTS: The mean lactic acid level and the proportion of hyperlactatemia of metformin group were significantly higher than that of non-metformin group (P < 0.01), but no lactic acidosis was found in all patients. The correlation and multiple stepwise regression analysis indicated that the correlative factors of lactic acid in turn were Cr, metformin, alanine transferase (ALT), body mass index (BMI), Urine albumin (Ualb), and blood urea nitrogen (BUN) in total patients; and Cr, ALT, BMI and BUN in non-metformin treated patients; Cr and ALT in metformin-group. The lactate concentration increased with the increment of Cr levels, and reached its peak at Cr 111-130 micromol/L, and the optimal cutoff of Cr in predicting hyperlactacidemia was 96.5 micromol/L. CONCLUSIONS: Metformin can increase the incidence of lactatemia in type 2 diabetic patients without renal dysfunction. Cr, ALT, and BMI are independent associated factors of blood lactic acid levels. There is low proportion of lactatemia in type 2 diabetics without metformin therapy, the optimal cutoff of Cr to predict lactatemia in these patients is 96.5 micromol/L.

[Orthogonal factor analysis on metabolic syndrome].

To elucidate the principal of orthogonal factor analysis, using an example of factor analysis of metabolic syndrome. The basic structures and the fundamental concepts of orthogonal factor analysis were introduced and data involving 1877 women aged of 35-65 years, selected from a cross-sectional study, which was conducted in 1998 - 2001 in Shanghai, were included in this study. Factor analysis was carried out using principle components analysis with Varimax orthogonal rotation of the components of the metabolic syndrome. The different components of the metabolic syndrome were not linked closely with the other components and loaded on the six different factors,which mainly reflected by the variables of obesity, blood pressure, plasma glucose, plasma insulin, triglycerides and HDL-cholesterol respectively. Six major factors of the metabolic syndrome were uncorrelated with each other and explained 86% of the variance in the original data. The factor score and total factor score for the individual could be obtained according to the component score coefficient matrix. Although the components of the metabolic syndrome were related statistically, the finding of six factors suggested that the components of the metabolic syndrome did not show high degrees of intercorrelation. As a linear method of data reduction, the mode reduced a large set of measured intercorrelation variables into a smaller set of uncorrelated factors, which explained the majority of the variance in the original variables. Factor analysis was well suited for revealing underlying patterns or structure among variables showing high degrees of intercorrelation.

[Application of Excel Visual Basic for efficiently complete statistic analysis].

OBJECTIVE: In order to analyze multiple statistic tables more efficiently Excel Visual Basic for Application (VBA) was introduced through the use of an example of calculating standardized mortality rates (SMRs). METHODS: Mortality data of cancer and cardiovascular diseases, by sex and age, have been collected from 1991 to 2003 by the Center for Disease Control and Prevention of Shanghai Huangpu District. Standard population composition was defined as Chinese census statistics in 2000. The male's SMRs were calculated, using Excel VBA for each year and classification of cancers. RESULTS: The male's SMRs were obtained by year and different cancers. At the same time, the results were listed in the cancer's SMRs table for male. CONCLUSIONS: Excel is more flexible than general database on the combination of data and annotation. Excel VBA is better than the basic Excel in operating multiple tables simultaneously and man-machine conversation. Statistic analysis can be efficiently completed by using Excel VBA.

[A case control study on the risk factors of proteinuria in patients with type 2 diabetes].

OBJECTIVE: To assess factors predisposing to proteinuria in patients with type 2 diabetes mellitus (DM). METHODS: A case-control study was conducted on two groups of patients with type 2 diabetes without proteinuria (urine protein < 300 mg/24 h, n = 106) and with proteinuria (urine protein >or= 500 mg/24 h, n = 106). The two groups were matched by age (+/- 3 years), sex, race and place of residence. Information on these subjects including demography, history of disease, family history of diseases, lifestyle and behavioral variables, were obtained through questionnaire. Variables including blood pressure, fasting blood glucose (FBG), quantity of protein in 24-h urine were measured. Cox's proportional hazards regression analysis was then performed. RESULTS: Factors that were independently associated with the development of proteinuria, would include occupation, diabetic duration, glycemic control, hypertension, duration of hypertension and daily intake of vegetable after diagnosis of DM. Their corresponding odds ratios (OR) with 95% confidence intervals (CI) were 2.429 (1.299 - 4.542), 1.078 (1.029 - 1.131), 2.316 (1.341 - 3.998), 1.810 (1.059 - 3.092), 1.043 (1.012 - 1.074) and 0.551 (0.334 - 0.907), respectively, while the presence of proteinuria was not associated with family history of DM, family history of hypertension, certain dietary habits and smoking habit. Multivariate logistic regression model was then fitted with three variables, including diabetic duration, glycemic control and hypertension. CONCLUSION: The prevalence of proteinuria in labor workers was higher than that in intellectuals. Longer history of diabetic duration, poor glycemic control, hypertension and longer duration of hypertension all independently contributed to the development of proteinuria. The risk of proteinuria decreased with increasing daily intake of vegetables after the patients being diagnosed as having DM.