High risk of conversion to diabetes in first-degree relatives of individuals with young-onset type 2 diabetes: a 12-year follow-up analysis.

AIM: Family history of diabetes is an established risk factor for Type 2 diabetes, but the impact of a family history of young-onset diabetes (onset < 40 years) on future risk of diabetes among first-degree relatives is unclear. In this prospective study, we examined the influence of family history of late- versus young-onset diabetes on the development of diabetes in a young to middle-aged Chinese population. METHODS: Some 365 siblings identified through probands with Type 2 diabetes and 452 participants from a community-based health awareness project (aged 18-55 years) who underwent metabolic assessment during the period 1998-2002 were followed to 2012-2013 to determine their glycaemic status. Multivariate logistic regression was performed to investigate the association of family history of diabetes presented at different age categories with development of diabetes. RESULTS: In this cohort, 53.4% (n = 167) of participants with a family history of young-onset diabetes, 30.1% (n = 68) of those with a family history of late-onset diabetes and 14.4% (n = 40) of those without a family history developed diabetes. Using logistic regression, family history of diabetes presented at ages ≥ 50, 40-49, 30-39 and < 30 years, increased conversion to diabetes with respective odds ratios of 2.4, 5.8, 9.4 and 7.0 (P < 0.001 for all), after adjustment for socio-economic status, smoking, obesity, hypertension and dyslipidaemia. Among participants without diabetes at baseline, risk association of family history of late-onset diabetes with incident diabetes was not sustained, whereas that of family history of young-onset diabetes remained robust on further adjustment for baseline glycaemic measurements. CONCLUSIONS: First-degree relatives of people with Type 2 diabetes, especially relatives of those with young-onset diabetes, are at high risk for diabetes.

A multicentre demonstration project to evaluate the effectiveness and acceptability of the web-based Joint Asia Diabetes Evaluation (JADE) programme with or without nurse support in Chinese patients with Type 2 diabetes.

AIMS: To test the hypothesis that delivery of integrated care augmented by a web-based disease management programme and nurse coordinator would improve treatment target attainment and health-related behaviour. METHODS: The web-based Joint Asia Diabetes Evaluation (JADE) and Diabetes Monitoring Database (DIAMOND) portals contain identical built-in protocols to integrate structured assessment, risk stratification, personalized reporting and decision support. The JADE portal contains an additional module to facilitate structured follow-up visits. Between January 2009 and September 2010, 3586 Chinese patients with Type 2 diabetes from six sites in China were randomized to DIAMOND (n = 1728) or JADE, plus nurse-coordinated follow-up visits (n = 1858) with comprehensive assessments at baseline and 12 months. The primary outcome was proportion of patients achieving ≥ 2 treatment targets (HbA1c < 53 mmol/mol (7%), blood pressure < 130/80 mmHg and LDL cholesterol < 2.6 mmol/l). RESULTS: Of 3586 participants enrolled (mean age 57 years, 54% men, median disease duration 5 years), 2559 returned for repeat assessment after a median (interquartile range) follow-up of 12.5 (4.6) months. The proportion of participants attaining ≥ 2 treatment targets increased in both groups (JADE 40.6 to 50.0%; DIAMOND 38.2 to 50.8%) and there were similar absolute reductions in HbA1c [DIAMOND -8 mmol/mol vs JADE -7 mmol/mol (-0.69 vs -0.62%)] and LDL cholesterol (DIAMOND -0.32 mmol/l vs JADE -0.28 mmol/l), with no between-group difference. The JADE group was more likely to self-monitor blood glucose (50.5 vs 44.2%; P = 0.005) and had fewer defaulters (25.6 vs 32.0%; P < 0.001). CONCLUSIONS: Integrated care augmented by information technology improved cardiometabolic control, with additional nurse contacts reducing the default rate and enhancing self-care. (Clinical trials registry no.: NCT01274364).

Non-linear relationship between birthweight and cardiometabolic risk factors in Chinese adolescents and adults.

AIM: To investigate the relationship between birthweight and cardiometabolic traits in two cohorts: one of Chinese adolescents and one of Chinese adults. METHODS: Birthweight and clinical data, including anthropometric traits, fasting plasma glucose and fasting plasma insulin levels, blood pressure and lipid profiles were collected from 2035 adolescents and 456 adults. A subset of 735 subjects underwent an oral glucose tolerance test to measure the glucose and insulin concentrations at 0, 15, 30, 60 and 120 min. RESULTS: Among adolescents, birthweight showed U-shaped relationships with larger body size, obesity, abdominal obesity in girls, insulin resistance and worse lipid profiles (0.0013 < P(quadratic) < 0.0499), as well as an inverse association with fasting plasma glucose (P(linear) = 0.0368). After further adjustment for adiposity, decreasing birthweight was associated with elevated fasting plasma glucose levels, greater insulin resistance and worse lipid profiles (3.1 × 10⁻5 < P(linear) < 0.0058). Among adults, high birthweight was associated with larger body size and abdominal obesity in men, while low birthweight was associated with elevated glucose levels at 15, 30, 60 and 120 min and a greater area under the curve at 0-120 min, as well as with ß-cell dysfunction (6.5 × 10⁻5 < P(linear) < 0.0437). Adjustment for adult adiposity did not substantially change the relationships. There was significant interaction between birthweight and abdominal obesity in elevating fasting plasma insulin and homeostasis model assessment of insulin resistance (P > 0.05), with abdominally obese adolescents in the lowest birthweight category (≤ 2.5 kg) having the highest risk of insulin resistance. CONCLUSIONS: Both high and low birthweights are associated with an increased risk of cardiometabolic abnormalities including obesity, abdominal obesity, hyperglycaemia, dyslipidaemia and insulin resistance, as well as with ß-cell dysfunction.

Delayed gastric emptying is related to cardiovascular autonomic neuropathy in Chinese patients with type 2 diabetes.

BACKGROUND AND STUDY AIMS: Delayed gastric emptying (DGE) is the commonest gastrointestinal (GI) complication in type 2 diabetes. We aimed to evaluate the association between DGE and cardiovascular autonomic neuropathy (CAN) in type 2 diabetes. PATIENTS AND METHODS: A total of 71 Chinese patients (39 men and 32 women, aged 60-90 years) and 30 controls (12 men and 18 women, aged 50-79 years) were studied in Nanjing, China. The gastric emptying was assessed by 13C-octanoic acid breath test (OBT) and gastric emptying ultrasonography (GEU). Cardiovascular autonomic neuropathy (CAN) was assessed by a scoring system being validated before. RESULTS: The diabetic patients, except for a higher plasma glucose level, had similar characteristics compared to the non-diabetic controls. Diabetic patients had higher incidence of DGE and CAN than controls (48.5% vs. 10.7%, p = 0.001). Among diabetic patients with DGE (n = 27), 18 (66.7%) had CAN and 9 (33.3%) did not. Corresponding figures for those without DGE (n = 39) were 14 (35.9%) and 25 (64.1%), respectively (p = 0.014). Diabetes was independently associated with the risk of DGE with odd ratio (95% CI) of 15.6 (1.92, 127.06) (p = 0.010). The presence of diabetes or CAN was independently associated with the half gastric emptying time after adjusting for age, gender, plasma glucose and blood pressure. CONCLUSIONS: We found a much prolonged gastric emptying time in Chinese patients with type 2 diabetes as compared to non-diabetic controls. There was a high rate of CAN in diabetic patients, and it was associated with gastric emptying.

A randomized-controlled trial to investigate the effects of rivoglitazone, a novel PPAR gamma agonist on glucose-lipid control in type 2 diabetes.

AIM: To examine the efficacy, safety and tolerability of rivoglitazone, a novel thiazolidinedione (TZD), and explore its effects on glucose and lipid control compared to placebo and pioglitazone in Chinese type 2 diabetic patients who are treatment naÏve or treated with a single oral blood glucose-lowering drug. METHODS: This was a double-blind, randomized, placebo- and active-controlled study. A total of 287 Chinese type 2 diabetic patients with suboptimal glycaemic control (defined as HbA1c ≥6.5 to <10% and fasting plasma glucose ≥7 to ≤15 mmol/l) were enrolled. One hundred and seventy-four eligible patients were randomized into one of the five treatment arms for 12 weeks: placebo, pioglitazone 30 mg daily, rivoglitazone of dose 0.5, 1.0 or 1.5 mg daily. In a full set analysis, we used analysis of covariance to compare the primary endpoint defined as change in HbA1c from baseline to week 12/last observation carried forward in the rivoglitazone group at each dose level with the placebo group. RESULTS: Changes in HbA1c were -0.11% in the 0.5-mg group; -0.22% in the 1-mg group and -0.17% in the 1.5-mg rivoglitazone group; -0.06% in the 30-mg pioglitazone group and 0.61% in the placebo group. Compared to placebo, changes were significant in all active treatment groups (all p < 0.05). Increase in high-density lipoprotein cholesterol and decrease in triglyceride were observed in the rivoglitazone 1 and 1.5 mg groups, respectively, compared to placebo from baseline to week 12 (p < 0.05). Drug-related oedema was reported in eight patients (7.7%) in all rivoglitazone groups compared to six patients (16.2%) in the pioglitazone group and one patient (3.0%) in the placebo group. CONCLUSIONS: Rivoglitazone is an efficacious, safe and well-tolerated TZD which improved glycaemic control in Chinese type 2 diabetic patients up to 3 months.

High rate of increased carotid intima-media thickness and atherosclerotic plaques in Chinese asymptomatic subjects with central obesity.

Both central obesity and increased carotid intima-media thickness (IMT) are markers of atherosclerosis and associated with cardiovascular diseases (CVD). Information of IMT in Chinese subjects with central obesity is limited. This study was performed to assess the rate of atherosclerosis and abnormal IMT in asymptomatic Chinese subjects with central obesity, and to investigate the association between IMT values and CVD risk factors including hypertension, hyperglycaemia and dyslipidaemia. We studied 122 centrally obese adults who had good past health. IMT measurements on carotid arteries were performed and fasting blood taken for plasma glucose and lipid profiles. Abnormal IMT was defined as > 0.9 mm. Atherosclerosis was defined as the presence of one or more visible plague. Of the 122 subjects, the mean (±SD) age was 59.4 ± 5.8 years (median [range]: 59.0 [45-75] years). The median IMT value was 0.70 mm (range: 0.53-1.19 mm) [men vs. women: 0.74 mm vs. 0.66 mm, P-value: < 0.001]. IMT values and the rate of atherosclerosis increased with age and the number of CVD risk factors (P-value for trend: < 0.05). Using binary logistic regression to predict the presence of atherosclerosis with the presence of abnormal IMT, age, gender, and other CVD risk factors as independent variables, age (OR [95% CI] = 1.13 [1.03, 1.23], P = 0.009) and abnormal IMT (OR [95% CI] = 4.05 [1.09, 15.03], P = 0.037) were independently associated with atherosclerosis. In conclusion, among Hong Kong Chinese asymptomatic subjects with central obesity, there was a high rate of CVD risk factors. We found that 19% of these subjects had carotid atherosclerotic plaques and 10% of them had abnormal IMT (>0.9 mm). Carotid IMT study may serve as an appropriate screening tool to diagnose atherosclerosis in the centrally obese middle-aged population.

Sonographic measurement of mesenteric fat predicts presence of fatty liver among subjects with polycystic ovary syndrome.

OBJECTIVE: Visceral fat is believed to be important in the pathogenesis of metabolic syndrome and fatty liver. In this study, we examined the relationship between mesenteric fat thickness and other sonographic indices of adiposity and the presence of fatty liver among subjects with polycystic ovary syndrome (PCOS). SUBJECTS AND METHODS: A total of 117 Chinese subjects with PCOS were evaluated (mean age, 28.6 ± 6.5 yr; mean body mass index, 24.3 ± 5.3 kg/m(2)). Anthropometric measurements and metabolic risk profile, including a standard oral glucose tolerance test, were assessed in all subjects. All subjects underwent an ultrasound examination for measurement of thickness of mesenteric, preperitoneal, and sc fat as well as evaluation for fatty liver. RESULTS: Forty-six (39.3%) of the subjects had fatty liver. PCOS subjects with fatty liver had higher body mass index, waist circumference, waist-hip ratio, and systolic blood pressure; a more unfavorable lipid profile with higher triglyceride; lower high-density lipoprotein cholesterol; higher fasting glucose and insulin; higher 2-h glucose during oral glucose tolerance test; lower SHBG; and higher alanine aminotransferase. Subjects with fatty liver had increased thickness of preperitoneal, mesenteric, and sc fat, as well as increased carotid intima-media thickness. Abdominal fat thickness showed moderate correlation to alanine aminotransferase as well as fasting insulin. On multivariate logistic regression, fasting insulin and mesenteric fat thickness were identified as independent predictors of fatty liver among subjects with PCOS. CONCLUSION: Fatty liver is present in a significant proportion of Chinese patients with PCOS. Sonographic measurement of mesenteric fat is an independent determinant of fatty liver among subjects with PCOS and identifies subjects at increased cardiovascular risk.

Risk associations of obesity with sugar-sweetened beverages and lifestyle factors in Chinese: the 'Better Health for Better Hong Kong' health promotion campaign.

BACKGROUND/OBJECTIVES: Excessive consumption of sugar-sweetened beverages (SSBs) increases risk of obesity. Similar data are lacking in Chinese populations with rapid nutritional transition. We aimed to examine the association between SSB intake, lifestyle factors and obesity in Hong Kong Chinese. SUBJECTS/METHODS: This is a cross-sectional survey on SSB intake with 2295 (49.6%) men and 2334 (50.4%) women (age: median 43.0 years, range 18-81 years). They were recruited from a territory-wide health promotion campaign in Hong Kong. All subjects completed a questionnaire and underwent simple health tests. Their SSB intake was based on a 1-week recall (1 unit of SSB=250 ml, frequent SSB consumption=daily intake ≥2 units). RESULTS: Men were more likely than women to smoke, drink alcohol, frequently consumed SSB (20.5 vs 9.5%) and ate more meat portions (2.32±0.57 vs 2.15±0.44) but were physically more active (no exercise: 31.2 vs 39.2%) (P-values: all <0.001). After adjusting for confounding factors, frequent SSB intake remained independently associated with obesity in women (odds ratio (95% confidence interval): 1.86 (1.36-2.55)) while physical inactivity (1.84 (1.41-2.39) for none vs regular), smoking (1.29 (1.05-1.58)) and high daily meat intake (2.15 (1.36, 3.42)) predicted obesity in men. CONCLUSIONS: In Chinese of working age, SSB consumption in women and physical inactivity, smoking and high meat intake in men were associated with obesity.

Worsening trend of central obesity despite stable or declining body mass index in Hong Kong Chinese between 1996 and 2005.

We analyzed the obesity trends in Hong Kong using data from a health assessment program. We recruited 84 357 subjects (27 452 men and 56 905 women; age: mean+/-s.d. 49.0+/-14.7 years, range 20-98 years) in three phases: (1) April 1996 to August 1997 (n=17 119); (2) February 2001 to December 2002 (n=16 978); and (3) January 2004 to December 2005 (n=50 260). Waist circumferences were available only in phases 2 and 3. Central obesity was defined as waist > or =90 cm in men and > or =80 cm in women. Overweight and obesity (general) were defined as body mass index (BMI) > or =23 and > or =25 kg/m(2), respectively. The age-standardized rate (95% CI) of general obesity was stable in men (31.6% (29.6, 33.7) in 1996 vs 31.0% (30.0, 32.0) in 2005, P: NS) but declined in women (22.4% (21.3, 23.5) in 1996 vs 18.8% (18.2, 19.4) in 2005, P<0.05). The prevalence of central obesity increased from 23.0% (20.6, 25.4) in 2001 to 26.9% (26.0, 27.8) in 2005 in men (P<0.05) and remained stable in women, with corresponding rates of 27.5% (25.8, 29.3) and 26.6% (26.0, 27.3), respectively (P: NS). In summary, despite stable or declining BMI, age-standardized central obesity failed to decline in Hong Kong Chinese women and continued to increase in Chinese men over a 10-year period.

Hypoadiponectinaemia enhances waist circumference as a predictor of glucose intolerance and clustering of risk factors in Chinese men.

AIM: This study aimed to confirm the hypothesis that adiponectin levels can enhance the discriminative value of waist circumference (WC) in predicting impaired glycaemic status and clustering of risk factors. METHODS: We used receiver operating characteristic (ROC) curve analysis to define the optimal cut-off value of adiponectin to predict diabetes in Chinese men with no relevant past medical history. This value was combined with WC to increase its discriminative power in ascertaining impaired glycaemic status and various cardiovascular risk factors. RESULTS: In 360 men (mean+/-S.D.; age: 41.3+/-9.2 years), the mean+/-S.D. adiponectin level was 5.2+/-2.7 microg/mL. Based on oral glucose tolerance tests (OGTTs), 84 men (23.3%) had undiagnosed diabetes, 52 (14.4%) had impaired glucose tolerance (IGT) and 224 (62.3%) had normal glucose tolerance. On ROC analysis, 5.7 microg/mL was the optimal cut-off value of adiponectin in this population to predict diabetes. Compared with subjects who had normal WC (defined as less than 90 cm) and high adiponectin levels (> or =5.7 microg/mL), the likelihood ratio of diabetes was 2.54 in those with central obesity and hypoadiponectinaemia. CONCLUSION: The combined use of low adiponectin levels and large WC measures has greater discriminative power than using either index alone to identify subjects at particular risk of glucose intolerance and clustering of risk factors.

Metabolic syndrome, endothelial injury, and subclinical atherosclerosis in patients with systemic lupus erythematosus.

OBJECTIVES: To study the link between metabolic syndrome (MetS), endothelial injury, and atherosclerosis in patients with systemic lupus erythematosus (SLE). METHODS: Consecutive SLE patients without a history of arterial thrombosis were screened for atherosclerosis at the carotid and coronary arteries by B-mode ultrasound [intima-media thickness (IMT)] and multidetector computed tomography (MDCT) scan (Agatston calcium scores), respectively. Plasma levels of homocysteine, high-sensitivity C-reactive protein (hsCRP), soluble vascular cell adhesion molecule (sVCAM)-1, P-selectin, and soluble thrombomodulin (sTM) were assayed. Patients were stratified according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria for MetS, using the Asian criteria for abdominal obesity. Risk factors for atherosclerosis were studied. RESULTS: Of the 123 SLE patients (93% women; age 47.9+/-11 years; SLE duration 10.9+/-7.0 years) studied, 20 (16.3%) had MetS. The prevalence of MetS in the SLE patients was significantly higher than in 492 age- and sex-matched healthy controls (9.6%; p=0.03). Coronary calcification and abnormal carotid IMT were detected in 38 (31%) and 72 (59%) of SLE patients, respectively. Patients with MetS had a significantly higher Agatston score (69.5+/-95 vs. 16.4+/-57; p=0.03) and a numerically higher carotid IMT (p=0.43) than those without. In a logistic regression model, the MetS [odds ratio (OR) 3.11, 95% confidence interval (CI) 1.01-9.59, p=0.049] was associated with coronary atherosclerosis after adjustment for age and other risk factors. In addition, patients with MetS had significantly higher levels of hsCRP (p=0.002), homocysteine (p=0.03), and sTM (p=0.01). CONCLUSIONS: The MetS is more prevalent in SLE patients than the general population and is associated with endothelial injury and coronary atherosclerosis. More aggressive control of risk factors is justified in these patients.

ABCG2 polymorphism is associated with the low-density lipoprotein cholesterol response to rosuvastatin.

The ATP-binding cassette G2 (ABCG2) c.421C>A (rs2231142) polymorphism influences the pharmacokinetics of rosuvastatin. We examined whether this polymorphism influences the low-density lipoprotein cholesterol (LDL-C)-lowering efficacy of the drug. In 305 Chinese patients with hypercholesterolemia who were treated with rosuvastatin at a dosage of 10 mg daily, the c.421A variant was found to be significantly associated with greater reduction in LDL-C level, in a gene-dose-dependent manner. As compared with subjects with the c.421CC genotype, those with the c.421AA genotype showed a 6.9% greater reduction in LDL-C level, which would be equivalent to the effect obtained by doubling the dose of rosuvastatin.

Evaluation of erectile dysfunction and associated cardiovascular risk using structured questionnaires in Chinese type 2 diabetic men.

Erectile dysfunction (ED) is not uncommon, but frequently underdiagnosed in type 2 diabetic men. In this study, we aimed to explore the frequency and severity of ED in Chinese type 2 diabetic men using a structured questionnaire. We furthermore sought to investigate the associations of ED with diabetes-related complications and metabolic indices. A consecutive cohort of 313 Chinese type 2 diabetic men aged between 25 and 76 years attending a diabetic centre were recruited between October 2006 and June 2007. Of the study population, the frequency of ED was 39.3% according to the National Institutes of Health (NIH) Consensus Conference criteria, compared with 84.3% (41.7% of them having moderate to severe ED) as diagnosed by International Index of Erectile Function (IIEF-5) questionnaire. After adjusting for potential confounding factors by multivariable logistic regression, ED defined by NIH criterion was associated with advanced age [OR = 1.05 (95% CI 1.01-1.09), p = 0.012], the presence of diabetic retinopathy [OR = 2.43 (95% CI 1.27-4.66), p = 0.008] and coronary heart disease [OR = 2.63 (95% CI 1.21-5.70), p = 0.015]. ED defined by IIEF-5 was associated with advanced age [OR = 1.12 (95% CI 1.06-1.17), p < 0.0001], use of insulin therapy [OR = 2.94 (95% CI 1.12-7.73), p = 0.029] and urinary albumin-creatinine ratio [OR = 2.29 (95% CI 1.05-5.01), p = 0.037]. In conclusion, ED was highly prevalent in Chinese type 2 diabetic men and was associated with multiple cardiovascular risk factors and complications. Advanced age, use of insulin therapy, the existence of microvascular complications such as retinopathy, albuminuria and coronary heart disease were associated with ED. NIH criteria diagnosed a much lower rate of ED compared with IIEF-5. Overall, structured questionnaires are useful and objective tools to detect ED, which should prompt a comprehensive risk assessment in these subjects.

Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups.

Current waist circumference (WC) and waist-to-hip ratio (WHR) cutoffs have been identified from studies of predominantly European-derived populations. However, these cutoffs may not be appropriate for other ethnic groups. This paper reviews the literature regarding ethnic differences in body composition and the appropriateness of ethnic-specific WC and WHR cutoffs in various ethnic groups. Studies investigating ethnic-specific cutoffs were identified among Aboriginal, Asian, African (Sub-Saharan), African-American, Hispanic, Middle Eastern, Pacific Islander and South American populations. Abstracts that recommended WC and/or WHR cutoffs (or rejected the use of cutoffs) were included with their supporting literature. The evidence for ethnic-specific WC and/or WHR cutoffs was then rated as either convincing, probable, possible or insufficient. The majority of studies recommending ethnic-specific cutoffs was for Asian populations. Few studies recommended cutoffs in Aboriginal, African (Sub-Saharan), Pacific Islanders and South American populations. All studies were cross-sectional, and the overwhelming majority of studies used receiver operating characteristic curves. The studies used a number of methods for assessing WC and WHR, and a variety of outcome measures, making cross-study comparison difficult. There is possible evidence that Asians should have a lower WC cutoff than Europeans. The evidence is insufficient for specific cutoffs for African-American, Hispanic and Middle Eastern populations but some studies indicate current cutoffs for Europeans may be appropriate, whereas there is insufficient evidence for the other ethnic groups. Future studies are needed to address the methodological limitations of the current literature.

Body fat distribution and noncommunicable diseases in populations: overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist-Hip Ratio.

A World Health Organization (WHO) Expert Consultation on Waist Circumference (WC) and Waist-Hip Ratio (WHR) was convened in Geneva from 8 to 11 December 2008 to consider approaches to developing international guidelines for indices and action levels in order to characterize health risks associated with these measures of body fat distribution-alternative or complementary to the existing WHO guidelines for assessments of generalized obesity on the basis of body mass index. Six background papers prepared for the Consultation are compiled in this issue. These six papers examine a range of health outcomes and issues, including whether there is a basis for choosing WC over WHR and whether different action levels by gender, age, ethnicity, country or region are warranted. Although guidelines involving WC and WHR are potentially useful and clearly required, the challenges in identifying cutoffs for international guidelines should not be underestimated or oversimplified. The final report and outcomes of the Expert Consultation will be published by WHO.

The effects of diet and orlistat on body weight and lipid profiles in high risk Chinese patients with coronary artery disease, obesity and hypercholesterolemia.

BACKGROUND: Orlistat is a gastrointestinal lipase inhibitor approved for use in obesity. So far, no evidence has been reported on the use of orlistat in obese patients with coronary artery disease (CAD). AIM: To investigate the effect of orlistat on body weight and lipid profiles in obese patients with CAD and hypercholesterolemia. METHODS: Thirty non-diabetic patients with CAD, body mass index (BMI) > or = 25 kg/m(2) and low-density lipoprotein cholesterol (LDL-C) > or = 2.6 and < 4.1 mmol/L were put on diet for 12 weeks. Those still having a BMI > or = 25 kg/m(2) received orlistat 120 mg thrice daily for another 24 weeks. RESULTS: BMI was significantly reduced by 1.7% after 12 weeks of dietary treatment. The 24-week orlistat treatment resulted in further significant reduction in BMI (-2.8%) and LDL-C (-7.0%). CONCLUSION: Diet and orlistat treatment significantly reduced BMI and improved LDL-C in obese patients with CAD and hypercholesterolemia.

The NCEP-ATPIII but not the IDF criteria for the metabolic syndrome identify Type 2 diabetic patients at increased risk of chronic kidney disease.

AIM: To examine the association between chronic kidney disease (CKD) and the metabolic syndrome (MetS) using both International Diabetes Federation (IDF) and National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATPIII) definitions in Chinese subjects with Type 2 diabetes. METHODS: Subjects with Type 2 diabetes were categorized according to the presence or absence of MetS by IDF or NCEP-ATPIII criteria. CKD was considered present if glomerular filtration rate, calculated using the abbreviated equation developed by the Modification of Diet in Renal Disease study with Chinese modification, was < 60 ml/min per 1.73 m2. Multivariate logistic regression analysis of the association between CKD and MetS by either definition was performed. RESULTS: Of 6350 subjects (mean age 55.1 +/- 13.3 years), 3439 (54.2%) and 3204 (50.5%) had MetS by IDF and NCEP-ATPIII definitions, respectively. Using the IDF definition, the presence of MetS was not associated with CKD [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.71, 1.29, P = 0.784]. In contrast, the association with CKD was significant when MetS was defined by the NCEP-ATPIII definition (OR 1.75, 95% CI 1.37, 2.24, P < 0.001). In subjects who did not have MetS (n = 2911) as defined by IDF criteria, 997 fulfilled the MetS criteria of NCEP-ATP III. The association with CKD was stronger, after adjustment for covariates, in these subjects (OR 1.42, 95% CI 1.03, 1.97, P = 0.032) compared with subjects who met IDF criteria of MetS. CONCLUSION: In Type 2 diabetes, NCEP-ATPIII, but not the IDF definition of MetS, identifies a subgroup of patients who have a higher risk of CKD.

Burden of obesity--lessons learnt from Hong Kong Chinese.

There is now a pandemic of chronic diseases in Asian countries, driven mainly by obesity, diabetes and cardio-renal complications. In Hong Kong, the reported prevalence of obesity, defined as body mass index (BMI) > or = 25 kg m(-2), varied from one-quarter to one-third of the population. In a population-based survey conducted in 1995, 16.7% of Hong Kong adults had the metabolic syndrome (MES) (National Cholesterol Education Programme criterion). Obesity is now a global concern not only in adults but also among children and adolescents. In 2003, a territory-wide survey in Hong Kong reported the prevalence of central obesity and MES to be 9.0% and 2.4%, respectively, in Chinese adolescents. Overweight, positive family history of diabetes and studying at schools of lower academic grading were independent risk factors for the adolescent MES. Lifestyle modification with proper diet and exercise is essential for health protection. In accord with western data, a weight management programme in Hong Kong Chinese with a 4-6% reduction in body weight or waist circumference was associated with significant reductions in all cardiovascular risk factors. Psychosocial factors related to chronic diseases are also of growing concern. In Hong Kong Chinese, increasing BMI was associated with a lower number of sleeping hours and increasing working hours, suggesting an intimate relationship between physical health and psychosocial stress. Chronic non-communicable diseases are therefore major health threats in Hong Kong, with obesity as one of the major risk factors. A multidimensional and multidisciplinary health promotion and disease management plan is urgently needed to control these epidemics.

The cost of obesity in Hong Kong.

Obesity is now being considered a rapid growing economic burden on the healthcare system of many countries. These costs should include expenditure on prevention, as well as the investigation and treatment of obesity and its related problems. Accurate information on the cost of obesity in Hong Kong is lacking so we analysed the annual hospital discharges in a representative district hospital in Hong Kong. The estimated hospitalization costs in Hong Kong' public hospitals were HK$ 2.29 billion (US$ 0.29 billion) in 1998 and HK$ 3.36 billion (US$ 0.43 billion) in 2002 accounting for 8.2-9.8% of total public expenditure on health in Hong Kong. Based on the likelihood ratio of diabetes, hypertension and dylsipidaemia related to obesity in Hong Kong Chinese (defined as body mass index > or = 25 kg m(-2)) the estimated proportion of these conditions attributable to obesity are 10-20%. In addition, significant amounts of money are being spent by the public on obesity self management schemes of no proven benefit. In 2005, 5.5% of Hong Kong's total population was consuming proprietary drugs for obesity or its related conditions. To properly assess the overall costs of obesity, other indirect costs should also be considered such as economic losses on sick leave because of obesity and its related conditions.