Lilin Gong

The risk factors of mild decline in estimated glomerular filtration rate in a community-based population

OBJECTIVES The study aimed to analyze the relationship between metabolic variables and estimated glomerular filtration rate (eGFR) and explore the potential risk factors for a mildly reduced eGFR in a community-based population. DESIGN AND METHODS Cross-sectional study in 643 adults without a history of kidney disease whose eGFR levels were greater than 60 mL/min/1.73 m(2) according to the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). Anthropometric measurements, blood pressure, fasting lipid profile and levels of fasting and post-load glucose, insulin, serum creatinine and uric acid (UA) were tested. The eGFR was calculated, and the correlations between eGFR and each variable were analyzed. RESULTS The subjects were divided into two groups by using 90 mL/min/1.73 m(2) as the cut-off value of the eGFR. In the lower eGFR group, the age, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), waist circumference (WC), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), 2 h post-load plasma glucose (2 h-PG) levels and UA were significantly increased, and the incidences of hypertension, diabetes, obesity, hypertriglyceridemia and hypercholesterolemia were also higher (P<0.05). A multiple linear stepwise regression analysis showed that the WC, SBP, FPG and UA were independently correlated with the eGFR after adjusting for the other covariables. CONCLUSIONS The WC, SBP, FPG and UA were closely related to the eGFR in the subjects whose eGFR levels were greater than 60 mL/min/1.73 m(2). The increased WC, SBP, FPG and UA may be the main risk factors for a mildly reduced eGFR.

The lipid accumulation product is highly related to serum alanine aminotransferase level in male adults

Studies confirm that the lipid accumulation product (LAP), which is based on the waist circumference and fasting serum triglycerides, is highly related to cardiovascular and metabolic diseases. Nonalcoholic fatty liver disease is a hepatic manifestation of metabolic syndrome and closely correlated with the alanine aminotransferase (ALT) elevation. Abdominal obesity and dyslipidemia are the important risk factors for nonalcoholic fatty liver disease. Our aim was to examine the correlation between the LAP and ALT in apparently healthy adults. We conducted a cross-sectional study of 587 adults. The blood pressure, anthropometric measurements, fasting and postload glucose, insulin, fasting lipid profile, and liver enzymes were measured. The LAP was calculated. For each gender, the subjects were divided into 3 groups according to the ALT level. The correlation between the LAP and ALT was analyzed. The LAP increased progressively across the ALT tertiles. A Pearson correlation analysis demonstrated that the LAP positively associated with the ALT in men and women (both P < .05) but independently related to the ALT only in men. Furthermore, after adjusting for the other confounding factors, the subjects in the upper quartile of LAP was 3.61 times more likely to show ALT elevation compared with those in the lower quartiles in men. In addition, in men, the LAP was considered as the best marker to predict increased ALT. Our findings suggested that the LAP was independently correlated with the ALT but only in men. The LAP was the main risk marker and might be superior to other variables in recognizing increased ALT.

Serum LBP Is Associated with Insulin Resistance in Women with PCOS.

Introduction Lipopolysaccharide-binding protein (LBP) is closely associated with many metabolic disorders. However, no study has been done to explore the relationship between LBP and polycystic ovary syndrome (PCOS). The objective of this study was to investigate whether the serum LBP level is elevated and associated with insulin resistance (IR) in PCOS. Participants and Design In this cross-sectional study, 117 PCOS patients and 121 age-matched controls were recruited. Hyperinsulinemic-euglycemic clamp was performed with an expression of M value for insulin sensitivity. Fasting serum samples were collected to detect LBP, lipids, insulin, sex hormones and high sensitive C reactive protein (hs-CRP). Pearson’s correlation and multiple linear regression was used to analyze the associations between M value and LBP level. Settings The study was performed in a clinical research center. Results Compared with controls, PCOS subjects had a significantly higher LBP concentration (33.03±14.59 vs. 24.35±10.31 μg/ml, p<0.001), and lower M value (8.21±3.06 vs. 12.31±1.72 mg/min/kg, p<0.001). Both in lean and overweight/obese individuals, serum LBP level was higher in PCOS subjects than that in controls. M value was negatively correlated with body mass index (BMI), fasting serum insulin, triglycerides, low-density lipoprotein cholesterol (LDL-c), free testosterone, high sensitive C reactive protein (hs-CRP) and LBP, whereas positively correlated with high-density lipoprotein cholesterol (HDL-c) and sex hormone binding globulin (SHBG). Serum LBP level was associated with M value after adjusting for BMI, fasting serum insulin, SHBG, as well as hs-CRP. Conclusion Serum LBP level significantly is elevated in PCOS, and is independently associated with IR in PCOS.

The impact of family history of type 2 diabetes on pancreatic β-cell function

AIMS To study the impact of genetic factor on pancreatic beta-cell function in the Chinese population. METHODS 233 first-degree relatives of patients with type 2 diabetes (T2D) with no history of blood glucose abnormalities and their 190 spouses, who did not have a family history of T2D, underwent a 75-g oral glucose tolerance test (OGTT). Based upon the OGTT, these two groups were further divided into three subgroups, including groups with normal glucose tolerance (NGT), impaired glucose regulation (IGR), and type 2 diabetes. Insulin resistance (IR) was evaluated using the homeostasis model assessment-IR (HOMA-IR), beta-cell function indices of basal and first-phase were measured by DI1 (HOMA-beta/HOMA-IR) and DI2 (DeltaI30/DeltaG30/HOMA-IR), respectively. RESULTS Among the first-degree relatives and their spouses, the HOMA-IR was highest in the T2D group and lowest in the NGT group. However, the HOMA-beta, DI1 and DI2 declined significantly with progressive reductions in glucose tolerance (P<0.01 or 0.05). DI1 and DI2 of the NGT group of first-degree relatives (FNGT) were significantly lower than those of the spouse NGT (SNGT) group (P<0.05). DI1 and DI2 of the IGR of first-degree relatives (FIGR) group were significantly lower than those of the spouse IGR (SIGR) group. CONCLUSIONS Defects in pancreatic beta-cell function exist in the first-degree relatives, who have different glucose tolerance statuses, of T2D patients. These defects are more profound in FNGT and FIGR when compared to their spouses in corresponding glucose tolerance subgroups. However, there is no difference in IR between the corresponding glucose tolerance subgroups of the first-degree relatives and their spouses. It suggests that the genetic factor possibly aggravates beta-cell lesion.

The Great Chinese Famine Exposure in Early Life and the Risk of Nonalcoholic Fatty Liver Disease in Adult Women

INTRODUCTION AND AIM Previous studies found famine exposure was associated with a higher risk of metabolic syndrome (MetS). In the study, we investigated the relationship between Chinese famine exposure and the risk of nonalcoholic fatty liver disease (NAFLD) in adult women. MATERIALS AND METHODS Data were obtained from subjects via routine physical examinations in the Public Health Center of our hospital between 2011 and 2014. Women were categorized into the following three groups: control, pre-natally exposed, and postnatally exposed. Hepatic steatosis was diagnosed according to the guidelines established for the diagnosis and treatment of NAFLD. RESULTS The prevalence rates of NAFLD among non-exposed, prenatally, and postnatally exposed women were 17.3, 23.0, and 22.9%, respectively. Pre-exposed and postnatally exposed women had higher risks of NAFLD, exhibiting ORs (95% CI) of 1.33 (1.04-1.70) and 1.26 (1.03-1.55), respectively. Prenatally, but not postnatally, exposed women had significantly higher risks of having abnormal alanine aminotransferase (ALT), with ORs of 1.30 (1.05-1.61). CONCLUSIONS The results indicate a significant association between famine exposure in early life and the risk of NAFLD in adult women. Prenatally exposed women displayed higher risks of NAFLD and mild, moderate and severe steatosis.INTRODUCTION AND AIM Previous studies found famine exposure was associated with a higher risk of metabolic syndrome (MetS). In the study, we investigated the relationship between Chinese famine exposure and the risk of nonalcoholic fatty liver disease (NAFLD) in adult women. MATERIALS AND METHODS Data were obtained from subjects via routine physical examinations in the Public Health Center of our hospital between 2011 and 2014. Women were categorized into the following three groups: control, prenatally exposed, and postnatally exposed. Hepatic steatosis was diagnosed according to the guidelines established for the diagnosis and treatment of NAFLD. RESULTS The prevalence rates of NAFLD among non-exposed, prenatally, and postnatally exposed women were 17.3, 23.0, and 22.9%, respectively. Pre-exposed and postnatally exposed women had higher risks of NAFLD, exhibiting ORs (95% CI) of 1.33 (1.04-1.70) and 1.26 (1.03-1.55), respectively. Prenatally, but not postnatally, exposed women had significantly higher risks of having abnormal alanine aminotransferase (ALT), with ORs of 1.30 (1.05-1.61). CONCLUSIONS The results indicate a significant association between famine exposure in early life and the risk of NAFLD in adult women. Prenatally exposed women displayed higher risks of NAFLD and mild, moderate and severe steatosis.

Efficacy of metformin‐based oral antidiabetic drugs is not inferior to insulin glargine in newly diagnosed type 2 diabetic patients with severe hyperglycemia after short‐term intensive insulin therapy

Insulin therapy should be strongly considered in newly diagnosed type 2 diabetic (T2D) patients with severe hyperglycemia. However, whether insulin be continued or patients switched to an oral antidiabetic drug (OAD) after short‐term intensive insulin therapy (ITT) is not clear.

A Novel Visceral Adiposity Index for Prediction of Type 2 Diabetes and Pre-diabetes in Chinese adults: A 5-year prospective study

The Chinese visceral adiposity index (CVAI) is a recently developed indicator of visceral adiposity. We investigated the predictive value of the CVAI for the development of dysglycemia (pre-diabetes and type 2 diabetes) and compared its predictive power with that of the Visceral adiposity index (VAI) and various anthropometric indices. This community-based study included 2,383 participants. We assessed the predictive power of adiposity indices by performing univariate and multivariate binary logistic regression analysis and calculating the area under the receiver-operating characteristic (ROC) curve according to their quartiles. Logistic regression analysis showed that individuals in higher CVAI quartiles at baseline were more likely to develop dysglycemia than those in lower CVAI quartiles. The area under the ROC curve for CVAI was significantly higher than that of other adiposity indices. In addition, among the various adiposity indices tested, the CVAI had the greatest Youden index for identifying dysglycemia in both genders. Our data demonstrate that the CVAI is a better predictor of type 2 diabetes and pre-diabetes than the VAI, BMI, waist circumference, waist-to-hip ratio and waist-to-height ratio in Chinese adults.

The FOXO1 Gene-Obesity Interaction Increases the Risk of Type 2 Diabetes Mellitus in a Chinese Han Population

Here, we aimed to study the effect of the forkhead box O1-insulin receptor substrate 2 (FOXO1-IRS2) gene interaction and the FOXO1 and IRS2 genes-environment interaction for the risk of type 2 diabetes mellitus (T2DM) in a Chinese Han population. We genotyped 7 polymorphism sites of FOXO1 gene and IRS2 gene in 780 unrelated Chinese Han people (474 cases of T2DM, 306 cases of healthy control). The risk of T2DM in individuals with AA genotype for rs7986407 and CC genotype for rs4581585 in FOXO1 gene was 2.092 and 2.57 times higher than that with GG genotype (odds ratio [OR] = 2.092; 95% confidence interval [CI] = 1.178–3.731; P = 0.011) and TT genotype (OR = 2.571; 95% CI = 1.404–4.695; P = 0.002), respectively. The risk of T2DM in individuals with GG genotype for Gly1057Asp in IRS2 gene was 1.42 times higher than that with AA genotype (OR = 1.422; 95% CI = 1.037–1.949; P = 0.029). The other 4 single nucleotide polymorphisms (SNPs) had no significant association with T2DM (P > 0.05). Multifactor dimensionality reduction (MDR) analysis showed that the interaction between SNPs rs7986407 and rs4325426 in FOXO1 gene and waist was the best model confirmed by interaction analysis, closely associating with T2DM. There was an increased risk for T2DM in the case of non-obesity with genotype combined AA/CC, AA/AC or AG/AA for rs7986407 and rs4325426, and obesity with genotype AA for rs7986407 or AA for rs4325426 (OR = 3.976; 95% CI = 1.156–13.675; P value from sign test [Psign] = 0.025; P value from permutation test [Pperm] = 0.000–0.001). Together, this study indicates an association of FOXO1 and IRS2 gene polymorphisms with T2DM in Chinese Han population, supporting FOXO1-obesity interaction as a key factor for the risk of T2DM.

Increased β-Cell Mass in Obese Rats after Gastric Bypass: A Potential Mechanism for Improving Glycemic Control

Background Over the past few decades, bariatric surgery, especially Roux-en-Y gastric bypass (RYGB), has become widely considered the most effective treatment for morbid obesity. In most cases, it results in enhanced glucose management in patients with obesity and type 2 diabetes (T2D), which is observed before significant weight loss. However, what accounts for this effect remains controversial. To gain insight into the benefits of RYGB in T2D, we investigated changes in the β-Cell mass of obese rats following RYGB. Material/Methods RYGB or a sham operation was performed on obese rats that had been fed a high-fat diet (HFD) for 16 weeks. Then, the HFD was continued for 8 weeks in both groups. Additional normal chow diet (NCD) and obese groups were used as controls. Results In the present study, RYGB induced improved glycemic control and enhanced β-Cell function, which was reflected in a better glucose tolerance and a rapidly increased secretion of insulin and C-peptide after glucose administration. Consistently, rats in the RYGB group displayed increased β-Cell mass and islet numbers, which were attributed in part to increased glucagon-like peptide 1 levels following RYGB. Conclusions Our data indicate that RYGB can improve β-Cell function via increasing β-Cell mass, which plays a key role in improved glycemic control after RYGB.