Xueli Zhang

Neck circumference as an effective measure for identifying cardio-metabolic syndrome: a comparison with waist circumference

Neck circumference is a new anthropometric index for estimating obesity. We aimed to determine the relationship between neck circumference and body fat content and distribution as well as the efficacy of neck circumference for identifying visceral adiposity and metabolic disorders. A total of 1943 subjects (783 men, 1160 women) with a mean age of 58u2009±u20097 years were enrolled in this cross-sectional study. Metabolic syndrome was defined according to the standard in the 2013 China Guideline. Analyses were conducted to determine optimal neck circumference cutoff points for visceral adiposity quantified by magnetic resonance imaging, and to compare the performance of neck circumference with that of waist circumference in identifying abdominal obesity and metabolic disorders. Visceral fat content was independently correlated with neck circumference. Receiver operating characteristic curves showed that the area under the curve for the ability of neck circumference to determine visceral adiposity was 0.781 for men and 0.777 for women. Moreover, in men a neck circumference value of 38.5u2009cm had a sensitivity of 56.1u2009% and specificity of 83.5u2009%, and in women, a neck circumference value of 34.5u2009cm had a sensitivity of 58.1u2009% and specificity of 82.5u2009%. These values were the optimal cutoffs for identifying visceral obesity. There were no statistically significant differences between the proportions of metabolic syndrome and its components identified by an increased neck circumference and waist circumference. Neck circumference has the same power as waist circumference for identifying metabolic disorders in a Chinese population.

Osteocalcin value to identify subclinical atherosclerosis over atherosclerotic cardiovascular disease (ASCVD) risk score in middle-aged and elderly Chinese asymptomatic men

Abstract Background: Our study examined whether osteocalcin contributed to identifying carotid intima-media thickness (C-IMT) over the atherosclerotic cardiovascular disease (ASCVD) risk score. Methods: We recruited 618 middle-aged and elderly men from communities in Shanghai. Serum osteocalcin levels were determined using an electrochemiluminescence immunoassay. C-IMT was measured by ultrasonography. Results: The study included 245 men with low ASCVD risk and 373 men with moderate-to-high ASCVD risk. Serum osteocalcin levels were lower in the moderate-to-high risk vs. low risk men (p=0.042). Multivariate stepwise regression analysis showed that body mass index (BMI) and glycated hemoglobin were predictors for reduced osteocalcin levels (both p<0.001). Among all subjects, the proportion with an elevated C-IMT was higher in the low-osteocalcin group than in the high-osteocalcin group (p=0.042), and the significance of this result was greater when considering only subjects with a moderate-to-high ASCVD risk (p=0.011). The recognition rate of elevated C-IMT was superior with both low osteocalcin and moderate-to-high ASCVD risk vs. either parameter alone (p<0.001 and p=0.015, respectively). Osteocalcin was independently and inversely associated with elevated C-IMT after adjusting for the 10-year ASCVD risk score (p=0.004). The negative relationship remained statistically significant in subjects with a moderate-to-high ASCVD risk in particular (standardized β=−0.104, p=0.044). Conclusions: In middle-aged and elderly men, serum osteocalcin levels strengthen identifying subclinical atherosclerosis over ASCVD risk score, especially among subjects with a moderate-to-high ASCVD risk.

Contribution of serum FGF21 level to the identification of left ventricular systolic dysfunction and cardiac death

AimThe relationship between fibroblast growth factor 21 (FGF21) and cardiovascular disease has been well established in recent studies. This study aimed to investigate the relationship between FGF21 and left ventricular systolic dysfunction and cardiac death.MethodsTwo-dimensional echocardiography was used to measure the left ventricular ejection fraction (LVEF) to estimate left ventricular systolic function. The optimal cutoff of FGF21 for identifying left ventricular systolic dysfunction at baseline was analyzed via receiver operating characteristic (ROC) curves. The identification of different serum levels of FGF21 and their association with cardiac death was analyzed via Kaplan–Meier survival curves. Serum FGF21 level was measured by an enzyme-linked immunosorbent assay kit, and serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) level was determined by a chemiluminescent immunoassay.ResultsA total of 253 patients were recruited for this study at baseline. Patients were excluded if they lacked echocardiography or laboratory measurement data, and there were 218 patients enrolled in the final analysis. The average age was 66.32xa0±xa010.10xa0years. The optimal cutoff values of FGF21 and NT-pro-BNP for identifying left ventricular systolic dysfunction at baseline were 321.5xa0pg/mL and 131.3xa0ng/L, respectively, determined separately via ROC analysis. The areas under the curves were non-significant among FGF21, NT-pro-BNP and FGF21xa0+xa0NT-pro-BNP as determined by pairwise comparisons. Both a higher serum level of FGF21 and a higher serum level of NT-pro-BNP were independent risk factors for left ventricular systolic dysfunction at baseline (odd ratio (OR) 3.138 [1.037–9.500], Pxa0=xa00.043, OR 9.207 [2.036–41.643], Pxa0=xa00.004, separately). Further Kaplan–Meier survival analysis indicated an association between both a higher serum level of FGF21 and a higher serum level of NT-pro-BNP with cardiac death in 5xa0years [RR 5.000 (1.326–18.861), Pxa0=xa00.026; RR 9.643 (2.596–35.825), Pxa0=xa00.009, respectively].ConclusionsSerum FGF21 level was significantly correlated with left ventricular systolic dysfunction at baseline. Patients with higher serum levels of FGF21 tended to suffer greater risks of cardiac death than patients with lower serum levels of FGF21. The identification of FGF21 and its relationship with left ventricular systolic function and cardiac death were non-inferior to NT-pro-BNP.

Association between serum osteocalcin level and blood pressure in a Chinese population

Abstract Purpose: This observational study investigated the association between serum osteocalcin level and blood pressure in a Chinese population. Materials and methods: A total of 2241 subjects (909 men and 1,332 women; age, 24–78 years) from Shanghai communities were recruited. Subjects were divided into non-hypertensive and hypertensive groups according to diagnosis of hypertension based on the 1999 World Health Organization-International Society of Hypertension Guidelines. Serum osteocalcin levels were measured using an electrochemiluminescence immunoassay. Results: Men in the hypertensive group showed lower serum osteocalcin level compared with those in the non-hypertensive group, [16.37 (13.34–20.11) ng/mL versus 17.01 (14.23–20.79) ng/mL, pu2009=u2009.039]. No difference in serum osteocalcin level was found between the two groups of women (pu2009=u2009.675). An inverse association was observed between serum osteocalcin level and systolic blood pressure (SBP) in men (pu2009=u2009.004), but serum osteocalcin level was not associated with diastolic blood pressure (DBP) in men (pu2009=u2009.472). No associations were detected between serum osteocalcin level and SBP or DBP in women (SBP: pu2009=u2009.108; DBP: pu2009=u2009.575). A multiple stepwise regression analysis showed an inverse association between serum osteocalcin level and SBP in men after adjusting for age, smoking status, family history of hypertension, and lipid and C-reactive protein levels (standardized βu2009=u2009–0.074, pu2009=u2009.023), but the association disappeared after adjustment for body mass index, waist circumference, blood glucose, and homeostasis model assessment of insulin resistance (pu2009=u2009.327). Conclusions: Serum osteocalcin level was not independently associated with blood pressure in a Chinese population.

Association of serum fibroblast growth factor 19 levels with visceral fat accumulation is independent of glucose tolerance status

BACKGROUND AND AIMSnRecent studies suggested that circulating fibroblast growth factor (FGF) 19 levels might be associated with the fat content and distribution, and varied with different glucose tolerance status. This study aimed to investigate the association of serum FGF19 levels with obesity and visceral fat accumulation in a Chinese population with differing glucose tolerance status.nnnMETHODS AND RESULTSnThe 2383 participants were divided into subgroups of glucose tolerance status: normal glucose tolerance (NGT, nxa0=xa01754), impaired glucose regulation (IGR, nxa0=xa0499), and newly diagnosed diabetes mellitus (DM, nxa0=xa0130). They were further stratified into quartiles of serum FGF19 levels (Q1-Q4). Visceral fat area (VFA) and subcutaneous fat area were measured using magnetic resonance imaging. FGF19 were detected via quantitative sandwich enzyme-linked immunosorbent assay. Serum FGF19 levels showed a downtrend across the NGT, IGR, and DM groups (P for trendxa0=xa00.016). VFA was an independent and negative factor of serum FGF19 levels (standardized βxa0=xa0-0.108, Pxa0=xa00.001). After adjustment for glucose tolerance status, VFA differed significantly among FGF19 quartiles (Pxa0<xa00.001), showing a downtrend from Q1-Q4. The associations of serum FGF19 levels and glucose tolerance status with VFA were independent of each other. After adjustment for insulin resistance and secretory function separately, VFA still decreased significantly from Q1-Q4 (all Pxa0<xa00.001).nnnCONCLUSIONnSerum FGF19 levels were related to visceral fat accumulation. Independent of glucose tolerance status, serum FGF19 levels were inversely associated with VFA.

Serum FGF21 Is Associated with Future Cardiovascular Events in Patients with Coronary Artery Disease.

Objectives: To investigate whether serum fibroblast growth factor 21 (FGF21) levels can be used to predict the future development of major adverse cardiovascular events (MACEs). Methods: This study included 253 patients who received subsequent follow-up, and complete data were collected for 234 patients. Independent predictors of MACEs were identified by using the Cox proportional-hazards regression analysis. The prognostic value of FGF21 levels for MACEs was evaluated by Kaplan-Meier survival analysis. Results: Of 229 patients finally enrolled in the analysis, 27/60 without coronary artery disease (CAD) at baseline experienced a MACE, and 132/169 patients with CAD at baseline experienced a MACE. Among patients with CAD at baseline, serum FGF21 levels were significantly higher in patients with MACEs (p < 0.05) than in patients without MACEs. Kaplan-Meier survival analysis showed patients with a higher serum FGF21 had a significantly lower event-free survival (p = 0.001) than those with a lower level. Further Cox proportional-hazards regression analysis, including the traditional risk factors for cardiovascular disease, showed that serum FGF21 was an independent predictor of MACE occurrence. Conclusions: In patients with CAD at baseline, an elevated serum FGF21 level was associated with the development of a MACE in the future.

Contribution of maternal diabetes to visceral fat accumulation in offspring

BACKGROUND/OBJECTIVESnGenetic and epidemiological studies provide evidence supporting the contribution of a genetic background of diabetes to the development of obesity and further suggest differences in the metabolic and cardiovascular risks between offspring with a paternal versus maternal family history of diabetes (FHD). The goal of this study was to explore the contribution of a parental FHD to visceral fat area (VFA).nnnSUBJECTS/METHODSnThis study enrolled 1875 subjects with normal glucose tolerance (age range: 20-78 years). VFA was assessed with magnetic resonance imaging.nnnRESULTSnThe study population consisted of 1573 subjects without a FHD, 115 subjects with a paternal FHD, and 187 subjects with a maternal FHD. For both genders, VFA was greater in offspring with a maternal FHD compared with those without a FHD (both P<0.05). For both genders, only VFA was an independent factor associated with a maternal FHD (both P<0.01). Compared with those without a FHD, men and women with a maternal FHD, but not those with a paternal FHD, were more likely to develop abdominal obesity (both P<0.05). After adjustment for independent factors related to VFA, VFA was increased by 9.60cm2 (standardized β=0.069, P=0.012) and 4.57cm2 (standardized β=0.056, P=0.007) in men and women with a maternal FHD, respectively.nnnCONCLUSIONnA maternal FHD contributed to visceral fat accumulation independently in both genders. Maternal transmission had a pronounced effect on obesity and related cardiovascular risk factors.

Body mass index, waist circumference, body fat mass, and risk of developing hypertension in normal-weight children and adolescents

BACKGROUND AND AIMSnWe prospectively examined the association between three adiposity indices, including body mass index (BMI), waist circumference (WC), and percentage of body fat (PBF), and risk of hypertension in normal-weight Chinese children.nnnMETHODS AND RESULTSnThe current study included 1526 (713 boys and 813 girls) normal-weight Chinese children (age 6-14 years old), who were free of hypertension at baseline (2014). Heights, body weight, WC, and PBF (estimated by bioelectrical impedance analysis) were measured at the baseline. Blood pressure was repeatedly measured in 2014, 2015 and 2016. Hypertension was defined as either high systolic blood pressure and/or high diastolic blood pressure, according to age- and sex-specific 95th percentile for Chinese children. We used Cox proportional hazards model to calculate the association between exposures and hypertension. We identified 88 incident hypertension cases during two years of follow up. High BMI was associated with high risk of developing hypertension after adjusting for potential confounders. The adjusted hazard ratio for hypertension was 2.88 (95% CI: 1.24, 6.69) comparing two extreme BMI quartiles. Each SD increase of BMI (≈1.85xa0kg/m2) was associated with a 32% higher likelihood to developing hypertension (Hazard ratioxa0=xa01.32; 95% CI: 1.003, 1.73). In contrast, we did not find significant associations between WC or PBF and higher hypertension risk (p-trend >0.2 for both).nnnCONCLUSIONnHigh BMI, but not WC and PBF, was associated with high risk of hypertension in normal-weight Chinese children.

Association of serum osteocalcin levels with major adverse cardiovascular events: a 4.4‐year retrospective cohort study

We investigated whether the serum osteocalcin levels at baseline were associated with the incidence of major adverse cardiovascular events (MACE) in a population‐based retrospective cohort study of Chinese subjects. Coronary angiography was used to diagnose coronary artery disease (CAD). Survival curves were analyzed by performing log‐rank tests with Kaplan‐Meier figures. Multivariable Cox proportional hazards regression was performed to identify the association of serum osteocalcin levels with the incidence of MACE. A total of 247 subjects with a mean age of 65.50 ± 10.38 years were enrolled in the analysis. After a mean follow‐up time of 4.4 ± 2.6 years, MACE occurred in 175 cases. For men patients, those with serum osteocalcin levels higher than 17.22 ng/mL had significantly lower fasting plasma glucose (FPG) than those with serum osteocalcin levels lower than 17.22 ng/mL (P < .05). According to the multivariate Cox proportional hazards regression, the lower serum osteocalcin levels and the higher risk of future MACE occurred in men with CAD at baseline (hazard ratio = 0.970; 95% confidence interval 0.943‐0.999, P = .04). However, this difference was not significant either in men without CAD or in women. In conclusion, relatively lower serum osteocalcin levels were associated with a higher risk of MACE in Chinese men with CAD.

Low serum osteocalcin levels are correlated with left ventricular systolic dysfunction and cardiac death in Chinese men

Osteocalcin is a newly identified type of cytokine secreted by osteoblasts, which has an endocrine function, mediates energy and glycol-lipid metabolism, and is closely related to cardiovascular diseases. In this study, we investigated the value of serum osteocalcin levels in predicting left ventricular systolic dysfunction and cardiac death. A total of 258 patients in the Department of Cardiology were included. Two-dimensional echocardiography was performed in all the subjects. The cardiac death of subjects occurring with a median follow-up of 4.6 years was informed via phone calls or the electronic medical records. The serum osteocalcin levels were measured using electrochemiluminescent immunoassay. We found that the median left ventricular ejection fractions (LVEFs) were 62% in men and 63% in women. In the men with a LVEFu2009>u200962%, the serum osteocalcin levels were significantly higher than in those with LVEFu2009≤u200962% (Pu2009=u20090.042), whereas this difference was absent in the women. Both the serum osteocalcin (βu2009=u20090.095, Pu2009=u20090.028) and serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP; βu2009=u2009−0.003, Pu2009<u20090.01) levels remained independently significantly correlated with LVEF in the men but not in the women. Receiver operating characteristic (ROC) analyses of the men revealed that the serum osteocalcin (Pu2009=u20090.007), serum NT-pro-BNP (Pu2009=u20090.018) and serum osteocalcinu2009+u2009NT-pro-BNP (Pu2009<u20090.01) levels were all significant in identifying left ventricular systolic dysfunction at baseline, but the pairwise comparisons of the three areas under the curves (AUCs) were all non-significant. The men in the lower osteocalcin level group at baseline suffered a greater risk of future cardiac death than those in the higher osteocalcin level group, whereas the result for NT-pro-BNP exhibited the opposite pattern. In conclusion, lower serum osteocalcin levels in the men could identify left ventricular systolic dysfunction and cardiac death in a manner that was not inferior to high serum NT-pro-BNP levels.