MR diffusion tensor imaging of normal kidneys.

PURPOSE: To assess the feasibility of diffusion tensor imaging (DTI) of normal kidneys and the influence of hydration state. MATERIALS AND METHODS: Ten healthy volunteers underwent renal DTI after fasting for 12 hours and 4 hours, without fasting, and following water diuresis. Medullary and cortical apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured and compared in the four different states of hydration. DTI was performed with a 3T magnetic resonance imaging (MRI) system using fat-saturated single-shot spin-echo echo planar imaging sequence. RESULTS: ADC of normal cortex (2.387 ± 0.081 × 10(-3) mm(2) /s) was significantly higher (t = 20.126, P = 0) than that of medulla (1.990 ± 0.063 × 10(-3) mm(2) /s). The FA value of normal cortex (0.282 ± 0.017) was significantly lower (t = -42.713, P = 0) than that of medulla (0.447 ± 0.022). The ADC and FA values of the left renal cortex (2.404 ± 0.082 × 10(-3) mm(2) /s, 0.282 ± 0.017) and medulla (2.002 ± 0.081 × 10(-3) mm(2) /s, 0.452 ± 0.024) were not significantly different (P > 0.05) from those of right renal cortex (2.369 ± 0.080 × 10(-3) mm(2) /s, 0.283 ± 0.018) and medulla (1.978 ± 0.039 × 10(-3) mm(2) /s, 0.443 ± 0.019). Values for ADC (×10(-3) mm(2) /s) and FA in the 12-hour fasting, 4-hour fasting, nonfasting, and water diuresis states were 2.372 ± 0.095 and 0.278 ± 0.018, 2.387 ± 0.081 and 0.282 ± 0.017, 2.416 ± 0.051 and 0.279 ± 0.023, 2.421 ± 0.068, and 0.270 ± 0.021, respectively, in cortex, 1.972 ± 0.084 and 0.438 ± 0.014, 1.990 ± 0.063 and 0.447 ± 0.022, 2.021 ± 0.081 and 0.450 ± 0.031, 2.016 ± 0.076 and 0.449 ± 0.028, respectively, in medulla. The ADC and FA values in different hydration states were not significantly different (P > 0.05). CONCLUSION: DTI of normal kidneys is feasible with reproducible ADC and FA values independent of hydration states.

PPAR α and PPAR γ polymorphisms as risk factors for dyslipidemia in a Chinese Han population.

BACKGROUND: The PPAR α and PPAR γ are the key messengers responsible for the translation of nutritional stimuli into changes for the expression of genes, particularly genes involved in lipid metabolism. However, the associations between PPAR α/γ polymorphisms and lipid serum levels in the general population were rarely studied, and the conclusions were conflicting. The objective was to investigate the associations of the PPAR α and PPAR γ polymorphisms with dyslipidemia. METHODS: 820 subjects were randomly selected from the Prevention of Multiple Metabolic Disorders and MS in Jiangsu Province cohort populations. The logistic regression model was used to examine the association between these polymorphisms and dyslipidemia. SNPstats was used to explore the haplotype association analyses. RESULTS: In the codominant and log-additive models, rs1800206, rs1805192 and rs3856806 were all associated with dyslipidemia (P < 0.005). When the most common haplotype L-G (established by rs1800206, rs4253778) was treated as the reference group, the V-G haplotype was associated with dyslipidemia (P < 0.001), higher TC and TG levels (P < 0.01). Moreover, when compared to Pro-C haplotype (established by rs1805192, rs3856806), the Pro-T, Ala-C, Ala-T haplotypes were associated with dyslipidemia (p < 0.001). A-T haplotype was associated with higher TC levels, (p < 0.01), and the P-T, A-C, A-T haplotypes were associated with higher TG levels (p < 0.01). CONCLUSIONS: PPAR α and PPAR γ polymorphisms and haplotypes may be the genetic risk factors for dyslipidemia.

The application of visceral adiposity index in identifying type 2 diabetes risks based on a prospective cohort in China.

BACKGROUND: Visceral adiposity index (VAI), a novel sex-specific index for visceral fat measurement, has been proposed recently. We evaluate the efficacy of VAI in identifying diabetes risk in Chinese people, and compare the predictive ability between VAI and other body fatness indices, i.e., waist circumference (WC), body mass index (BMI) and waist- to- height ratio (WHtR). METHODS: Participants (n=3,461) were recruited from an ongoing cohort study in Jiangsu Province, China. Hazard ratio (HR) and corresponding 95% confidence interval (CI) between diabetes risk and different body fatness indices were evaluated by Cox proportional hazard regression model. Receiver operating characteristic (ROC) curve and area under curve (AUC) were applied to compare the ability of identifying diabetes risk between VAI, WC, WHtR and BMI. RESULTS: A total number of 160 new diabetic cases occurred during the follow-up, with an incidence of 4.6%. Significant positive associations were observed for VAI with blood pressure, fasting plasma glucose, triglyceride, WC, BMI and WHtR. Moreover, increased VAI was observed to be associated with higher diabetes risk with a positive dose-response trend (p for trend<0.001). As compared to individuals with the lowest VAI, those who had the highest VAI were at 2.55-fold risk of diabetes (95% CI: 1.58-4.11). The largest AUC was observed for VAI, following by WC, WHtR and BMI. CONCLUSIONS: VAI is positively associated with the risk of diabetes. Compared to other indices for body fatness measurements, VAI is a better and convenience surrogate marker for visceral adipose measurement and could be used in identifying the risk of diabetes in large-scale epidemiologic studies.

[The prospective study of association between C-reactive protein and hypertension in community population].

OBJECTIVE: The aim was to explore the association between high-sensitivity C-reactive protein level at baseline and hypertension in follow-up periods in a Chinese cohort. METHODS: We analyzed data from a cohort established in "Prevention of metabolic syndrome and multi-metabolic disorders in Jiangsu province" in April 2000. A follow-up investigation was carried out for those whose follow up time met 5 years in June 2006. A total of 2035 persons completed investigation and hs-CRP was tested. Subjects with normal baseline blood pressure were classified into four groups(514, 498, 515 and 508 subjects in each group) according to quartiles of hs-CRP level (<1.3, 1.3-1.9, 2.0-3.2 and ≥ 3.3 mg/L). The relationship between the risk of hypertension and baseline level of hs-CRP were analyzed using Cox proportional hazards regression model. RESULTS: The median of follow up time was 6.39 years among the 2035 subjects (926 males and 1109 females). Hypertension incidence was 2378/100 000 person-years, 2942/100 000 person-years, 3693/100 000 person-years and 4390/100 000 person-years in hs-CRP < 1.3, 1.3-1.9, 2.0-3.2 and ≥ 3.3 mg/L groups respectively. Compared to the group of hs-CRP < 1.3 mg/L, the relative risk (RR) (95%CI) of hypertension in groups of hs-CRP 1.3-1.9, 2.0-3.2 and ≥ 3.3 mg/L was 1.22 (0.87-1.72), 1.43 (1.03-2.00), 1.70 (1.21-2.41) respectively, adjusted for sex, age, baseline blood pressure, BMI, smoking, alcohol drinking, physical activity and family history of myocardial infarction and diabetes.When stratified by quartiles of baseline blood pressure, the incidence of hypertension in each group increased with level of hs-CRP.In the group whose baseline SBP < 110 mm Hg (1 mm Hg = 0.133 kPa) , compared to the group of hs-CRP < 1.3 mg/L, RR (95%CI) were 2.24 (1.32-4.03), 2.57 (1.57-4.57) and 3.57 (2.54-5.90) in hs-CRP 1.3-1.9, 2.0-3.2 and ≥ 3.3 mg/L groups respectively.In the group whose baseline DBP < 65 mm Hg, RR (95%CI) were 1.78 (1.03-3.24), 2.74 (1.63-4.93) and 4.13 (2.35-7.27) respectively. CONCLUSION: Inflammation was an important process in the development of hypertension.

[Impact of lifestyle and obesity to the risk of type 2 diabetes: a prospective study in Jiangsu province].

OBJECTIVE: To investigate the relative contribution of lifestyle and obesity to the risk of developing type 2 diabetes. METHODS: All baseline survey data were based on the program Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu Province (PMMJS) which was conducted during April 1999 to May 2004. In the baseline survey, 8685 participants were selected using multi-stage sampling method. Frem March 2006 to November 2007, 4582 participants who had been in the study for at least 5 years were included in the follow-up survey. A total of 3847 participants were followed and of them 3461 non-diabetic subjects were included in this analysis. High fat diet or not, low fiber diet or not, sedentary or not and occupational physical activity classification were defined as lifestyle variables and the incidence of type 2 diabetes at follow-up survey was defined as outcome variable. It was prospectively examined that the separate and joint association of lifestyle and obesity with the development of type 2 diabetes in subjects recruited from PMMJS, using logistic regression model. RESULTS: A total of 162 incident cases of type 2 diabetes during 6.3 years of follow-up in total 3461 participants were documented. The incidence rate was 4.7%. After adjusted for sex, age, family history of diabetes, blood pressure, lipids and fast plasma glucose, risk of type 2 diabetes increased with lighter occupational physical activity (compared with vigorous group, moderate group aRR = 2.15, 95%CI: 1.26 - 3.68; light group aRR = 2.39, 95%CI: 1.12 - 4.87), sedentary lifestyle (aRR = 2.94, 95%CI: 1.90 - 4.54), low fiber diet (aRR = 1.58, 95%CI: 1.01 - 2.53), overweight (aRR = 1.33, 95%CI: 1.01 - 1.90) and obesity (aRR = 1.59, 95%CI: 1.07 - 3.75). In joint analysis of lifestyle and obesity, the impact of sedentary lifestyle (in BMI < 25 group, aRR = 3.42, 95%CI: 1.99 - 5.86; in BMI ≥ 25 group, aRR = 2.41, 95%CI: 1.13 - 5.12) and low fiber diet (in BMI < 25 group, aRR = 1.42, 95%CI: 0.81 - 2.54; in BMI ≥ 25 group, aRR = 2.63, 95%CI: 1.15 - 6.03) on diabetes were independent of overweight and obesity. When stratified by sedentary lifestyle or low fiber diet, there was no association between overweight/obesity and diabetes risk (sedentary aRR = 2.04, 95%CI 0.87 - 4.71, non sedentary aRR = 1.21, 95%CI: 0.82 - 1.78; non low fiber diet aRR = 1.26, 95%CI: 0.87 - 1.84, low fiber diet aRR = 1.88, 95%CI: 0.80 - 4.80). CONCLUSION: Unhealthy lifestyle, overweight and obesity independently increase the risk of type 2 diabetes. The magnitude of risk contributed by sedentary lifestyle and low fiber diet are much greater than that imparted by overweight and obesity.

[Impact of dynamic change of waist circumference or body mass index in hypertension incidence].

OBJECTIVE: To study the impact of dynamic change of waist circumference (WC) and body mass index(BMI) in two years on hypertension incidence in cohort populations. METHODS: A perspective cohort study was conducted. The participants (5888 subjects) whose follow-time were 2 years or longer from the program Prevention of multiple metabolic disorders and metabolic syndrome (MS) in Jiangsu province were investigated. Amongst 5888 subjects, 4582 participants received the first follow-up investigation in January 2002. Among 4582 subjects who received first follow-up investigation and whose follow-time met 5 years, total 3847 participants received the second follow-up investigation in March 2006. Total 2778 free hypertension subjects were included in this analysis. Subjects with normal WC or BMI at baseline but abnormal WC or BMI at the first follow-up or subjects with abnormal WC or BMI both at baseline and the first follow-up were defined as non-control group. Subjects with abnormal WC or BMI at baseline but normal WC or BMI at the first follow-up or subjects with normal WC or BMI both at baseline and the first follow-up were defined as control group. The incidence of hypertension at second follow-up investigation was defined as the final variable(hypertension = 1, non-hypertension = 0). The association between dynamic change of WC or BMI and incident hypertension was analyzed by using Cox proportional hazards regression model. The OR, RR value and 95%CI were calculated through WC and BMI risk stratification. RESULTS: Among 2778 participants without hypertension at baseline, 660 subjects developed hypertension. When both BMI difference value (D-value) and WC D-value were included in the regression model, WC D-value was associated with hypertension in both genders (males: OR = 1.04, 95%CI: 1.01 - 1.05; females: OR = 1.04, 95%CI: 1.02 - 1.06), but BMI D-value was not associated with hypertension in both men and women (males: OR = 1.04, 95%CI: 0.97 - 1.11; females: OR = 0.98, 95%CI: 0.93 - 1.03). Hypertension risk of WC non-control group was higher than that in WC control group in baseline normal and abnormal WC groups (normal baseline WC group: RR = 1.41, 95%CI: 1.01 - 2.39, abnormal baseline WC group: RR = 4.41, 95%CI: 1.66 - 9.80). But in baseline abnormal BMI group, there was no significant difference between BMI control and non-control group (RR = 1.33, 95%CI: 0.88 - 2.02). Whether BMI was controlled can not influence hypertension risk if WC was controlled (males: RR = 1.03, 95%CI: 0.36 - 2.96; females: RR = 1.02, 95%CI: 0.70 - 5.85), however, control WC could reduce hypertension risk obviously even though BMI was not controlled (males: RR = 4.03, 95%CI: 1.61 - 10.09; females: RR = 1.55, 95%CI: 1.13 - 3.60). CONCLUSION: Both WC and BMI dynamic change were associated with change of hypertension. But reducing WC can decrease hypertension risk more than reducing BMI.

[Expression and Clinical Significance of Long Non-Coding RNA PRAL in Patients with Multiple Myeloma].

OBJECTIVE: To investigate the expression and clinical significance of long non-coding RNA PRAL in patients with multiple myeloma(MM). METHODS: Clinical data of 60 MM patients and 60 healthy people with the same age(as controls) were selected. Real time-quantitative fluorescence PCR (RT-qPCR) was used to determine the expression levels of serum LncRNA PRAL in the patients and controls, and the relationship of its expression with the clinicopathological characteristics and prognosis of patients was analyed. RESULTS: LncRNA PRAL expression in MM patients was significantly lower than that in healthy people (F=13.294, P<0.001). LncRNA PRAL expression correlated with D-S staging and ISS staging in MM patients. PAD efficacy was significantly improved in MM patients with high expression of LncRNA PRAL, and median survival time was significantly prolonged (P<0.05). CONCLUSION: LncRNA PRAL expression decreases in MM patients, while MM patients with high expression of LncRNA PRAL can obtain better therapeutic efficacy and longer survival time.

[A comparison of applicability in three diagnostic criteria of metabolic syndrome in Jiangsu population].

OBJECTIVE: To compare the applicability of the three diagnostic criteria for metabolic syndrome (MS) proposed by the International Diabetes Federation (IDF) in 2005, Adult Treatment Panel III of National Cholesterol Education Program (NCEP-ATP III) in 2005 and Chinese Diabetes Socie (CDS) in 2004. METHODS: Based on the findings of cohort study of multiple metabolic disorders and metabolic syndrome (1971 cases) in Jiangsu province, MS was diagnosed according to these three definitions respectively, and by calculating the sensitivity, specificity, and ROC curve distance, those with lower false positive and false negative rates were identified as to detecting cardio vascular diseases (CVD) and type 2 diabetes mellitus (T2DM). While, through Cox regression analysis, to compare their relative risk (RR) and 95% confidential interval (CI) was wade. RESULTS: Among three diagnostic criteria, the specificity by CDS of MS was higher than the other criteria (83.52%, 76.36%, 89.57%; 85.02%, 78.67%, 92.28%), however the sensitivity of CDS of MS was low (40.82%, 29.47%). When using CDS, over 50 percent of diagnosis might be missed. ATP III definition corresponded to the shortest distance in ROC curve, namely, at the diagnostic criteria, the rates of false positive and false negative for identifying clustering of CVD and T2DM were minimum (0.4369; 0.5777). The incidence of CVD [5.59 (2.62 - 11.92) vs 2.90 (1.41 - 5.93)], T2DM [3.36 (1.92 - 5.79) vs 1.97 (1.16 - 3.34)] was significantly higher in cases of ATP III+/IDF-than ATP III+/IDF+, as compared with ATP III-/IDF-. CONCLUSION: Among three diagnostic criteria, the ATP III definition of the MS should be the most applicable diagnostic criteria for MS in Jiangsu population.

[Association and interaction between the components of metabolic syndrome and cardiovascular disease].

OBJECTIVE: To explore the association and interaction between the components of metabolic syndrome (MS) and cardiovascular disease (CVD). METHOD: In this cohort study, participants (total 3598, male 1451) were recruited and followed up for five years from the program "prevention of multiple metabolic disorders and MS in Jiangsu province". We used modified Asian criteria of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) to define the presence of MS. COX regression was used to analyze the association between the MS and its components with CVD; both the multiplication of blood pressure (BP) and 2, 3, or 4 other components of MS in the logistic regression model and the estimation of the relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP), and the synergy index (S) and 95% confidence intervals (95%CI) were used to evaluate the interactions between the components of MS. RESULTS: After adjustment for traditional CVD risks, the adjusted risk ratio (aRR) of CVD was 2.49 (95%CI: 1.59 - 3.90) in the MS group compared with the non-MS group at baseline. The aRRs of MS components to CVD were as follows: 1.44 (95%CI: 0.88 - 2.37) for waist circumference; 2.84 (95%CI: 1.73 - 4.68) for BP; 1.31 (95%CI: 0.83 - 2.07) for low high density lipoprotein; 1.84 (95%CI: 1.19 - 2.85) for triglyceride; 1.55(95%CI: 0.98 - 2.45) for fasting plasma glucose, respectively. BP was the single component significantly related to CVD (aRR = 2.58, 95%CI: 1.55 - 4.29). The risk of CVD was significantly increased (aOR = 4.47, 95%CI: 2.35 - 8.51) when BP was combined with 2, 3 or 4 other components of MS in the participants. CONCLUSIONS: Only BP is an independent CVD risk factor in the components of MS, the risk of CVD was significantly increased when BP was combined with other components of MS in this cohort.

Association of smoking, alcohol drinking and dietary factors with esophageal cancer in high- and low-risk areas of Jiangsu Province, China.

AIM: To study the main environmental and lifestyle factors that account for the regional differences in esophageal cancer (EC) risk in low- and high-risk areas of Jiangsu Province, China. METHODS: Since 2003, a population-based case-control study has been conducted simultaneously in low-risk (Ganyu County) and high-risk (Dafeng County) areas of Jiangsu Province, China. Using identical protocols and pre-tested standardized questionnaire, following written informed consent, eligible subjects were inquired about their detail information on potential determinants of EC, including demographic information, socio-economic status, living conditions, disease history, family cancer history, smoking, alcohol drinking, dietary habits, frequency, amount of food intake, etc. Conditional logistic regression with maximum likelihood estimation was used to obtain Odds ratio (OR) and 95 % confidence interval (95% CI), after adjustment for potential confounders. RESULTS: In the preliminary analysis of the ongoing study, we recruited 291 pairs of cases and controls in Dafeng and 240 pairs of cases and controls in Ganyu, respectively. In both low-risk and high-risk areas, EC was inversely associated with socio-economic status, such as level of education, past economic status and body mass index. However, this disease was more frequent among those who had a family history of cancer or encountered misfortune in the past 10 years. EC was also more frequent among smokers, alcohol drinkers and fast eaters. Furthermore, there was a geographic variation of the associations between smoking, alcohol drinking and EC risk despite the similar prevalence of these risk factors in both low-risk and high-risk areas. The dose-response relationship of smoking and smoking related variables, such as age of the first smoking, duration and amount were apparent only in high-risk areas. On the contrary, a dose-response relationship on the effect of alcohol drinking on EC was observed only in low-risk areas. CONCLUSION: The environmental risk factors, together with genetic factors and gene-environmental interactions might be the main reason for this high-risk gradient in Jiangsu Province, China.

Effect of obesity on the association between common variations in the PPAR gene and C-reactive protein level in Chinese Han population.

The peroxisome proliferator-activated receptors (PPARs)-α, -ß/δ, and -γ are the ligand-activated transcription factors that function as the master regulators of glucose, fatty acid and lipoprotein metabolism, inflammation, and atherosclerosis. Our aim was to test the association between ten single nucleotide polymorphisms of PPARs and CRP level, as well as their interaction with overweight/obesity. A sample population of 643 subjects was recruited from the prevention of MetS and multi-metabolic disorders in Jiangsu Province of China Study. The selected SNPs in PPAR α (rs135539, rs4253778, rs1800206), PPAR ß/δ (rs2016520 and rs9794), and PPAR γ (rs10865710, rs1805192, rs709158, rs3856806, and rs4684847) were genotyped. After adjustment for smoking, alcohol consumption, SBP, DBP, TG, and HDL-C, rs1800206, rs709158, rs1805192, and rs4684847 polymorphisms were significantly associated with CRP level in normal weight subjects (P < 0.05). In the overweight/obese subjects, rs1800206 was also significant associated with CRP level (P<0.01). In addition, the rs709158, rs1805192, and rs4684847 polymorphisms were shown interactions with overweight/obesity to influence CRP level (P<0.05). PPARs polymorphisms are independently associated with CRP levels in Chinese Han population. Further, PPARs polymorphisms interact with overweight/obesity to set CRP levels.

Peroxisome proliferator­activated receptor γ polymorphisms as risk factors for dyslipidemia.

Peroxisome proliferator­activated receptor Î³ (PPARγ) may play an important role in lipid metabolism directly or by inducing the transcription of target genes. The aim of the present study was to investigate the association between common variants at the PPARγ locus (C1431T and Pro12Ala polymorphisms) and lipid serum levels. The studied population consisted of 820 subjects randomly selected from the Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu Province cohort population. All subjects were interviewed and blood samples were obtained for laboratory analysis and DNA extraction. The TaqMan single nucleotide polymorphism genotyping assay was used for polymorphism genotyping. Individual polymorphisms and haplotype data were available for analysis. The 12Ala allele was found to be associated with significantly increased levels of triglyceride (TG) (P<0.01), whilst the 1431T allele was found to be associated with significantly increased levels of TG, total cholesterol (TC) and non­high­density lipoprotein (non­HDL) (P<0.01). When P­C, the most common haplotype, was used as the reference group, the P­T, A­C and A­T haplotypes were found to be associated with significantly increased levels of TG (P<0.01). In addition, the A­T haplotype was shown to be associated with significantly increased levels of TC and non­HDL (P<0.01). In conclusion these results suggest that PPARγ gene variability may increase the risk of dyslipidemia.

[Effects related to gene-gene interactions of peroxisome proliferator-activated receptor on essential hypertension].

OBJECTIVE: To explore the impact of the gene-gene interaction among the single nucleotide polymorphisms (SNPs) of peroxisome proliferator-activated receptor α/δ/γ on essential hypertension (EH). METHODS: Participants were recruited based on the previous work of the PMMJS (Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu Province) cohort study in Jiangsu province of China. A total number of 820 subjects were randomly selected from the cohort and received gene polymorphism detection covered ten SNPs:PPARα/δ/γ (PPARα: rs135539, rs1800206 and rs4253778; PPARδ: rs2016520 and rs9794; PPARγ: rs10865710, rs1805192, rs4684847, rs709158 and rs3856806). Generalized Multifactor Dimensionality Reduction (GMDR) model was used to evaluate the association between gene-gene interaction among the ten SNPs and EH. RESULTS: After adjusting factors as gender, age, BMI, FPG, TG, HDL-C, high fat diet, low fiber diet and physical activity, results from the GMDR analysis showed that the best qualitative trait models were 7/9-dimensional model (EH: cross-validation consistency were 9/10 and 10/10, prediction accuracy were 0.5862 and 0.5885), 5/9-dimensional model (SBP:cross-validation consistency were 10/10 and 8/10, prediction accuracy were 0.6055 and 0.6011), and 8/9-dimensional model (DBP: cross-validation consistency both were 10/10, prediction accuracy were 0.5926 and 0.5972), while the best quantitative trait models were 4/5-dimensional model (SBP: cross-validation consistency were 10/10 and 8/10, prediction accuracy were 0.6111 and 0.6072), and 5-dimensional model (DBP: cross-validation consistency were 9/10, prediction accuracy were 0.5753). CONCLUSION: Interactions among ten SNPs of PPARs seemed to have existed and with significant impact on the levels of blood pressure.

[Interaction of both hypertriglyceridemic waist and impaired fasting glucose on the incidence of diabetes mellitus].

OBJECTIVE: To study the use of hypertriglyceridemic waist (HTGW) to predict the occurrence of diabetes. Also to independently study whether there was an interaction between HTGW and impaired fasting glucose impaired fasting glucose (IFG) on the cause of diabetes. METHODS: We undertook a cohort study based on data from the "Prevention of Multiple Metabolic Disorders and Metabolic Syndrome (MS) Study in Jiangsu Province, China". We used the logistic regression model to analyze the relations between both HTGW, IFG and diabetes mellitus and to evaluate the multiplied interaction between HTGW and IFG to include product terms method. Counting additive interaction was carried out under the Excel Calculation Sheet, compiled by Anderson and his colleagues. RESULTS: After adjusted for general risk factors and baseline fasting plasma glucose (FPG), results showed that subjects with HTGW had a 2.10 (95% CI: 1.36 - 3.25) adjusted relative risk (HR) of developing a diabetes when compared with those individuals without HTGW at the baseline study. When IFG was stratified, participants with HTGW were significantly associated with diabetes, regardless of IFG. The multi-adjusted HRs of diabetes were 3.09 (1.70 - 5.61) and 2.09 (1.08 - 4.02), respectively. Compared to the participants with non-HTGW and their FPG level below the threshold, those having HTGW and their FPG level was above the threshold, had the highest adjusted HR values [12.05 (95% CI: 6.89 - 21.07)]. Data from the additive interaction analysis showed that RERI as 7.00 (95% CI: 0.49 - 13.51), AP as 0.57 (95% CI: 0.32 - 0.82) and SI as 2.66 (95% CI: 1.36 - 5.21). CONCLUSION: HTGW could predict the occurrence of diabetes, independent from IFG while the presence of HTGW with IFG could have an additive interaction on the cause of diabetes.

[A prospective study on the association between dynamic change of waist circumference and incident hypertension].

OBJECTIVE: To study the impact on dynamic change of waist circumference (WC) through follow-up data on the incidence of hypertension in several cohort groups. METHODS: In this prospective study, 2778 free-hypertension subjects were recruited from a program "Prevention of Multiple Metabolic disorders and metabolic syndrome (MS) in Jiangsu province" (PMMJS) to evaluate the risk of hypertension in relation to WC dynamic change on normal WC or abnormal obesity group. Dynamic change of WC was measured by WC D-value, which was expressed by data on the difference of WC between baseline and the first follow up. Study outcome was defined as incident hypertension during the first to the second follow up period in this study. The association between dynamic change of WC and incident hypertension was analyzed by using Cox proportional hazards regression model. RESULTS: There were 2778 participants, 660 subjects developed hypertension during the follow-up, regardless of the normality of the baseline WC, the risk of hypertension increased across the tertiles of WC, while the incidence of hypertension was higher in non-control group than that in control group. In populations with abdominal obesity and normal WC at baseline, RRs (95%CI) of hypertension were 1.95 (1.19 - 3.19) and 2.38 (1.89 - 2.99) in subjects with abdominal obesity seen at the first follow up period, compared to subjects with normal WC in the same period. After adjustment for gender, age and other hypertension related risk factors, in populations with abdominal obesity and normal WC at baseline survey, RRs (95%CI) of hypertension were 4.36 (1.69 - 9.74) and 1.44 (1.03 - 2.35) respectively, for the non-control group. CONCLUSION: WC dynamic change was associated with hypertension, WC control while WC reduction was important for early prevention on hypertension.

Continuous metabolic syndrome risk score for predicting cardiovascular disease in the Chinese population.

Although the metabolic syndrome (MetS) is a predictor of cardiovascular disease (CVD), the current dichotomous definition of MetS cannot be used to evaluate context-specific identification or for efforts to reduce the risk of CVD in the population. In this study, we assigned MetS a continuous risk score for predicting the development of CVD. In total, 3,598 participants recruited from the Jiangsu Province of China were followed for a median of 6.3 years. A total of 82 participants developed CVD during the follow-up period. Receiver operating characteristic (ROC) curve was used to analyze the association between components of MetS and CVD. The results show that systolic blood pressure (SBP) was associated with CVD more intimately (area under receiver-operator characteristic curve (AUC)=0.72, 95% confidence interval (CI), 0.66-0.77) than other features of MetS. When each MetS component was assigned according to the magnitude of regression coefficients in the Cox regression hazard model, the AUC of the continuous MetS risk score (AUC=0.80, 95% CI, 0.75-0.84) exceeded that of the dichotomized definition of MetS (AUC=0.63, 95% CI, 0.56-0.69) (p<0.01). The incidence of CVD increased with the MetS risk score. This prospective cohort study suggests that the use of continuous MetS risk score would significantly improve the capability for predicting the development of CVD compared to current definition of MetS. Further, the appropriate cut-off points need to be verified in other races and regions.

[A prospective study on the association between lipid accumulation product or body mass index and diabetes].

OBJECTIVE: To measure the association between lipid accumulation product (LAP) or body mass index (BMI) and diabetes. METHODS: In this prospective study, subjects were recruited and followed up for more than five years from the program "Prevention of Multiple Metabolic Disorders and MS in Jiangsu Province" (PMMJS). A total number of 3598 people participating in the follow-up program, with complete information. Incidence rates of diabetes and relative risk in different levels of LAP and BMI were compared and analyzed. Areas under the receiver operation characteristic curve for obesity indicators such as LAP, BMI, waist circumference (WC), waist-to-hip ratio (WHR) in predicting diabetes of cohort population were calculated. RESULTS: The number and the cumulative incidence of diabetes increased with the LAP levels in both men and women. After adjusting for age and other traditional risk factors on diabetes, the adjusted risk ratios (aRR) value of diabetes were 4.33 (1.34 - 14.01) for men and 5.04 (2.06 - 12.34) for women, between the highest and the lowest level of LAP groups. When further adjusted for BMI, the aRR value decreased to 3.15 (1.13 - 8.80) for men and 4.84 (2.16 - 10.84) for women. The number and the cumulative incidence of diabetes also increased with the BMI levels in both men and women but not significantly as the LAP showed, and the aRR values were 1.34 (0.61 - 2.93) for men and 1.69 (0.91 - 3.06) for women in the highest level of BMI group, when compared with the lowest level group. Again, when further adjusted for LAP, the aRR values decreased to 1.23 (0.59 - 2.69) for men and 1.39 (0.74 - 2.60) for women. The area under the ROC curve (AUC) for the four kinds of obesity indicators in predicting diabetes in the descending order were LAP, WHR, WC, BMI in both men and women. CONCLUSION: LAP seemed more associated to diabetes than to BMI. When comparing with weight gain, diabetes might be more closely associated with the lipid accumulation product.

[A comparison between the metabolic syndrome score and the Framingham risk score in the prediction of cardiovascular disease].

OBJECTIVE: To compare metabolic syndrome (MS) score with the 10-year-Framingham risk score (FRS) to predict the occurrence of cardiovascular disease (CVD). METHODS: MS score for prediction of CVD was developed based on the 10-year FRS. Cox proportional hazard model and receiver-operating characteristic (ROC) curves were used to compare the predictive effects, based on data from a cohort study on the prevention of multiple metabolic disorders and MS in Jiangsu province. RESULTS: Area under the curve (AUC) increased after changing MS components into continuous variables. AUC of MS score/MS components aggregation was 0.70/0.65, P < 0.05 and sensitivity of MS score/MS components aggregation was 80.5%/74.4% for a given specificity. After mutually adjusted risk factors of MS score and the FRS, when age was exclusively excluded, AUC of the FRS decreased from 0.78 to 0.65 (P < 0.05). However, when age was included, the AUC of MS score increased to 0.78 (sensitivity of MS score including the age/the FRS: 90.2% vs. 87.8%); In Cox proportional hazards multiple risk factors analysis, MS score including age appeared greater association with CVD than FRS on the same exposed subjects. CONCLUSION: The new developed MS score with age included was a valid tool for predicting CVD and its predictive ability was as good as the FRS.

Differential diagnosis of metastasis from non-metastatic lymph nodes in cervical cancers: pilot study of diffusion weighted imaging with background suppression at 3T magnetic resonance.

BACKGROUND: Diffusion weighted imaging with background suppression (DWIBS) is potentially useful in detecting metastatic lymph nodes. This study aimed to evaluate the efficacy of DWIBS at 3T magnetic resonance (MR) for diagnosing metastatic lymph nodes in cervical cancer. METHODS: This retrospective study included 25 patients with cervical cancer who underwent MR examination and were treated by hysterectomy and lymphadenectomy. The metastatic and non-metastatic lymph nodes were histologically proven by operation. Apparent diffusion coefficient (ADC) values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of all the identifiable lymph nodes were measured and compared. RESULTS: Twenty-five primary tumor lesions, 17 metastatic lymph nodes and 140 non-metastatic lymph nodes were pathologically confirmed in 25 cases with cervical cancer. The difference of ADC values between primary tumor lesions, metastatic and non-metastatic lymph nodes were statistically significant (F = 7.93, P = 0.001). There was no statistically significant difference between primary tumor lesions of cervical cancer and metastatic lymph nodes (t = -0.75, P = 0.456), and the difference between primary tumor lesions and non-metastatic lymph nodes was statistically significant (t = 4.68, P < 0.001). The ADC values, long-axis diameters, short-axis diameters, ratio of short- to long-axis diameters of metastatic and non-metastatic lymph nodes were (0.86 ± 0.36) × 10(-3) mm(2)/s vs. (1.12 ± 0.34) × 10(-3) mm(2)/s, (1.51 ± 0.41) cm vs. (1.19 ± 0.36) cm, (1.16 ± 0.35) cm vs. (0.77 ± 0.22) cm, 0.78 ± 0.17 vs. 0.68 ± 0.19 respectively, and statistically significant difference existed between two groups. CONCLUSIONS: DWIBS at 3T MR has the distinct advantages in detecting pelvic lymph nodes of cervical cancer. Quantitative measurement of ADC values could reflect the degree of restriction of diffusion of metastatic and non-metastatic lymph nodes. The combination of size and ADC value would be useful in the accurate diagnosis of metastatic lymph nodes.

[A prospective study on the association between control of blood pressure and incidence of type 2 diabetes mellitus.].

OBJECTIVE: To investigate the relationship on the effect of blood pressure (BP) control and the incidence of new diabetes mellitus (DM) in a follow-up study. METHODS: In this prospective study, non-diabetic subjects (n = 3146, 41% men) were recruited from the program "Prevention of Multiple Metabolic disorders and metabolic syndrome (MS) in Jiangsu province" (PMMJS) to evaluate the risk of DM in relation to BP control program on both healthy or hypertensive patients. RESULTS: During the follow-up period, 102 subjects developed diabetes. In both healthy or hypertensive patients groupes, the incidence rates of diabetes increased along with the increase of either systolic or diastolic BP and were significantly higher in subjects who had become hypertension (5.6%) or patients with uncontrolled (7.1%) BP at baseline survey than in those who had maintained normal BP (1.9%) or with controlled BP at baseline survey (2.2%). After adjusted for age, sex and other diabetes-related risk factors at baseline study, the aRR of diabetes incidence for subjects with normal BP at baseline who became hypertension (1.84, 95%CI: 1.00 - 3.63) was higher than who maintained normal BP (1.90, 95%CI: 1.03 - 3.74) after the follow-up program, and hypertensive patients with uncontrolled BP was higher than those with controlled BP. When adjusted for baseline MS, the aRR (95%CI) for subjects with normal BP at baseline who had developed hypertension was 1.70 (0.99 - 2.78) compared those remained normal BP levels after the follow-up program, and 1.90 (1.04 - 3.75) for hypertensive patients with uncontrolled BP when compared with those whose BP had been under control. CONCLUSION: When the BP level had been effectively under control, the risk of developing a type 2 diabetes could be reduced.