The CODATwins Project: The Current Status and Recent Findings of COllaborative Project of Development of Anthropometrical Measures in Twins.

The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural-geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.

miR-200b promotes cell proliferation and invasion in t-cell acute Lymphoblastic leukemia through NOTCH1.

MicroRNA-200b (miR-200b) functions as an oncogenic regulator in human lung cancer. However, the effect of miRNA-200b on the development and progression of T-Cell acute lymphoblastic leukemia (T-ALL) remains largely unknown. In this study, we evaluated the impact of miR-200b in T-ALL cell proliferation, survival and invasion using gain and loss of function approaches. Human Jurkat cells, a widely used in-vitro T-ALL cell model, were transfected with miR-200b mimic or miR-200b inhibitor. miR-200b mimics substantially inhibited Jurkat cell proliferation and invasion while significantly stimulating cell apoptosis compared to the control miRNA-treated cells. In contrast, Jurkat cells treated with anti-miR200 demonstrated induction of cell growth and invasion but repression of cell apoptosis. Such effect was accompanied by the corresponding alteration in NOTCH1 expression, suggesting that NOTCH1 might be the target gene for miR-200b function in Jurkat cells. In summary, our findings demonstrate that miR-200b may serve as a potential therapeutic target for T-ALL by negatively regulating the NOTCH1 signaling pathway.

Exposure to famine in early life and the risk of obesity in adulthood in Qingdao: Evidence from the 1959-1961 Chinese famine.

BACKGROUND AND AIMS: We aimed to evaluate the association between famine exposure during early life and obesity and obesitymax (obese at the highest weight) in adulthood. METHODS AND RESULTS: Data were from two population-based cross-sectional surveys conducted in 2006 and 2009 in Qingdao, China. A total of 8185 subjects born between 1/1/1941 and 12/31/1971 were categorized into unexposed (born between 01/01/1962 and 12/31/1971), fetal/infant exposed (born between 01/01/1959 and 12/31/1961), childhood exposed (born between 01/01/1949 and 12/31/1958) and adolescence exposed (born between 01/01/1941 and 12/31/1948) according to their age when exposed to the Chinese famine from 1959 to 1961. Obesity was defined as BMI (body mass index) ≥28.0 and obesitymax was defined as BMImax (BMI at the highest weight) ≥28.0. We compared fetal/infant exposed, childhood exposed and adolescence exposed to the unexposed using logistic regression models to assess the effect of famine exposure on later obesity and obesitymax. Fetal/infant exposed (OR = 1.59, P < 0.001), childhood exposed (OR = 1.42, P < 0.01) and adolescence exposed (OR = 1.86, P < 0.01) all had higher risks of obesity than the unexposed. Exposure groups were more likely to be obese at their highest weight than the unexposed, and ORs (95%CIs) for obesitymax in the fetal/infant exposed, childhood exposed and adolescence exposed were 1.49(1.20-1.86), 1.24(1.02-1.49) and 1.64 (1.40-1.93), respectively. Similar results were found in both men and women. CONCLUSION: Exposure to famine in early life was associated with increased risks of obesity and obesitymax in adulthood. Preventing undernutrition in early life appears beneficial to reduce the prevalence of later obesity.

Mitochondrial DNA insertions in the nuclear Capra hircus genome.

Nuclear mitochondrial pseudogenes (numts), originating from mtDNA insertions into the nuclear genome, have been detected in many species. However, the distribution of numts in the newly published nuclear genome of domestic goat (Capra hircus) has not yet been explored. We used the entire goat mtDNA sequence and nuclear genome, to identify 118 numts using BLAST. Of these, 79 were able to map sequences to the genome. Further analysis showed that the size of the numts ranged from 318 to 9608 bp, and the homologous identity between numts and their respective corresponding mtDNA fragments varied between 65 and 99%. The identified Yunnan black goat numts covered nearly all the mitochondrial genes including mtDNA control region, and were distributed over all chromosomes with the exception of chromosomes 18, 21, and 25. The Y chromosome was excluded from our analysis, as sequence data are currently not available. Among the discovered 79 numts that we were able to map to the genome, 26 relatively complete mitochondrial genes were detected. Our results constitute valuable information for subsequent studies related to mitochondrial genes and goat evolution.

Changes of expression of estrogen and progestrone receptors, human epithelial growth factor receptor 2 and Ki-67 after neoadjuvant chemotherapy in the treatment of breast cancer.

Recent studies suggest that the development and prognosis of breast cancer is in close correlation to molecular subtype of breast cancer. Neoadjuvant chemotherapy has been extensively applied in the treatment of local breast cancer in advanced stage. In order to verify the correlation between expression changes of estrogen receptor, progestrone receptor, human epithelial growth factor receptor 2 and Ki-67 after neoadjuvant chemotherapy and neoadjuvant chemotherapy, we studied 120 patients with stage IIAIIIC breast cancer who underwent neoadjuvant chemotherapy in Binzhou Medical University Hospital, Shandong, China from February 2011 to February 2015. Clinical characteristics were retrospectively analyzed. The expression of estrogen receptor, progesterone receptor, human epithelial growth factor receptor 2 and Ki-67 of patients were detected using the immunohistochemical method before and after neoadjuvant chemotherapy. The results suggest that the overall remission rate of neoadjuvant chemotherapy was 76.7% (92/120) of which 16.7% (20/120) of cases had complete remission, 60% (72/120) had partial remission and 23.3% (28/120) were stable. There were no cases of progressive disease. The property of estrogen receptor and the expression of Ki-67 of primary tumor were correlated to the remission rate of neoadjuvant chemotherapy (P less than 0.05). The expression of Ki-67 had a significant decline after neoadjuvant chemotherapy, and the difference had statistical significance (P less than 0.05). The difference in expression of estrogen receptor, progesterone receptor and human epithelial growth factor receptor 2 before and after neoadjuvant chemotherapy had statistical significance (P > 0.05). Hence, it can be concluded that breast cancer patients with negative estrogen receptor expression and high Ki-67 expression before neoadjuvant chemotherapy can achieve better curative effects. Neoadjuvant chemotherapy cannot change the expression states of estrogen receptor, progesterone receptor and human epithelial growth factor receptor 2, but it can lower the expression level of Ki-67. Ki-67 can also be used for predicting the curative effect of neoadjuvant chemotherapy.

NMR investigation of the quasi-one-dimensional superconductor K(2)Cr(3)As(3).

We report ^{75}As NMR measurements on the new quasi-one-dimensional superconductor K_{2}Cr_{3}As_{3} (T_{c}∼6.1 K) [J. K. Bao et al., Phys. Rev. X 5, 011013 (2015)]. We found evidence for strong enhancement of Cr spin fluctuations above T_{c} in the [Cr_{3}As_{3}]_{∞} double-walled subnanotubes based on the nuclear spin-lattice relaxation rate 1/T_{1}. The power-law temperature dependence, 1/T_{1}T∼T^{-γ} (γ∼0.25), is consistent with the Tomonaga-Luttinger liquid. Moreover, absence of the Hebel-Slichter coherence peak of 1/T_{1} just below T_{c} suggests an unconventional nature of superconductivity.

Compressibility, thermal expansion coefficient and heat capacity of CH4 and CO2 hydrate mixtures using molecular dynamics simulations.

Understanding the thermal and mechanical properties of CH4 and CO2 hydrates is essential for the replacement of CH4 with CO2 in natural hydrate deposits as well as for CO2 sequestration and storage. In this work, we present isothermal compressibility, isobaric thermal expansion coefficient and specific heat capacity of fully occupied single-crystal sI-CH4 hydrates, CO2 hydrates and hydrates of their mixture using molecular dynamics simulations. Eight rigid/nonpolarisable water interaction models and three CH4 and CO2 interaction potentials were selected to examine the atomic interactions in the sI hydrate structure. The TIP4P/2005 water model combined with the DACNIS united-atom CH4 potential and TraPPE CO2 rigid potential were found to be suitable molecular interaction models. Using these molecular models, the results indicate that both the lattice parameters and the compressibility of the sI hydrates agree with those from experimental measurements. The calculated bulk modulus for any mixture ratio of CH4 and CO2 hydrates varies between 8.5 GPa and 10.4 GPa at 271.15 K between 10 and 100 MPa. The calculated thermal expansion and specific heat capacities of CH4 hydrates are also comparable with experimental values above approximately 260 K. The compressibility and expansion coefficient of guest gas mixture hydrates increase with an increasing ratio of CO2-to-CH4, while the bulk modulus and specific heat capacity exhibit the opposite trend. The presented results for the specific heat capacities of 2220-2699.0 J kg(-1) K(-1) for any mixture ratio of CH4 and CO2 hydrates are the first reported so far. These computational results provide a useful database for practical natural gas recovery from CH4 hydrates in deep oceans where CO2 is considered to replace CH4, as well as for phase equilibrium and mechanical stability of gas hydrate-bearing sediments. The computational schemes also provide an appropriate balance between computational accuracy and cost for predicting mechanical and thermal properties of gas hydrates in the high temperature range (≥260 K), and the schemes may be useful for the study of other complex hydrate systems.

Cardiovascular risk profiles in relation to newly diagnosed type 2 diabetes diagnosed by either glucose or HbA1c criteria in Chinese adults in Qingdao, China.

AIMS: To study the cardiovascular disease risk profiles in newly diagnosed diabetes diagnosed by either glucose or/and HbA(1c) criteria in Chinese adults. METHODS: Two population-based cross-sectional studies were conducted in 2006 and 2009, respectively. Data from 1987 men and 2815 women aged 35-74 years were analysed. Newly diagnosed diabetes was defined according to either glucose (fasting and/or 2-h glucose), HbA(1c) or both criteria. RESULTS: Ageing, positive family history of diabetes, elevated levels of waist circumference, systolic blood pressure, total cholesterol, triglycerides and γ-glutamyl transferase were independently associated with newly diagnosed diabetes defined by glucose criterion alone, but not for diabetes defined by HbA(1c) criterion alone. Only waist circumference, total cholesterol and smoking were significantly associated with the presence of diabetes defined by HbA(1c) criterion alone. CONCLUSIONS: Cardiovascular disease risk profiles were different in patients with newly diagnosed diabetes defined by the two diagnostic criteria for diabetes. This may have certain clinical implications on diabetes management and research.

Association between p53 codon 72 polymorphisms and clinical outcome of nasopharyngeal carcinoma.

We conducted a cohort study to investigate whether polymorphisms in p53 at codon 72 are associated with tumor response and survival time of advanced nasopharyngeal carcinoma (NPC) patients treated with radiotherapy. The study population included 127 subjects with NPC who were enrolled at Binzhou Medical University between September 2008 and December 2009. Cox proportional hazard regression was used to assess the association between polymorphisms in the p53 gene and progression-free survival (PFS) and overall survival (OS) of NPC patients. During the follow-up period, 42 patients died and 72 patients showed progression at the end of the study. Of the 127 patients, median PFS was 22.5 ± 1.2 months (1-36 months), and the median OS time was 28.2 ± 1.1 months (2-36 months). The p53 codon 72 Pro/Pro genotype was associated with a longer median PFS time of 30.3 months compared with 18.2 months for patients with Arg/Arg variants. Moreover, the p53 codon 72 Pro/ Pro genotype was associated with a longer median OS time of 31.6 months compared with 25.8 months for those with Arg/Arg variants; the P value was marginally significant. We showed that variants in p53 codon 72 may be an independent predictor for PFS and OS of NPC patients.

Association between Periodontal Diseases and the Risk of Site-Specific Gastrointestinal Cancers: A Systematic Review and Meta-Analysis.

The association between periodontal diseases and the risk of gastrointestinal cancers, especially site-specific gastrointestinal cancers, remains unclear. Here, we comprehensively searched PubMed, EMBASE, Web of Science, and Google Scholar from inception to April 2024 to identify relevant studies. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with a random-effects model. Subgroup analyses and sensitivity analyses were conducted to confirm the robustness of the main findings in different populations. This study was reported according to PRISMA 2020 guidelines. In total, we identified 19 studies, including 16.6 million participants. Individuals with periodontal diseases had an increased risk of overall gastrointestinal cancers compared with those without periodontal diseases (HR 1.31, 95% CI 1.16-1.49). Periodontal diseases significantly increased the risk of esophageal cancer by 39% (HR 1.39, 95% CI 1.15-1.68), gastric cancer by 13% (HR 1.13, 95% CI 1.01-1.26), colorectal cancer by 21% (HR 1.21, 95% CI 1.05-1.39), pancreatic cancer by 35% (HR 1.35, 95% CI 1.00-1.82), and liver cancer by 9% (HR 1.09, 95% CI 1.04-1.13). The risk of gastrointestinal cancers was significantly increased by periodontitis (HR 1.45, 95% CI 1.14-1.85), gingivitis (HR 1.03, 95% CI 1.01-1.04), and periodontitis/gingivitis (HR 1.27, 95% CI 1.07-1.51). Furthermore, severe periodontal diseases showed a significantly increased risk of gastrointestinal cancer (HR 1.79, 95% CI 1.07-2.99). Results of sensitivity analyses for site-specific gastrointestinal cancers were robust with the main findings. In summary, periodontal diseases, especially severe periodontitis, increase the risk of overall and site-specific gastrointestinal cancers. Interventions to prevent and manage periodontal diseases may reduce the risk of developing gastrointestinal cancers.

Genetic and environmental correlations between body mass index and waist circumference in China: the Qingdao adolescent twin study.

We aimed to analyze how genetic and environmental factors account for variations in body mass index (BMI), waist circumference (WC) and their mutual correlation in Chinese children. We measured BMI and WC in 588 pairs of twins (53 % monozygotic twins) aged 8-17 years and applied structural equation modeling to the data. For the younger children (8-12 years of age), heritability estimates of BMI were 0.56 for boys and 0.69 for girls; for the older children (13-17 years of age), the corresponding figures were 0.64 and 0.71, respectively. We observed moderate heritability estimates in WC: the corresponding figures were 0.24 and 0.56 for the younger children, and 0.27 and 0.33 for the older children, respectively. The heterogeneity test for genetic variance of BMI and WC was statistically significant between the two age groups for both sexes (p < 0.001). The proportions of BMI and WC variations due to shared and non-shared environmental factors remained stable during childhood in both sexes. Bivariate genetic analyses showed that genetic correlations between BMI and WC were strong for the younger children (rg = 0.75 for boys, rg = 0.98 for girls) and the older children (rg = 1.0 for both boys and girls). Both sexes showed moderate non-shared environmental correlations in the two age groups, whereas shared environmental correlations--except among male younger children--were not statistically significant. Genetic factors play an important role in variations in BMI and WC during childhood. Common genetic and non-shared environmental factors explained most of the association between BMI and WC for both boys and girls.

NMR search for the spin nematic state in a LaFeAsO single crystal.

We report a (75)As single crystal NMR investigation of LaFeAsO, the parent phase of a pnictide high T(c) superconductor. We demonstrate that spin dynamics develop a strong twofold anisotropy within each orthorhombic domain below the tetragonal-orthorhombic structural phase transition at T(TO) ≈ 156 K. This intermediate state with a dynamical breaking of the rotational symmetry freezes progressively into a spin density wave below T(SDW) ≈ 142 K. Our findings are consistent with the presence of a spin nematic state below T(TO) with an incipient magnetic order.

Diabetes self-risk assessment questionnaires coupled with a multimedia health promotion campaign are cheap and effective tools to increase public awareness of diabetes in a large Chinese population.

AIMS: To evaluate costs and effectiveness of implementing a diabetes self-risk assessment (Diabetes Risk Score) questionnaire coupled with a multimedia health promotion campaign on changes in diabetes awareness in a large diabetes prevention programme. METHODS: Between 2007 and 2010, a multimedia health promotion campaign was conducted targeting the 1.94 million population of Qingdao, China, using newspapers, radio programmes, distribution of free booklets and Diabetes Risk Score flyers. Diabetes awareness questionnaires filled out by people first interviewed in 2006 (survey A), before the initiation of the campaign, were compared with those first interviewed between 2007 and 2010 during the campaign period (survey B). The rates of diabetes awareness in both surveys were studied amongst adults aged 35-74 years without a prior history of diabetes, but with a Diabetes Risk Score of ≥ 14. RESULTS: In survey B, 85, 82 and 76% of the urban participants correctly recognized obesity, family history of diabetes and physical inactivity, respectively, as important risk factors for diabetes; while the awareness rates were 43, 46 and 25%, respectively, in survey A (P < 0.001). The corresponding figures among rural participants were 65, 63 and 53% in survey B and 29, 22 and 11% in survey A (P < 0.001). To cover 1000 individuals, the programme spent €5.4 on the use of the Diabetes Risk Score flyer, €31.3 on the education booklet, €7.7 on the newspaper campaign and €37.5 on radio programmes. CONCLUSIONS: The combination of a Diabetes Risk Score questionnaire with a multimedia health promotion campaign is a cheap and effective health promotion tool to raise public awareness of diabetes.

Spin ice: magnetic excitations without monopole signatures using muon spin rotation.

Theory predicts the low temperature magnetic excitations in spin ices consist of deconfined magnetic charges, or monopoles. A recent transverse-field (TF) muon spin rotation (µSR) experiment [S. T. Bramwell et al., Nature (London) 461, 956 (2009)] reports results claiming to be consistent with the temperature and magnetic field dependence anticipated for monopole nucleation-the so-called second Wien effect. We demonstrate via a new series of µSR experiments in Dy(2)Ti(2)O(7) that such an effect is not observable in a TF µSR experiment. Rather, as found in many highly frustrated magnetic materials, we observe spin fluctuations which become temperature independent at low temperatures, behavior which dominates over any possible signature of thermally nucleated monopole excitations.

Prevalence of metabolic syndrome in rural and urban Chinese population in Qingdao.

AIMS: To investigate the prevalence of metabolic syndrome and its components in both rural and urban Chinese population. SUBJECTS AND METHODS: A population-based crosssectional survey was conducted in Qingdao, China in 2006 with 6100 Chinese aged 35-74 yr invited and 5355 who attended; 3357 subjects, 1562 urban (46.5%) and 1795 rural residents (53.5%) met the inclusion criteria for the current data analysis. The metabolic syndrome definitions of National Cholesterol Education Program Adult Treatment Expert Panel III (NCEPATPIII) 2004, NCEP 2005 and International Diabetes Federation (IDF) were used. RESULTS: The age-standardized prevalences of metabolic syndrome were 16.2%, 32.2%, and 28.3% in men and 26.8%, 37.2%, and 34.6%in women, according to the definitions of the NCEP 2004, NCEP 2005, and IDF, respectively. Urban men have more risk factors and higher prevalence of the metabolic syndrome than rural men, but the differences in women were not that striking. Elevated blood pressure (62.6%) was, among risk factors, most common in the study population, followed by central obesity (53.4%), and hyperglycemia (52.2%) defined using the NCEP 2005 criteria. CONCLUSIONS: Metabolic disorders were common among adult Chinese in both rural and urban areas in Qingdao.

[Analysis of clinical characteristics of middle ear osteoma at different locations].

Objective: To explore the clinical characteristics, intervention and treatment of tympanic osteoma at different locations. Methods: The medical history, audiological and imaging examination, operation and follow-up results of two patients with tympanic osteoma at different sites were reviewed and summarized. Furthermore, the clinical characteristics and interventions of 36 patients reported in literatures with tympanic osteomas were also summarized and analyzed. Results: Osteoma of the two patients collected in this study located at promontory and incus respectively;both of them presented with intact tympanum and conductive deafness, without obvious etiology or predisposing factor. Both of them underwent surgeries and the hearing improved significantly. For patient one, the ossicular chain was intact and restored to activity after removed the osteoma. For patient two, an artificial ossicle was implanted after removed the osteoma and incus. In the 36 patients reported in literatures, the average age was 26.5 years, and 39.47% of them located at promontory; in addition, the main symptoms of them were progressive hearing loss, tinnitus and ear stuffy. Conclusions: Patients with tympanic osteoma are characterized by conduction deafness with intact tympanic membrane, and the most common lesion is promontory. Hearing can be restored by excision of the osteoma and maintenance or reconstruction of the ossicle chain.

Contrasting spin dynamics between underdoped and overdoped Ba(Fe1-xCox)2As2.

We report the first NMR investigation of spin dynamics in the overdoped nonsuperconducting regime of Ba(Fe1-xCox)2As2 up to x=0.26. We demonstrate that the absence of interband transitions with large momentum transfer Q{AF} approximately (pi/a,0) between the hole and electron Fermi surfaces results in complete suppression of antiferromagnetic spin fluctuations for x greater than or approximately 0.15. Our experimental results provide direct evidence for a correlation between T{c} and the strength of Q{AF} antiferromagnetic spin fluctuations.

Does abnormal insulin action or insulin secretion explain the increase in prevalence of impaired glucose metabolism with age in populations of different ethnicities?

BACKGROUND: Age is associated with both impaired glucose and insulin metabolism. To what extent the age-related changes in insulin resistance (IR) and beta-cell function contribute to the increase in prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) is less known, and this is investigated in this study. METHODS: This study included 6610 men and 7664 women of different ethnic groups aged 30-69 years. IR and beta-cell function were examined by the homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of beta-cell function (HOMA-B). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression analysis adjusting for body mass index and study. RESULTS: In Chinese men, the ORs (95% CIs) for IFG were 2.69 (1.70, 4.26), 2.51 (1.49, 4.21) and 2.89 (1.68, 4.97), respectively, in age groups of 40-49, 50-59 and 60-69 years compared with 30-39 years (p < 0.001 for trend); the corresponding figures for IGT were 1.73 (1.25, 2.38), 2.54 (1.78, 3.63) and 3.57 (2.46, 5.19) (p < 0.001 for trend). Similar trends for IGT were observed also in Chinese women and other ethnic groups, but not for IFG in Mauritius Indian and Creole men. Adjustment for HOMA-IR and HOMA-B reduced the ORs in all age groups of all ethnicities for both IFG and IGT, but the risk gradient between age groups remained particularly for the IGT. CONCLUSIONS: The age-related increase in glucose intolerance may not be fully explained by the defect in HOMA-IR and HOMA-B. As HOMA-IR and HOMA-B are only surrogate measures of insulin sensitivity and insulin secretion, the results need to be further investigated.

Increasing trend in the prevalence of Type 2 diabetes and pre-diabetes in the Chinese rural and urban population in Qingdao, China.

AIMS: To determine the secular trend of prevalence of Type 2 diabetes and pre-diabetes in a Chinese population from 2001 to 2006. METHODS: Two consecutive population-based surveys for diabetes were conducted in a randomly selected population aged 35-74 years and living in Qingdao, China in 2001-2002 (n = 10854) and 2006 (n = 4416). All participants underwent standardized 2-h 75-g oral glucose tolerance tests (OGTTs), along with fasting capillary plasma glucose (FCG) tests in 2006. One urban community underwent OGTTs directly in 2002 (n = 1815), while a two-step screening strategy using FCG as a first-line screening test followed by OGTTs was used in 9039 individuals in 2001. Diabetes and pre-diabetes was defined according to the 2006 World Health Organization/International Diabetes Federation criteria. RESULTS: Based on the results of direct OGTTs, the age-standardized prevalence of diabetes and pre-diabetes in urban areas was 12.2 and 15.4% in 2002, whereas the prevalences were 18.8 and 28.7% in urban areas and 14.1 and 20.2% in rural areas in 2006 (P < 0.001, in urban areas). Using the two-step screening strategy, the prevalence of diabetes in 2001 was 10.1% in urban and 7.7% in rural areas and 13.8% in urban and 12.2% in rural areas in 2006 (P < 0.001). Based on the data of the 2006 survey, the two-step screening strategy missed 30.2% of diabetes cases when compared with the number defined by the direct OGTT approach. CONCLUSIONS: Qingdao has experienced a marked increase in the prevalence of diabetes and pre-diabetes in the past 5 years. Intervention to prevent a further increase in the prevalence of diabetes is urgently required.