Jixing Liang

Associations Between Age at Menarche and Menopause With Cardiovascular Disease, Diabetes, and Osteoporosis in Chinese Women

CONTEXT Ages at menarche and menopause are associated with cardiovascular disease (CVD), diabetes, and osteoporosis in Caucasian women, but associations remain unexplored in Chinese women. OBJECTIVE The purpose of this study was to assess associations between age at menarche and menopause with CVD, diabetes, and osteoporosis in Chinese women. DESIGN AND SETTING A cross-sectional, population-based study was conducted in Fujian, China, from June 2011 to January 2012. PARTICIPANTS Among 6242 women aged 21 to 92 years, 3304 postmenopausal women were enrolled, excluding premenopausal women (n = 2527), those with unreported ages at menarche and menopause (n = 138), those with unrecorded physical measurements (n = 203), and those with menarche age <8 years or >20 years (n = 70). MAIN OUTCOME MEASURES An oral glucose tolerance test, a 12-lead resting electrocardiogram, and calcaneus quantitative ultrasound were performed. RESULTS No significant associations were found between menarche age, diabetes, and osteoporosis (both P > .05); later menarche (>18 years) was significantly associated with lower CVD risk (odds ratio = 0.71, 95% confidence interval, 0.57-0.89; P = .002). Menopause age was not associated with diabetes; higher menopause age was associated with decreasing CVD risk (P for trend = .020) and earlier menopause (≤46 years) with significantly higher osteoporosis risk (odds ratio = 1.59, 95% confidence interval, 1.07-2.36; P = .023). CONCLUSIONS In China, ages at menarche and menopause are not associated with diabetes. Later menarche and menopause are associated with decreasing CVD risk and earlier menopause with higher osteoporosis risk. Menarche and menopause history may help identify women with increased risk of developing CVD and osteoporosis.

Associations Between Sleep Duration, Daytime Nap Duration, and Osteoporosis Vary by Sex, Menopause, and Sleep Quality

CONTEXT Associations between sleep, daytime nap duration, and osteoporosis remain uncertain, and far less is even known about the influence of sex, menopause, and sleep quality on them. OBJECTIVE The objective of the study was to test the associations between sleep, daytime nap duration, and osteoporosis and whether they vary by sex, menopause, and sleep quality. DESIGN, SETTING, AND PATIENTS This cross-sectional study was based on two communities in China. A total of 8688 participants (3950 males and 4738 females) aged 40 years or older were enrolled in the study. MAIN OUTCOMES MEASURES Self-reported sleep duration, daytime nap duration, sleep quality, and calcaneus bone mineral density were recorded. RESULTS Sleep duration of 8-9 h/d and nap duration of 0 min/d were regarded as reference values. In postmenopausal women, risks (odds ratio and 95% confidence interval) of osteoporosis for sleep durations of 7-8 h/d, 9-10 h/d, and 10 h/d or longer were 1.531 (1.106, 2.121), 1.360 (1.035, 1.787), and 1.569 (1.146, 2.149), respectively (P < .05), and risks of osteoporosis for daytime nap durations of 30-60 min/d and longer than 60 min/d were 1.553 (1.212-1.989) and 1.645 (1.250-2.165), respectively (P < .05). However, a significant difference was not consistently observed in men or premenopausal women, regardless of sleep or daytime nap duration. As for sleep quality, positive results were seen most remarkably in postmenopausal females with good sleep. CONCLUSIONS Sleep durations of 7-8 h/d, 9-10 h/d, and 10 h/d or longer, as well as longer daytime napping times, tend to present higher risks of having osteoporosis, and this tendency is most obvious in postmenopausal women reporting good-quality sleep.

Adiponectin inhibits KISS1 gene transcription through AMPK and specificity protein-1 in the hypothalamic GT1-7 neurons

Adiponectin secreted from adipose tissues plays a role in the regulation of energy homeostasis, food intake, and reproduction in the hypothalamus. We have previously demonstrated that adiponectin significantly inhibited GNRH secretion from GT1-7 hypothalamic GNRH neuron cells. In this study, we further investigated the effect of adiponectin on hypothalamic KISS1 gene transcription, which is the upstream signal of GNRH. We found that globular adiponectin (gAd) or AICAR, an artificial AMPK activator, decreased KISS1 mRNA transcription and promoter activity. Conversely, inhibition of AMPK by Compound C or AMPKα1-SiRNA augmented KISS1 mRNA transcription and promoter activity. Additionally, gAd and AICAR decreased the translocation of specificity protein-1 (SP1) from cytoplasm to nucleus; however, Compound C and AMPKα1-siRNA played an inverse role. Our experiments in vivo demonstrated that the expression of Kiss1 mRNA was stimulated twofold in the Compound C-treated rats and decreased about 60-70% in gAd- or AICAR-treated rats compared with control group. The numbers of kisspeptin immunopositive neurons in the arcuate nucleus region of Sprague Dawley rats mimicked the same trend seen in Kiss1 mRNA levels in animal groups with different treatments. In conclusion, our results provide the first evidence that adiponectin reduces Kiss1 gene transcription in GT1-7 cells through activation of AMPK and subsequently decreased translocation of SP1.

Is Normocalcemic Primary Hyperparathyroidism Harmful or Harmless

CONTEXT Primary hyperparathyroidism (PHPT) is reported to be associated with an increased frequency of hypertension, however, information in this regard is sparse in relation to normocalcemic primary hyperparathyroidism (NPHPT). OBJECTIVE The aim of this study was to determine the association between NPHPT and blood pressure. DESIGN, SETTING, AND PATIENTS We retrospectively enrolled 940 patients who visited the Fujian Provincial Hospital between September 2010 and December 2013 with a measured serum parathyroid hormone (PTH) and calcium level. Among them, 11 patients were diagnosed with NPHPT, while 296 cases with normal PTH and albumin-adjusted serum calcium. MAIN OUTCOMES MEASURES Systolic blood pressure (SBP), diastolic blood pressure (DBP), intact serum PTH, and serum calcium were recorded. RESULTS There were no significant differences between subjects identified with NPHPT and those with normal PTH in terms of age, sex, body mass index, serum calcium, 25-Hydroxyvitamin D, serum creatinine, fasting plasma glucose, triglycerides, total cholesterol, high density lipoprotein, and low density lipoprotein. The subjects with a diagnosis of NPHPT had higher levels of SBP (141.9 ± 20.2 vs 131.2 ± 16.5, P = .041) and DBP (85.2 ± 12.4 vs 76.8 ± 10.3, P = .026) than the subjects in the cohort with normal PTH. After adjustment for all potential confounders, risks (odds ratios and 95% confidence interval) of SBP and DBP in NPHPT patients were 1.035 (1.000, 1.071) and 1.063 (1.004, 1.125), respectively (P < .05). CONCLUSIONS The NPHPT had higher risk of high blood pressure than subjects with normal PTH. It is worth considering the necessity of more aggressive therapeutic intervention aimed to normalize PTH even if patients with NPHPT continue to be normocalcemic.

Overweight, obesity, and their associations with insulin resistance and β-cell function among Chinese: a cross-sectional study in China.

The aim of this study was to evaluate the associations of body mass index (BMI) with insulin resistance and β-cell function in subjects with normal glucose tolerance. A cross-sectional study was carried out in Fujian province by multistratified sampling from July 2007 to May 2008. The sample consisted of 2931 subjects aged from 20 to 79 years. The questionnaires, physical examinations, and laboratory tests were obtained from all the participants. The homeostasis model assessment of insulin resistance (HOMA-IR) index was used to estimate insulin sensitivity, insulin secretion was assessed using the HOMA-β index, and β-cell function was quantified as the ratio of the incremental insulin to glucose responses over the first 30 minutes during the oral glucose tolerance test (ΔI30/ΔG30). Another measure was adjusted for insulin sensitivity as it modulates β-cell function ([ΔI30/ΔG30]/HOMA-IR). Associations of BMI with morbidities were estimated using multiple logistic regression analysis. Relationships of BMI to insulin resistance and β-cell function were assessed using multiple linear regression analysis and analysis of covariance. The age- and sex-adjusted prevalence of overweight and obesity was 23.04% (27.44% in men and 18.40% in women) and 2.65% (2.75% in men and 2.55% in women), respectively. After adjustment for covariables, BMI was independently associated with morbidity conditions; and there were increasing trend for odds ratios of morbidities across the BMI categories. There were independent differences for HOMA-IR, HOMA-β, and ΔI30/ΔG30 between the normal-weight, overweight, and obese groups except for (ΔI30/ΔG30)/HOMA-IR. Body mass index was significantly and independently associated with HOMA-IR, HOMA-β, and ΔI30/ΔG30 in the multiple linear regression analysis. Body mass index was an independent risk factor for hypertension, type 2 diabetes mellitus, dyslipidemia, metabolic syndrome, as well as the indexes of insulin resistance and β-cell function. It is imperative that the whole society pay more attention to the identification and intervention of overweight and obesity to prevent obesity-related diseases at the very early stage.

Retrospective analysis of thyroid nodules by clinical and pathological characteristics, and ultrasonographically detected calcification correlated to thyroid carcinoma in South China.

Objective: To investigate the clinical and pathological characteristics of thyroid nodules, as well as to evaluate the significance of ultrasonographically detected thyroid calcification in the diagnosis of thyroid carcinomas. Methods: Retrospective data were studied from 1,051 consecutive patients who underwent a thyroidectomy in the Provincial Hospital of Fujian Medical University in South China between January 2003 and July 2006 for nodular thyroid disease. Complete sonographical information before surgery was only collected from 758 of the 1,051 patients. Results: Among the 1,051 patients, benign lesions were found in 857 (81.54%) patients, of whom 612 (71.41%) were nodular goiter; malignant lesions were found in 194 (18.46%) patients, in whom benign thyroid lesions were also found in 85 (43.81%) patients. A total of 48 patients suffered from microcarcinomas, of whom 37 patients had benign lesions; these 37 accounted for 43.53 and 77.08%, respectively, of the 85 malignant cases with benign lesions and the 48 cases with microcarcinomas. In the 758 patients who underwent thyroid ultrasonography before surgery, intrathyroidal calcifications were apparent in 243 patients (32.06%). The incidence of calcification was significantly higher in patients with thyroid carcinoma (54.17%) than in those with benign lesions (26.87%; p < 0.005). Detection of calcification in thyroid lesions by ultrasound had a sensitivity of 32.38% and a specificity of 87.35%, with an OR of 3.31 (95% CI, 2.24–4.63), positive likelihood ratio of 2.56, negative likelihood ratio of 0.77 and a κ value of 0.23. Conclusion: Thyroid carcinoma, especially microcarcinoma, often coexists with benign thyroid disease. Calcification detected by thyroid ultrasound represents a risk factor for malignancy, but is of limited use as a sole marker of malignancy.

Diabetes, pre‐diabetes and associated risks on Minnesota code‐indicated major electrocardiogram abnormality among Chinese: a cross‐sectional diabetic study in Fujian province, southeast China

The goal of this study was to determine the prevalence of diabetes mellitus (DM), impaired glucose regulation (IGR) and related metabolic disorders (overweight, obesity and hypertension) in a Chinese population (20–74 years old). An additional goal was to investigate the relationship between glucose metabolism and the Minnesota code‐indicated major abnormal electrocardiogram (MA‐ECG). There were 3960 individuals selected from urban and rural areas of Fujian, China from July 2007 to May 2008 by multistage‐stratified sampling. Ultimately, data from 3208 subjects (20–74 years old) were analysed (including physical measurements, blood biochemical analysis, oral glucose tolerance test and 12‐lead resting ECG). According to World Health Organization diagnostic criteria, the prevalence rates of DM and IGR were 9.51% (male, 10.08%; female, 9.14%) and 14.40% (male, 14.48%; female, 14.35%) respectively. Newly diagnosed DM was found in 53.44% of the diabetic subjects. Based on the 2000 China census, the age‐standardized prevalence rates of DM and IGR were 7.19% (male, 7.74%; female, 6.61%) and 11.96 % (male, 12.35%; female, 11.56%) respectively. The age‐standardized prevalence rates of DM and IGR in urban areas (7.74% and 12.97% respectively) were slightly but no significantly higher than in rural areas (6.67%, 10.86%). The prevalence rates of overweight, obesity and hypertension were 25.50%, 3.52% and 28.52% respectively (age‐ and sex‐ standardized rates: 23.69%, 3.02 % and 22.45 %). After adjusting for other confounding risk factors, multiple logistic regression analysis showed that DM and impaired glucose tolerance were independent risk factors for MA‐ECG. Non‐diabetic subjects with increased 30‐min plasma glucose (PG) after an oral glucose load had a higher risk of MA‐ECG after adjusting for other risk factors, especially in those with normal glucose tolerance but with 30‐min PG ≥ 7.8 mmol L−1 (odds ratio = 1.371 [1.055–1.780]). The prevalence rates of DM and IGR as well as other metabolic disorders have increased dramatically in the last decade in China, especially in rural areas, with many undiagnosed cases of DM. Even slightly elevated PG levels may predict early cardiovascular events.

Body fat distribution and their associations with cardiovascular risk, insulin resistance and β-cell function: are there differences between men and women?

Objective:  The objective was to examine the independent and gender‐specific effects of WC and BMI on CVD risk factors, insulin resistance and β‐cell function.

Impact of Family History of Diabetes on β-Cell Function and Insulin Resistance Among Chinese with Normal Glucose Tolerance

OBJECTIVE This study investigated the impact of family history of diabetes (FHD) on β-cell function among Chinese with normal glucose tolerance. RESEARCH DESIGN AND METHODS A multistage, stratified, cluster random sampling method was used to select a provincially representative sample from Fujian Province. Eventually, a total of 1,183 subjects were entered into the analysis. Several indexes were used to assess the function of β cells, including homeostasis model assessment (HOMA) of insulin resistance (IR), HOMA of β cells, insulinogenic index (IGI), and disposition index. RESULTS Overweight, increased body mass index, higher low-density lipoprotein cholesterol, and higher total cholesterol (TC) were the dominant features of positive FHD (FHD(+)). The FHD(+) subjects had lower insulin sensitivity (P<0.05). FHD(+) subjects showed higher risk of IR after adjusting for other risk factors (odds ratio 1.523 [1.272-2.009]). However, there was no significant difference in insulin secretion between the two groups. With the use of the multiple linear regression model, waist circumference (WC) and triglycerides (TGs) were found to be independent risk factors of the decline of insulin sensitivity in FHD(+) subjects, and insulin sensitivity declined significantly (P<0.05) with the increase of WC and TGs. In addition, the offspring of fathers with diabetes (PT2D) were much older and had higher TC than those of mothers with diabetes (MT2D). After adjusting for gender of the parents, there was no difference between MT2D and PT2D on insulin sensitivity. CONCLUSIONS Inheritance if diabetes is associated with the decline of insulin sensitivity. In addition, insulin sensitivity declined with increasing WC and TG in FHD(+) subjects.

Cardiovascular disease (CVD) risk, insulin resistance and β-cell function in prehypertension population of China

OBJECTIVE To explore the cardiovascular disease (CVD) risk in prehypertensive subjects and evaluate whether high blood pressure (BP) is associated with insulin resistance (IR) and β-cell dysfunction. METHODS A total of 2949 people aged 20-94 years old were selected in Fujian province of China. We assessed CVD risk using Minnesota code-indicated major abnormal electrocardiography (MA-ECG) and presence of microalbuminuria in all population. IR/sensitivity and β-cell function indices were derived from an oral glucose tolerance test. RESULTS Prehypertensives with systolic/diastolic BP (SBP/DBP) 130-139/85-89 mm Hg had significant higher risk of MA-ECG and presence of microalbuminuria compared with normotensives (odds ratio [OR]: 1.483, 95% confidence interval [CI]: 1.016-2.165 and OR: 1.613, 95% CI: 1.142-2.277, respectively). In non-diabetic subjects, we found that prehypertensives and hypertensives had significant higher HOMA-IR and lower Matsudas insulin sensitivity index compared with normotensives. There was a slightly decreased trend in β-cell function assessed by disposition index (DIo) across the BP categories, when adjusted with age and BMI. The slight decline of DIo remained between hypertension and normotension, after additional adjustments were made, but the reduction of DIo lost statistic significance between prehypertension and normotension. CONCLUSIONS Prehypertensives with SBP/DBP 130-139/85-89 mm Hg have higher CVD risk than normotensives. Prehypertension and hypertension are both in IR condition, however, what is more important is that early β-cell dysfunction may exists in hypertension to some extent, while for prehypertension the compensation of β-cell function may be appropriate.