Zhiyun Zhao

Metabolic Syndrome among Adults in China - The 2010 China Noncommunicable Disease Surveillance

Context: In China, data on the prevalence of metabolic syndrome have been rare recently. Objective: The objective of the study was to evaluate the prevalence of metabolic syndrome and its components in 2010. Design, Setting, and Participants: The study covered all 31 provinces of mainland China and consisted of a nationally representative population sample of 98,658 Chinese adults aged ≥18 years. Of these, 97,098 participants were eligible for the data analysis reported here. Main Outcome Measures: Estimates of the prevalence of metabolic syndrome and its components were calculated. To further explore whether metabolic syndrome is associated with the 10-year coronary heart disease risk, sex-stratified logistic regression models were used. Results: The prevalence of the metabolic syndrome was 33.9% (31.0% in men and 36.8% in women), which indicates that metabolic syndrome affects approximately 454 million adults in China. More than half of total adult population was suffering from low high-density lipoprotein cholesterol (HDL-C), and nearly half of participants had high blood pressure. Abdominal obesity and low HDL-C were more prevalent in women than in men, whereas high blood pressure, high blood glucose, and high triglycerides were more common in men. Metabolic syndrome was associated with a higher 10-year coronary heart disease risk after adjustment for potential risk factors and each component of metabolic syndrome as continuous variables. Conclusion: Our results showed a high prevalence of metabolic syndrome and its components in the general adult population in mainland China. Metabolic syndrome was independently associated with a higher 10-year risk of developing coronary heart disease.

Prevalence of metabolic syndrome and its association with obesity indices in a Chinese population

Background:  To investigate the prevalence of metabolic syndrome in an urbanizing community in Qingpu, a suburb of Shanghai, and to determine which obesity indices, including body mass index, waist circumference (WC), and waist:hip (WHpR), and waist:height (WHtR) ratios, are most closely associated with metabolic syndrome.

Visceral adiposity is significantly associated with type 2 diabetes in middle‐aged and elderly Chinese women: A cross‐sectional study

Previous studies suggest that visceral fat is associated with type 2 diabetes (T2D) independent of body mass index (BMI). However, epidemiological data about the relationship between visceral fat and T2D are rare in Chinese. The aim of the present study was to investigate whether visceral fat area (VFA) is associated with T2D beyond and above BMI in the Chinese population.

Type 2 Diabetes, Diabetes Genetic Score and Risk of Decreased Renal Function and Albuminuria: A Mendelian Randomization Study

Background Type 2 diabetes (T2D) is a risk factor for dysregulation of glomerular filtration rate (GFR) and albuminuria. However, whether the association is causal remains unestablished. Research Design and Methods We performed a Mendelian Randomization (MR) analysis in 11,502 participants aged 40 and above, from a well-defined community in Shanghai during 2011–2013, to explore the causal association between T2D and decreased estimated GFR (eGFR) and increased urinary albumin-to-creatinine ratio (uACR). We genotyped 34 established T2D common variants in East Asians, and created a T2D-genetic risk score (GRS). We defined decreased eGFR as eGFR < 90 ml/min/1.73 m2 and increased uACR as uACR ≥ 30 mg/g. We used the T2D_GRS as the instrumental variable (IV) to quantify the causal effect of T2D on decreased eGFR and increased uACR. Results Each 1-standard deviation (SD, 3.90 points) increment in T2D_GRS was associated with decreased eGFR: odds ratio (OR) = 1.18 (95% confidence interval [CI]: 1.01, 1.30). In the MR analysis, we demonstrated a causal relationship between genetically determined T2D and decreased eGFR (OR = 1.47, 95% CI: 1.15, 1.88, P = 0.0003). When grouping the genetic loci according to their relations with either insulin secretion (IS) or insulin resistance (IR), we found both IS_GRS and IR_GRS were significantly related to decreased eGFR (both P < 0.02). In addition, T2D_GRS and IS_GRS were significantly associated with Log-uACR (both P = 0.04). Conclusion Our results provide novel evidence for a causal association between T2D and decreased eGFR by using MR approach in a Chinese population.

Urinary bisphenol A concentration and risk of central obesity in Chinese adults: a prospective study

Bisphenol A (BPA) exposure has been associated with diabetes and related metabolic disorders, such as obesity, but studies of the association of urinary BPA concentrations with central obesity risk are limited. The aim of this study was to prospectively investigate the association between urinary BPA and incident central obesity in a Chinese population aged ≥40 years.

The impact of fat distribution on subclinical coronary atherosclerosis in middle-aged Chinese adults

BACKGROUND The relationship between obesity and cardiovascular disease (CVD) depends not only on the amount of body fat but also on its distribution, which has not been fully investigated in Chinese populations. We aimed to compare measures of fat accumulation in associations with subclinical coronary atherosclerosis in middle-aged Chinese adults. METHODS A total of 548 participants aged 40-60years without previous history or clinical symptoms of CVD were randomly selected to undergo abdominal computed tomography (CT) scanning and coronary CT angiography for the evaluation of subcutaneous and visceral fat accumulation and coronary atherosclerosis, respectively. γ-glutamyltranspeptidase (GGT) was used as a surrogate indicator of liver fat accumulation. RESULTS Measures of obesity such as body-mass index (BMI), waist circumference, visceral fat areas, and GGT levels, but not subcutaneous fat areas increased substantially across groups of participants without coronary stenosis, with <50% stenosis, and with significant (≥50%) stenosis after adjustment for age and sex. The multivariable multinomial logistic regression analysis showed that most obesity indicators such as BMI, waist circumference, visceral fat areas, and GGT levels were significantly associated with risks of having <50% coronary stenosis after adjustment for conventional cardiovascular risk factors. However, only GGT levels were significantly associated with risks of having significant (≥50%) coronary stenosis after adjustment. In addition, no significant associations were found between measures of fat accumulation and coronary calcification. CONCLUSIONS Liver fat accumulation might be more important in the association with subclinical coronary atherosclerosis compared with general and abdominal fat accumulation.

Insulin Resistance and β-Cell Dysfunction in Relation to Cardiometabolic Risk Patterns

Context Insulin resistance (IR) and β-cell dysfunction are two major defects synergistically inducing the development of diabetes and related cardiometabolic disorders. Objective To investigate the independent and joint associations of IR and β-cell dysfunction with the prevalence of multiple cardiometabolic disorders, including obesity, central obesity, diabetes, dyslipidemia, and hypertension. Design and Settings A nationally representative population of 93,690 Chinese adults. Main Outcome Measures IR and β-cell dysfunction were assessed by the homeostasis model assessment of IR (HOMA-IR) and of β-cell function (HOMA-B), respectively. Results High HOMA-IR was independently associated with high prevalence of all estimated cardiometabolic disorders, whereas low HOMA-B was independently associated with high prevalence of diabetes, dyslipidemia, and hypertension but low prevalence of obesity and central obesity. When examined jointly, the associations of HOMA-IR and HOMA-B with multiple cardiometabolic disorders showed different patterns with varying magnitudes. The strongest joint associations were observed for diabetes, with low HOMA-B associated with high prevalence of diabetes regardless of HOMA-IR; joint associations with dyslipidemia and hypertension prevalence appeared to be additive and had moderate changing trends; and low HOMA-B was not associated with high prevalence of obesity or central obesity unless combined with high HOMA-IR. Conclusion IR was associated with more prevalent cardiometabolic disorders than was β-cell dysfunction, and combinations of IR and β-cell dysfunction showed distinct relations with cardiometabolic risk patterns in Chinese adults.

Ideal Cardiovascular Health Is Inversely Associated with Nonalcoholic Fatty Liver Disease: A Prospective Analysis

BACKGROUND Cardiovascular health has been proven to be associated with major cardiometabolic diseases. However, little is known of associations between cardiovascular health and nonalcoholic fatty liver disease. METHODS This study included 3424 adults aged ≥40 years who were free of nonalcoholic fatty liver disease at baseline from a community cohort followed for up to 5 years. Liver ultrasonography was conducted at baseline and at follow-up to diagnose incident nonalcoholic fatty liver disease. Six metrics including smoking, physical activity, body mass index, total cholesterol, blood pressure, and fasting glucose were used to define cardiovascular health status. Associations of individual cardiovascular health metrics, number of cardiovascular health metrics, and overall cardiovascular health status at baseline, as well as changes in cardiovascular health during follow-up with risks of developing nonalcoholic fatty liver disease, were examined. RESULTS A total of 649 participants developed nonalcoholic fatty liver disease during follow-up. Risks of nonalcoholic fatty liver disease reduced in a dose-response manner in participants with 3-4 ideal cardiovascular health metrics (odds ratio 0.50; 95% confidence interval, 0.41-0.61) and in participants with 5-6 ideal metrics (odds ratio 0.34; 95% confidence interval 0.22-0.51) compared with participants with 0-2 ideal metrics. An overall ideal or intermediate cardiovascular health was associated with 37% reduction in developing nonalcoholic fatty liver disease compared with poor cardiovascular health. In addition, improving cardiovascular health during follow-up reduced the risk by 71% compared with deteriorating cardiovascular health. Furthermore, an overall ideal or intermediate cardiovascular health was significantly associated with a lower fibrosis score in nonalcoholic fatty liver disease patients compared with an overall poor cardiovascular health. CONCLUSIONS Ideal cardiovascular health was inversely associated with risks of nonalcoholic fatty liver disease. Although treatment of nonalcoholic fatty liver disease and subsequent inflammation and fibrosis remains a challenge, cardiovascular health goals should be advocated for nonalcoholic fatty liver disease prevention.

Association between smoking and glycemic control in diabetic patients: R esults from the R isk E valuation of c A ncers in C hinese diabe T ic I ndividuals: A l ON gitudinal ( REACTION ) study

A number of primary studies suggested that active smoking could be independently associated with incident diabetes. However less is known about the effect of active smoking and smoking cessation on glycemic control in patients with diabetes. The aim of this study was to evaluate the associations of active smoking and smoking cessation with glycemic control in diabetic patients.Background A number of primary studies suggested that active smoking could be independently associated with incident diabetes. However less is known about the impact of active smoking and smoking cessation on glycemic control in patients with diabetes. We aimed to evaluate the associations of active smoking and smoking cessation with glycemic control in diabetic patients. Methods This is a cross-sectional study of 10,551 man and 15,297 women with diabetes from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Risk factors for glycemic control and the association of active smoking with glycemic control were evaluated using logistic regression models. Hemoglobin A1c (HbA1c) ≥7.0% was defined as poor glycemic control. Results Current smokers have increased risk for poor glycemic control, and the multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) of HbA1c≥7.0% with current smoking were 1.49 (1.35-1.66) in men and 1.56 (1.13-2.15) in women. Further analysis demonstrated a dose–response relationship between active smoking and the risk of poor glycemic control in men. Former smokers who quit smoking for <10 years remained at increased risk for poor glycemic control, and the risk leveled off after 10 years of smoking cessation compared with non-smokers, while the risk was significantly decreased compared with current smokers. Conclusions Active smoking is a modifiable risk factor for poor glycemic control in Chinese diabetic patients.

Association between smoking and glycemic control in diabetic patients: Results from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal (REACTION) study: 吸烟与糖尿病患者血糖控制的相关性研究:来自中国2型糖尿病患者恶性肿瘤发生风险的纵向研究(REACTION)的发现

A number of primary studies suggested that active smoking could be independently associated with incident diabetes. However less is known about the effect of active smoking and smoking cessation on glycemic control in patients with diabetes. The aim of this study was to evaluate the associations of active smoking and smoking cessation with glycemic control in diabetic patients.Background A number of primary studies suggested that active smoking could be independently associated with incident diabetes. However less is known about the impact of active smoking and smoking cessation on glycemic control in patients with diabetes. We aimed to evaluate the associations of active smoking and smoking cessation with glycemic control in diabetic patients. Methods This is a cross-sectional study of 10,551 man and 15,297 women with diabetes from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Risk factors for glycemic control and the association of active smoking with glycemic control were evaluated using logistic regression models. Hemoglobin A1c (HbA1c) ≥7.0% was defined as poor glycemic control. Results Current smokers have increased risk for poor glycemic control, and the multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) of HbA1c≥7.0% with current smoking were 1.49 (1.35-1.66) in men and 1.56 (1.13-2.15) in women. Further analysis demonstrated a dose–response relationship between active smoking and the risk of poor glycemic control in men. Former smokers who quit smoking for <10 years remained at increased risk for poor glycemic control, and the risk leveled off after 10 years of smoking cessation compared with non-smokers, while the risk was significantly decreased compared with current smokers. Conclusions Active smoking is a modifiable risk factor for poor glycemic control in Chinese diabetic patients.