Xiuxia Han

Prevalence of Type 2 Diabetes among Newly Detected Pulmonary Tuberculosis Patients in China: A Community Based Cohort Study

Background Patients with type 2 diabetes (DM) have a higher risk of developing pulmonary tuberculosis (PTB); moreover, DM co-morbidity in PTB is associated with poor PTB treatment outcomes. Community based prevalence data on DM and prediabetes (pre-DM) among TB patients is lacking, particularly from the developing world. Therefore we conducted a prospective study to investigate the prevalence of DM and pre-DM and evaluated the risk factors for the presence of DM among newly detected PTB patients in rural areas of China. Methods and Findings In a prospective community based study carried out from 2010 to 2012, a representative sample of 6382 newly detected PTB patients from 7 TB clinics in Linyi were tested for DM. A population of 6674 non-TB controls from the same community was similarly tested as well. The prevalence of DM in TB patients (6.3%) was higher than that in non-TB controls (4.7%, p<0.05). PTB patients had a higher odds of DM than non-TB controls (adjusted OR 3.17, 95% CI 1.14–8.84). The prevalence of DM increased with age and was significantly higher in TB patients in the age categories above 30 years (p<0.05). Among TB patients, those with normal weight (BMI 18.5–23.9) had the lowest prevalence of DM (5.8%). Increasing age, family history of DM, positive sputum smear, cavity on chest X-ray and higher yearly income (≥10000 RMB yuan) were positively associated and frequent outdoor activity was negatively associated with DM in PTB patients. Conclusions The prevalence of DM in PTB patients was higher than in non-TB controls with a 3 fold higher adjusted odds ratio of having DM. Given the increasing DM prevalence and still high burden of TB in China, this association may represent a new public health challenge concerning the prevention and treatment of both diseases.

Factors Associated with Patient and Provider Delays for Tuberculosis Diagnosis and Treatment in Asia: A Systematic Review and Meta-Analysis

Background Delays in tuberculosis (TB) diagnosis and treatment is a major barrier to effective management of the disease. Determining the factors associated with patient and provider delay of TB diagnosis and treatment in Asia may contribute to TB prevention and control. Methods We searched the PubMed, EMBASE and Web of Science for studies that assessed factors associated with delays in care-seeking, diagnosis, or at the beginning of treatment, which were published from January 1992 to September 2014. Two reviewers independently identified studies that were related to our meta-analysis and extracted data from each study. Independent variables were categorized in separate tables for patient and provider delays. Results Among 45 eligible studies, 40 studies assessed patient delay whereas 30 assessed provider delay. Cross-sectional surveys were used in all but two articles, which included 17 countries and regions. Socio-demographic characteristics, TB-related symptoms and medical examination, and conditions of seeking medical care in TB patients were frequently reported. Male patients and long travel time/distance to the first healthcare provider led to both shorter patient delays [odds ratio (OR) (95% confidence intervals, CI) = 0.85 (0.78, 0.92); 1.39 (1.08, 1.78)] and shorter provider delays [OR (95%CI) = 0.96 (0.93, 1.00); 1.68 (1.12, 2.51)]. Unemployment, low income, hemoptysis, and positive sputum smears were consistently associated with patient delay [ORs (95%CI) = 1.18 (1.07, 1.30), 1.23 (1.02, 1.49), 0.64 (0.40, 1.00), 1.77 (1.07, 2.94), respectively]. Additionally, consultation at a public hospital was associated with provider delay [OR (95%CI) = 0.43 (0.20, 0.91)]. Conclusions We propose that the major opportunities to reduce delays involve enabling socio-demographic factors and medical conditions. Male, unemployed, rural residence, low income, hemoptysis, positive sputum smear, and long travel time/distance significantly correlated with patient delay. Male, long travel time/distance and consultation at a public hospital were related to provider delay.

Vitamin E supplementation protects erythrocyte membranes from oxidative stress in healthy Chinese middle-aged and elderly people

Elderly people are subject to higher levels of oxidative stress than are young people. Vitamin E, as a powerful antioxidant residing mainly in biomembranes, may provide effective protection against oxidative membrane damage and resultant age-related deterioration, especially in the elderly. We hypothesized that appropriate levels of vitamin E supplementation would protect erythrocyte membranes from oxidative stress and thus improve membrane fluidity in healthy middle-aged and elderly people. To test this, we conducted a 4-month double-blind, randomized trial in which 180 healthy subjects (55-70 years old) were randomly divided into 4 groups: group C (control), and 3 treatment groups in which daily doses of 100 mg (VE1), 200 mg (VE2), and 300 mg (VE3) dl-α-tocopheryl acetate were administered. We measured plasma α-tocopherol concentration, malondialdehyde, and superoxide dismutase levels, erythrocyte hemolysis, and erythrocyte membrane fluidity at the beginning and end of the trial. After 4 months supplementation, plasma α-tocopherol concentrations in the 3 treatment groups had increased by 71%, 78%, and 95%, respectively (all P < .01), and significant decreases in plasma malondialdehyde concentrations were observed in these groups (all P < .05). Erythrocyte hemolysis was decreased by 20% to 38% after vitamin E supplementation (all P < .05), and in addition, groups VE2 and VE3 showed dramatic improvements in erythrocyte membrane fluidity (P < .01). Surprisingly, superoxide dismutase activity also decreased significantly in the treatment groups (all P < .05). In summary, vitamin E supplementation apparently alleviates oxidative stress in healthy middle-aged to elderly people, at least in part by improving erythrocyte membrane fluidity and reducing erythrocyte hemolysis.

Effects of vitamin E on plasma lipid status and oxidative stress in Chinese women with metabolic syndrome.

Following the change of dietary structure and living style, metabolic syndrome (MetS) has become increasingly common in China, especially in women, who have abnormal plasma lipid profiles with increased levels of oxidative stress. Vitamin E (VitE) is a powerful chain-breaking antioxidant, which may be a protective factor against oxidative stress-related diseases. This study investigated the effects of three different dosages of tocopherol supplementation (100 IU /day, 200 IU /day, 300 IU /day) for 4 months in Chinese women with MetS. The plasma VitE concentrations increased significantly after the 4 months of supplementation (p < 0.01). The protective decreases in plasma total cholesterol were significant in 200 IU/day and 300 IU/day VitE groups (p < 0.05), but decreases in high-density lipoprotein cholesterol were also significant in all the supplementation groups (p < 0.05). Plasma triglycerides were unaltered (p > 0.05). The indicators of oxidative stress decreased substantially in all of the VitE supplementation groups: malondialdehyde (MDA) was reduced by nearly 50 percent (all groups, p < 0.001), erythrocyte hemolysis was decreased by nearly 40 percent (all groups, p < 0.05); among which the 300IU/day VitE group showed the most significant effect. However, the activity of superoxide dismutase (SOD) decreased after the trial (p < 0.001). VitE provided marked benefits in reducing oxidative stress levels and improving lipid status in women with MetS. Although no dose-effect relationship was observed, 300 IU VitE per day showed the optimal effect. Research is needed to identify potential protective mechanisms or utilization of vitamin E during MetS.

Relation of Leptin, Ghrelin and Inflammatory Cytokines with Body Mass Index in Pulmonary Tuberculosis Patients with and without Type 2 Diabetes Mellitus

Background Pulmonary tuberculosis (TB) patients often suffer from anorexia and poor nutrition, causing weight loss. The peptide hormones leptin and its counterpart ghrelin, acting in the regulation of food intake and fat utilization, play an important role in nutritional balance. This study aimed to investigate the association of blood concentrations of leptin, ghrelin and inflammatory cytokines with body mass index (BMI) in TB patients with and without type 2 diabetes mellitus (T2DM). Methods BMI, biochemical parameters and plasma levels of leptin, ghrelin and inflammatory cytokines were measured before the start of treatment in 27 incident TB patients with T2DM, 21 TB patients and 23 healthy subjects enrolled in this study. Results The levels of leptin were significantly higher in TB patients (35.2±19.1 ng/ml) than TB+T2DM (12.6±6.1 ng/ml) and control (16.1±11.1 ng/ml) groups. The level of ghrelin was significantly lower in TB (119.9±46.1 pg/ml) and non-significantly lower in TB+T2DM (127.7±38.6 pg/ml) groups than control (191.6±86.5 pg/ml) group. The levels of TNF-α were higher, while IFN-γ and IL-6 levels were lower in patients than in the control group. Leptin showed a negative correlation with BMI in TB (r=-0.622, p<0.05) and TB+T2DM (r= -0.654, p<0.05) groups, but a positive correlation with BMI in the control group (r=0.521, p<0.05). Contrary ghrelin showed a positive correlation with BMI in TB (r=0.695, p<0.05) and TB+T2DM (r= 0.199, p>0.05) groups, but negative correlation with BMI in the control (r=-0.693, p<0.05) group. Inflammatory cytokines were poorly correlated with BMI in this study. Only IFN-γ showed a significant negative correlation with BMI in the control group (r=-0.545, p<0.05). Conclusions This study may suggest that possible abnormalities in ghrelin and leptin regulation (high levels of leptin and low levels of ghrelin) may be associated with low BMI and may account for the poor nutrition associated with TB and TB+T2DM.

Screening and intervention of diabetes mellitus in patients with pulmonary tuberculosis in poverty zones in China: rationale and study design.

BACKGROUND The merging epidemics of pulmonary tuberculosis (PTB) and diabetes mellitus (DM) have been raised concerns by many experts but no large scale screening and intervention have been launched yet, especially in low-income areas. The current study aims to understand the prevalence of DM in active PTB patients and evaluate the outcomes of diet and living habit intervention in poverty zones in China. METHODS/DESIGN A cross-sectional investigation and intervention study will be carried out. At least 7000 active PTB patients will be recruited, together with 7000 nonTB persons from the same community. The project will be divided into two stages. The first stage is to train TB workers on DM screening and regular treatment. Screening and related investigation will be carried out afterwards. The second stage is focussed on intervention. A comprehensive strategy will be utilized to conduct health promotion among the patients, the health providers and the lay public. DISCUSSION To our knowledge, this is the first and largest study which focuses on the prevalence of DM in PTB in China. We hypothesize that the current prevalence of DM in PTB in China will be understood and the results of our study will provide important evidence for preventing and controlling DM and PTB.

Correlations between Drug Resistance of Beijing/W Lineage Clinical Isolates of Mycobacterium tuberculosis and Sublineages: A 2009–2013 Prospective Study in Xinjiang Province, China

Background The prevalence of drug-resistant tuberculosis (TB) in Xinjiang is higher than in other regions of China, and Beijing/W lineage Mycobacterium tuberculosis (MTB) is the dominant strain of MTB in Xinjiang. However, information on multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, particularly the correlation between MDR and the Beijing/W lineage and the correlation between drug resistance and the Beijing/W sublineage strains, is limited. Material/Methods We conducted a prospective study to describe the prevalence of MDR/XDR TB, Beijing/W lineage and sublineage strains in Xinjiang in China from 2009 to 2013. All MTB underwent drug susceptibility testing to the first- and second-line anti-tuberculosis drugs. The Beijing/W lineages and sublineages were detected by large-sequence polymorphisms with polymerase chain reaction. Results A total of 410 clinical isolates were identified. The overall percentage of MDR and XDR cases in Xinjiang was 13.2% (54/410) and 13.0% (7/54), respectively. Overall, 9.8% (14/143) of the Beijing lineage MTB were MDR patients, and 15.6% (40/257) of the Non-Beijing lineage MTB were MDR patients. In the 143 Beijing MTB lineages, 11.2% isolates were in sublineage 105, 15.4% isolates were in sublineage 207, 69.2% isolates were in sublineage 181, and 4.2% isolates were in sublineage 150. None of the isolates were detected in sublineage 142. Significant differences between the Beijing/W and non-Beijing/W strains were observed regarding INH and EMB resistance, respectively. Conclusions The prevalence of the MDR TB in Xinjiang remains high and imposes challenges for TB control. Four Beijing/W sublineage isolates were observed in Xinjiang. There was no correlation between MDR and the Beijing/W lineage and no correlation between drug resistance and the Beijing/W sublineage strains. Surveillance of the clinical isolates of MTB is recommended to strengthen the identification of MDR/XDR TB and sublineages of the Beijing/W strains.

Is low serum 25-hydroxyvitamin D a possible link between pulmonary tuberculosis and type 2 diabetes?

BACKGROUND AND OBJECTIVES Although vitamin D is implicated in the generation of anti-microbial peptide cathelicidin, which plays a key role against pulmonary tuberculosis (PTB), and may have an inverse association with the risk of type 2 diabetes (DM), its role in the co-existence of these two diseases (PTB-DM) is still uncertain. This study explored the association of vitamin D status with prevalent PTB, PTB-DM and DM. METHODS AND STUDY DESIGN We randomly selected 130 PTB patients, 90 PTB-DM, 91 DM and 134 controls. Serum 25(OH)D levels were determined. A structured questionnaire and anthropometric measurements were administered. RESULTS Serum 25(OH)D levels in PTB and PTB-DM were 12.2±2.2 ng/mL and 12.9±2.5 ng/mL, respectively, which were lower than those in DM and control groups. Odds ratios of PTB and PTB-DM comparing extreme quartiles of 25(OH)D (lower than 8.6 ng/mL versus >=26.6 ng/mL) were 3.26 and 2.27, respectively. These associations remained after adjustment for possible risk factors [OR (95% CI)=4.73 (2.04-10.9) and 2.50 (1.04- 6.02), respectively]. A synergistic interaction was observed between low 25(OH)D and underweight in respect to prevalent PTB-DM [OR=24.6 vs 2.50 for lowest quartile of 25(OH) D and 4.59 for underweight]. CONCLUSIONS Odds ratios of low serum 25(OH)D levels for PTB and PTB-DM were greater than 1.0, and were even much greater when combined with underweight. However, since the association of serum 25(OH)D levels with PTB was stronger than with PTB-DM, we could not draw the conclusion that vitamin D is a link between PTB and DM.

Hyperglycemia is associated with increased risk of patient delay in pulmonary tuberculosis in rural areas

第一次出现肺结核(PTB)症状与诊断之间的间隔时间过长可导致结核不断传播,并且也增加了在社区中传染的风险,除此之外还可以导致疾病加重,死亡率增高。2型糖尿病(T2DM)患者发生PTB的风险更高。然而,目前还尚未完全明确T2DM对PTB的诊断延误有何影响。这项研究在中国的一个农村地区调查了高血糖(糖尿病与糖尿病前期)以及其他因素对PTB患者诊断延误的影响。

Antioxidant micronutrient supplementation increases erythrocyte membrane fluidity in adults from a rural Chinese community

The objective of the present study was to investigate age-related differences in erythrocyte membrane fluidity (EMF) and changes in antioxidant capacity following supplementation. A total of seventy-four children were randomly divided into two groups: group A1 was the placebo-controlled group and group A2 was supplemented daily with 600 μg retinol, 1·0 mg β-carotene, 100 mg tocopherol, 300 mg ascorbic acid and 200 μg Se. A total of ninety young people were randomly divided into B1 and B2 groups, and ninety-one elderly subjects were divided into C1 and C2 groups. Groups B1 and C1 were placebo-controlled groups, and groups B2 and C2 were daily supplemented with 900 μg retinol, 1·5 mg β-carotene, 200 mg tocopherol, 500 mg ascorbic acid and 400 μg Se. Results showed that plasma malondialdehyde (MDA) was 5·35 μmol/l in children, which was lower than in young and elderly people. The MDA levels of the young and elderly individuals in the treated groups were significantly lower compared with the control groups, but the supplementation did not alter MDA levels in children. At baseline, there was a lower value of polarisation (ρ) and microviscosity (η) in children, indicating a higher EMF, than in both the young and elderly subjects. After the 2-month trial, the ρ and η values of young and elderly subjects in the treated groups decreased significantly in comparison with the placebo groups, indicating an increase in EMF. In conclusion, there was a background of higher MDA levels and lower EMF in young and elderly people than in children, which could be improved by antioxidant supplementation.