Association of Plasma Sex-Related Hormones Levels with Bone Mineral Densities and Risk of Osteoporosis and Osteopenia in Men and Menopausal Women with Type 2 Diabetes Mellitus.

Objective: This study aimed to examine associations between plasma sex-related hormones with bone mineral density (BMD) and risks of osteoporosis or osteopenia in men and postmenopausal women patients with type 2 diabetes mellitus (T2DM). Methods: Baseline information on an ongoing cohort of 149 men and 102 postmenopausal women with T2DM in Xiamen, China were analyzed. Plasma estradiol (E2), total testosterone (T), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL) were measured. BMD of lumbar spine (L2-4), femoral neck (FN) and total hip (TH) were determined by dual-energy X-ray absorptiometry (DXA). Osteoporosis or osteopenia was defined as the minimum T-scores of BMD of these three different sites of -1.0 or below. Results: T2DM patients with osteoporosis/osteopenia (66.4% in men and 79.4% in postmenopausal women), compared to those without, showed significantly decreased level of E2 (75.3±28.9 vs. 107.8±25.9pmol/L and 18.4 (18.4-29.5) vs. 22.8 (18.4-40.5) pmol/L for men and postmenopausal women, respectively, both p-values <0.05), but not other sex-related hormones (including T, FSH, LH, or PRL). For all T2DM patients together and men separately, multivariable linear regression and logistic regression analyses showed that higher E2 levels were significantly associated with higher BMD T-scores in L2-4, FN, TH and minimum of these three different sites, lower 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HFs) estimated by Fracture Risk Assessment Tool score, as well as decreased risk of osteoporosis/osteopenia. As for postmenopausal women T2DM patients, E2 level was positively associated with BMD T-scores in L2-4 and minimum of three different sites but was not independently associated with risk of osteoporosis/osteopenia. Conclusion: Higher plasma E2 was significantly associated with increased BMD and lower risk of osteoporosis or osteopenia in T2DM patients, especially for men. Screening of BMD and estradiol levels as well as evaluating risks of osteoporosis/osteopenia are important for T2DM patients.

Associations of Obesity Indices with Bone Mineral Densities and Risk of Osteoporosis Stratified Across Diabetic Vascular Disease in T2DM Patients.

Objective: To evaluate associations of obesity indices with bone mineral densities (BMD) and risk of osteoporosis in T2DM patients totally and stratified across presence of any diabetic cardiovascular complications. Methods: Cross-sectional analyses of baseline information on a cohort of 250 T2DM patients were conducted in Xiamen, China. Obesity indices included body weight, height, body mass index (BMI), waist and waist hip ratio (WHR). BMD was measured using dual-energy X-ray absorptiometry at three different sites, and osteoporosis was defined based on the minimum T-scores of BMD. Presence of any diabetic vascular complications was confirmed by checking their medical records histories. Results: Among the 250 T2DM patients, 50 (20.0%) were defined as osteoporosis. Multivariable linear regression and multivariable logistic regression analyses showed that igher obesity indices, including body weight, BMI and waist, but neither body height nor waist hip ratio, were positively associated with the minimum T-scores of BMD and had significantly decreased risk of osteoporosis. Stratified analyses across presence of any of diabetic vascular complications showed similar results for those with any of diabetic vascular complications, while no significant association between obesity indices and minimum T-scores of BMD was found for those without. Postmenopausal women (vs men) and ever drinking were significantly associated with increased risk of osteoporosis, and the adjusted odds ratios (95% CIs) were 5.165 (1.762-15.138, p = 0.003) and 3.789 (1.087-13.214, p = 0.037), respectively. None of metabolic profiles, including systolic and diastolic blood pressure, triglyceride, total cholesterol, high-density lipoprotein cholesterol, HbA1c and blood uric acid, was significantly associated with either minimum T-scores of BMD or risk of osteoporosis. Conclusion: Associations of obesity indices with either BMD or risk of osteoporosis in T2DM patients varied by presence of any diabetic vascular complication and should be not interpreted as causal without considering the often-unmeasured effect modification by health status.

Pulmonary tuberculosis as a risk factor for chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BACKGROUND: Prior pulmonary tuberculosis (TB) can cause permanent changes in lung anatomy and is associated with lung function loss. However, it remains unclear whether pulmonary function impairment owing to TB is associated with airflow obstruction, the hallmark of chronic obstructive pulmonary disease (COPD). The aim of this systematic review and meta-analysis was to assess the association and quantify the magnitudes of association between pulmonary TB and COPD, and to evaluate the prevalence of COPD in patients with prior pulmonary TB. METHODS: We searched the PubMed, Embase, and Web of Science databases for studies published from inception to January 1, 2020. Pooled effect sizes were calculated according to a random effects model or fixed effect model depending on heterogeneity. Specific subgroups (different diagnostic criteria, smoking status, income level) were examined. RESULTS: A total of 23 articles were included in this study. Compared with controls, patients with pulmonary TB had an odds ratios (ORs) of 2.59 [95% confidence interval (CI): 2.12-3.15; P<0.001] for developing COPD. In jackknife sensitivity analyses, the increased risk of prior pulmonary TB remained consistent for COPD; when the meta-analysis was repeated and one study was omitted each time, the ORs and corresponding 95% CIs were greater than 2. Funnel plots of ORs with Egger's linear regression (t=2.00, P=0.058) and Begg's rank correlation (Z=0.75, P=0.455) showing no significant publication bias. Subgroup analysis showed that the same conclusion was still present in never smokers (ORs 2.41; 95% CI: 1.74-3.32; P<0.001), patients with pulmonary TB diagnosed using chest X-ray (ORs 2.47; 95% CI: 1.23-4.97; P<0.001), and low- and middle-income country (LMIC) settings (ORs 2.70; 95% CI: 2.08-3.51; P<0.001). The pooled prevalence of COPD in patients with prior pulmonary TB was 21% (95% CI: 16-25%; P<0.001). CONCLUSIONS: Individuals with prior pulmonary TB have an increased risk and high prevalence of COPD. Future studies identifying the underlying mechanisms for TB-associated COPD and therapeutic strategies are required.

Association Between Non-obstructive Chronic Bronchitis and Incident Chronic Obstructive Pulmonary Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis.

BACKGROUND: Chronic bronchitis in patients with chronic obstructive pulmonary disease (COPD) is associated with poor respiratory health outcomes. However, controversy exists around whether non-obstructive chronic bronchitis (NOCB) is associated with airflow obstruction, lung function decline, and all-cause mortality in ever smoker or never smoker. RESEARCH QUESTION: This systematic review and meta-analysis aimed to clarify the relationship between NOCB and incident COPD, lung function decline, and all-cause mortality, and to quantify the magnitude of these associations. STUDY DESIGN AND METHODS: We searched PubMed, Embase, and Web of Science for studies published up to October 1, 2021. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Studies were included if they were original articles comparing incident COPD, lung function decline, and all-cause mortality in normal spirometry with and without chronic bronchitis. The primary outcomes were incident COPD and all-cause mortality. The secondary outcomes were respiratory disease-related mortality and lung function decline. Pooled effect sizes and 95% confidence intervals (CIs) were calculated using the random-effects model. RESULTS: We identified 17,323 related references and included 14 articles. Compared with individuals without NOCB, individuals with NOCB had an increased risk of incident COPD (odds ratio: 1.98, 95% CI: 1.21-3.22, I 2 = 76.3% and relative risk: 1.44, 95%CI: 1.13-1.85, I 2 = 56.1%), all-cause mortality (hazard ratio [HR]: 1.38, 95%CI: 1.26-1.51, I 2 = 29.4%), and respiratory disease-related mortality (HR: 1.88, 95%CI: 1.37-2.59, I 2 = 0.0%). Data on the decline in lung function could not be quantitatively synthesized, but the five articles that assessed the rate of decline in lung function showed that lung function declines faster in individuals with NOCB. The mean difference in the additional decline in forced expiratory volume in 1 s ranged from 3.6 to 23.2 mL/year. INTERPRETATION: Individuals with NOCB are at a higher risk of incident COPD and all-cause mortality than individuals without NOCB, highlighting the crucial need for strategies to screen for and reduce NOCB risk. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/ PROSPERO, identifier CRD42020202837.

Neck circumference is a good predictor for insulin resistance in women with polycystic ovary syndrome.

OBJECTIVE: To assess the role of neck circumference (NC) in assessing insulin resistance (IR) in polycystic ovary syndrome (PCOS). DESIGN: A cross-sectional study. SETTING: University-affiliated hospital. PATIENT(S): One hundred forty-three women with PCOS were recruited from November 2018 to February 2020. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The associations of NC with IR and the cutoff points of NC for IR. RESULT(S): The prevalence rates of IR were 64.3%. The patients with PCOS with IR had significantly greater values of systolic blood pressure, NC, body mass index, waist-to-hip ratio, waist circumference, fasting blood glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR). Pearson correlation analysis showed body mass index (log-transformed), waist circumference, waist-to-hip ratio, and HOMA-IR (log-transformed) were positively correlated with NC. Multivariable linear regression showed that NC was significantly associated with HOMA-IR (log-transformed), with the standardized regression coefficient of 0.330 with adjustment for potential confounding factors. Furthermore, multivariate logistic regression analyses showed NC was associated significantly with increased risk of IR, with the adjusted odds ratio of 1.423. Additionally, NC was able to identify IR in women with PCOS; the optimal cut-off points was 34.3 cm (Youden index = 0.586). CONCLUSION(S): Neck circumference is positively associated with IR in women with PCOS. We suggest NC as a novel, simple, practical, and reliable anthropometric measure to be used to predict the risk of IR in patients with PCOS.

Associations of apnea hypopnea index and educational attainments with microvascular complications in patients with T2DM.

PURPOSE: The relationship between obstructive sleep apnea (OSA) and diabetic microvascular complications (DMC) are controversial. Whether low education is associated with increased risk of DMC independently of poor lifestyles are currently unknown. The aim of this study is to explore the independent associations of different PSG index and educational attainment with risks of DR, DKD, and DPN. METHODS: A cross-sectional study of 330 patients with T2DM who underwent overnight polysomnography (PSG) tests. Multivariable logistic regression analysis was performed to determine the associations of PSG index and educational attainments with DR, DKD, and DPN. RESULTS: The prevalence rates of DMC were 30.6% for DR, 24.9% for DKD, and 64.6% for DPN. All PSG index (AHI, REM-AHI, NREM-AHI, the severity of OSAS, ODI, MAI, and lowest SaO2) were not significantly associated with risks of DR, DKD, or DPN with adjustment for potential confounding factors. Subjects with increasing educational attainments showed significantly decreased prevalence rates of DR (42.6, 27.3, and 21.3%, p = 0.005), DKD (31.7, 25.3, and 14.7%, p = 0.035) and DPN (74.3, 63.6, and 53.3%, p = 0.015), respectively. Logistic regression analyses showed that educational attainment of primary or below showed significantly increased risks of DR (OR (95% CIs): 3.596 (1.453-8.899, p = 0.006)) and DKD (OR (95% CIs): 3.201 (1.244-8.242, p = 0.016)) as compared with that of college or above. There were significant trends of lower educational attainment with increased risks of DR and DKD (p values < 0.05). CONCLUSION: PSG index were not significantly associated with DMC. But lower education was significantly associated with increased risks of DR and DKD, and strategies to prevent DMC for those with low education should be strengthened.

Lipid accumulation product independently correlate with hepatic steatosis quantified by controlled attenuation parameter in women with polycystic ovary syndrome.

OBJECTIVE: To explore the independent associations of the new adiposity indices lipid accumulation product (LAP) index, visceral adiposity index (VAI), and product of triglycerides and glucose (TyG) with the risks of hepatic steatosis (HS) in women with polycystic ovary syndrome (PCOS). DESIGN: This is a cross-sectional study with 101 women with PCOS undergoing controlled attenuation parameter (CAP) measurement who were recruited from November 2018 to August 2019. Multivariable logistic regression analysis was performed to determine the associations of adiposity indices with HS. RESULT(S): Among the 101 PCOS patients, the prevalence rate of HS was 70.3%. The PCOS patients with HS have higher percentage of overweight/obesity status, higher level of aminotransferase (AST and ALT), homeostasis model assessment of insulin resistance (HOMA-IR), LAP, VAI, TyG, waist circumference (WC), and BMI (P < 0.05). Partial correlation analysis showed LAP, WC and BMI were significantly positively associated with CAP (P < 0.05) after controlling for confounding factors. Besides, BMI, WC, and CAP were gradually elevated with the increase of LAP level. Further, multivariable logistic regression analysis showed adjusted odd ratio (OR) with associated 95% CI (OR (95% CI)) were respectively 1.09 (1.03-1.16) for LAP, 1.14 (1.05-1.23) for WC, 1.28 (1.08-1.51) for BMI, respectively. CONCLUSIONS: The present study demonstrates that in women with PCOS, except for the traditional adiposity indices (WC and BMI), LAP is independently correlated with the risk of HS.

Serum Uric Acid Is Independently Associated with Risk of Obstructive Sleep Apnea-Hypopnea Syndrome in Chinese Patients with Type 2 Diabetes.

PURPOSE: We aimed to investigate the association between serum uric acid (SUA) levels and obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients with type 2 diabetes. METHODS: A cross-sectional study of 212 type 2 diabetes mellitus (T2DM) patients was conducted in Xiamen, China. All patients underwent polysomnography (PSG) recordings for OSAHS diagnosis. Patients were grouped according to the apnea-hypopnea index (AHI) as mild (5-14.9), moderate (15-29.9), and severe (≧30) OSAHS. Patients with AHI ≤ 4.9 served as the control group. Weight, body mass index (BMI), SUA, liver function, renal function, blood pressure, lipid profiles, and glycemic parameters were measured. RESULTS: A total of 158 patients (101 men and 57 women) with complete data were analyzed in this study. 127 patients were identified as OSAHS. Among the 127 patients with OSAHS, 56 (44.1%), 37 (29.1%), and 34 (26.8%) had mild, moderate, and severe OSAHS, respectively. Correlation analyses showed that the SUA level was significantly related to the apnea-hypopnea index (AHI) (r = 0.194, p = 0.016). The level of SUA was significantly higher among OSAHS patients compared to the control group (control group: 333.14 ± 80.52 µmol/L, mild group: 345.50 ± 90.27 µmol/L, moderate group: 363.59 ± 134.26 µmol/L, and severe group: 428.37 ± 123.58 µmol/L and p = 0.029). Multivariable logistic regression analyses showed that SUA was the independent risk factor for OSAHS (OR: 1.006, 95% CI: 1.001-1.011, p = 0.020). CONCLUSIONS: The SUA level is significantly associated with the severity of OSAHS and should be controlled when managing OSAHS.