Fangjian Guo

Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010

OBJECTIVES The purpose of this study was to quantify the trends in blood pressure (BP), and the prevalence, awareness, management, and control of hypertension in U.S. adults (≥20 years of age) from 1999 to 2010, and to assess the efficacy of current clinical measures in diagnosing and adequately treating hypertensive patients. BACKGROUND Hypertension is a major independent risk factor for cardiovascular disease and stroke. Recent data indicate a decreasing trend in hypertension prevalence, along with improvements in hypertension awareness, management, and control. METHODS The study used regression models to assess the trends in hypertension prevalence, awareness, management, and control from 1999 to 2010 among 28,995 male and female adults with BP measurements from a nationally representative sample of the noninstitutionalized U.S. population (National Health and Nutrition Examination Survey [NHANES] 1999 to 2010), with special attention given to 5,764 participants in NHANES 2009 to 2010. RESULTS In 2009 to 2010, the prevalence of hypertension was 30.5% among men and 28.5% among women. The hypertension awareness rate was 69.7% (95% confidence interval [CI]: 62.0% to 77.4%) among men and 80.7% (95% CI: 74.5% to 86.8%) among women. The hypertension control rate was 40.3% (95% CI: 33.7% to 46.9%) for men and 56.3% (95% CI: 49.2% to 63.3%) for women. From 1999 to 2010, the prevalence of hypertension remained stable. Although hypertension awareness, management, and control improved, the overall rates remained poor (74.0% for awareness, 71.6% for management, 46.5% for control, and 64.4% for control in management); worse still, no improvement was shown from 2007 to 2010. CONCLUSIONS From 1999 to 2010, prevalence of hypertension remained stable. Hypertension awareness, management, and control were improved, but remained poor; nevertheless, there has been no improvement since 2007.

Liver retinol transporter and receptor for serum retinol-binding protein (RBP4).

Background: Mechanisms by which RBP4 interacts with cells are not completely understood. Results: 1300002K09Rik (RBPR2) is identified as a Stra6-related protein expressed in liver, intestine, and obese fat that mediates RBP4 binding and retinol transport. Conclusion: RBPR2 is a novel RBP4 receptor that mediates retinol uptake. Significance: RBPR2 may be important for whole body retinol homeostasis or cellular actions of RBP4 in certain tissues. Vitamin A (retinol) is absorbed in the small intestine, stored in liver, and secreted into circulation bound to serum retinol-binding protein (RBP4). Circulating retinol may be taken up by extrahepatic tissues or recycled back to liver multiple times before it is finally metabolized or degraded. Liver exhibits high affinity binding sites for RBP4, but specific receptors have not been identified. The only known high affinity receptor for RBP4, Stra6, is not expressed in the liver. Here we report discovery of RBP4 receptor-2 (RBPR2), a novel retinol transporter expressed primarily in liver and intestine and induced in adipose tissue of obese mice. RBPR2 is structurally related to Stra6 and highly conserved in vertebrates, including humans. Expression of RBPR2 in cultured cells confers high affinity RBP4 binding and retinol transport, and RBPR2 knockdown reduces RBP4 binding/retinol transport. RBPR2 expression is suppressed by retinol and retinoic acid and correlates inversely with liver retinol stores in vivo. We conclude that RBPR2 is a novel retinol transporter that potentially regulates retinol homeostasis in liver and other tissues. In addition, expression of RBPR2 in liver and fat suggests a possible role in mediating established metabolic actions of RBP4 in those tissues.

The progression of cardiometabolic disease: Validation of a new cardiometabolic disease staging system applicable to obesity

To validate a Cardiometabolic Disease Staging (CMDS) system for assigning risk level for diabetes, and all‐cause and cardiovascular disease (CVD) mortality.

Use of HbA1c for Diagnoses of Diabetes and Prediabetes: Comparison with Diagnoses Based on Fasting and 2-Hr Glucose Values and Effects of Gender, Race, and Age

BACKGROUND Glycated hemoglobin (HbA1c) has been advocated for the diagnosis of diabetes and prediabetes. Its performance has been commonly assessed in corroboration with elevated fasting plasma glucose (FPG), but not the combination of FPG and 2-hr glucose values. This study assesses receiver operating characteristics (ROC) curves of HbA1c pertaining to the diagnoses of prediabetes and diabetes by FPG and/or 2-hr glucose, and the effects of age, gender, and race. METHODS We assessed the utility of HbA1c for diagnosing diabetes and prediabetes among 5395 adults without known diabetes from the National Health and Nutrition Examination Survey (NHANES) 2005-2010. RESULTS Current cutoffs of HbA1c for diabetes (6.5%) or prediabetes (5.7%) exhibited low sensitivity (0.249 and 0.354, respectively) and high specificity in identifying patients diagnosed using both FPG and 2-hr glucose, resulting in large false-negative rates (75.1% and 64.9%). Misdiagnosis rates increased with age and in non-Hispanic whites and Mexican Americans. When HbA1c was combined with FPG for diagnoses, the false-negative rate remained high for diabetes (45.7%), but was reduced for prediabetes (9.2%). CONCLUSIONS When assessed against diagnoses using both FPG and 2-hr glucose, HbA1c had low sensitivity and high specificity for identifying diabetes and prediabetes, which varied as a function of age and race. Regarding recently released American Diabetes Association (ADA) and joint European guidelines, it is important to consider that HbA1c values below 6.5% and 5.7% do not reliably exclude the presence of diabetes and prediabetes, respectively. Overall, the data argue for greater use of oral glucose tolerance tests (OGTTs) and both FPG and 2-hr glucose values for diagnosis of diabetes and prediabetes.

BMI, RQ, diabetes, and sex affect the relationships between amino acids and clamp measures of insulin action in humans.

Previous studies have used indirect measures of insulin sensitivity to link circulating amino acids with insulin resistance and identify potential biomarkers of diabetes risk. Using direct measures (i.e., hyperinsulinemic-euglycemic clamps), we examined the relationships between the metabolomic amino acid profile and insulin action (i.e., glucose disposal rate [GDR]). Relationships between GDR and serum amino acids were determined among insulin-sensitive, insulin-resistant, and type 2 diabetic (T2DM) individuals. In all subjects, glycine (Gly) had the strongest correlation with GDR (positive association), followed by leucine/isoleucine (Leu/Ile) (negative association). These relationships were dramatically influenced by BMI, the resting respiratory quotient (RQ), T2DM, and sex. Gly had a strong positive correlation with GDR regardless of BMI, RQ, or sex but became nonsignificant in T2DM. In contrast, Leu/Ile was negatively associated with GDR in nonobese and T2DM subjects. Increased resting fat metabolism (i.e., low RQ) and obesity were observed to independently promote and negate the association between Leu/Ile and insulin resistance, respectively. Additionally, the relationship between Leu/Ile and GDR was magnified in T2DM males. Future studies are needed to determine whether Gly has a mechanistic role in glucose homeostasis and whether dietary Gly enrichment may be an effective intervention in diseases characterized by insulin resistance.

Cardiometabolic disease risk in metabolically healthy and unhealthy obesity: Stability of metabolic health status in adults

To assess the stability of metabolic status and body mass index (BMI) status and their relative contribution to risk of diabetes, cardiovascular events, and mortality.

Use of BRCA Mutation Test in the U.S., 2004–2014

INTRODUCTION BRCA mutation testing has been used for screening women at high risk of breast and ovarian cancer and for selecting the best treatment for those with breast cancer. To optimize the infrastructure and medical resources allocation for genetic testing, it is important to understand the use of BRCA mutation testing in the U.S. health system. METHODS This retrospective cohort study included 53,254 adult women with insurance claims for BRCA mutation testing between 2004 and 2014 from ClinformaticsTM Data Mart Database. Data analysis was performed in 2016. This study assessed trends in the use of BRCA mutation testing in women with previously diagnosed breast or ovarian cancer and those without (unaffected women). RESULTS Between 2004 and 2014, of those receiving BRCA testing, the proportion of BRCA tests performed in unaffected women increased significantly (p<0.001), from 24.3% in 2004 to 61.5% in 2014. An increase in the proportion of BRCA tests used in unaffected women was found in each characteristic subgroup. In 2014, most subgroups had a proportion surpassing 50%, except for those aged 51-65 years and those without a family history of breast cancer. There was a much lower proportion of those aged 20-40 years among tested women with previously diagnosed breast or ovarian cancer than in unaffected women (17.6% vs 41.7%, p<0.001). CONCLUSIONS During the past decade, the role of BRCA testing has gradually shifted from being used primarily in cancer patients to being used in unaffected women in the U.S.

Prevalence of oral human papillomavirus by vaccination status among young adults (18–30 years old)

BACKGROUND Although there is evidence that human papillomavirus (HPV) vaccination may protect against oral HPV infection, no current research has demonstrated this in the general population. METHODS We used repeated cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) between 2009 and 2014. Participants 18-30years who indicated whether they had received the HPV vaccine and provided an adequate oral sample were included (N=3040). Oral HPV types were grouped by vaccine-type (types 6, 11, 16, 18) and by risk (high or low risk). Chi-square analyses compared oral HPV prevalence by vaccination status. RESULTS Vaccinated adults had a lower prevalence of vaccine-type oral HPV (types 6, 11, 16, 18) compared to unvaccinated adults. Prevalence of non-vaccine high-risk oral HPV was similar between HPV vaccinated and unvaccinated participants. CONCLUSIONS HPV vaccination appears to provide protection against vaccine-type oral HPV infection among males and females in the general population.

Type 2 diabetes with partial lipodystrophy of the limbs: a new lipodystrophy phenotype.

OBJECTIVE Lipodystrophies are categorized by the extent of fat loss (generalized vs. partial) and by inheritance (congenital vs. acquired). We examined whether a group of patients with partial lipodystrophy of the limbs (PLL), type 2 diabetes mellitus (T2DM), and an absence of a family history of lipodystrophy constitute a new clinical subtype. RESEARCH DESIGN AND METHODS Ten women with T2DM and PLL were identified in academic diabetes clinics and were matched by age, sex, BMI, ethnicity, and diabetes status with 10 women with control T2DM without lipodystrophy. All patients were characterized by clinical evaluation and hyperinsulinemic clamp. RESULTS Patients with T2DM and PLL exhibited symmetrical loss of subcutaneous fat in forearms, or forearms plus calves, and acanthosis nigricans. Maximally stimulated glucose disposal rates were markedly reduced by 56% in the T2DM with PLL group compared with the control T2DM patients, whether normalized by body weight or surface area. Most PLL patients exhibited little or no insulin-mediated glucose uptake after subtraction of non-insulin–mediated glucose uptake. The T2DM with PLL group also had greater elevations in hepatic transaminases and triglycerides and earlier onset of diabetes compared with control T2DM. CONCLUSIONS T2DM with PLL represents a previously unrecognized phenotype of lipodystrophy and of T2DM. These T2DM patients exhibit symmetrical lipodystrophy of the distal limbs, acanthosis nigricans, marked insulin resistance with little insulin-mediated glucose uptake, hypertriglyceridemia, and hepatic transaminase elevations, which are greater in severity than observed in patients with common T2DM.

Comparison of HPV prevalence between HPV-vaccinated and non-vaccinated young adult women (20–26 years)

There is some concern about the effectiveness of the HPV vaccine among young adult women due to the risk of prior HPV infection. This study used National Health and Nutrition Examination Survey (NHANES) 2007–2012 data to evaluate the effectiveness of HPV vaccination among women 20–26 years of age who were vaccinated after 12 years of age. This cross-sectional study examined 878 young adult women (20–26 years) with complete information on HPV prevalence and HPV vaccination status from NHANES 2007–2012. Vaginal swab specimens were analyzed for HPV DNA by L1 consensus polymerase chain reaction followed by type-specific hybridization. Multivariate logistic regression models controlling for sociodemographic characteristics and sexual behaviors were used to compare type-specific HPV prevalence between vaccinated and unvaccinated women. A total of 21.4% of young adult women surveyed through NHANES between 2007 and 2012 received the HPV vaccine. Vaccinated women had a lower prevalence of vaccine types than unvaccinated women (7.4% vs 17.1%, prevalence ratio 0.43, 95% CI 0.21–0.88). The prevalence of high-risk nonvaccine types was higher among vaccinated women than unvaccinated women (52.1% vs 40.4%, prevalence ratio 1.29, 95% CI 1.06–1.57), but this difference was attenuated after adjusting for sexual behavior variables (adjusted prevalence ratio 1.19, 95% CI 0.99–1.43). HPV vaccination was effective against all 4 vaccine types in young women vaccinated after age 12. However, vaccinated women had a higher prevalence of high-risk nonvaccine types, suggesting that they may benefit from newer vaccines covering additional types.