Baojun Yuan

Association between serum ferritin, hemoglobin, iron intake, and diabetes in adults in Jiangsu, China

OBJECTIVE—To investigate the association between iron status, iron intake, and diabetes among Chinese adults. RESEARCH DESIGN AND METHODS—This cross-sectional household survey was carried out in 2002 in Jiangsu Province, China. The sample contained 2,849 men and women aged ≥20 years with a response rate of 89.0%. Iron intake was assessed by food weighing plus consecutive individual 3-day food records. Fasting plasma glucose (FPG), serum ferritin, and hemoglobin were measured. RESULTS—The prevalence of anemia was 18.3% in men and 31.5% in women. Mean hemoglobin and serum ferritin increased across groups with increasing FPG. The prevalence of anemia among women was 15.0% in individuals with FPG >7.0 mmol/l compared with 32.6% in individuals with FPG <5.6 mmol/l. There was a similar, however not significant, trend among men. In women, after adjusting for known risk factors, the odds ratio (OR) of diabetes was 2.15 (95% CI 1.03–4.51) for subjects in the upper quartile of hemoglobin compared with the rest, and the corresponding OR for the upper quartile of serum ferritin was 3.79 (1.72–8.36). Iron intake was positively associated with diabetes in women; fourth quartile intake of iron yielded an OR of 5.53 (1.47–20.44) compared with the first quartile in the multivariate analyses. In men, similar trends were suggested, although they were not statistically significant. CONCLUSIONS—Iron status and iron intake was independently associated with risk of diabetes in Chinese women but not in men.

Vegetable-rich food pattern is related to obesity in China

Objective:To investigate the association between a vegetable-rich food pattern and obesity among Chinese adults.Design:A food pattern rich in vegetables is associated with lower risk of obesity and non-communicable chronic disease in Western countries. A similar food pattern is found in the Chinese population but the cooking method is different. A cross-sectional household survey of 2849 men and women aged 20 years and over was undertaken in 2002 in Jiangsu Province (response rate, 89.0%). Food intake was assessed by food frequency questionnaire. Factor analysis was used to identify food patterns. Nutrient intake was measured by food weighing plus consecutive individual 3-day food records. Height, weight and waist circumference were measured.Results:The prevalence of general obesity (BMI ⩾28 kg m−2) was 8.0% in men and 12.7% in women, central obesity was 19.5% (⩾90 cm) and 38.2% (⩾80 cm), respectively. A four-factor solution explained 28.5% of the total variance in food frequency intake. The vegetable-rich food pattern (whole grains, fruits and vegetables) was positively associated with vegetable oil and energy intake. Prevalence of obesity/central obesity increased across the quartiles of vegetable-rich food pattern. After adjusting for sociodemographic factors and four distinct food patterns, the vegetable-rich pattern was independently associated with obesity. Compared with the lowest quartile of vegetable-rich pattern, the highest quartile had higher risk of general obesity (men, prevalence ratio (PR): 1.82, 95% confidence interval (CI): 1.05–3.14; women, PR: 2.25, 95% CI: 1.45–3.49).Conclusion:The vegetable-rich food pattern was associated with higher risk of obesity/central obesity in Chinese adults in both genders. This association can be linked to the high intake of energy due to generous use of oil for stir-frying the vegetables.

Monosodium glutamate is not associated with obesity or a greater prevalence of weight gain over 5 years: findings from the Jiangsu Nutrition Study of Chinese adults

Animal studies and one large cross-sectional study of 752 healthy Chinese men and women suggest that monosodium glutamate (MSG) may be associated with overweight/obesity, and these findings raise public concern over the use of MSG as a flavour enhancer in many commercial foods. The aim of this analysis was to investigate a possible association between MSG intake and obesity, and determine whether a greater MSG intake is associated with a clinically significant weight gain over 5 years. Data from 1282 Chinese men and women who participated in the Jiangsu Nutrition Study were analysed. In the present study, MSG intake and body weight were quantitatively assessed in 2002 and followed up in 2007. MSG intake was not associated with significant weight gain after adjusting for age, sex, multiple lifestyle factors and energy intake. When total glutamate intake was added to the model, an inverse association between MSG intake and 5 % weight gain was found (P = 0.028), but when the model was adjusted for either rice intake or food patterns, this association was abolished. These findings indicate that when other food items or dietary patterns are accounted for, no association exists between MSG intake and weight gain.

Association between serum leptin concentrations and insulin resistance: a population-based study from China.

Background Insulin resistance contributes to the cardio-metabolic risk. The effect of leptin in obese and overweight population on insulin resistance was seldom reported. Methods A total of 1234 subjects (572 men and 662 women) aged ≥18 y was sampled by the procedure. Adiposity measures included BMI, waist circumference, hip circumference, WHR, upper arm circumference, triceps skinfold and body fat percentage. Serum leptin concentrations were measured by an ELISA method. The homeostasis model (HOMA-IR) was applied to estimate insulin resistance. Results In men, BMI was the variable which was most strongly correlated with leptin, whereas triceps skinfold was most sensitive for women. More importantly, serum leptin levels among insulin resistant subjects were almost double compared to the subjects who had normal insulin sensitivity at the same level of adiposity in both men and women, after controlling for potential confounders. In addition, HOMA-IR increased significantly across leptin quintiles after adjustment for age, BMI, total energy intake, physical activity and smoking status in both men and women (p for trend <0.0001). Conclusions There was a significant association between HOMA-IR and serum leptin concentrations in Chinese men and women, independently of adiposity levels. This may suggest that serum leptin concentration is an important predictor of insulin resistance and other metabolic risks irrespective of obesity levels. Furthermore, leptin levels may be used to identify the cardio-metabolic risk in obese and overweight population.

Iron intake and body iron stores, anaemia and risk of hyperglycaemia among Chinese adults: the prospective Jiangsu Nutrition Study (JIN).

OBJECTIVE Fe supplementation has been used to prevent anaemia in China; however, high Fe intake and body Fe stores may increase diabetes risk. The present study aimed to prospectively examine the association between Fe intake/stores and hyperglycaemia, and to assess the joint effects on anaemia. DESIGN We followed 1056 healthy adults aged 20 years and older from 2002 to 2007. Body Fe stores were measured. Dietary data were collected using a 3 d food record and FFQ. Hyperglycaemia was defined as fasting plasma glucose >5.6 mmol/l. RESULTS Of the participants, 28.8 % were anaemic at baseline. During the 5 years of follow-up, we documented 125 incident cases of hyperglycaemia, among them twenty-three were diabetic. Haem Fe intake was positively associated with the risk of hyperglycaemia in men and women: the OR (95 % CI) across increasing quartiles of haem Fe intake was 1.00 (referent), 1.49 (0.74, 3.01), 2.16 (1.06, 4.42) and 3.48 (1.71, 7.11), respectively (P for trend <0.001). Comparing the fourth quartile of serum ferritin with the others, the age- and gender-adjusted OR (95 % CI) was 1.54 (1.01, 2.34), P for trend = 0.043. The association between total Fe intake and the risk of hyperglycaemia was significant in men (P for trend = 0.002). Anaemia added additional risk of hyperglycaemia on haem Fe intake. Comparing extreme quartiles of haem Fe intake, the OR (95 % CI) was 5.67 (1.43, 22.49) and 3.44 (1.51, 7.85) for hyperglycaemia among anaemic and non-anaemic participants (P for trend = 0.008 and 0.010, respectively). CONCLUSIONS The present cohort study suggests that high haem Fe intake, anaemia and high ferritin are associated with an increased risk of hyperglycaemia in Chinese men and women. There was a joint effect between anaemia and haem Fe intake on the risk of hyperglycaemia.

Familial hypercholesterolemia in China: Prevalence and evidence of underdetection and undertreatment in a community population

deaths may go unreported. Current Canadian guidelines state that intervention may be considered when the ascending aortic dimension reaches at least 55 mm [8]. When the aortic root is not well visualized by echocardiography, we would strongly advocate for alternate imaging, such as CT or magnetic resonance imaging, to document baseline dimensions and monitor for progressive aortic root dilation. In addition to absolute aortic dimensions, timing of aortic surgery should take into account other factors such as a family history of dissection, the rate of dilation and other planned cardiac surgery. It is important to highlight that this case was a “limited aortic dissection” which is characterized by an intimal tear but no intimal flap or hematoma. In patients with an aortic aneurysm N45 mm with strong clinical suspicion for aortic dissection and a non-diagnostic transesophageal echocardiogram or CT, the clinician should consider a dedicated aortogram to exclude a limited dissection [9]. This case is especially unique in that the dissection occurred at a lower aortic dimension than in previous case reports. In addition, the patient did not have any risk factors for dissection. Furthermore, this was a limited dissection that may not be well visualized by usual imaging such as CT. These observations suggest that although dissection seems to be a rare complication in TOF patients, a high clinical suspicion should always be maintained and pursued depending on the clinical presentation.

Egg consumption and the risk of diabetes in adults, Jiangsu, China

BACKGROUND Although egg consumption has been associated with elevated plasma levels of cholesterol and triglyceride and with risk of cardiovascular disease in some populations, epidemiologic studies on egg consumption and the risk of diabetes are extremely sparse, particularly in the Chinese population. METHOD Data from a household survey in the year 2002 among 2849 adults aged ≥20 y from a nationally representative sample in Jiangsu Province, China, were used. Dietary information was assessed by a validated food frequency questionnaire and 3 d weighed food records. Fasting blood specimens were collected. RESULTS After the adjustment for age, total calorie intake, education, smoking, family history of diabetes, and sedentary activity, egg consumption was significantly and positively associated with diabetes risk, particularly in women. The odds ratios (OR) (95% CI) of diabetes associated with egg consumption <2/wk, 2-6/wk, and ≥1/d in the total sample were 1.00, 1.75, 2.28 (1.14-4.54), respectively (P for trend 0.029). Corresponding ORs (95% CI) in women were 1.00, 1.66, and 3.01 (1.12, 8.12), respectively (P for trend 0.022). Additional adjustment of body mass index attenuated the association, but it remained significant. There was a similar, however, not statistically significant association in men. In addition, plasma triglyceride and total cholesterol levels were significantly higher in women who consumed ≥2 eggs/wk than those who consumed eggs less often. CONCLUSION Egg consumption was positively associated with the risk of diabetes among the Chinese, particularly in women.

Interaction between physical activity and sleep duration in relation to insulin resistance among non-diabetic Chinese adults

BackgroundIt is of a public health interest to explore the relationship between different types of physical activity, sleep duration and diabetes/insulin resistance. However, little is known about such relationship. This study examines the single and joint associations of different types of physical activity, and sleep duration on insulin resistance among non-diabetic Chinese adults.MethodsData was collected from 1124 non-diabetic adults in Jiangsu Province from the China Health and Nutrition Survey (CHNS). Domestic, occupational, transportation and leisure physical activity were assessed in terms of metabolic equivalent (MET)-hours-per-week to account for both intensity and time spent. Sleep duration was categorized into three groups: ≤ 7 hours, 7-9 hours, and ≥ 9 hours. Insulin resistance was evaluated by the homeostasis model of assessment (HOMA) and defined as the highest quartile of HOMA.ResultsTotal physical activity was mainly composed of occupational activity (75.1%), followed orderly by domestic, transportation and leisure time activity in both men and women. Total physical activity level was strongly negatively associated with fasting insulin and HOMA (p < 0.001). Among four types of physical activity, occupational activity was significantly negatively associated with HOMA after full adjustment (p < 0.05). Transportation activity was also negatively associated with HOMA when adjusted for age and gender (p = 0.028). Moreover, the combination of low physical activity and short sleep duration was associated with the highest odds of insulin resistance (adjusted OR = 3.26, 95% CI: 1.57-6.78), compared to those with high physical activity and adequate sleep duration.ConclusionsPhysical activity, mainly occupational physical activity, was negatively associated with insulin resistance in non-diabetic Chinese population, independently of potential confounders. There was a synergic effect of low physical activity and short sleep duration on insulin resistance.

Anemia in relation to body mass index and waist circumference among Chinese women

BackgroundThis study aimed to investigate the relationship of anemia and body mass index among adult women in Jiangsu Province, China. Data were collected in a sub-national cross-sectional survey, and 1,537 women aged 20 years and above were included in the analyses. Subjects were classified by body mass index (BMI) categories as underweight, normal weight, overweight and obese according to the Chinese standard. Central obesity was defined as a waist circumference ≥ 80 cm. Anemia was defined as hemoglobin concentration < 12 g/dl. Prevalence ratios (PRs) of the relationship between anemia and BMI or waist circumference were calculated using Poisson regression.FindingsOverall, 31.1% of the Chinese women were anemic. The prevalence of overweight, obesity and central obesity was 34.2%, 5.8% and 36.2%, respectively. The obese group had the highest concentrations of hemoglobin compared with other BMI groups. After adjustment for confounders, overweight and obese women had a lower PR for anemia (PR: 0.72, 95% CI: 0.62-0.89; PR: 0.59, 95% CI: 0.43-0.79). Central obesity was inversely associated with anemia.ConclusionIn this Chinese population, women with overweight/obesity or central obesity were less likely to be anemic as compared to normal weight women. No measures are required currently to target anemia specifically for overweight and obese people in China.

Monosodium glutamate is related to a higher increase in blood pressure over 5 years: findings from the Jiangsu Nutrition Study of Chinese adults

Objective One large cross-sectional study across four countries suggests that glutamate intake may be inversely associated with blood pressure (BP). The aim of this analysis was to investigate a possible association between monosodium glutamate (MSG) intake and change in blood pressure over 5 years. Methods Data from 1227 Chinese men and women who participated in the Jiangsu Nutrition Study (JIN) were analyzed. In this study, MSG intake and blood pressure were quantitatively assessed in 2002, and followed-up in 2007. Results MSG intake was associated with a significant increase in SBP and DBP. A strong sex interaction was observed in relation to SBP change. Women with high MSG intake were more likely to have increased SBP and DBP. Total glutamate intake was also positively associated with an increase in SBP. In those chronically taking antihypertensive medications, there was a strong association between MSG intake and an increase in DBP. Conclusion MSG intake may have independent BP-increasing effects, especially among women and those taking hypertension medications at baseline and follow-up.