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Objective:To investigate the relationship between thyroid-stimulating hormone(TSH) levels and 10-year mortality in women aged 40 years and older.Methods:Residents aged 40 and over in urban areas of Guiyang City who participated in the " Epidemiological Study of Cancer Risk in Patients with Type 2 Diabetes in China(REACTION)" were followed up in 2011. Finally, 5 614 people were enrolled, and the baseline general information, physical examination and TSH detection were carried out. The average follow-up was(9.77±1.55) years, and the treatment and death of thyroid-related diseases were recorded. The Cox proportional hazards model was used to analyze the relationship between TSH level and 10-year mortality in middle-aged and elderly women, and plotting survival time curves(Kaplan-Meier curves) to study the association between elevated TSH levels and lifespan in subjects under 65 years old. Results:The multivariate Cox proportional hazards model showed that compared with the normal group, after multivariate adjustment, the risk of death in the TSH increased group was decreased( HR=0.644, 95% CI 0.478-0.868, P<0.05); after stratifying the elevated TSH group, the risk of death was decreased in the slightly elevated TSH group( HR=0.566, 95% CI 0.405-0.791, P<0.001); the elevated TSH group was further stratified by age. In the group under 65 years old, compared to the normal group, the mildly elevated group showed a reduced risk of mortality( HR=0.429, 95% CI 0.245-0.751, P=0.003). In the group aged 65 and above, there were no statistically significant differences in mortality risk between the mildly elevated group, severely elevated group, and the normal group( P>0.05). In the group under 65 years old, the K-M curve indicated that the survival rate of the mildly elevated TSH group was significantly higher than that of the normal group( χ2=11.931, P=0.003), the difference was statistically significant. Conclusion:Mildly elevated TSH levels in women aged 40-65 years are associated with a reduced risk of all-cause death and longer lifespan.
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Objective:To explore whether metabolically healthy obesity(MHO) is a healthy state by observing the incidence of metabolic syndrome(MS) including its components and cardiovascular disease(CVD) in this population.Methods:In 2011, a cohort of 10 140 residents aged 40-79 years old was selected with cluster sampling in the Guiyang urban area. Fasting plasma glucose(FPG), blood lipids, and blood pressure were examined to assess their metabolic status. Height and weight were also measured. Among them, 1 299 metabolically healthy subjects were divided into 3 groups according to body mass index, namely metabolically healthy normal weight(MHNW), metabolically healthy overweight(MHOW), and MHO. Three groups were reassembled in 2014, and finally a total of 966 subjects with baseline and complete follow-up data were included in the analysis. The relationship between MS and its components, and the incidence of CVD were compared among the three groups.Results:(1) After an average follow-up of 3 years, 47.77% of the MHO population transformed into a metabolically unhealthy state. There was no significant difference in the incidence of MS components among the three groups( P>0.05), but there was a significant difference in the incidence of MS( P<0.05); (2) There was no significant difference in the incidence of CVD among the three groups after 3 years of follow-up. Logistic regression was used to analyze the risk factors of CVD in the three groups. Taking the MHNW as the control group, after adjusting for age, gender, FPG, blood lipids, and blood pressure, the risk ratio of the MHOW group was 0.941(0.661-1.202), and MHO group was 0.974(0.702-1.291). Conclusions:After 3 years of follow-up, although the risk of CVD in the MHO population did not increase significantly, the incidences of MS, triglycerides, and FPG abnormality increased compared with the normal people, suggesting that the MHO is not a " stable" healthy state.
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Objective:To investigate the effect of the interaction between metabolic syndrome and smoking on the risk of subsequent cardiovascular events.Methods:Urban residents aged 40 and above in the Yunyan District of Guiyang City were selected from " Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal(REACTION) Study". The baseline survey started in 2011 and general information including gender, age, medical history, lifestyle habits, and smoking status were collected. Additionally, biochemical indicators related to metabolic syndrome(MS) were measured. The study participants were then followed up, and the first cardiovascular events occurring after the initial survey were recorded. The average follow-up period was 10.07±1.49 years. The interaction between metabolic syndrome and smoking on subsequent cardiovascular events was analyzed using Cox proportional hazards models.Results:The study included a total of 7 275 individuals, among whom 639 experienced cardiovascular events. After adjusting for multiple variables, compared to non-smokers without metabolic syndrome(MS), smokers with MS showed a higher risk of cardiovascular events, with a hazard ratio( HR) of 6.54(95% CI 4.88, 8.78). This risk was higher than that of individuals with MS who never smoked [ HR 1.39(95% CI 1.11, 1.75)] and non-MS smokers [ HR 2.48(95% CI 1.77, 3.49)]. There was an additive interaction between MS and smoking on the occurrence of cardiovascular events, with a relative excess risk due to interaction(RERI) of 3.30(95% CI 1.89, 4.70), an attributable proportion(AP) of 0.55(95% CI 0.43, 0.59), and a synergy index(S) of 3.07(95% CI 1.94, 4.84). Furthermore, when stratifying the duration of smoking cessation, long-term quitters(≥8 years) showed a lower risk of cardiovascular events compared to current smokers, regardless of whether they had MS. The hazard ratios were 0.45(95% CI 0.26, 0.78) for individuals with MS and 0.42(95% CI 0.19, 0.95) for individuals without MS. Conclusions:There is an additive interaction between smoking and MS on the risk of cardiovascular events. The coexistence of both factors significantly increases the risk of cardiovascular events.
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Objective:To investigate the relationship between cardiometabolic index and metabolic syndrome in people aged 40 and beyond in Guiyang city.Methods:A total of 4 506 residents over 40 years(including 3 067 females and 1 439 males) were enrolled in the analysis from those who participated in the epidemiological study of cancer risk in Chinese patients with type 2 diabetes in 2011 in Guiyang City. The cardiometabolic index (CMI) is calculated by triglycerides(TG)/high-density lipoprotein-cholesterol(HDL-C)×waist-to-height ratio (WHtR). Multivariable logistic regression was used to analyze the correlation between cardiometabolic index and metabolic syndrome, and ROC was used to analyze the predictive ability of CMI on the incidence of metabolic syndrome. Results:The average follow-up period was 3 years. According to the International Diabetes Federation (IDF) diagnostic criteria for metabolic syndrome in 2005, 985 patients (774 women and 211 males) had metabolic syndrome. The incidence rate of metabolic syndrome in the general population was 21.86%, the incidence rate of male metabolic syndrome was 14.66%, and that of women was 25.24%, and the incidence of CMI increased with the increase of the number of women. After multivariable logistic regression analysis, the odds ratio of CMI for metabolic syndrome in women is 1.303(95% CI 1.263-1.344) and 1.724(95% CI 1.162-2.558) in men, respectively. ROC results showed that CMI had a good ability to predict the incidence (AUC: 0.759 for men and 0.852 for women). Conclusion:CMI is positively associated with the incidence of metabolic syndrome. It supports CMI as a useful method to screen metabolic syndrome in China′s general population.
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Objective:To explore the association of cardiometabolic index(CMI) and other body fat evaluation indicators [body mass index(BMI), waist circumference(WC), waist to height ratio(WHtR), lipid accumulation index(LAP)] with the prevalence of metabolic syndrome(MS) as well as the predictive value of the above indicators for MS.Methods:A total of 10 140 residents over 40 years old in Guiyang city who participated in the " Epidemiological study on tumor risk of type 2 diabetes patients in China" in 2011 were recruited. The 2005 International Diabetes Federation diagnostic criteria were used to identify MS. Logistic regression was used to analyze the association of CMI and other body fat evaluation indicators with MS. Receiver operating characteristic(ROC) curve was used to evaluate the predictive value and the optimal cut-off point of different indicators. Taking the best cut-off point value of each index as the boundary, the prevalence of MS was evaluated again by Chi square test.Results:The prevalence of MS in the study population was 39.81%(27.23% for men and 44.39% for women). Logistic regression analysis showed that the risk of MS increased with increasing CMI and quartile level of other body fat evaluation indicators in both men and women( P<0.05). The risks of MS in CMI Q4 group were 17.15(95% CI 11.64-25.27) for male and 45.14(95% CI 37.07-54.96) for female compared with Q1 group. In male, the area under curve(AUC) of MS by predicted CMI was 0.761(sensitivity 79.8%, specificity 63.2%, optimal cut-off point 0.71). WC displayed the highest value of AUC among the body fat evaluation indicators. In women, the AUC value of MS predicted by CMI was 0.831(sensitivity 76.8%, specificity 75.7%, optimal cut-off point 0.65), higher than those of BMI and WHtR while lower than those of WC and LAP. Further calculating the prevalence of MS with the best cut-off point value of each index as the boundary, WC was still the best predictor for male, while CMI was only secondary to LAP for women. Conclusion:CMI and other body fat evaluation indicators are significantly associated with MS. CMI could be used to predict MS.
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Objective:Explore the relationship between sleep duration, sleep time and brachial-ankle pulse wave velocity(baPWV) in community population.Methods:Questionnaire, physical examination, blood tests, and baPWV detection were applied to a community based population. Finally, 3 912 subjects with complete data were included in the study. The relationship between sleep duration, time to fall asleep and PWV was evaluated with binary logistic regression analysis. Results:Being adjusted for age, sex, prevalence of diabetes, sleep condition, body mass index, blood glucose, blood pressure, dyslipidemia, ankle-brachial index, sleep duration and time to fall asleep were correlated with PWV. The risk of PWV abnormalities was increased in the≥8 h group compared to the 6-8 h group( OR=1.155, 95% CI 0.995-1.367, P=0.037). The risk of abnormalities PWV was higher in the group with sleep time after 00: 00 than in the group -23: 00( OR=1.482, 95% CI 1.008-2.179, P=0.045). Conclusion:Long sleep duration(≥8 h) and late sleep time(after 00: 00) may be associated with higher risk of atherosclerosis.
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Objective:To investigate the outcomes and influencing factors of newly diagnosed prediabetic subjects aged 40 years and above in Guiyang.Methods:A total of 10 015 residents aged 40 years and above were recruited from the Yunyan community, Guiyang, from May to August 2011. Physical examination, laboratory measurements, and questionnaires were conducted. The follow-up survey was conducted in July 2014. A total of 2 530 newly diagnosed prediabetic subjects at baseline were included in the analysis.Results:The 3-year cumulative morbidity of diabetes mellitus was 14.3%, and the risk of diabetes mellitus in combined impaired fasting glucose(IFG)and impaired glucose tolerance(IGT)groups was significantly higher than that in isolated IFG(i-IFG)or isolated IGT(i-IGT)group( P<0.01). High baseline fasting plasma glucose, 2 h plasma glucose, and HbA 1C levels were the independent risk factors for the development of diabetes( OR=1.836, 95% CI 1.374-2.454; OR=1.398, 95% CI 1.261-1.550; OR=2.526, 95% CI 1.804-3.538, all P<0.01)and the inhibitory factors for reversion to normal glucose tolerance( OR=0.511, 95% CI 0.409-0.638; OR=0.715, 95% CI 0.661-0.774; OR=0.638, 95% CI 0.500-0.816, all P<0.01). High level of high density lipoprotein-cholesterol(HDL-C)was an promoting factor for reversion to normal glucose tolerance( OR=1.306, 95% CI 1.017-1.678, P=0.036). Subjects in the highest tertile of baseline HbA 1C level and body mass index(BMI)change before and after follow-up(ΔBMI=follow-up BMI minus baseline BMI)had a higher risk of diabetes mellitus than those in the lowest tertile( OR=2.398, 95% CI 1.733-3.322; OR=2.402, 95% CI 1.859-3.105, both P<0.01). The risk of diabetes mellitus in the significant weight loss group was reduced by 40.4% compared with the non-significant weight loss group when the subjects were divided into two groups according to the cutoff of the lower tertile of ΔBMI( RR=0.596, 95% CI 0.463-0.766, P<0.01). Conclusion:The risk of diabetes mellitus in combined IFG/IGT group was significantly higher than that in i-IFG or i-IGT group. High baseline fasting plasma glucose, 2 h plasma glucose, and HbA 1C levels were the independent risk factors for the development of diabetes. High level of HDL-C was an promoting factor for reversion to normal glucose tolerance. Weight loss can significantly reduce the risk of progression to diabetes in individuals with prediabetes.
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Objective:To discuss hypertension situations of 40-79 years old residents with different glucose metabolic status in Guiyang urban area under the new hypertension diagnostic criteria proposed by American College of Cardiology/American Heart Association (ACC/AHA) in 2017 and provide a clue for diagnostic criteria and treatment strategy of hypertension.Methods:10 140 residents in 40-79 years old in Risk Evaluation of cAncers in Chinese diabeTic Individuals: a IONgitudinal (REACTION) Study Research Guiyang Sub-center were conducted retrospective analysis. According to medical history of diabetes and oral glucose tolerance test results, these residents were divided into normal glucose group, impaired fasting glucose(IFG) group, impaired glucose tolerance (IGT) group, IFG+ IGF group, previous diagnostic diabetes group and newly diagnosed diabetes group. Hypertension situation of residents with different glucose metabolic status under the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), and Hypertension Guide of ACC/AHA in 2017 were calculated.Results:Under JNC 7 criteria, hypertension′s standardized prevalence rate of normal blood glucose people, prediabetes patients, and diabetes patients in 40-79 years old respectively reached 8.19%, 9.57%, and 8.19%. Under ACC/AHA 2017 criteria, hypertension′s standardized prevalence rate respectively reached 20.27%, 16.35%, and 11.59%. By contrast, the most obvious increase of hypertension′s prevalence rate was in the normal blood glucose group and IGT group. Newly increased hypertension patients reached 1 739. Among them, 25.8% required antihypertensive drugs for treatment. According to the 6th demographic census data of Guizhou Province in 2010, it was estimated that newly increased hypertensive patients aged 40-79 years in prediabetes patients reached 123 000, among them, 20 000 required treatment. Newly increased hypertensive patients aged 40-79 years in diabetes patients reached 68 000, among them, 21 000 required treatment.Conclusions:ACC/AHA Hypertension Guide in 2017 will obviously increase hypertension′s prevalence rate of people with different glucose metabolic status in 40-49 years old. The treatment ratio of hypertension groups with diabetes and prediabetes is considerably high. As a result, social medical burdens is going to aggravate.
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Objective:To investigate the effects of severe famine exposure during early life on their later adult obesity/central obesity.Methods:We recruited 4 495 subjects who were born before and during 3 years of unpredictable natural disasters in China and from Guiyang subcenter of the Risk Evaluation of cAncers in Chinese diabeTic Individual: a lONgitudinal (REACTION) Study for data analysis. The subjects were divided into childhood exposure group(born from October 1, 1954 to September 30, 1956, n=947), infant exposure group(born from October 1, 1956 to September 30, 1958, n=939), fetal exposure group(born from October 1, 1959 to September 30, 1961, n=525), and control group(born from October 1, 1952 to September 30, 1954 and from October 1, 1962 to September 30, 1964, n=1 525) according to their birth date. Obesity was defined as body mass index (BMI)≥28 kg/m 2, and central obesity was defined as waist circumference≥90 cm in men and ≥85 cm in women. We used logistic regression models to assess the effect of severe famine exposure on adult obesity/central obesity. Results:After adjusting for confounding factors, we found that men in the fetal exposure group had higher risk of adult obesity than the control group( OR=2.817, 95% CI 1.120-7.088, P=0.028), women in the fetal exposure group( OR=2.383, 95% CI 1.517-3.743, P=0.000), and infant exposure group( OR=1.554, 95% CI 1.039-2.324, P=0.032) had higher risk of adult obesity than the control group. In addition, compared with the control group, the male fetal exposure group had an increased risk of adult central obesity ( OR=2.440, 95% CI 1.253-4.752, P=0.009), which was unfound in females. Conclusion:Severe famine exposure during earlylife, especially in fetus and female infancy, increases the risk of obesity in their adulthood. In addition, males who experienced severe famine in their fetuses period may have higher risks of central obesity when reaching adulthood.
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Objective:To explore the relationship between famine exposure in early life and bone mineral density measured by ultrasound in postmenopausal women.Methods:From May 2011 to October 2011, 10 140 residents over 40 years old in Yunyan District of Guiyang City were randomly selected, and followed up for 3 years, 7 493 subjects were selected and finally included a total of 1 504 subjects. Grouped by date of birth, the differences in bone mineral density measured by ultrasound, and risk of osteoporosis between the exposed and non-exposed groups were compared.Results:SOS, T-score, and QUI in infant- and preschool-exposed group were lower than those of non-exposed group. The medium/high risk of osteoporosis in non-exposed, fetal-exposed, infant-exposed, and preschool-exposed groups were 50%, 46.8%, 58.4%, and 62.8%, respectively ( P<0.01). Multivariate linear regression analysis showed that famine exposure in infant- and preschool-exposed groups were significantly negative correlated with SOS, T-score, and QUI, while fetal-exposed group was not significantly correlated with SOS, T-score, and QUI. Compared with the non-exposed group, the OR of the medium/high risk of osteoporosis in the infant- and preschool-exposed groups were( OR=1.41, 95% CI 1.02-1.96)、( OR=1.68, 95% CI 1.21-2.34), with statistically significance ( P<0.05), and there was no statistical significance in the fetal-exposed group. After adjusting for confounding factors, the medium/high risk of osteoporosis in infant- and preschool-exposed group were 1.64 and 1.90 as compared with the non-exposed group ( OR=1.64, 95% CI 1.16-2.32, P<0.05 and OR=1.90, 95% CI 1.35-2.70, P<0.05). Conclusion:In postmenopausal women, famine exposure in early life was significantly negatively correlated with bone mineral density measured by ultrasound (SOS, T-score, and QUI), and was associated with an increased risk of osteoporosis.
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Objective:To explore the predictive value of brachial-ankle pulse wave velocity (baPWV)>1 400 cm/s in fragility fracture in middle-aged and elderly population.Methods:From May to October 2011, questionnaire survey was conducted on a total of 3 265 males over 50 years old and postmenopausal females in Yunyan District, Guiyang City, and physical examination was carried out to measure their metabolic related indicators such as blood lipids, QUS calcaneus bone densities, and brachial-ankle pulse wave velocities. According to their baPWV, the enrolled subjects were divided into a normal baPWV group and an elevated baPWV group. Follow-up was performed for 38 months, and the incidence of fractures was tracked. Finally, 2 637 subjects with complete baseline and follow-up data were enrolled in this research for analysis.Results:The 3-year total incidence of fragility fracture was 5.08%. In particular, the rate of fragility fractures among males in the normal baPWV group was 1.6%, and that in the elevated baPWV group was 2.0%. There was no statistically significant difference between the two groups ( P>0.05). The rate of fragility fracture events among postmenopausal females in the normal baPWV group was 4.4%, and that in the elevated baPWV group was 7.1%. There was statistically significant difference between the two groups ( P<0.05). Further multivariate COX regression (or proportional hazards regression) analysis showed that the bone density T value ( HR 0.839, 95% CI 0.741-0.952, P=0.006) and baPWV ( HR 1.700, 95% CI 1.046-2.763, P=0.042) were related with risk of fragility fractures in postmenopausal women. Conclusion:A baPWV greater than 1 400 cm/s could be independently associated with the risk of fragility fractures in postmenopausal females and might be an independent risk factor for predicting fragility fractures. However, such differences were not as evident in middle-aged and elderly male patients.
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Objective:To investigate the correlation between sleep duration, sleep timing and the risk of osteoporosis in postmenopausal women, to identify contributing mechanisms and guide the prevention and treatment of osteoporosis.Methods:A total of 5 449 postmenopausal women were included in this study. All participants completed questionnaires, medical examinations, blood test and the measurement of bone mineral density using calcaneal quantitative ultrasonography. After adjusting for potential confounders, logistic regression model was used to assess the association of sleep duration, sleep timing with the risk of osteoporosis. Results:In postmenopausal women, there were significant differences in sleep duration and timing among groups with different risk of osteoporosis( P<0.05). After controlling ages, BMI, diabetes, hypertension, dyslipidemia, smoking, alcohol consumption and physical activity, sleep duration was correlated with the risk of osteoporosis, long sleep duration(≥9 h)increased the risk of osteoporosis( OR=1.39, 95% CI 1.17-1.65, P<0.05)compared with the group with sleep duration of 7~8 hours. In analysis of the combined effect of sleep duration and sleep time on the risk of osteoporosis, compared with normal sleep duration(7-8 h)and normal sleep timing(22: 00-23: 00), long sleep duration(≥9 h)and normal sleep timing(22: 00-23: 00)increased the risk of osteoporosis( OR=1.38, 95% CI 1.01-1.87, P<0.05), which was higher in the group of long sleep duration(≥9 h)and late sleep timing(≥23: 00; OR=1.43, 95% CI 1.01-2.01, P<0.05). Conclusion:Long sleep duration(≥9 h)and late sleep timing(≥22: 00)are risk factors for the increased risk of osteoporosis in postmenopausal women, the late sleep timing leads to the higher risk.
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Objective To explore the relationship between different smoking status and hypothyroidism in six iodine-suitable areas of China. Methods A total of 8187 residents were investigated by cluster sampling in six cities, and 7448 residents were included in the survey. The height, weight, waist circumference, and blood pressure were measured by filling out epidemiological questionnaire. Blood samples were collected to detect thyroid stimulating hormone ( TSH) , thyroid peroxidase antibody ( TPOAb) , and thyroglobulin antibody ( TgAb) . Results The mean TSH, TPOAb, and TgAb positive rates in passive smoking and active smoking groups were all lower than those in non-smoking group ( all P<0.01) . In the active smoking group, the TSH value decreased by 0.023 units for every unit increase in smoking index. The positive rates of TgAb and TPOAb in both passive smoking and active smoking groups were lower than those in non-smoking group (all P<0.01). Active and passive smoking reduced the prevalence of hypothyroidism (both P<0.01). Among women, the risks of clinical hypothyroidism and subclinical hypothyroidism were reduced in both active and passive smoking groups. Besides, the risk of subclinical hypothyroidism decreased significantly when the smoking index was more than 70. In male population, the risk of subclinical hypothyroidism in active and passive smoking group decreased. Besides, the risk of clinical hypothyroidism and subclinical hypothyroidism decreased significantly when the smoking index was more than 70. Conclusion Smoking in iodine-suitable areas may reduce TSH level and the positive rates of TPOAb and TgAb.
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Objective To explore the influence of metabolic syndrome on the risks of cardiovascular disease ( CVD) events and all-cause mortality. Methods In this prospective cohort study, urban residents aged 40-79 years in Guiyang were followed-up for three years. The end-points were CVD events and all-cause mortality. COX proportional hazards model were used for the corresponding hazard ratios ( HRs ) of CVD events and all-cause mortality. Metabolic syndrome was defined according to the 2005 International Diabetes Federation ( IDF ) criteria. Results A total of 7313 subjects were included. 146 cases of CVD events and 80 cases of all-cause mortality were recorded. After adjusting for gender, age, smoking, alcohol consumption, and blood lipid levels, the metabolic syndrome increased the risks of CVD events and all-cause mortality. The HRs were 1.43 (P=0.037) and 1.25 (P=0.418) , respectively. As compared metabolic syndrome with non-metabolic syndrome, an increased risk of CVD events was found. The HR was 1.43 (P=0.013). No significantly increased risk of all-cause mortality was found in subjects with metabolic syndrome. Conclusion The metabolic syndrome was associated with increased risk of CVD events and there was no significant increase in all-cause mortality. Metabolic syndrome is an important risk factor for CVD events.
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Objective@#To explore the influence of metabolic syndrome on the risks of cardiovascular disease (CVD) events and all-cause mortality.@*Methods@#In this prospective cohort study, urban residents aged 40-79 years in Guiyang were followed-up for three years. The end-points were CVD events and all-cause mortality. COX proportional hazards model were used for the corresponding hazard ratios (HRs) of CVD events and all-cause mortality. Metabolic syndrome was defined according to the 2005 International Diabetes Federation (IDF) criteria.@*Results@#A total of 7 313 subjects were included. 146 cases of CVD events and 80 cases of all-cause mortality were recorded. After adjusting for gender, age, smoking, alcohol consumption, and blood lipid levels, the metabolic syndrome increased the risks of CVD events and all-cause mortality. The HRs were 1.43 (P=0.037) and 1.25 (P=0.418), respectively. As compared metabolic syndrome with non-metabolic syndrome, an increased risk of CVD events was found. The HR was 1.43 (P=0.013). No significantly increased risk of all-cause mortality was found in subjects with metabolic syndrome.@*Conclusion@#The metabolic syndrome was associated with increased risk of CVD events and there was no significant increase in all-cause mortality. Metabolic syndrome is an important risk factor for CVD events.
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Objective To study the relationship between liver enzymes [ alanine transaminase ( ALT), gamma-glutamyltransferase ( GGT), aspartate amino transferase ( AST)] and the incidence of impaired glucose tolerance(IGT) in middle-aged and elderly people. Methods A group of middle-aged and elderly residents who participated in the REACTION study in 2011 from Guiyang community were enrolled in our study. Of which, a total of 4228 participants with normal blood glucose detected by oral glucose tolerance test (OGTT) and serum ALT levels were investigated as baseline population. The baseline survey included questionnaire survey and physical examination (height, weight, waist circumference, blood pressure, etc. ), and the serum ALT, AST, GGT, total cholesterol ( TC ), triglyceride ( TG ), high density lipoprotein-cholesterol ( HDL-C ), low density lipoprotein-cholesterol (LDL-C), fasting blood glucose, postprandial 2h plasma glucose(2hPG) in OGTT, and fasting insulin(FINS) were tested. After 3 years of follow-up, all subjects received quartile grouping according to the basal liver enzyme levels, and the incidence of IGT was respectively calculated. One-way analysis of variance was used to compare the differences of basal liver enzyme levels between IGT and normal blood glucose groups. The risk of IGT based on quartile grouping was assessed by multivariate regression analysis, and the odds ratios (ORs) were estimated by the logistic regression model. Results After eliminating the 35 died patients, 3188 participants were followed over 3 years. Among them, 2400 subjects revealed normal blood glucose level, 61 developed into type 2 diabetes mellitus(T2DM), 91 developed into IFG, and 636 developed into IGT. The incidence of IGT increased along with the elevation of serum ALT level (P<0. 01). After adjusting the risk factors including body mass index, regular smoking, regular drinking, regular exercise, family history of diabetes,homeostasis model assessment for insulin resistant index(HOMA-IR), post-load 2h blood glucose, and GGT, the results manifested that patients in high basal ALT level group had 1. 462-fold chance of susceptibility in developing IGT compared with that in the low level group, with 95％ CI of 1. 129 to 1. 891. The analysis based on gender showed that the incidence of IGT was associated with basal ALT level in the female group. The OR value was estimated to be 1. 481(95％ CI 1. 107-1. 981) in high basal ALT level group as compared with the low level group. Basal serum GGT and AST levels were not associated with the incidence of IGT. Conclusion Even an elevated level of ALT within normal reference range also tends to be a risk factor for IGT in middle-aged and elderly women.
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Objective To investigate the accumulative 3-year morbidity of diabetes in the residents aged 40 years and above in a community of Guiyang and the risk factors. Methods A total of 10140 permanent residents aged over 40 years in a community of Guiyang were selected from May 2011 to October 2011 using randomized sampling. This population was followed up again in 2014. Questionnaires, physical examination, blood lipids and oral glucose tolerance test were performed among the subjects of study for two surveys with the same criteria. Finally, 5958 subjects with complete data and without baseline diabetes at the two time points were enrolled in this study for analysis. Results The 3-year accumulative morbidity of diabetes in this population was 6. 13％ (6. 59％ in males, 5. 65％ in females). The main factors influencing the incidence of diabetes mellitus were age (OR = 1. 589, 95％ CI 1. 395-1. 809, P<0. 01), body mass index ( OR = 2. 012, 95％ CI 1. 632-2. 479, P<0. 01), pulse rate ( OR =1. 019, 95％ CI 1. 012-1. 025, P<0. 01), family history (OR = 1. 700, 95％ CI 1. 299-2. 225, P<0. 05), fasting plasma glucose at baseline(OR = 3. 132, 95％ CI 2. 478-3. 958, P<0. 01), 2 h plasma glucose at baseline( OR =1. 698,95％ CI 1. 574-1. 832, P < 0. 01), total cholesterol ( OR = 1. 350, 95％ CI 1. 060-1. 719, P < 0. 05), triglyceride(OR=2. 196, 95％ CI 1. 758-2. 743, P<0. 01),high density lipoprotein-cholesterol(OR = 0. 540, 95％CI 0. 375-0. 776, P < 0. 01), and low density lipoprotein-cholesterol ( OR = 1. 614, 95％ CI 1. 094-2. 382, P<0. 05). Conclusion 3-year morbidity of diabetes in Guiyang was 6. 13％ . The incidence of diabetes is notably correlated with aging, faster pulse frequency, overweight and obesity, higher baseline blood glucose, and dyslipidemia.
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A total of 10140 adult residents aged 40-80 years living for more than five years in Yunyan district of Guiyang were recruited by cluster sampling method from May to October, 2011. The epidemiological questionnaire investigations were performed in all subjects and basic information was collected. Body mass index (BMI), waist circumference, blood pressure, blood glucose, blood lipids, serum insulin, and TSH levels were measured. The results showed that the prevalence of metabolic syndrome ( MS) was 40. 3％ in 7743 subjects with normal thyroid function, which was 27. 4％ for men and 45. 6％ for women. The TSH level in MS group was significantly higher than that in non-MS group [(2. 63 ± 1. 01 vs 2. 53 ± 1. 04) mU/ L, P < 0. 01]. Significant differences in BMI, triglycerides(TG), and high density lipoprotein cholesterol(HDL-C) were found in groups with different TSH levels(P<0. 05). The normal TSH level was positively related to TG, fasting insulin,and the prevalence of MS after adjusting for age, BMI, and homeostasis model assessment for insulin resistance ( P < 0. 05). Logistic regression showed that the TSH was an influencing factor for MS(OR=1. 056, 95％ CI 1. 004-1. 111).
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Objective To explore the epidemiological characteristics of the prevalence and incidence of metabolic syndrome(MS) in subjects with different TSH levels, which can provide a certain clinical basis for the prevention and treatment of MS. Methods According to the reference range of the TSH test system in our hospital, the subjects were divided into TSH normal group and TSH elevation group. From May to August of 2011, the whole group sampling method was used to conduct a baseline survey of 10140 permanent residents aged 40 and above in Yunyan district of Guiyang City. A total of 9618 cases were included. The prevalence of MS and its components were calculated with different TSH levels at baseline. After eliminating 3926 MS in 2011, 5692 patients with no MS were followed up for 3 years. Incidence of MS and its components were compared among different TSH levels. The median follow-up was (38. 6 ± 1. 6) months and the completion rate was 75. 40％. Results The total crude and standard prevalence of MS were 40. 82％ and 34. 46％ respectively. The crude and standard prevalence of MS in TSH normal group were 39. 96％ and 33. 90％, respectively, and in TSH elevation group were 44. 3％ and 37. 56％respectively . The comparison of crude prevalence of MS between the two groups was statistically significant (P>0. 05) and the standard prevalence of MS in TSH elevation group was also higher than that in TSH normal group. After 3 years of follow-up, the total crude and standard incidences of MS were 22. 51％ and 20. 64％, respectively. The total crude and standard incidence of MS in TSH normal group were 22. 01％ and 20. 22％, respectively and in TSH elevatlon group were 24. 69％ and 23. 20％, respectively. There was no statistically significant difference between crude incidences of MS in two groups, but the standard incidence of MS in TSH elevation group was higher than that in TSH normal group. Binary Logistic regression analysis showed that there was a positive correlation between TSH and incidence of MS in TSH elevation group. Conclusion Higher than normal levels of TSH may increase the prevalence and incidence of MS and its some components.
RÉSUMÉ
Objective To investigate the association between blood glucose level and cardiovascular disease ( CVD) risk in elderly people aged 40 and older in Guiyang City. Methods Population-based cross-sectional studies on diabetes were performed in 10140 adults, aged 40-78 years, living in the Yunyan Community in Guiyang City, during May, 2011 to August, 2011. The fasting venous blood samples were drawn for the measurements of serum creatinine(Cr), fasting plasma glucose(FPG), OGTT 2hPG, fasting triglyceride(TG), total cholesterol(TC), high-density lipoprotein-cholesterol ( HDL-C ) , low-density lipoprotein-cholesterol ( LDL-C ) , and fasting plasma insulin. The diabetes status and the classification system for diabetes in our study were categorized according to the Diabetes Diagnostic Standard which was issued by WHO in 1999. An estimated 10-year Framingham risk for coronary heart disease was calculated. Results Compared with those in normal glucose regulation( NGR) group, the subjects in abnormal glucose metabolism were associated with higher prevalence of various cardiovascular risk factors, including age, body mass index, blood pressure, HbA1C , HOMA-IR, total cholesterol, triglycerides, waist circumference, waist-hip ratio, and creatinine, as well as 10-year Framingham risks for coronary heart disease. The difference was statistically significant ( all P<0. 05 ) . Men were more likely to have cardiovascular risk than women. Women developing the disease only begins to increase after the age of 59. The difference was statistically significant(P<0.05). Compared with the subjects in NGR group, the 10-year Framingham risk for coronary heart disease in impaired fasting glucose ( IFG ) , impaired glucose tolerance ( IGT ) , and diabetes mellitus ( DM ) groups shown 10％of increase were 1.13( OR=1.13, 95％CI 0.81-1.58, P>0.05) , 1.18( OR=1.18, 95％CI 0.95-1.45, P>0.05), and 1.44(OR=1.44, 95％CI 1.10-1.88, P<0.05), respectively, after adjusting for various influencing factors. Conclusion Diabetic patients and pre-diabetic individuals were independently associated with the increased 10-year risks for CVD.