Utilización de Métodos Anticonceptivos en estudiantes de Enfermería / Use of Contraceptive Methods on Nursing Students / Utilização de métodos contraceptivos em alunos de enfermagem

Objetivo: Identificar el uso de métodos anticonceptivos como medida de prevención de infecciones de transmisión sexual (ITS) y embarazos no planeados, en estudiantes de la Licenciatura en Enfermería de una universidad pública de la Ciudad de México. Método: Estudio cuantitativo, descriptivo y transversal. Se realizó en una población total de 364 estudiantes, con una muestra de 71 universitarios, mayores de 18 años, de ambos sexos e inscritos en alguno de los últimos nueve módulos de la Licenciatura en Enfermería. Se utilizó un diseño de muestreo aleatorio por conglomerados y un instrumento cerrado para la obtención de datos. Se realizaron medidas de tendencia central para el análisis de datos. Resultados: Participó una mayor proporción de mujeres en comparación con los hombres (62% y 38%, respectivamente). La edad promedio fue de 22 años. El 80% de los estudiantes declaró haber iniciado vida sexual, de los cuales el 82% mencionó haber utilizado algún método anticonceptivo. El 56% de los estudiantes que mencionó tener una vida sexual activa utilizó la anticoncepción de emergencia en el último año. Conclusiones: A pesar de estar involucrados en una carrera de la salud, los estudiantes no toman las medidas efectivas para evitar un embarazo no planeado y tampoco para prevenir una ITS. La adquisición de medidas de autocuidado requiere la elaboración de programas y estrategias que apoyen y combinen la sensibilidad, la educación y la consejería oportuna que permitan el conocimiento y la apropiación del cuerpo como espacio de cuidado.

Objective: To identify the use of contraceptive methods among students of the Bachelor of Nursing at a public university in Mexico City. Method: This was a quantitative, descriptive and transversal study. The study was conducted in a total population of 364 students, with a sample of 71 university students, over 18 years, of both sexes and enrolled in any of the nine modules of the Bachelor of Nursing. Random sampling design was used and a closed cluster for the data collection instrument. Measures of central tendency for data analysis were performed. Results: It involved a higher proportion of women compared with men, 62% and 38% respectively. The average age was 22 years. 80% of students reported having initiated sexual life, of which, 82% reported having used birth control. 56% of students mentioned sexually active, used emergency contraception in the last year. Conclusions: Despite being involved in a health career, students do not take effective measures to prevent an unplanned pregnancy and also to prevent sexually transmitted infection. The acquisition of self-care measures requires the development of programs and strategies to support and combine the sensitivity, education and counseling to enable timely knowledge and ownership of the body as a space of care.

Objetivo: Identificar o uso de métodos contraceptivos como medida de prevenção de doenças sexualmente transmissíveis (DST) e gravidezes não planejadas, em discentes da Licenciatura em Enfermagem de uma universidade pública da Cidade de México. Método: Estudo quantitativo, descritivo e transversal. Realizou-se em uma população total de 364 alunos, com amostra de 71 universitários, maiores de 18 anos, de ambos os gêneros e matriculados em algum dos últimos nove módulos da Licenciatura em Enfermagem. Utilizou-se desenho de amostragem aleatório por conglomerados e um instrumento fechado para a coleta de dados. Medidas de tendência central para a análise de dados foram realizadas. Resultados: Participou uma maior proporção de mulheres em comparação com os homens (62% e 38%, respetivamente). A média de idade foi 22 anos. O 80% dos alunos relatou ter iniciado vida sexual, dos quais 82% relatou ter utilizado qualquer método contraceptivo. 56% dos alunos que relatou ter vida sexual ativa utilizou a contracepção de emergência no último ano. Conclusões: Embora estiver envolvidos numa formatura de saúde, os alunos não tomam medidas efetivas para evitar uma gravidez não planejada nem mesmo para prevenir uma DST. A aquisição de medidas de autocuidado requer a elaboração de programas e estratégias que auxiliem e misturem a sensibilidade, a educação e a aconselhamento atempado a permitir o conhecimento e apropriação do corpo como espaço de cuidado.

Cumplimiento de las metas internacionales para la seguridad del paciente / Compliance with international patient safety goals

Resumen:

Introducción: las metas internacionales para la seguridad del paciente (MISP) son directrices importantes a nivel internacional para promover mejoras específicas en el proceso de atención médica segura y de alta calidad.

Objetivo: medir el nivel de cumplimiento de las MISP que lleva a cabo el personal de enfermería de un hospital de tercer nivel de atención.

Metodología: Estudio descriptivo. Se diseñó un instrumento con opción de respuestas "Sí", "No" y "No aplica"; posteriormente se hizo la prueba de Kuder Richardson 20 (Kr-20), que reportó 0.89. Se audita-ron 97 profesionales de enfermería. Una vez obtenida la calificación, se estableció una semaforización en cuatro rubros por colores según el nivel de cumplimiento: verde (82-100 %), amarillo (71-80 %), rojo (60-70 96) y negro, equivalente a < 59 %; se obtuvo el tiempo promedio de su aplicación. Resultados: el nivel de cumplimiento del instrumento fue de 72.6 %, y se asignó el color amarillo La calificación global de NA fue de 2.9 %. El tiempo promedio fue de 20 minutos con un mínimo de 13 y un máximo de 50 minutos, con una desviación estándar de 7.93.

Conclusiones: el enlace de turno es el momento idóneo para aplicar la medición. Según la semaforización, el nivel de cumplimiento en general se encuentra en color amarillo, por lo que se requiere reforzar la capacitación para la aplicación de las metas y asegurar una atención de calidad que pueda verse reflejada en la disminución de eventos adversos por los profesionales de enfermería.

Abstract:

Introduction: The international patient safety goals (IPSG) are important guidelines at the international level to promote specific improvements in the process of providing safe and high-quality patient care.

Objective: To measure the level of compliance of the IPSG that is carried out by nursing staff in a tertiary care level hospital.

Methodology: Descriptive study. We designed an instrument with three choices: "Yes", "No" and "Not applicable" (NA). Then, we applied the Kuder Richardson 20 (Kr-20), with a result of 0.89. We surveyed a total of 97 nurses. Once we obtained scores, we established a four-item color code, according to the level of compliance: green (82-100 %), yellow (71-80 %), red (60-70 %) and black, whose value was < 59 %. Then, the average implementation time was obtained. Results: The level of compliance was 72.6 % and the yellow color was assigned, according to the color scheme established. The overall rating of NA was 2.9 %. The average time was 20 minutes with a minimum of 13 and a maximum of 50 minutes, with a standard deviation of 7.93. Conclusions: This instrument is efficient to measure the way the IPSG are applied. Shift change is the ideal time to apply the measurement. According to the color code, the overall level of compliance is in yellow, so it is necessary to reinforce training in order to improve the application of these goals and provide high-quality care to patients.

Genetic Variation and Insulin Resistance in Middle-Aged Chinese Men.

We investigated the effect of variants in the first three genes in the insulin signaling pathway and genes identified from genome wide association studies (GWAS) of T2D quantitative traits with IR (fasting insulin and the homeostasis model assessment of IR, HOMA-IR) and evaluated gene-environment interactions with IR traits among 1879 nondiabetic middle-aged men from a population-based study conducted in Shanghai, China. One candidate gene, IGF1, was associated with fasting insulin and HOMA-IR. We observed four BMI-gene interactions (P < 0.05) with HOMA-IR (INRS rs7254060, INRS rs7254358, GLU4 rs2113050, and GLU4 rs7713127) and seven BMI-gene interactions with fasting insulin (INRS rs7254060, INRS rs7254358, INRS rs10417205, INRS rs1799817, GLU4 rs12054720 GLU4 rs2113050, and GLU4 rs7713127). There were four WHR-gene interactions with HOMA-IR (INRS rs10417205, INRS rs12971499, INRS rs7254060, and INRS rs7254358), five WHR-gene interactions with fasting insulin (INRS rs10417205, INRS rs7254060, INRS rs7254358, GLU4 rs2113050, and GLU4 rs7713127), eight physical activity-gene interactions with HOMA-IR (INRS rs10411676, INRS rs11671297, INRS rs2229431, INRS rs12461909, INRS rs6510950, INRS rs10420382, IRS2 rs913949, and IRS2 rs2241745) and five physical activity-gene interactions with fasting insulin (INRS rs2229431, INRS rs12461909, INRS rs10420382, IRS2 rs913949, and IRS2 rs2241745). Our results suggest that BMI, WHR and physical activity may modify IR-associated variants.

Reflexiones sobre el proceso de reforma sanitaria (1993-2013) y participación social en Perú / Considerations on health reform process (1993-2013) and social participation in Peru

El proceso de reforma sanitaria que el Estado peruano emprendió entre 1993 y 2013 ha privilegiado el aspecto financiero respecto a los temas de salud y se ha enfocado fundamentalmente a contener costos, restringir la calidad y el acceso a los servicios. La respuesta del movimiento sanitario que encabeza el Foro de la Sociedad Civil en Salud (Forosalud) frente a estas políticas y lo que esta experiencia puede significar para los movimientos sociales emprendidos en América Latina es motivo de nuestro análisis. El propósito del estudio es analizar los alcances de la participación social en oposición a las reformas contemporáneas de los sistemas de salud en Perú.

The sanitary reform process undertaken by the Peruvian government (1993-2013) has favored the financial aspect over the health issues and has focused primarily on constraining the costs. This has lead to a restriction in the quality and access to the services. It is important to analyze the Peruvian case especially the health movement led by Foro de la Sociedad Civil en Salud (Forosalud) and what this experience can mean for social movements undertaken in our Latin American continent. In this study the purpose is to analyze the extent of social participation as opposed to contemporary reforms of health systems in Peru.

Proceso de enfermería en cuidados paliativos al paciente pediátrico con retinoblastoma bilateral / Nursing process with a focus on palliative care to the pediatric patient with bilateral retinoblastoma

Resumen:

Introducción: el proceso de enfermería garantiza la calidad del cuidado al intervenir en los principales problemas de salud de las personas. Una forma de abordar esto es el modelo integrativo metodológico para el cuidado de enfermería (MIMCE). Se utilizaron ambas metodologías con enfoque en los cuidados paliativos para el diseño e implementación de la atención de enfermería a una paciente pediátrica con retinoblastoma bilateral con mal pronóstico para la vida y la función. Objetivo: implementar y evaluar el proceso de enfermería con enfoque en los cuidados paliativos en una paciente pediátrica con retinoblastoma bilateral.

Metodología: la base conceptual para la valoración fue el modelo de Marjory Gordon. La formulación de diagnósticos de enfermería, resultados esperados e intervenciones se formuló con la vinculación taxonómica reconocida en sus siglas como NANDA-NOC-NIC. La evaluación de la mejora del estado de la paciente se realizó con base en los indicadores de resultados y la puntuación diana. Resultados: en la puntuación diana, la paciente presentó mejora en el estado inmune y nivel de dolor, de grave y sustancialmente comprometido a levemente comprometido; en el estado de comodidad disminuyó el estado de irritabilidad de sustancial a levemente comprometido, no así en el de la integridad tisular de piel, membranas y mucosas, que se mantuvo sustancialmente comprometido en el indicador de destrucción tisular. Los padres mostraron capacidad para los cuidados. Conclusiones: a partir de los resultados obtenidos y tomando en cuenta el estado hemodinámico de la paciente, se disminuyó la intensidad de la sintomatología y hubo una mejora en la relación parental.

Abstract:

Introduction: The nursing process guarantees quality nursing care to effectively intervene on major health problems of people; a way of addressing these problems is the proposal of methodological integrative model for nursing care (MIMCE). In particular, both methodologies were used with palliative care approach to the design and implementation of the nursing care process in a pediatric patient with bilateral retinoblastoma and poor prognosis for life and function. Objective: To implement and evaluate the nursing process with a focus on palliative care in a pediatric patient with bilateral retinoblastoma.

Methods: The conceptual basis for assessment was Marjory Gordon's model. The formulation of nursing diagnoses, expected outcomes and interventions were made with the NANDA-NOC-NIC taxonomy. The evaluation of the improvement in the condition of the patient was made on the basis of the performance indicators and target score.

Results: In target score, the patient showed improvement in immune status and pain level, from serious and substantially committed to slightly compromised; in the state of comfort irritability, the state decreased from substantially to slightly compromised, but not in the tissue integrity of skin and mucous membranes, since this remained substantially jeopardized in the indicator of tissue destruction. Parents showed ability for continued care.

Conclusions: On the basis of these results and considering the hemodynamic status of the patient, the intensity of symptoms decreased, and there was an improvement in the parental relationship.

Gene-carbohydrate and gene-fiber interactions and type 2 diabetes in diverse populations from the National Health and Nutrition Examination Surveys (NHANES) as part of the Epidemiologic Architecture for Genes Linked to Environment (EAGLE) study.

BACKGROUND: Both environmental and genetic factors impact type 2 diabetes (T2D). To identify such modifiers, we genotyped 15 T2D-associated variants from genome-wide association studies (GWAS) in 6,414 non-Hispanic whites, 3,073 non-Hispanic blacks, and 3,633 Mexican American participants from the National Health and Nutrition Examination Surveys (NHANES) and evaluated interactions between these variants and carbohydrate intake and fiber intake. RESULTS: We calculated a genetic risk score (GRS) with the 15 SNPs. The odds ratio for T2D with each GRS point was 1.10 (95% CI: 1.05-1.14) for non-Hispanic whites, 1.07 (95% CI: 1.02-1.13) for non-Hispanic blacks, and 1.11 (95% CI: 1.06-1.17) for Mexican Americans. We identified two gene-carbohydrate interactions (P < 0.05) in non-Hispanic whites (with CDKAL1 rs471253 and FTO rs8050136), two in non-Hispanic blacks (with IGFBP2 rs4402960 and THADA rs7578597), and two in Mexican Americans (with NOTCH2 rs1092398 and TSPAN8-LGRS rs7961581). We found three gene-fiber interactions in non-Hispanic whites (with ADAMT59 rs4607103, CDKN2A/2B rs1801282, and FTO rs8050136), two in non-Hispanic blacks (with ADAMT59 rs4607103 and THADA rs7578597), and two in Mexican Americans (with THADA rs7578597 and TSPAN8-LGRS rs796158) at the P < 0.05 level. Interactions between the GRS and nutrients failed to reach significance in all the racial/ethnic groups. CONCLUSION: Our results suggest that dietary carbohydrates and fiber may modify T2D-associated variants, highlighting the importance of dietary nutrients in predicting T2D risk.

Genetic variation in the peroxisome proliferator-activated receptor (PPAR) and peroxisome proliferator-activated receptor gamma co-activator 1 (PGC1) gene families and type 2 diabetes.

We used a two-stage study design to evaluate whether variations in the peroxisome proliferator-activated receptors (PPAR) and the PPAR gamma co-activator 1 (PGC1) gene families (PPARA, PPARG, PPARD, PPARGC1A, and PPARGC1B) are associated with type 2 diabetes (T2D) risk. Stage I used data from a genome-wide association study (GWAS) from Shanghai, China (1019 T2D cases and 1709 controls) and from a meta-analysis of data from the Asian Genetic Epidemiology Network for T2D (AGEN-T2D). Criteria for selection of single nucleotide polymorphisms (SNPs) for stage II were: (1) P < 0.05 in single marker analysis in Shanghai GWAS and P < 0.05 in the meta-analysis or (2) P < 10(-3) in the meta-analysis alone and (3) minor allele frequency ≥ 0.10. Nine SNPs from the PGC1 family were assessed in stage II (an independent set of middle-aged men and women from Shanghai with 1700 T2D cases and 1647 controls). One SNP in PPARGC1B, rs251464, was replicated in stage II (OR = 0.87; 95% CI: 0.77-0.99). Gene-body mass index (BMI) and gene-exercise interactions and T2D risk were evaluated in a combined dataset (Shanghai GWAS and stage II data: 2719 cases and 3356 controls). One SNP in PPARGC1A, rs12640088, had a significant interaction with BMI. No interactions between the PPARGC1B gene and BMI or exercise were observed.

Physical activity, smoking, and alcohol consumption in association with incidence of type 2 diabetes among middle-aged and elderly Chinese men.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease worldwide. The prevalence of T2DM is increasing rapidly in China. Understanding the contribution of modifiable lifestyle factors on T2DM risk is imperative to prevent the development of T2DM in China. METHODS: We examined associations between lifestyle factors including physical activity, smoking and alcohol consumption with incidence of T2DM among middle-aged and elderly men in urban Shanghai. Information on socio-demographics, lifestyle habits, dietary habits, and disease history was collected via in-person interviews. Anthropometric measurements were taken. A total of 51 464 Chinese men aged 40-74 years free of T2DM, coronary heart disease (CHD), and stroke at baseline were included in the current study. Incident T2DM was identified through follow-up surveys conducted every 2-3 years. Cox proportional hazard analyses were conducted to evaluate associations between lifestyle risk factors and incidence of T2DM. RESULTS: We documented 1304 new cases of T2DM during 276 929 person-years of follow-up (average: 5.4 years). Physical activity was inversely associated with T2DM risk. Daily living, commuting, and total physical activity METs had inverse negative dose-response relationships with T2DM (P-trend = 0.0033, 0.0022, and <0.0001, respectively). Regular participation in exercise or sports reduced T2DM risk (HR = 0.86, 95%CI: 0.76-0.98). Moderate alcohol intake (1-3 drinks/day) was inversely related to T2DM risk (HR = 0.80, 95%CI: 0.67-0.94). Cigarette smoking, on the other hand, was associated with increased T2DM risk; HRs were 1.25 (95%CI: 1.00-1.56) for smoking more than 20 cigarettes per day and 1.28 (95%CI: 1.04-1.57) for smoking more than 40 pack-years. CONCLUSIONS: Physical activity and moderate alcohol intake are inversely associated with T2DM risk, whereas smoking was positively associated with T2DM risk among middle-age and elderly Chinese men. Preventive measures should be developed to focus on these modifiable lifestyle habits to reduce the upward trend of T2DM.

Predictors of late presentation for HIV diagnosis: a literature review and suggested way forward.

Early commencement of antiretroviral treatment can be beneficial and economical in the long run. Despite global advances in access to care, a significant proportion of adults presenting at HIV/AIDS care facilities present with advanced HIV disease. Understanding factors associated with late presentation for HIV/AIDS services is critical to the development of effective programs and treatment strategies. Literature on factors associated with late presentation for an HIV diagnosis is reviewed. Highlighted is the current emphasis on socio-demographic factors, the limited exploration of psychosocial correlates, and inconsistencies in the definition of late presentation that make it difficult to compare findings across different studies. Perspectives based on experiences from resource limited settings are underreported. Greater exploration of psychosocial predictors of late HIV diagnosis is advocated for, to guide future intervention research and to inform public policy and practice targeted at 'difficult to reach' populations.

Joint effect of genetic and lifestyle risk factors on type 2 diabetes risk among Chinese men and women.

More than 40 genetic susceptibility loci have been reported for type 2 diabetes (T2D). Recently, the combined effect of genetic variants has been investigated by calculating a genetic risk score. We evaluated 36 genome-wide association study (GWAS) identified SNPs in 2,679 T2D cases and 3322 controls in middle-age Han Chinese. Fourteen SNPs were significantly associated with T2D in analysis adjusted for age, sex and BMI. We calculated two genetic risk scores (GRS) (GRS1 with all the 36 SNPs and GRS2 with the 14 SNPs significantly associated with T2D). The odds ratio for T2D with each GRS point (per risk allele) was 1.08 (95% CI: 1.06-1.09) for GRS1 and 1.15 (95% CI: 1.13-1.18) for GRS2. The OR for quintiles were 1.00, 1.26, 1.69, 1.95 and 2.18 (P<0.0001) for GRS1 and 1.00, 1.33, 1.60, 2.03 and 2.80 (P<0.001) for GRS2. Participants in the higher tertile of GRS1 and the higher BMI category had a higher risk of T2D compared to those on the lower tertiles of the GRS1 and of BMI (OR = 11.08; 95% CI: 7.39-16.62). We found similar results when we investigated joint effects between GRS1 and WHR terciles and exercise participation. We finally investigated the joint effect between tertiles of GRSs and a composite high risk score (no exercise participation and high BMI and WHR) on T2D risk. We found that compared to participants with low GRS1 and no high risk factors for T2D, those with high GRS1 and three high risk factors had a higher risk of T2D (OR = 13.06; 95% CI: 8.65-19.72) but the interaction factor was of marginal significance. The association was accentuated when we repeated analysis with the GRS2. In conclusion we found an association between GRS and lifestyle factors, alone and in combination, contributed to the risk of and T2D among middle age Chinese.

HTR1B, ADIPOR1, PPARGC1A, and CYP19A1 and obesity in a cohort of Caucasians and African Americans: an evaluation of gene-environment interactions and candidate genes.

The World Health Organization estimates that the number of obese and overweight adults has increased to 1.6 billion, with concomitant increases in comorbidity. While genetic factors for obesity have been extensively studied in Caucasians, fewer studies have investigated genetic determinants of body mass index (BMI; weight (kg)/height (m)(2)) in African Americans. A total of 38 genes and 1,086 single nucleotide polymorphisms (SNPs) in African Americans (n = 1,173) and 897 SNPs in Caucasians (n = 1,165) were examined in the Southern Community Cohort Study (2002-2009) for associations with BMI and gene × environment interactions. A statistically significant association with BMI survived correction for multiple testing at rs4140535 (ß = -0.04, 95% confidence interval: -0.06, -0.02; P = 5.76 × 10(-5)) in African Americans but not in Caucasians. Gene-environment interactions were observed with cigarette smoking and a SNP in ADIPOR1 in African Americans, as well as between a different SNP in ADIPOR1 and physical activity in Caucasians. A SNP in PPARGC1A interacted with alcohol consumption in African Americans, and a different SNP in PPARGC1A was nominally associated in Caucasians. A SNP in CYP19A1 interacted with dietary energy intake in African Americans, and another SNP in CYP191A had an independent association with BMI in Caucasians.

Peroxisome proliferator-activated receptor delta (PPARD) genetic variation and type 2 diabetes in middle-aged Chinese women.

Animal studies have shown that the peroxime proliferator-activated receptor delta (PPARD) gene regulates glucose metabolism and insulin sensitivity. Genetic variation in the PPARD gene might affect physical endurance and has been associated with obesity. We investigated the independent and modifying effect of variants in the PPARD gene with exercise participation and body mass index (BMI) on type 2 diabetes (T2D), using data from a genome-wide association study (GWAS) of middle-aged women living in Shanghai, China, with 1019 T2D cases and 1709 controls. The genotyping was performed using the Affymetrix Genome-Wide Human SNP Array 6.0 platform. Imputation was used to determine missing genotypes. Participation in exercise was assessed by a questionnaire. Anthropometric variables were measured by trained interviewers. The association between polymorphisms and T2D was assessed by logistic regression analyses. The combined effects of polymorphisms in the PPARD gene with exercise participation and BMI on T2D risk was assessed by conducting stratified analysis with exercise participation and BMI categories. No significant associations between PPARD and T2D were found in either genotyped or imputed SNPs and no effect modification between exercise participation and PPARD genetic variation was found, suggesting that PPARD is not a risk factor for T2D in this population.

Fish, shellfish, and long-chain n-3 fatty acid consumption and risk of incident type 2 diabetes in middle-aged Chinese men and women.

BACKGROUND: Long-chain polyunsaturated n-3 (omega-3) fatty acids, found mainly in fish, have been postulated to reduce type 2 diabetes (T2D) risk. However, the role of long-chain n-3 fatty acids and fish intake in the development of T2D remains unresolved. OBJECTIVE: We examined associations between fish, shellfish, and long-chain n-3 fatty acids and the risk of T2D in a middle-aged Chinese population. DESIGN: This was a prospective population-based cohort study in 51,963 men and 64,193 women free of T2D, cardiovascular disease, and cancer at baseline with valid dietary information. Dietary intake, physical activity, and anthropometric measurements were collected. A Cox regression model was used to evaluate the association of fish, shellfish, and long-chain n-3 fatty acid (in g/d) with risk of T2D. RESULTS: Fish, shellfish, and long-chain n-3 fatty acid intakes were inversely associated with T2D in women. The relative risks [RRs (95% CI)] for quintiles of fish intake were 1.00, 0.96 (0.86, 1.06), 0.84 (0.75, 0.94), 0.80 (0.71, 0.90), and 0.89 (0.78, 1.01) (P for trend = 0.003) and for shellfish were 1.00, 0.91 (0.82, 1.01), 0.79 (0.71, 0.89), 0.80 (0.71, 0.91), and 0.86 (0.76, 0.99) (P for trend = 0.006). In men, only the association between shellfish intake and T2D was significant. The RRs (95% CI) for quintiles of fish intake were 1.00, 0.92 (0.75, 1.13), 0.80 (0.65, 1.00), 0.89 (0.72, 1.11), and 0.94 (0.74, 1.17) (P for trend = 0.50) and for shellfish intake were 1.00, 0.93 (0.76, 1.12), 0.70 (0.56, 086), 0.66 (0.53, 0.82), and 0.82 (0.65, 1.02) (P for trend = 0.003). CONCLUSIONS: An inverse association between fish and shellfish intake and T2D in women was found. No evidence of a detrimental effect of fish intake in this population was observed.

Hip circumference and the risk of type 2 diabetes in middle-aged and elderly men and women: the Shanghai women and Shanghai men's health studies.

PURPOSE: We sought to determine the association of hip circumference with risk of type 2 diabetes in a relatively lean population. METHODS: The relationship between hip circumference for a given waist circumference or BMI and risk of type 2 diabetes was investigated in 56,100 men and 68,273 women, aged 40 to 74, from the Shanghai Men's Health Study and the Shanghai Women's Health Study. Cox analyses were used. RESULTS: Over an average of 4.0 years and 7.8 years of follow-up of the men and women, respectively, 2754 new diabetes cases (955 males; 1799 females) were documented. After adjustment for body mass index (BMI), waist circumference, and other potential confounders, the hazard ratios (HRs) and 95% confidence intervals (CIs) for type 2 diabetes in quintiles 2 to 5 compared with the first quintile of hip circumference were 0.95 (95% CI, 0.76-1.18), 0.72 (95% CI, 0.57-0.91), 0.83 (95% CI, 0.67-1.04), 0.78 (95% CI, 0.63-0.97), respectively, among men and 0.83 (95% CI, 0.72-0.96), 0.74 (95% CI, 0.64-0.86), 0.72 (95% CI, 0.62-0.84), and 0.65 (95% CI, 0.56-0.75) among women. This relationship was stronger for men and women with a BMI less than or equal to the median (23.6 kg/m(2) for each gender; interaction p-value = .04 for men and .01 for women). CONCLUSIONS: A greater hip circumference for a given waist circumference and BMI is associated with a reduced risk of type 2 diabetes.

Liver enzymes, type 2 diabetes, and metabolic syndrome in middle-aged, urban Chinese men.

BACKGROUND: We examined associations between elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) with physical activity and obesity measures in middle-aged urban Chinese men. The associations between elevated aminotransferases with impaired fasting glucose, newly diagnosed type 2 diabetes (T2D), and metabolic syndrome were also evaluated in this population. METHODS: The study included 3,978 urban Chinese men 40-74 years of age from a population-based cohort study, the Shanghai Men's Health Study, who were free of T2D at baseline and had provided fasting blood samples. Elevated AST and ALT levels were defined as >40 U/L. Anthropometric measurements and information on lifestyle factors and disease history were collected by in-person interviews. RESULTS: A total of 11.13% and 5.85% study participants had elevated serum ALT and AST levels, respectively. Both body mass index (BMI) and waist-to-hip ratio (WHR) were positively associated with elevated ALT and AST. We found stronger associations between ALT and BMI/WHR than between AST and BMI/WHR. Physical activity was inversely associated with ALT and AST, but the association was attenuated after adjustment for BMI and WHR. Elevated serum aminotransferase levels were associated with T2D and metabolic syndrome. CONCLUSIONS: In this representative sample of middle-aged Chinese men, elevated ALT and AST were associated with a prevalence of metabolic syndrome and T2D. These findings suggest that the relationship between obesity and T2D might involve liver injury. Physical activity might reduce the levels of ALT and AST, probably mediated through weight reduction.

Dietary patterns are associated with lower incidence of type 2 diabetes in middle-aged women: the Shanghai Women's Health Study.

BACKGROUND: Data linking risk of type 2 diabetes (T2D) and dietary patterns in Chinese populations are scarce. METHODS: A population-based prospective study of 64,191 middle-aged women in urban Shanghai, China, who were free of T2D and other chronic diseases at study recruitment, was conducted. Dietary intake, physical activity and anthropometric measurements were assessed through in-person interviews. Dietary patterns were assessed by using K-means cluster analysis. Cox regression model was used to evaluate the association of dietary patterns with the risk of T2D. RESULTS: We identified three dietary clusters in this population. Cluster 1 (56.3%; N = 36,159) had the highest intake of staples, cluster 2 (40.4%: N = 25,948) had the highest intake of dairy milk, and cluster 3 (2.9%; N = 1843) had the highest energy intake. Participants in cluster 2 had lower prevalence of obesity, central obesity and hypertension at baseline. Using cluster 1 as the reference, participants in cluster 2 had a lower incidence of T2D after 6.9 years of follow-up [relative risk (RR) 0.78; 95% confidence interval (CI) 0.71-0.86]. The RR for the incidence of T2D for cluster 3 compared with cluster 1 was 1.05 (95% CI 0.81-1.35). The association was not modified by age category, body mass index category, waist-to-hip ratio category or exercise participation. CONCLUSIONS: We identified and characterized dietary patterns in middle-aged Chinese women by using cluster analysis. We identified a dietary pattern low in staple foods and high in dairy milk, which was associated with lower risk of T2D. Study of dietary patterns will help elucidate links between diet and disease, and contribute to the development of healthy eating guidelines for health promotion.

Prevalence and determinants of hyperuricemia in middle-aged, urban Chinese men.

BACKGROUND: Hyperuricemia is associated with metabolic syndrome and has emerged as a marker for both type 2 diabetes and cardiovascular disease. We estimated the prevalence and lifestyle risk factors of hyperuricemia in middle-aged, urban Chinese men. METHODS: The study included 3,978 urban Chinese men 40-74 years of age from a population-based cohort study, the Shanghai Men's Health Study, who were free of type 2 diabetes at baseline and had provided fasting blood samples. Uric acid concentrations were measured by the uricase method. Hyperuricemia was defined as >7.0 mg/dL. Anthropometric measurements and information on lifestyle factors and disease history were collected by in-person interviews. RESULTS: One quarter of the study subjects had hyperuricemia. Participants with metabolic syndrome had a higher prevalence of hyperuricemia. Body mass index (BMI), waist-to-hip ratio (WHR), waist circumference, and weight gain (since age 20) were positively associated with the prevalence of hyperuricemia. Physical activity was inversely related to the prevalence of hyperuricemia. The odds ratios for hyperuricemia for quintiles of nonoccupational physical activity were 1.00, 0.80, 0.73, 0.75, and 0.57 (P trend <0.001). Participants with hyperuricemia were less likely to be current smokers, but were more likely to drink alcohol regularly. Beer consumption was associated with higher risk of hyperuricemia compared with consumption of wine or liquor. CONCLUSIONS: In this representative sample of middle-aged, urban Chinese men, hyperuricemia is highly prevalent. Obesity, weight gain in adulthood, and alcohol intake were associated with a higher prevalence of hyperuricemia, whereas daily physical activity and smoking were inversely related to the prevalence of hyperuricemia.

Dietary calcium and magnesium intakes and the risk of type 2 diabetes: the Shanghai Women's Health Study.

BACKGROUND: Diet plays a key role in the development of type 2 diabetes (T2D), but little is known about the contributions of specific nutrients in populations in which dietary patterns differ from Western populations. OBJECTIVE: We examined associations between calcium and magnesium intakes and the risk of T2D in a Chinese population. DESIGN: We used data from a population-based, prospective study of 64,191 women who were free of T2D or other chronic diseases at study recruitment and were living in urban Shanghai, China. Dietary intake, physical activity, and anthropometric measurements were assessed through in-person interviews. A Cox regression model was used to evaluate the association of the exposures under study with the risk of T2D. RESULTS: An inverse association between calcium and magnesium intakes and T2D risk was observed. The relative risks for the lowest to the highest quintiles of calcium intake were 1.00, 0.82, 0.73, 0.67, and 0.74 (P for trend < 0.001), and for magnesium they were 1.00, 0.84, 0.84, 0.79, and 0.86 (P for trend < 0.001). Milk intake was also inversely associated with the risk of T2D. CONCLUSION: Our data suggest that calcium and magnesium intakes may protect against the development of T2D in this population.

Prevalence and determinants of metabolic syndrome according to three definitions in middle-aged Chinese men.

BACKGROUND: The prevalence of metabolic syndrome has varied markedly between different studies because of the lack of internationally agreed-upon criteria to define the condition. We estimated the prevalence and lifestyle risk factors of metabolic syndrome according to three definitions of metabolic syndrome in urban Chinese men participating in the Shanghai Men's Health Study (SMHS). METHODS: In this cross-sectional study, 3988 middle-aged, urban Chinese men 40-74 years of age who were free of type 2 diabetes at baseline provided fasting blood samples, anthropometric measurements, and information on lifestyle factors and disease history. RESULTS: The three definitions of metabolic syndrome used in this report are from the International Diabetes Federation (IDF), the U.S. Third Report of the National Cholesterol Education Program, Adult Treatment Panel (ATP III), and a modified version of the ATP III criteria for Asian populations (ATP III-modified criteria). The prevalence of metabolic syndrome was 18.63%, 18.36%, and 29.34% according to IDF, ATP III, and ATP III-modified criteria, respectively. Agreement between the IDF and ATP III criteria was moderate (kappa = 0.43), whereas agreement between ATP III-modified and the IDF and ATP III criteria was good (kappa = 0.71 and 0.70, respectively). Physical activity was associated with a lower prevalence of metabolic syndrome, whereas drinking more than three drinks per day was associated with a higher risk of metabolic syndrome, regardless of the criteria employed. The association between smoking and the prevalence of metabolic syndrome in this population failed to reach significance. CONCLUSIONS: Results from this representative sample of middle-aged, urban Chinese men show that metabolic syndrome is highly prevalent in this population. Our data support the hypothesis that physical activity decreases the risk of developing metabolic syndrome and that high alcohol consumption increases risk.