Jieli Lu

Prevalence and Control of Diabetes in Chinese Adults

IMPORTANCE Noncommunicable chronic diseases have become the leading causes of mortality and disease burden worldwide. OBJECTIVE To investigate the prevalence of diabetes and glycemic control in the Chinese adult population. DESIGN, SETTING, AND PARTICIPANTS Using a complex, multistage, probability sampling design, we conducted a cross-sectional survey in a nationally representative sample of 98,658 Chinese adults in 2010. MAIN OUTCOMES AND MEASURES Plasma glucose and hemoglobin A1c levels were measured after at least a 10-hour overnight fast among all study participants, and a 2-hour oral glucose tolerance test was conducted among participants without a self-reported history of diagnosed diabetes. Diabetes and prediabetes were defined according to the 2010 American Diabetes Association criteria; whereas, a hemoglobin A1c level of <7.0% was considered adequate glycemic control. RESULTS The overall prevalence of diabetes was estimated to be 11.6% (95% CI, 11.3%-11.8%) in the Chinese adult population. The prevalence among men was 12.1% (95% CI, 11.7%-12.5%) and among women was 11.0% (95% CI, 10.7%-11.4%). The prevalence of previously diagnosed diabetes was estimated to be 3.5% (95% CI, 3.4%-3.6%) in the Chinese population: 3.6% (95% CI, 3.4%-3.8%) in men and 3.4% (95% CI, 3.2%-3.5%) in women. The prevalence of undiagnosed diabetes was 8.1% (95% CI, 7.9%-8.3%) in the Chinese population: 8.5% (95% CI, 8.2%-8.8%) in men and 7.7% (95% CI, 7.4%-8.0%) in women. In addition, the prevalence of prediabetes was estimated to be 50.1% (95% CI, 49.7%-50.6%) in Chinese adults: 52.1% (95% CI, 51.5%-52.7%) in men and 48.1% (95% CI, 47.6%-48.7%) in women. The prevalence of diabetes was higher in older age groups, in urban residents, and in persons living in economically developed regions. Among patients with diabetes, only 25.8% (95% CI, 24.9%-26.8%) received treatment for diabetes, and only 39.7% (95% CI, 37.6%-41.8%) of those treated had adequate glycemic control. CONCLUSIONS AND RELEVANCE The estimated prevalence of diabetes among a representative sample of Chinese adults was 11.6% and the prevalence of prediabetes was 50.1%. Projections based on sample weighting suggest this may represent up to 113.9 million Chinese adults with diabetes and 493.4 million with prediabetes. These findings indicate the importance of diabetes as a public health problem in China.

Urinary bisphenol A (BPA) concentration associates with obesity and insulin resistance.

CONTEXT Bisphenol A (BPA) is one of the worlds highest-volume chemicals in use today. Previous studies have suggested BPA disturbs body weight regulation and promotes obesity and insulin resistance. But epidemiological data in humans were limited. OBJECTIVE Our objective was to determine whether BPA associates with obesity and insulin resistance. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 3390 adults aged 40 yr or older, in Songnan Community, Baoshan District, Shanghai, China. MAIN OUTCOME MEASURES Questionnaire, clinical and biochemical measurements, and urinary BPA concentration were determined. Generalized overweight was defined as body mass index (BMI) of 24 to less than 28 kg/m(2) and obesity was defined as BMI of 28 kg/m(2) or higher. Abdominal obesity was defined as waist circumference at least 90 cm for men and at least 85 cm for women. Insulin resistance was defined as the index of homeostasis model assessment of insulin resistance higher than 2.50. RESULTS The participants in the highest quartile of BPA had the highest prevalence of generalized obesity [odds ratio (OR) = 1.50; 95% confidence interval (CI) = 1.15-1.97], abdominal obesity (OR = 1.28; 95% CI = 1.03-1.60), and insulin resistance (OR = 1.37; 95% CI = 1.06-1.77). In participants with BMI under 24 kg/m(2), compared with the lowest quartile, the highest quartile of BPA increased the prevalence of insulin resistance by 94% (OR = 1.94; 95% CI = 1.20-3.14), but this association was not observed in those with BMI of 24 kg/m(2) or higher. CONCLUSIONS BPA was positively associated with generalized obesity, abdominal obesity, and insulin resistance in middle-aged and elderly Chinese adults.

Nuclear-Cytoplasmic Shuttling of Menin Regulates Nuclear Translocation of β-Catenin

ABSTRACT Menin, which is encoded by the multiple endocrine neoplasia type 1 (MEN1) gene, is a tumor suppressor and transcriptional regulator. Menin controls proliferation and apoptosis of cells, especially pancreatic β cells. We have found that menin contains two functional nuclear export signals and that there is nuclear accumulation of β-catenin in Men1-null mouse embryonic fibroblasts and insulinoma tissues from β-cell-specific Men1 knockout mice. It is reported that the deregulation of Wnt/β-catenin signaling caused by inactivation of tumor suppressors results in abnormal development or tumorigenesis. We further revealed that overexpression of menin reduces β-catenin nuclear accumulation and its transcriptional activity. Menin is able to directly interact with β-catenin and carry β-catenin out of the nucleus via nuclear-cytoplasmic shuttling in a CRM1-dependent manner. These results imply that menin may control cell proliferation through suppression of Wnt/β-catenin signaling.

Cohort profile: Risk evaluation of cancers in Chinese diabetic individuals: A longitudinal (REACTION) study

To demonstrate whether abnormal glucose metabolism (diabetes and prediabetes) is associated with increased risk for cancer in the Chinese population and to identify factors that modify the risk of cancer among individuals with abnormal glucose metabolism.

Association between Nonalcoholic Fatty Liver Disease (NAFLD) and Osteoporotic Fracture in Middle-Aged and Elderly Chinese

CONTEXT Nonalcoholic fatty liver disease (NAFLD) has been considered as a hepatic manifestation of the metabolic syndrome and is associated with various metabolic abnormalities, which may link to an increased risk of osteoporotic fracture. However, epidemiological studies investigating the association between NAFLD and osteoporotic fracture were not available. OBJECTIVE The objective of the study was to determine whether NAFLD associates with osteoporotic fracture. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional study of 7797 Chinese adults aged 40 yr or older in the Jiading District, Shanghai, China. MAIN OUTCOME MEASURES A questionnaire, anthropometric measurements, laboratory tests, and a hepatic ultrasonic examination were conducted. NAFLD was diagnosed by hepatic ultrasound after the exclusion of alcohol abuse and other liver diseases. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low-trauma in 2 yr prior to the study. RESULTS Among men, the prevalence of osteoporotic fractures was significantly higher in those with NAFLD (3.6 vs. 1.7%, P = 0.003); however, no difference was found in women (3.4 vs. 2.6%, P = 0.14). The presence of NAFLD was significantly associated with increased odds of osteoporotic fracture among men (odds ratio 2.53; 95% confidence interval 1.26-5.07; P = 0.009) after controlling for potential confounders. The significant associations were not detected in women. CONCLUSIONS The presence of NAFLD was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese men.

Nonalcoholic Fatty Liver Disease Is Associated With Atherosclerosis in Middle-Aged and Elderly Chinese

Objective—To evaluate the associations between nonalcoholic fatty liver disease (NAFLD) and atherosclerosis. Methods and Results—A total of 8632 participants aged ≥40 years from Jiading district, Shanghai, were included in the present study. The presence of NAFLD was evaluated by ultrasonography. Carotid intima-media thickness (CIMT) and brachial-ankle pulse wave velocity (ba-PWV) were measured in each participant. The prevalence of NAFLD was 30.0% in the total population, with 30.3% in men and 29.9% in women, respectively. Subjects with NAFLD had remarkably higher CIMT and ba-PWV compared with those without NAFLD (0.594±0.105 mm versus 0.578±0.109 mm, P<0.0001; 1665±424 cm/s versus 1558±430 cm/s, P<0.0001). Subjects with both NAFLD and metabolic syndrome had significantly higher CIMT and ba-PWV compared with those with neither or either of these 2 diseases after adjustment for age and sex (all P<0.05). Logistic regressions also revealed that NAFLD conferred 35% and 30% increased odds ratios of elevated CIMT and ba-PWV, independent of conventional risk factors and the presence of metabolic syndrome. Conclusion—NAFLD was associated with elevated CIMT and ba-PWV, independent of conventional cardiovascular disease risk factors and metabolic syndrome. The effects of NAFLD and metabolic syndrome on atherosclerosis might not fully overlap.

The relationship between insulin-sensitive obesity and cardiovascular diseases in a Chinese population: results of the REACTION study.

OBJECTIVE Obesity and insulin resistance are risk factors for cardiovascular diseases. Whether insulin-sensitive obese individuals are at higher risk for cardiovascular diseases is still debated. We aim to investigate whether insulin-sensitive obesity associates with prevalent cardiovascular diseases and 10-year coronary heart disease (CHD) risk. RESEARCH DESIGN AND METHODS At the baseline of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study, 211,641 participants aged 40 years or older were recruited from 25 communities across the China mainland, in 2011 to 2012. Participants were categorized by insulin-sensitive/resistant and general/abdominal obese status. Cardiovascular diseases included CHD, stroke, and myocardial infarction. Framingham risk score (FRS) was calculated according to National Cholesterol Education Program-Adult Treatment Panel III and FRS greater than 20% or cardiovascular diseases were identified as high risk for 10-year CHD. RESULTS Controlling for potential confounders, compared with insulin-sensitive normal weight individuals, insulin-sensitive general obese individuals had increased risks for prevalent cardiovascular diseases (men: OR, 2.55, 95% CI, 2.04-3.18; women: 1.73, 1.45-2.06) and 10-year Framingham risk for CHD (men: 2.26, 1.86-2.76; women: 1.73, 1.46-2.06). Compared with insulin-sensitive normal waist subgroup, insulin-sensitive abdominal obesity was associated with higher risks for prevalent cardiovascular diseases (men: 1.32, 1.20-1.46; women: 1.36, 1.27-1.47) and 10-year Framingham risk for CHD (men, 1.34, 1.23-1.45; women, 1.37, 1.27-1.47). CONCLUSION Both general and abdominal obesity were associated with elevated prevalent cardiovascular diseases and 10-year CHD risk, regardless of the presence or absence of insulin resistance.

Advanced research on risk factors of type 2 diabetes.

The prevalence of type 2 diabetes is increasing globally and poses a heavy burden on public health and socioeconomic development of all nations. Type 2 diabetes is a multifactorial disease and due to a combination of environmental and genetic risk factors. Many environmental risk factors contribute to the pathogenesis of type 2 diabetes, including lifestyles such as sedentary behaviour, diet, smoking and alcohol consumption, internal environmental factors such as inflammatory factors, adipocytokines and hepatocyte factors, external environmental factors such as environmental endocrine disruptors. This review summarizes current research efforts concentrated on the contributors for accelerated type 2 diabetes epidemic. It also provides a novel prospect for future researches.

Urinary bisphenol a concentration and thyroid function in Chinese adults

Background: Bisphenol A (BPA) is an endocrine disruptor that in animal studies can bind to the thyroid hormone receptor and affect thyroid function. Relevant epidemiologic studies are limited and results are inconsistent. We explored the relationship between urinary BPA and thyroid function in a Chinese population. Methods: The study population included 3394 subjects age 40 years or older who were enrolled in a population-based study from Songnan Community, Baoshan District, Shanghai, China, from June through August 2009. We analyzed the association between urinary BPA and thyroid function using multivariate linear regression. Participants were further divided according to thyroid function status, and logistic regression was applied to determine the relationship between urinary BPA and thyroid function. Results: Each one-quartile increase in BPA was related to an increase of 0.068 pmol/l (95% confidence interval = 0.065– 0.071) in free triiodothyronine and a 0.084 &mgr;IU/ml decline (−0.099 to −0.069) in thyroid-stimulating hormone (TSH) in men. For women, there was a 0.10 pmol/l (0.09 to 0.11) increase in free triiodothyronine and a 0.13 &mgr;IU/ml decline (−0.14 to −0.11) in TSH. High urinary BPA level was associated with increased thyroid function (adjusted odds ratio= 1.71 [1.26 to 2.32]). Conclusions: Our results support previous reports of associations between BPA exposure and altered thyroid hormones in animal models and epidemiologic studies. Because our study is cross-sectional, no causal relationships can be established.

Status of cardiovascular health in Chinese adults.

BACKGROUND Cardiovascular disease has become the leading cause of death in China. OBJECTIVES The goal of this study was to evaluate the current status of cardiovascular health in Chinese adults. METHODS Cardiovascular health data were collected from a nationally representative sample of 96,121 Chinese adults age ≥ 20 years in 2010. Ideal cardiovascular health was defined according to the American Heart Associations 2020 Strategic Impact Goals as follows: the simultaneous presence of 4 favorable health behaviors (ideal smoking status, ideal body mass index, physical activity at goal, and healthy dietary habits) and 4 favorable health factors (ideal smoking status, untreated total cholesterol <200 mg/dl, untreated blood pressure <120/<80 mm Hg, and untreated fasting plasma glucose <100 mg/dl) in the absence of a history of cardiovascular disease. RESULTS The estimated percentage of ideal cardiovascular health was 0.2% in the general adult population in China (0.1% in men and 0.4% in women). An estimated 0.7% (0.4% in men and 1.0% in women) of Chinese adults had all 4 ideal health behaviors, and 13.5% (5.0% in men and 22.3% in women) had all 4 ideal health factors. Men most frequently had 3 to 4 ideal components, and women most commonly had 4 to 5 ideal components of the 7 cardiovascular health metrics. Ideal diet (1.6%) was the least common among all cardiovascular health metrics. Female sex and younger age were the 2 most common protective factors for cardiovascular health in Chinese adults. CONCLUSIONS The percentage of ideal cardiovascular health in Chinese adults is extremely low. Both population-wide and high-risk strategies should be implemented with great effort to promote cardiovascular health in China.