Biphasic burrowing in Atlantic hagfish (Myxine limosa).

Myxine limosa is a burrowing species of hagfish that occurs in the western North Atlantic in areas with muddy substrate and at depths generally greater than 100 meters. Burrowing of M. limosa has been observed from submersibles, but little is known about the behavior of these animals within the substrate or the biomechanical mechanisms involved. Here, we investigated burrowing in M. limosa by observing individuals as they burrowed through transparent gelatin. A photoelastic setup using crossed polarizers allowed us to visualize stress development in the gelatin as the hagfish moved through it. We found that M. limosa created U-shaped burrows in gelatin using a stereotyped, two-phase burrowing behavior. In the first ('thrash') phase, hagfish drove their head and their anterior body into the substrate using vigorous sinusoidal swimming movements, with their head moving side-to-side. In the second ('wriggle') phase, swimming movements ceased, with propulsion coming exclusively from the anterior, submerged portion of body. The wriggle phase involved side-to-side head movements and movements of the submerged part of the body that resembled the internal concertina strategy used by caecilians and uropeltid snakes. The entire burrowing process took on average 7.6 min to complete and ended with the hagfish's head protruding from the substrate and the rest of its body generally concealed. Understanding the burrowing activities of hagfishes could lead to improved understanding of sediment turnover in marine benthic habitats, new insights into the reproductive behavior of hagfishes, or even inspiration for the design of burrowing robots.

Role of tri-ponderal mass index in cardio-metabolic risk assessment in children and adolescents: compared with body mass index.

OBJECTIVE: To investigate the performance of weight/heightn in discriminating obesity-related cardio-metabolic risks, and compare their performance with BMI in Chinese and American children. METHODS: 57,201 Chinese children aged 7-18 and 10,441 American children aged 12-18 with complete record of sex, age, height, weight, and waist circumference were included. Analyses and comparisons of BMI, weight/height2.5, and weight/height3 were predominantly discussed, while BMI z score, converted by BMI based on 2007 WHO growth standard, was set as the reference. Log-binomial regression models and areas under receiver-operating characteristic curves were used to examine their abilities on identifying cardio-metabolic risks, including elevated blood pressure, impaired fasting glucose, and dyslipidemia. Misclassification rates of each index were calculated. RESULTS: Weight/height3 is relatively stable during childhood in both populations. Odds ratio of weight/height3 in discriminating cardio-metabolic risks ranged from 1.09 (95% CI: 1.04, 1.14) to 1.23 (95% CI: 1.22, 1.25) and 1.06 (95% CI: 1.04, 1.08,) to 1.17 (95% CI: 1.15, 1.20) in Chinese and American participants, respectively. When 85th and 95th percentiles were set as thresholds for each sex, weight/height3 showed similar accuracy to BMI percentiles, and were more precise than BMI z scores. Misclassification rates of weight/height3 ranged from 19.1% (95% CI: 18.8%, 19.5%) to 34.7% (95% CI: 34.0%, 35.4%) compared to BMI z score, which ranged from 26.3% (95% CI: 26.0%, 26.7%) to 36.8% (95% CI: 36.0%, 37.5%) in Chinese participants. Results were similar in American participants. Combined use of weight/height3 and waist-to-height ratio did not change the classification accuracy. CONCLUSIONS AND RELEVANCE: Tri-ponderal mass index (TMI) performed superior to BMI z scores and similar to BMI percentiles in Chinese and American participants. TMI is stable in adolescents, and could be a more efficient indicator for screening obesity-related cardio-metabolic risks in routine health screening compared with BMI.

Spatial clusters of chronic preventable hospitalizations (ambulatory care sensitive conditions) and access to primary care.

BACKGROUND: Potentially preventable hospitalizations (PPHs) or ambulatory care sensitive conditions (ACSCs) represent hospitalizations that could be successfully managed in a primary care setting. Research from the USA and elsewhere on the role of primary care provider (PCP) access as a PPH driver has been conflicting. We investigated the role of PCP access in the creation of areas with persistently significant high rates of PPHs over time or PPH hotspots/spatial clusters. METHODS: Using a detailed dataset of PCPs and a dataset of 106 334 chronic PPH hospitalizations from South Western Sydney, Australia, we identified hotspots of chronic PPHs. We contrasted how hotspot PPHs were different from other PPHs on a range of factors including PCP access. RESULTS AND CONCLUSIONS: Six spatially contiguous areas comprising of eight postcodes were identified as hotspots with risks ranging from 1.6 to 2.9. The hotspots were found to be more disadvantaged and had better PCP access than other areas. Socioeconomic disadvantage explained the most variation (8%) in clustering while PCP access explained only a small fraction though using detailed PCP access measures helped. Nevertheless a large proportion of the variation remained unexplained (86.5%) underscoring the importance of individual level behaviours and other factors in driving chronic PPH clustering.

Association between birth weight and risk of abdominal obesity in children and adolescents: a school-based epidemiology survey in China.

BACKGROUND: Abdominal obesity is becoming an increasingly serious public health challenge in children and adolescents, there remains controversial opinions on birth weight and risk of childhood abdominal obesity. This study aims to assess the association between birth weight and the risk of abdominal obesity in childhood, as well as to compare the associations among different sex and age groups. METHODS: A total number of 30,486 (15,869 boys and 14,617 girls) participants aged 6-17 years old were included in this study. Participants were classified into five groups according to their birth weight. Waist-to-height ratio (WHtR) was used to define abdominal obesity. Fractional polynomial regression model was used to assess the association between birth weight and WHtR, and a multi-variable logistic regression model was applied to evaluate the risk of abdominal obesity in different birth weight groups. RESULTS: A J-shaped association was observed between birth weight and WHtR. Compared with birth weight of 2500-2999 g, high birth weight was associated with increased risk of abdominal obesity [OR (95% CI) for 3000-3499 g: 1.12(1.00-1.24); 3500-3999 g: 1.19(1.07-1.34); ≥4000 g: 1.42(1.24-1.62)]. No significant correlation was observed in children with birth weight ≤ 2499 g. Similar patterns were observed across different age groups. Abdominal obesity risk for high birth weight was particularly pronounced in boys compared to girls. CONCLUSIONS: Birth weight ≥ 3000 g, especially for boys, was associated with an elevated risk of abdominal obesity in childhood and may benefit from intervention to mitigate this risk.

The association between fetal-stage exposure to the China famine and risk of diabetes mellitus in adulthood: results from the China health and retirement longitudinal study.

BACKGROUND: The associations of famine exposure with diabetes risk in adulthood are still unclear. This study aimed to explore the association between famine exposure in early life and risk of diabetes in adulthood. METHODS: A total of 4138 subjects were selected from the data of the China Health and Retirement Longitudinal Study (CHARLS) 2011-2012. Diabetes was diagnosed as fasting plasma glucose (FPG) ≥7.0 mmol/L, glycated haemoglobin (HbA1C) > 6.5%, or self-reported diabetes. Birthdates of subjects were used to categorize famine exposure groups. The association of fetal-stage famine exposure with diabetes risk in adults was assessed using logistics regression model. RESULTS: The prevalence of diabetes in the non-exposed, fetal-stage exposed, infant-stage exposed, and preschool-stage exposed groups were 9.0, 13.6, 12.7 and 10.8%, respectively. Compared with the age-balanced control group, the fetal-stage exposed group was associated with the elevated risk of diabetes in later life after adjusting for covariates (OR = 1.37; 95%CI: 1.09-1.72; P = 0.008). Stratified analysis showed that the association between prenatal famine exposure and diabetes risk in adulthood was comparable between severely affected areas and less severely affected areas (P for interaction =0.153). CONCLUSIONS: Famine exposure in fetal stages was associated with the elevated diabetes risk in adults, which could be the critical periods for relative intervention.

Prevalence of excess body weight and underweight among 26 Chinese ethnic minority children and adolescents in 2014: a cross-sectional observational study.

BACKGROUND: Little is known regarding the nutritional burden in Chinese ethnic minority children. This study aimed to investigate the epidemiological characteristics of excess body weight and underweight for 26 ethnic groups. METHODS: Data on 80,821 participants aged 7-18 years across 26 minorities, with completed records from a large national cross-sectional survey, were obtained from Chinese National Survey on Students' Constitution and Health (CNSSCH) in 2014. Excess body weight, underweight and their components were classified according to Chinese national BMI references. RESULTS: The overall prevalence of excess body weight and underweight among ethnic groups were 12.0% and 14.5%, in which 4.4% and 4.1% of the participants were classified as obese and severe wasting, respectively. Compared with girls, boys showed a higher prevalence of underweight, severe wasting and obesity, but a lower prevalence of excess body weight (P < 0.05). Among 26 ethnic groups, Koreans had the highest prevalence of excess body weight (30.4%), while Bouyeis showed the highest prevalence of underweight (25.7%). The ethnic minority groups with high prevalence of excess body weight and underweight were more likely to show high burden of obesity and severe wasting, respectively. However, it is not the case for some groups, such as Miaos and Shuis. CONCLUSIONS: A worrying dual burden of excess body weight and underweight was recognized in Chinese ethnic minority children. Since various characteristics were found among different minorities, the ethnic-specific effort is warranted to improve their nutritional status.

The association between C-reactive protein levels and the risk for chronic kidney disease hospitalizations in adults of a remote Indigenous Australian community - A prospective cohort study.

BACKGROUND: Indigenous Australians are significantly burdened by chronic kidney disease (CKD). Elevated levels of C-reactive protein (CRP) have been associated with diabetes and cardiovascular incidence in previous studies. Elevated CRP has been associated with albuminuria and reduced eGFR in cross-sectional studies. This study investigated the long-term predictive association between CRP measured at a baseline exam and the incidence of a CKD-related hospitalization. METHODS: Health screening examinations were conducted in individuals of a remote indigenous Australian community between 1992 and 1998. The risk of subsequent CKD hospitalisations, documented through Northern Territory hospital records up to 2010, was estimated with Cox proportional hazard models in people aged over 18 years at the baseline screen and who had albumin-creatinine ratios (ACRs) less than 34g/mol. RESULTS: 546 participants were eligible for our study. Individuals in the highest CRP tertile at baseline had increased levels of traditional cardiovascular risk factors. They also had almost 4 times the risk of a CKD-related hospitalisation compared with participants in the lowest CRP tertile (HR=3.91, 95%CI 1.01-15.20, P=0.049) after adjustment for potential confounding factors. Participants with CRP concentrations greater than 3mg/L had almost 3 times the risk of CKD hospitalisations than those ≤3mg/L (HR=2.84, 95%CI 1.00-8.00, P=0.049). Furthermore, risk of CKD hospitalisations increased 34% per doubling of baseline CRP (HR=1.34, 95%CI 1.04-1.74, P=0.024). CONCLUSION: In individuals in this remote indigenous community without overt albuminuria at baseline the risk for incident CKD related hospitalisations was predicted by elevated C-reactive protein levels almost a decade earlier. Further research is needed to understand the roles that CRP and systemic inflammation play in CKD risk.

Simplifying the screening of abdominal adiposity in Chinese children with waist-to-height ratio.

OBJECTIVES: The current age- and sex-specific waist circumference (WC) reference for defining abdominal adiposity in Chinese children is quite complex. This study aimed to evaluate the optimal waist-to-height ratio (WHtR) thresholds based on the estimated WC references. METHODS: A cross-sectional analysis of data from 121,025 Chinese children aged 7-18 years collected in 2010 was performed. Optimal WHtR thresholds were selected by Youden's index using receiver operating characteristic (ROC) curve analysis, with the estimated references of WC in Chinese children used as the gold standard. RESULTS: The optimal cut-off values for identifying abdominally overweight and obese children were 0.44 and 0.46, respectively. Across the different sex and age groups, the proposed thresholds revealed high negative predictive values and areas under the ROC curve (≥0.857), and moderate to high sensitivity, specificity, and positive predictive values, ranging from 0.48 to 1.00. CONCLUSIONS: The proposed WHtR thresholds reduce the number of cut-off values from 48 to 2, and have a high discriminatory ability to identify abdominal adiposity in Chinese children. Am. J. Hum. Biol. 28:945-949, 2016. © 2016Wiley Periodicals, Inc.

Role of waist measures in addition to body mass index to assess the hypertension risk in children.

AIM: This study aimed to evaluate whether waist measures, including waist circumference (WC) and waist-to-height ratio (WHtR), can improve the ability of body mass index (BMI) to assess the hypertension risk when used as continuous variables. METHODS: In this cross-sectional study, 82 432 Chinese children aged 9-17 years were included. Elevated BP was defined using age-sex-and-height-specific references. Logistic regression model and area under the receiver operating characteristic curve (AUC) were performed after BMI and waist measures were converted into age-and-sex-based z-scores. RESULTS: WHtR, but not WC, was associated with elevated BP after adjusting for BMI, with the odds ratios ranging between 1.14 (95% confidence interval: 1.04, 1.25) and 1.30 (1.21, 1.39) for one unit increase in WHtR z-score. Combined use of BMI and WHtR z-scores showed a significantly larger AUC than BMI alone (p < 0.05), while joint use of BMI and WC was not better than BMI alone. CONCLUSION: WHtR, rather than WC, provided further information on hypertension risk beyond that provided by BMI alone when used as a continuous variable. This study suggests WHtR, in addition to BMI, should be included for the assessment of childhood adiposity in routine paediatric practice.

The Association between Breastfeeding Duration and Lipid Profile among Children and Adolescents.

To investigate the relationship between breastfeeding duration and lipid profile among children and adolescents, a cross-sectional survey using random cluster sampling was performed, and a national sample of 12,110 Chinese children and adolescents aged 5-19 years were collected. Breastfeeding duration and sociodemographic factors were collected by questionnaires. Fasting blood samples were obtained to test the lipid profile. Linear regression and logistic regression models were employed to evaluate the association between breastfeeding duration and lipid profile. We found that prolonged breastfeeding was related with a low level of total cholesterol (TC), LDL-C, HDL-C, and TC/HDL-C in children and adolescents. With an increased duration of breastfeeding, the magnitude of the association between breastfeeding and lipid profile enlarged. The levels of TC, LDL-C, HDL-C, and TC/HDL-C in participants who were breastfed for more than 12 months decreased by 6.225 (95% CI: -8.390, -4.059), 1.956 (95% CI: -3.709, -0.204), 1.273 (95% CI: -2.106, -0.440) mg/dL, and 0.072 (95%CI: -0.129, -0.015), respectively, compared with those who were not breastfed. The corresponding risk of high TC declined by 43% (aOR: 0.570, 95% CI: 0.403, 0.808). The association was similar in both boys and girls, but only statistically significant in children and young adolescents aged 5-14 years. This suggested that prolonged breastfeeding duration was related with low lipid levels and decreased abnormal lipid risk, especially in children and young adolescents. These findings support the intervention of prompting a prolonged duration of breastfeeding to improve the childhood lipid profile.

Tri-Ponderal Mass Index Reference Values for Screening Metabolic Syndrome in Children and Adolescents: Results From Two National-Representative Cross-Sectional Studies in China and America.

Introduction: To ascertain the possible cut point of tri-ponderal mass index (TMI) in discriminating metabolic syndrome (MetS) and related cardio-metabolic risk factors in Chinese and American children and adolescents. Methods: A total of 57,201 Chinese children aged 7-18 recruited in 2012 and and 10,441 American children aged 12-18 from National Health and Nutrition Examination Survey (NHANES 2001-2014) were included to fit TMI percentiles. Participants were randomly assigned to a derivation set (75%) and validation set (25%). The cut points of TMI with the lowest misclassification rate under the premise of the highest area under curves (AUC) were selected for each sex, which were additionally examined in the validation set. All of data analysis was conducted between September and December in 2019. Results: TMI showed good capacity on discriminating MetS, with AUC of 0.7658 (95% CI: 0.7544-0.7770) to 0.8445 (95% CI: 0.8349-0.8537) in Chinese and 0.8871 (95% CI: 0.8663-0.9056) to 0.9329 (95% CI: 0.9166-0.9469) in American children. The optimal cut points were 14.46 kg/m3 and 13.91 kg/m3 for Chinese boys and girls, and 17.08 kg/m3 and 18.89 kg/m3 for American boys and girls, respectively. The corresponding misclassification rates were 17.1% (95% CI: 16.4-17.8) and 11.2% (95% CI: 9.9-12.6), respectively. Performance of these cut points were also examined in the validation set (sensitivity 67.7%, specificity 82.4% in Chinese; sensitivity 84.4%, specificity 88.7% in American children). Conclusions: A sex- and ethnicity- specific single cut point of TMI could be used to distinguish MetS and elevated risk of cardio-metabolic factors in children and adolescents.

Association Between Maternal Lifestyle and Risk of Metabolic Syndrome in Offspring-A Cross-Sectional Study From China.

Background: The prevalence of MS among children and adolescents continues to rise, which has become an escalating serious health issue worldwide. It had been reported that maternal current lifestyle had a strong independent correlation with offspring health. However, it is not clear whether comprehensive lifestyle of mother has an impact on the MS risk in offspring and the role of offspring's lifestyle in it. Methods and Results: We included 4,837 mother-child pairs from a multi-centered cross-sectional study conducted in China. The information of maternal lifestyle was obtained by self-reported questionnaire, and metabolic syndrome (MS) in offspring was determined by anthropometric measurements and blood tests. Logistic regression models were employed to evaluate the association between maternal lifestyle and risk of MS in offspring. We found maternal healthy lifestyle was independently associated with lower risk of offspring MS, and the risk of MS in offspring decreased with the increased number of maternal ideal lifestyle factors. Although adolescents' lifestyle did not fully explain the relationship between maternal lifestyle and risk of offspring MS, compared with those had less ideal lifestyle factors in both mothers and offspring, the risk of offspring MS was lower in those had more ideal lifestyle factors in both mothers and adolescents. Conclusions: Healthy lifestyle in mothers was associated with a lower risk of MS in offspring, which was independent of offspring's lifestyle. These findings support mother-based lifestyle intervention could be an effective strategy to reduce the MS risk in adolescents.

A proteomic signature for CNS adaptations to the valence of environmental stimulation.

Environmental Enrichment leads to a significant improvement in long-term performance across a range of cognitive functions in mammals and it has been shown to produce an increased synaptic density and neurogenesis. Nevertheless it is still an open question as to whether some key aspects of spatial learning & memory and procedural learning might be embodied by different molecular pathways to those of social cognition. Associated with synaptic changes and potentially underlying conditions, the Ras-ERK pathway has been proposed to be the primary mediator of in vivo adaptations to environmental enrichment, acting via the downstream Ras-ERK signalling kinase MSK1 and the transcription factor CREB. Herein, we show that valence of environmental stimulation increased social competition and that this is associated with a specific proteomic signature in the frontal lobe but notably not in the hippocampus. Specifically, we show that altering the valence of environmental stimuli affected the level of social competition, with mice from negatively enriched environments winning significantly more encounters-even though mice from positive were bigger and should display dominance. This behavioural phenotype was accompanied by changes in the proteome of the fronto-ventral pole of the brain, with a differential increase in the relative abundance of proteins involved in the mitochondrial metabolic processes of the TCA cycle and respiratory processes. Investigation of this proteomic signature may pave the way for the elucidation of novel pathways underpinning the behavioural changes caused by negative enrichment and further out understanding of conditions whose core feature is increased social competition.

Association between the Great China Famine exposure in early life and risk of arthritis in adulthood.

BACKGROUND: The association between famine exposure in early life and risk of arthritis (combination of osteoarthritis and inflammatory arthritis) in adulthood is unclear. The aim of this study is to explore the association. METHODS: A total of 4124 subjects were selected from the national data of the China Health and Retirement Longitudinal Study in 2011-2012. Doctor-diagnosed arthritis was self-reported in participants' questionnaire. Birthdates were used to categorise participants into famine-exposed and non-exposed groups. Logistic regression model was used to explore the association of famine exposure in early life with the risk of arthritis in adulthood. RESULTS: The prevalence of arthritis in both infant-exposed and preschool-exposed groups was significantly higher than those in the non-exposed group (35.0% and 30.6% vs 27.3%; p<0.05). Compared with the non-exposed group, the infant-exposed group showed a significantly elevated risk of arthritis in adulthood after adjusting for confounding factors (OR=1.65; 95% CI 1.29 to 2.11; p<0.001). In the stratified analysis, we found that participants who lived in severely affected areas (OR=1.91; 95% CI 1.41 to 2.59; p<0.001), who are female (OR=2.21; 95% CI 1.57 to 3.11; p<0.001) and those with a body mass index ≥24.0 kg/m2 (OR=2.46; 95% CI 1.70 to 3.55; p<0.001) in the infant-exposed group had increased risk of arthritis in adulthood. Similar results were additionally observed when age-balanced control group was used. CONCLUSION: Great China Famine exposure in infancy may be associated with an elevated risk of arthritis in adulthood, particularly in women and participants with adiposity. These findings suggest nutrition intervention in infancy and weight control in later life may reduce the risk of arthritis in adulthood.

Low birthweight increases risk for cardiovascular disease hospitalisations in a remote Indigenous Australian community--a prospective cohort study.

OBJECTIVES: To investigate the association between low birthweight (LBW; <2,500 grams) and cardiovascular disease (CVD) hospitalisations in adult life in a remote Indigenous Australian community. METHODS: This was a prospective cohort of 852 participants with recorded birthweight using community-wide health screening examinations conducted between 1992 and 1999 and hospitalisation records up to 2012. Cox proportional hazard models assessed the association between LBW and hypertension, major CVD (heart failure, myocardial infarction and stroke) and any CVD hospitalisations. RESULTS: There were 236 participants (28%) who had a low birthweight. The LBW group had a higher risk of developing any CVD (HR = 1.43, 95%CI 1.01-2.03), major CVD (HR = 1.51, 95%CI 0.93-2.47) and hypertension (HR = 1.83, 95%CI 1.09-2.96) than the normal birthweight (NBW) group (≥2,500 g). Women with LBW had more than 2.6 times the risk of a hospitalisation associated with hypertension compared to their NBW counterparts (HR = 2.61, 95%CI 1.38-4.93), but this relationship was not seen in men. CONCLUSIONS AND IMPLICATIONS: LBW increased the risk of cardiovascular disease hospitalisations in adult life in this group. Further CVD prevention initiatives should continue to include LBW as a key predictor of CVD in this community. The mechanisms of gender influence on the hypertension relationship are unknown and require further investigation in indigenous populations worldwide.

Ethnic differences in cardiometabolic risk among adolescents across the waist-height ratio spectrum: National Health and Nutrition Examination Surveys (NHANES).

BACKGROUND: Although large waist-height ratio (WHtR) is associated with increased cardiometabolic risks, its ethnic difference in adolescents is unclear. This study aimed to investigate the ethnic differences in cardiometabolic risk across the WHtR spectrum among adolescents. METHODS: Data for this cross-sectional study were obtained from National Health and Nutrition Examination Surveys (2001-2014), and a total of 7385 participants aged 12-17years were involved. The associations between WHtR and cardiometabolic outcomes measures were assessed with fractional polynomial regression and logistic regression models. RESULTS: The risk of all cardiometabolic risk factors increased with increasing WHtR. However, significant ethnic differences in risk of adverse cardiometabolic outcomes were observed across the WHtR spectrum. At a WHtR of 0.5, compared with non-Hispanic (NH) whites, NH blacks revealed higher risks of elevated HbA1c, insulin resistance and hypertension, and lower risks of abnormal lipid profile, high glucose, elevated uric acid, and metabolic syndrome, with odds ratios (ORs) ranging from 1.36 (95% confidence interval: 1.17, 1.55) to 4.81 (2.94, 6.67) and 0.33 (0.23, 0.43) to 0.72 (0.53, 0.91), respectively. Additionally, significant differences in risks of abnormal lipid profile, elevated uric acid, abnormal glucose and insulin resistance were observed between Mexican Americans and NH whites as well. CONCLUSIONS: Significant ethnic disparities in cardiometabolic risk were observed in adolescents across the WHtR spectrum. Our findings pointed to opportunities to target particular cardiometabolic risk factors in specific ethnicities, and suggested the development of ethnicity-specific WHtR thresholds.

The Association between HbA1c and Cardiovascular Disease Markers in a Remote Indigenous Australian Community with and without Diagnosed Diabetes.

OBJECTIVES: This study investigates the burden of cardiovascular risk markers in people with and without diabetes in a remote Indigenous Australian community, based on their HbA1c concentration. METHODS: This study included health screening exams of 1187 remote Indigenous residents over 15 years old who represented 70% of the age-eligible community. The participants were stratified by HbA1c into 5 groups using cut-off points recommended by international organisations. The associations of traditional cardiovascular risk markers with HbA1c groups were assessed using logistic and linear regressions and ANOVA models. RESULTS: Of the 1187 participants, 158 (13%) had a previous diabetes diagnosis, up to 568 (48%) were at high risk (5.7-6.4% (39-46 mmol/mol) HbA1c), and 67 (6%) potential new cases of diabetes (≥6.5% (48 mmol/mol)) were identified. Individuals with higher HbA1c levels were more likely to have albuminuria (OR 3.14, 95% CI 1.26-7.82) and dyslipidaemia (OR 2.37, 95% CI 1.29-4.34) and visited the clinic more often (OR 2.52, 95% CI 1.26-4.99). Almost all traditional CVD risk factors showed a positive association with HbA1c. CONCLUSIONS: Screening in this remote Indigenous Australian community highlights the high proportion of individuals who are at high risk of diabetes as indicated by HbA1c and who also had an accentuated cardiovascular risk profile.

The association between blood pressure and grip strength in adolescents: does body mass index matter?

Increased body mass index (BMI) has been related to both low grip strength and high blood pressure (BP) in adolescents. Previous reports of high BP associated with decreased grip strength could be due to the inherent increase in BP in youths with high BMI. This cross-sectional study aimed to examine the association between grip strength and BP in adolescents independent of BMI. A total of 88 865 Chinese adolescents aged 13-17 years were included in this study. Sex-, age- and height-specific references were applied to calculate the BP z-score and define elevated BP. Grip strength was evaluated as handgrip (kg)/weight (kg) and converted into a sex- and age-specific z-score for analysis. Using fractional polynomial regression, we found that increased BMI was associated with enhanced BP and decreased grip strength; however, after stratification by or adjustment for BMI, strong grip strength was related to an increased BP. Logistic regression models revealed that a one s.d. increase in boys' grip strength z-score was associated with an 18% (95% confidence interval: 12, 25) to 37% (19, 59) higher risk of elevated BP when adjusted for BMI. These associations remained significant after further adjustment for cardiorespiratory fitness. A similar pattern was also observed in girls. These results indicated that strong grip strength was associated with increased adolescent BP after adjustment for BMI. Our findings raise questions about using muscle-strengthening training as an approach to improve the BP profile in adolescents.

The HbA1c and all-cause mortality relationship in patients with type 2 diabetes is J-shaped: a meta-analysis of observational studies.

BACKGROUND: Low blood glucose and HbA1c levels are recommended in the literature on management of diabetes. However, data have shown that low blood glucose is associated with serious adverse effects for the patients and the recommendation has been criticized. Therefore, this article revisits the relationship between HbA1c and all-cause mortality by a meta-analysis of observational studies. AIM: The aim of this study is to determine whether there is a J- or U-shaped non-linear relationship between HbA1c and all-cause mortality in type 2 diabetes patients, implying an increased risk to premature all-cause mortality at high and low levels of HbA1c. METHODS: A comprehensive literature search was conducted using PubMed, Medline, and Cochrane Library databases with strict inclusion/exclusion criteria. The published adjusted hazard ratios (HR) with 95% confidence intervals of all-cause mortality for each HbA1c category and per study were analyzed. Fractional polynomial regression was used with random effect modeling to assess the non-linear relationship of the HR trends between studies. Seven eligible observational studies with a total of 147,424 participants were included in the study. RESULTS: A significant J-shaped relationship was observed between HbA1c and all-cause mortality. Crude relative risk for all-cause mortality identified a decreased risk per 1% increase in HbA1c below 7.5% (58 mmol/mol) (0.90, CI 0.86-0.94) and an increased risk per 1% increase in HbA1c above 7.5% (58 mmol/mol) (1.04, CI 1.01-1.06). Observational studies revealed a J-shaped relationship between HbA1c and all-cause mortality, equivalent to an increased risk of mortality at high and low HbA1c levels. CONCLUSIONS: This increased mortality at high and low HbA1c levels has significant implications on investigating optimum clinical HbA1c targets as it suggests that there are upper and lower limits for creating a 'security zone' for diabetes management.