Inverted U-Shaped Associations between Glycemic Indices and Serum Uric Acid Levels in the General Chinese Population: Findings from the China Cardiometabolic Disease and Cancer Cohort (4C) Study / 生物医学与环境科学（英文）

Objective@#The relationship between serum uric acid (SUA) levels and glycemic indices, including plasma glucose (FPG), 2-hour postload glucose (2h-PG), and glycated hemoglobin (HbA1c), remains inconclusive. We aimed to explore the associations between glycemic indices and SUA levels in the general Chinese population.@*Methods@#The current study was a cross-sectional analysis using the first follow-up survey data from The China Cardiometabolic Disease and Cancer Cohort Study. A total of 105,922 community-dwelling adults aged ≥ 40 years underwent the oral glucose tolerance test and uric acid assessment. The nonlinear relationships between glycemic indices and SUA levels were explored using generalized additive models.@*Results@#A total of 30,941 men and 62,361 women were eligible for the current analysis. Generalized additive models verified the inverted U-shaped association between glycemic indices and SUA levels, but with different inflection points in men and women. The thresholds for FPG, 2h-PG, and HbA1c for men and women were 6.5/8.0 mmol/L, 11.0/14.0 mmol/L, and 6.1/6.5, respectively (SUA levels increased with increasing glycemic indices before the inflection points and then eventually decreased with further increases in the glycemic indices).@*Conclusion@#An inverted U-shaped association was observed between major glycemic indices and uric acid levels in both sexes, while the inflection points were reached earlier in men than in women.

Prevalence of hypertension with diabetes and the cardiovascular disease risk among adults in Zhejiang Province / 预防医学

Objective To investigate the prevalence of hypertension with diabetes and the cardiovascular disease risk among adults in Zhejiang Province. Methods Based on a population-based cross-sectional survey in Zhejiang Province in 2010, data of total 17437 adults aged 18 years and older were analyzed. Results The overall prevalence of hypertension with diabetes was 5.36％, which was significantly higher in females (5.71％) than in males (4.96％) (P<0.05) . With age increased, the prevalence of hypertension with diabetes significantly increased (P<0.01) . And 98.29％ of hypertension with diabetes patients had three or more cardiovascular disease risk factors. The exposure rate of clustering was higher in males (99.26％) than in females (97.54％)(P<0.05), and which increased significantly along with age (P<0.05) . Conclusion Hypertension with diabetes patients had higher cardiovascular disease risk in Zhejiang, and elder and male patients appeared to be the targeted population.

An analysis on health life expectancy of adult residents in Zhejiang Province / 预防医学

Objective To analyze the health life expectancy (HALE) of the residents aged 15 years and above in Zhejiang Province and to evaluate the health level among adults. Methods The study was based the mortality data collected from Zhejiang Chronic Disease Surveillance Information and Management System, and the mortality rates were from the Under-Reporting Survey and the sample data in Zhejiang from the 5th National Health Service Survey in 2013. A Sullivan' s method was used to calculate the HALE. Results The life expectancy and self-evaluated HALE were 63.62 years, 55.80 years, respectively, and the difference was 7.82 years (61.49 years VS 55.13 years in males and 66.10 years VS 56.57 years in females) . The self-evaluated HALE 55.89 years in urban and 55.54 years in rural residents aged 15 years and above. The proportion of self-evaluated HALE in the total life expectancy was 87.70%, and it decreased with age, and the proportion has dropped to 67.31% in ≥65 age group. Life expectancy without chronic morbidity was 46.68 years (46.35 years in males and 47.01 years in females; 44.03 years in urban and 47.15 years in rural areas) among residents aged 15 years and above, and the proportion of self-evaluated HALE without chronic morbidity in the total life expectancy without chronic morbidity was 73.37%. Conclusion In general the proportion of self-evaluated HALE in the total life expectancy was small , and males had a greater proportion than female, and adults in rural areas had a greater proportion than that in urban areas. We should consider NCDS management for the elderly residents and to improve the life quality among the elderly residents.

A study on the risk and economic burden of common malignant tumor due to type 2 diabetes mellitus / 预防医学

Objective To evaluate risk and the direct economic burden of malignant tumor due to type 2 diabetes mellitus. Methods Combing the data of chronic disease surveillance, follow-up and the fifth health service investigation, we calculated the population attributable risk and the direct economic burden for malignant tumor due to type 2 diabetes mellitus in order to estimate the direct economic burden for tumor caused by type 2 diabetes mellitus. Results The relative risk was 1.68 (95%CI: 1.68-1.70) for people with type 2 diabetes mellitus to develop the malignant tumor than the people without type 2 diabetes mellitus. The proportions of attributable risk (AR%) and population attributable risk (PAR%) were 40.57% and 2.05%, respectively. Moreover, the annual average hospitalization costs for malignant tumor reached 11 billion CNY, which took part 6.48% of total health service costs. And the direct economic burden for malignant tumor due to type 2 diabetes mellitus was 0.228 billion CNY. In addition, the top two highest population attributable risks were colorectal cancer and liver cancer, while the top three greatest direct economic burdens for malignant tumor or malignant tumor due to type 2 diabetes mellitus were lung cancer, colorectal cancer and stomach cancer. Conclusion From this study, we found that type 2 diabetes mellitus increased the risks of tumor and therefore lead to sharply increasing in medical costs of malignant tumor. In order to decrease the risk of malignant tumor and medical costs, we should pay more attention to the prevention of type 2 diabetes mellitus and the screening of malignant tumor due to type 2 diabetes mellitus.

An investigation on the awareness of osteoporosis among community doctors / 预防医学

Objective To analysis the awareness of community doctors on the knowledge of osteoporosis and to provide suggestions for conducting pertinent training for community doctors.Methods The design of questionnaire was based on the Osteoporosis Knowledge Questionnaire (OKT)and the Guideline of Diagnosis and Treatment of Osteoporosis in 2011.A total of 170 community doctors were investigated.Results The score of community doctors about osteoporosis was 29. There was 83.80% of community doctors who knew osteoporosis related knowledge well.However,there was 15.49% of community doctors'knowledge about osteoporosis that was not good enough.The most of community doctors got full score in the part of prevention knowledge with 52.82%.The most of community doctors failed in the part of treatment knowledge with 12.68%.The score of osteoporosis knowledge in different gender and title had no statistical significance (P >0.05). Conclusion It is necessary to strengthen community doctors's awareness about osteoporosis.

Circulating MicroRNA-21 is Downregulated in Patients with Metabolic Syndrome / 生物医学与环境科学（英文）

The microRNA-21 (miR-21) is known to play a major role in cancer progression; however, its function in the cardiovascular system appears to be even more complex and conflicting. To characterize miR-21 expression in the plasma of individuals with or without metabolic syndrome (MetS), 58 MetS cases and 96 non-MetS controls were investigated. Expression levels of miR-21 were significantly decreased in the circulation of MetS subjects (OR=0.52, 95% CI: 0.29-0.92) compared with that of non-MetS subjects. Body mass index (BMI) and the number of MetS components had a negative correlation with the level of miR-21, whereas age was inversely related to the level of miR-21. No significant difference was detected in miR-21 levels between the sexes (P=0.056). MiR-21 might be a negative regulating factor in MetS.

Lipoprotein lipase gene polymorphisms:associations with hypertension combined with obesity and their lipids metabolism / 预防医学

Objective To investigate the associations of lipoprotein lipase (LPL)gene Hind Ⅲ polymorphisms with hypertension combined with obesity and their lipids metabolism.Methods 326 subjects of hypertension combined with obesity and 326 healthy subjects were arranged to take questionnaires survey,physical examinations and blood biochemical tests.The LPL gene Hind Ⅲ polymorphisms were detected by PCR -RFLP.Regression analysis was used in this study. Results H +was the dominant allele in both groups.There was no significant difference among H +H +,H +H -, H -H -genotypes of LPL gene between the two groups (P >0.05).In the hypertension combined with obesity group, H +H +genotype had significantly higher triglyceride (TG),total cholesterol (TC)levels than H +H -/H -H -genotypes (P <0.05 )while no significantly different density lipoprotein cholesterol (HDLC)level (P >0.05 ).The results of conditional logistic regression analysis showed that high fasting blood glucose (FBG,adjusted OR =21.56, 95%CI:7.49 ~62.1 1 ),highTG(adjusted OR =7.5 1 ,95 % CI:4.20 ~1 3.43 ),lowHDLC(adjusted OR =2.67 ,95% CI:1.53 ~4.66),high uric acid (UA,adjusted OR =3.36 ,95% CI:1.55 ~7.29)and hypertension family history (adjusted OR =2.07,95% CI:1.21 ~3.55)were the main influencing factors of the hypertension combined with obesity (all P <0.05).Conclusion LPL Hind Ⅲ polymorphism is significantly associated with the lipids metabolism of the hypertension combined with obesity,but it is not an assured independent risk factor for hypertension combined with obesity.

A case -control study on risk factors of lung cancer among non -smoking women / 预防医学

Objective To explore the risk factors of lung cancer among non -smoking women.Methods A total of 229 new cases of lung cancer among non -smoking women from 2005 to 2008 were collected.The design method of 1 to 2 matching case -control study was used controlling age,sex and smoking conditions.The data was analyzed by univariate and multivariate conditional logistic regression analysis.Results Single factor analysis identified 13 risk factors (all P <0.05).The multivariate conditional logistic regression and factor analysis showed that respiratory disease history,family history of cancer,poor interpersonal relationship,psychological problems,feeling heavy smoke when cooking,consumption of salty and dry food,later menarche and passive smoking were risk factors (OR =24.427,5.539,3.041,2.622,1.856, 1.724,1.565 and 1.598 respectively),high income level and high consumption of vegetables were protective factors (OR =0.650 and 0.683 ).Conclusion respiratory disease history, family history of cancer, poor interpersonal relationship and psychological problems are main risk factors of lung cancer among non -smoking women.

A cross-sectional study on related risk factors of type II diabetes among rural residents / 预防医学

Objective ToexaminetheriskfactorsoftypeIIdiabetesinruralareaofHainingcityinordertoprovidebasis fordiseasecontrolandprevention.Methods Residentsagedover18infourtownswereselectedthroughmulti-stage stratified cluster random sampling method,and a questionnaire investigation,physical examination and blood biochemical indicatortestingwereconducted.Results TheadjustedprevalenceoftypeIIdiabetesinHainingcitywas5.17%overall with 5.81% in men and 4.56% in women.The results of multivariate logistic regression analysis showed that age (OR=1.78),overweight (OR=1.71),family history of diabetes (OR=16.05)were risk factors (all P<0.05).Conclusion The prevalence of type II diabetes is considerably high in rural area of Haining city. Risk factor monitoring and comprehensive intervention should strongly be advocated.

Analysis on Incidence and Mortality Characteristics of Thyroid Cancer during 2007 to 2011 in Zhejiang Province / 预防医学

Objective To analyze the characteristics and trend of incidence and mortality of thyroid cancer in Zhejiang Province from 2007 to 2011.Methods Data from cancer registry and death registry in Zhejiang province were used to calculate the crude incidence and mortality,age -specific incidence and mortality,China - and World -standardized incidence and mortality of thyroid cancer.Trend Chi -square test was used to analyze the trend of incidence and mortality. Results From 2007 to 2011,the reported incidence rate of thyroid cancer in Zhejiang Province was 8.37 /100,000 (China -and World -standardized incidence were 5.28 /100,000 and 6.14 /100,000 respectively).The mortality rate was 0.34 /100,000 (China -and World -standardized mortality were 0.17 /100,000 and 0.24 /100,000 respectively). The incidence and mortality were both significantly higher in females and urban residents than in males and rural residents (both P <0.01).With age increased,the mortality increased.However,the incidence increased at the beginning and then declined with a peak age of 30 -59.From 2007 to 2011,the incidence of thyroid cancer increased rapidly with a speed of 29.95% per year while the mortality did not show the similar trend.Conclusion The incidence of thyroid cancer in Zhejiang Province is growing rapidly and the relative risk factors should be taken into consideration in future researches.

Factors associated with awareness, treatment and control on diabetes in Zhejiang / 中华流行病学杂志

<p><b>OBJECTIVE</b>To investigate factors associated with awareness, treatment and control of diabetes in Zhejiang.</p><p><b>METHODS</b>Subjects under study were selected among local residents aged ≥ 18 years old by multi stage stratified-random sampling method. All participants received physical examinations including blood tests for lipids, fasting blood glucose, 2 h blood glucose and physical measurements for obesity and blood pressure in the year 2010.</p><p><b>RESULTS</b>Totally, 17 437 residents were finally included in the study, including 1529 patients with diabetes. The rates of awareness, treatment and control of diabetes among the subjects under study, were 59.19%, 46.63% and 23.87%, respectively. Rate of treatment in patients with awareness of diabetes and the rate of under control among patients with treated diabetes were 78.78% and 51.19% respectively. Data from multivariate logistic regression method showed that factors as older age, having family history of diabetes were associated with higher awareness of diabetes, being alcohol drinker and obese patients with lower awareness etc. Treatment rate was significantly higher among those patients with primary education than those under situations as illiteracy, hypertension and longer course of diabetes. The control rate was significantly lower among patients with longer course of diabetes and dyslipidemia.</p><p><b>CONCLUSION</b>Low rate on awareness, treatment and control of diabetes need to be changed.</p>

Survival rate of colorectal cancer patients during 2005-2010 in Zhejiang province, China / 中华流行病学杂志

Objective To analyze the survival rate of colorectal cancer,using data from the population-based cancer registry during 2005-2010 in Zhejiang.Methods The last follow-up activites on 17 235 cases regarding the survival status was December 31,2012.Both cumulative observed survival rate (OS) and relative survival rate (RS) were calculated with SURV 3.01 software drawn up by Hakulinen.Results The OS on 1,3 and 5 year were 76.71％,58.14％,50.58％ and the RS on 1,3 and 5 year were 78.93％,63.48％,58.73％,respectively.The 1,3 and 5 year relative survival rates on males vs.females were 79.36％ vs.78.35％,63.63％ vs.63.29％,and 58.85％ vs.58.57％,respectively and the difference between them was not statistically significant (x2=1.08,P=0.298).The 5 year OS and RS of the urban population were 55.06％ and 64.09％ and the 5 year OS and RS of the rural population were 47.59％ and 55.16％,with statistically significant differences (x2 =85.84,P＜0.001).The 55-64 age group appeared higher relative survival rate.There were significant differences in the survival rates among different age groups (x2=333.42,P＜0.001).The 5 year RS of colon vs.rectum were 61.47％ vs.56.45％.Colon patients showed better relative survival rate (x2=7.26,P＜0.05).Conclusion The wide variations in colorectal cancer survival rates were seen between the urban and rural populations.Public health resources should be focused on rural areas.Patients younger than 55 years should be under specific attention to further understand the related factors which influencing the prognosis of the diseases.

Prevalence and risk factors of pre-hypertension among adults of Zhejiang province / 中华流行病学杂志

<p><b>OBJECTIVE</b>To access the prevalence rates of pre-hypertensive patients at different stages and its associated risk factors among adults of Zhejiang province.</p><p><b>METHODS</b>Study subjects were selected among local residents aged ≥ 18 years from 15 counties by multi stage stratified cluster random sampling method, from July to November, 2010. Each participant was required to complete questionnaire, physical examination and testing for overnight fasting blood specimen.</p><p><b>RESULTS</b>17 437 residents were surveyed including 8169 males and 9268 females. The overall prevalence of prehypertension was 34.39%. The prevalence of pre-hypertension appeared to be higher in males (38.57%) than in females (30.70%) (χ(2) = 119.36, P < 0.0001). The prevalence of pre-hypertension decreased with the increase of age in males who were above 25 year olds (χ(2) = 76.94, P < 0.0001) and in females who were above 45 year olds (χ(2) = 114.66, P < 0.0001). The prevalence of pre-hypertension appeared to be higher in the rural (35.60%) than in the urban (32.39%) areas (χ(2) = 18.69, P < 0.0001). Data from multivariable logistic regression showed that factors as being male, aged older than 35 years of age, with waist circumference as ≥ 85 cm for men and ≥ 80 cm for women, body mass index ≥ 25.0 kg/m(2) and triglyceride ≥ 1.7 mmol/L were risk factors of pre-hypertension while having had higher education was a protective factor.</p><p><b>CONCLUSION</b>Pre-hypertension was prevalent among adults residents in Zhejiang province. Factors as overweight, obesity, dyslipidemia appeared to be major risk factors for pre-hypertension.</p>

Association between dyslipidemia and different subtypes of hypertension among Zhejiang population in 2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the association between dyslipidemia and different subtypes of hypertension among Zhejiang population.</p><p><b>METHODS</b>From June to October in 2010, 19 113 local residents aged ≥ 18 years old were selected among 7571 families from fifteen counties in Zhejiang by four stage stratified-random sampling method. A self-designed questionnaire was adopted to collect information on demographic characteristics, physical activity and life style. At the same time, physical examinations including height, weight, blood pressure and blood lipids were carried out.</p><p><b>RESULTS</b>A total of 19 113 participants completed the interviews, physical examinations and collected the blood samples.Excluding those who did not meet the criteria, 14 731 were finally enrolled in the study. The prevalence rates of isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), systolic and diastolic hypertension (SDH) were 7.16% (1055/14 731, standardized rate:5.46%), 4.60% (677/14 731, standardized rate:4.41%), 7.09% (1045/14 731, standardized rate:5.75%), respectively. Among normal blood pressure group, subjects with normal TC, high TC and abnormal TC were separately 10 571 (88.43%), 1173 (9.81%) and 210 (1.76%); subjects with normal HDL-C and low HDL-C were separately 6885 (57.60%) and 5069 (42.40%); subjects with normal TG, high TG, abnormal TG were separately 9952 (79.91%), 1213 (10.15%) and 1189(9.95%).In ISH group, subjects with normal TC, high TC and abnormal TC were separately 826 (78.29%), 188 (17.82%) and 41 (3.89%); subjects with normal HDL-C and low HDL-C were separately 666(63.13%) and 389 (36.87%); subjects with normal TG, high TG and abnormal TG were separately 737 (69.86%), 150 (14.22%) and 168 (15.92%). Multi factor analysis showed that high TG and abnormal TG were associated with ISH (OR (95%CI):1.43 (1.16-1.76), 1.65 (1.34-2.03) respectively). Among IDH group, subjects with normal TC, high TC, abnormal TC were separately 556(82.13%), 99(14.62%) and 22 (3.25%); subjects with normal HDL-C, low HDL-C were separately 335 (49.48%) and 342 (50.52%); subjects with normal TG, high TG, and abnormal TG separately were 402 (59.38%), 107 (15.81%) and 168 (24.82%). The multi factor analysis showed that high TG and abnormal TG could increase the risk of IDH (OR(95%CI):1.57 (1.24-1.98), 2.18 (1.76-2.70) respectively). Among SDH group, subjects with normal TC, high TC and abnormal TC were 817 (78.18%), 193 (18.47%) and 35 (3.35%); subjects with normal HDL-C and abnormal HDL-C were separately 599 (57.32%) and 446 (42.68%); subjects with normal TG, high TG, abnormal TG were separately 675 (64.59%), 164 (15.69%) and 206 (19.71%). The multi factor analysis showed that high TC, high TG and abnormal TG were also associated with the increased risk of SDH (OR (95%CI):1.38 (1.14-1.67), 1.43(1.18-1.75), 1.73 (1.43-2.10) respectively).</p><p><b>CONCLUSION</b>Dyslipidemia is an important factor of different subtypes of hypertension among Zhejiang population, especially triglycerides. Dyslipidemia screening should be strengthened to reduce the risk of cardiovascular diseases.</p>

Duodenojejunal bypass in treatment for 7 cases with non-severe obese type 2 diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and feasibility of duodenojejunal bypass(DJB)on non-severe obese patients with type 2 diabetes mellitus(T2DM).</p><p><b>METHODS</b>The body mass index (BMI), fasting plasma glucose(FPG), 2h-postprandial plasma glucose(2hPG), fasting insulin(F-ins), fasting c-peptide(F-CP), glycated hemoglobin and hypoglycemic agents dose changes were tested in 7 patients with non-severe obese T2DM undergoing DJB, preoperatively and within 24 weeks after surgery during the follow-up. Data were collected and the clinical outcomes of T2DM were analyzed.</p><p><b>RESULTS</b>In 7 cases of non-obese T2DM who underwent DJB, one patient was weaned off hypoglycemic agents with normal FPG, 2hPG and HbA1c postoperatively. Five required significantly lower dosage. No significant improvement in 1 case. Complete remission rate of hyperglycemia was 1/7, effective rate was 6/7, and effective rate of HbA1c was 5/7. No significant changes in BMI were observed between the preoperative and postoperative phases.</p><p><b>CONCLUSION</b>Plasma glucose level can be markedly reduced by duodenojejunal bypass in non-obese T2DM, independent of weight loss, and the mechanism remains unclear.</p>