Prevalence and risk factors of diabetic peripheral neuropathy in Chinese communities / 中华流行病学杂志

Objective@#To investigate the prevalence and risk factors of diabetic peripheral neuropathy in type 2 diabetic patients under community management programs.@*Methods@#A cross-sectional study was conducted on T2DM patients in eight communities in Wuhan and Changshu cities. Data would included questionnaire, body measurement, blood testing and clinical examination. The criterion of diabetic peripheral neuropathy was under the combination of symptoms with five physical examinations. Binary logistic regression model was used to analyze the influential factors.@*Results@#The overall prevalence of peripheral neuropathy was 71.2% among the diabetic patients who were managed in primary care health services in the two cities. The binary logistic regression method identified older age (≥60 years, OR=2.39, 95%CI:1.95-2.94), longer diabetic duration (≥10 years, OR=1.25, 95%CI: 1.02-1.54), and worse postprandial glucose control (2 h postprandial plasma glucose >10.0 mmol/L: OR=1.65, 95%CI:1.33-2.04) (all P<0.05) as risk factors for the presence of diabetic peripheral neuropathy, while higher education level was protective factor (compared to patients with education levels of primary school or below, OR=0.52, 95%CI: 0.41-0.66; OR=0.59, 95%CI: 0.44-0.79; OR=0.64, 95%CI: 0.44-0.94 for those with education levels of junior high school, senior high school, and college, respectively).@*Conclusions@#High rates of diabetic peripheral neuropathy among T2DM patients suggested the urgent need for early screening and standardized management at the community levels. It is necessary to promote appropriate screening techniques and methods to identify the peripheral neuropathy, in the primary health service institutions.

The relationship between physical activity and incident hypertension in rural Chinese / 中华预防医学杂志

Objective@#To investigate the relationship between physical activity (PA) and the risk of incident hypertension among population in rural areas of China.@*Methods@#The Community Intervention of Metabolic Syndrome in China & Chinese Family Health Study (CIMIC) was conducted in 2007-2008. Data on PA, smoking, drinking, blood pressure and other variables were obtained at baseline. Then the follow-up study of incident hypertension was performed during 2012-2015. A total of 41 457 participants aged ≥18 years and free from hypertension at baseline were included in the final analyses. PA was calculated as metabolic equivalent (MET) for each participant. Cox proportional hazard models were used to explore the relationship of PA with incident hypertension according to the quartiles of PA.@*Results@#A total of 6 780 participants developed hypertension during an average follow up of 5.8 years. The annual incidence of hypertension was 2.80%. Compared to participants in the first quartile of PA, HR (95%CI) of incident hypertension decreased with the level of PA of 0.92 (0.86, 0.99), 0.72 (0.67, 0.77) and 0.70 (0.65, 0.75) for the 2nd, 3rd and 4th quartile, respectively (Ptrend<0.001). In subgroup analyses, compared to the first quartile, hazards of hypertension among normotensive participants (systolic blood pressure less than 120 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure less than 80 mm Hg) in the 2nd, 3rd and 4th quartile were 0.82 (0.70, 0.95), 0.73 (0.63, 0.85) and 0.78 (0.67, 0.90), respectively (Ptrend=0.002). Among participants with prehypertension (systolic blood pressure from 120 to 139 mmHg and/or diastolic blood pressure from 80 to 89 mmHg), similar trend for the relationship of PA and incident hypertension was also found with HR (95%CI) of 0.94 (0.87, 1.01), 0.71 (0.65, 0.77) and 0.66 (0.61, 0.71) for the 2nd, 3rd and 4th quartile, respectively (Ptrend<0.001).@*Conclusion@#There was linear trend association between PA and incident hypertension. Increased PA in daily life may be a protective factor against hypertension.

Association and effects of gene-gene interactions between peroxisome proliferator-activated receptor and pulse pressure / 中华流行病学杂志

Objective To investigate the association between ten single nucleotide polymorphisms (SNPs) in the peroxisome proliferator-activated receptors and pulse pressure (PP) as well as the relationships between gene-gene interaction between PPARα/δ/γ genes and PP.Methods A total of 820 subjects,with 550 females and 270 males,were recruited from a cohort study of “Prevention of Metabolic Syndrome and Multi-metabolic Disorders in Jiangsu Province of China Study (PMMJS)”.Ten SNPs of PPARα/δ/γ genes were selected.GMDR software (version 1.0.1) was used to evaluate the gene-gene interactions among PPARs SNPs associated with PP.Results The mean levels of PP in people with mutant genotype of rs1805192 in PPARγ genes (PA+AA) showed a significant increase by 1.341 mmHg (95％CI:0.431-2.252 mmHg) when compared to the persons with wild genotype (PP).In the subgroup of subjects with more than 30 mmHg levels of PP,a six-locus model comprised rs135539 of PPARα,rs2016520 of PPARδ,rs10865710,rs1805192,rs709158 and rs3856806 of PPARγshowed a highest level of prediction accuracy (0.577) and displayed a better cross-validation consistency (10/10).In the subgroup of subjects with less than 40 mmHg levels of PP,a two-locus model was statistically associated with PP with 0.628 of prediction accuracy and 10/10 of cross-validation consistency.Conclusion PPARγrs1805192 was associated with the occurrence of PP.Gene-gene interactions among rs135539 of PPARα,rs2016520 of PPARδ,rs10865710,rs1805192,rs709158 and rs3856806 of PPARγ were all significantly related to PP.

Association and effects of gene-gene interactions between peroxisome proliferator-activated receptor and pulse pressure / 中华流行病学杂志

Objective To investigate the association between ten single nucleotide polymorphisms (SNPs) in the peroxisome proliferator-activated receptors and pulse pressure (PP) as well as the relationships between gene-gene interaction between PPARα/δ/γ genes and PP.Methods A total of 820 subjects,with 550 females and 270 males,were recruited from a cohort study of “Prevention of Metabolic Syndrome and Multi-metabolic Disorders in Jiangsu Province of China Study (PMMJS)”.Ten SNPs of PPARα/δ/γ genes were selected.GMDR software (version 1.0.1) was used to evaluate the gene-gene interactions among PPARs SNPs associated with PP.Results The mean levels of PP in people with mutant genotype of rs1805192 in PPARγ genes (PA+AA) showed a significant increase by 1.341 mmHg (95％CI:0.431-2.252 mmHg) when compared to the persons with wild genotype (PP).In the subgroup of subjects with more than 30 mmHg levels of PP,a six-locus model comprised rs135539 of PPARα,rs2016520 of PPARδ,rs10865710,rs1805192,rs709158 and rs3856806 of PPARγshowed a highest level of prediction accuracy (0.577) and displayed a better cross-validation consistency (10/10).In the subgroup of subjects with less than 40 mmHg levels of PP,a two-locus model was statistically associated with PP with 0.628 of prediction accuracy and 10/10 of cross-validation consistency.Conclusion PPARγrs1805192 was associated with the occurrence of PP.Gene-gene interactions among rs135539 of PPARα,rs2016520 of PPARδ,rs10865710,rs1805192,rs709158 and rs3856806 of PPARγ were all significantly related to PP.

Impact of dynamic changes of waist circumference and body mass index on type 2 diabetes mellitus risk / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the impact of dynamic change of waist circumference or body mass index (BMI) on type 2 diabetes mellitus (T2DM) populations in a cohort study.</p><p><b>METHODS</b>We not only obtained the baseline survey data from program 'Prevention of Multiple Metabolic Disorders and metabolic syndrome (MS) in Jiangsu Province'(PMMJS) which started in 1994, and we conducted twice follow-ups from January 2002 to August 2003, and March 2006 to November 2007. After excluding subjects who were found to have T2DM at baseline, cardiovascular disease(CVD), and BMI<18.5 kg/m(2) , and loss to follow up because of relocation, death or other reasons, a total of 3 461 subjects were included in this analysis. They received investigation including questionnaires investigation, measurement and laboratory examination. The differences of gender, smoking, alcohol drinking and T2DM family history in different groups were examined using χ(2)-test, median and inter-quartile range were calculated for TG, and they were examined by rank test. Four equal parts of the differences of waist circumference and BMI were carried out in the COX regression model, to investigate the association between 2 years change of waist circumference or BMI and incidence of T2DM. We also examined the association between BMI and waist circumference modification and incident risk of T2DM in subjects with normal baseline BMI, baseline obese subjects, subjects with normal baseline waist circumference and baseline abdominal obese subjects.</p><p><b>RESULTS</b>A total of 3 461 participants (1 406 males, 2 055 females) were investigated, including 160 new T2DM cases (60 males, 100 females) who were from between baseline and the second following up. The accumulative incidence was 4.6% (60/3 461). Multivariate COX regression model analysis results showed that the T2DM risk was relatively high in the highest quartile of waist circumference D-value group(HR=2.06, 95% CI: 1.27-3.16), the T2DM risk was also high in the highest quartile of BMI D-value group (HR=1.30, 95% CI: 0.86-1.95). In subjects with abdominal obesity and normal waist circumference at baseline, the incidence rate of T2DM in non-control group was 7.1% (40/565) , 6.3% (45/645), higher than that in control group (3.4%(71/2 096), 4.5%(4/155)) (χ(2) values were 3.98 and 15.18, P values were 0.043 and <0.001). In subjects with normal waist circumference, T2DM risk was higher in non-control group than that in control group (HR=2.12, 95% CI: 1.40-3.22). In abdominal obese subjects, T2DM risk was also higher in non-control group than that in control group (HR=1.14, 95% CI: 1.04-1.92). If waist circumference was not controlled, T2DM risk was high, no matter BMI controlled or not (HR(95% CI) were 1.73(1.17-2.54), 2.45(1.63-3.69) respectively).</p><p><b>CONCLUSION</b>Controlling the waistline could reduce the risk of diabetes, and once waist circumference was not controlled, T2DM risk would be increased no matter BMI was controlled or not.</p>

The impact of interaction between alcohol consumption and obesity on incident hypertension / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the combined effects of alcohol consumption and obesity hypertension risk.</p><p><b>METHODS</b>Based on data from program "Prevention of multiple metabolic disorders and metabolic syndrome in Jiangsu province", Baseline data were obtained in April 1999 to Jun 2004, we conducted the follow up investigation from March 2006 to October 2007 for subjects, those follow up time meet 5 years. A total of 4 083 participants completed the follow-up survey, and 2 778 eligible participants for final analysis. In the baseline and follow up survey, participants returned a completed questionnaire with information on diet, education, occupation, lifestyle factors, and medical history. Data on demographic characteristics, physical examination and laboratory tests were also obtained. Cox proportional hazards regression model was used to investigate the association between body mass index (BMI), waist circumference (WC) and waist to height ratio (WHtR). Logistic regression model was used to examine the interaction of alcohol consumption with WC, BMI and WHtR on risk of hypertension and the relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP), and the synergy index (SI) were calculated. If the 95% CI of SI do not include 1, the 95% CI of RERI and AP do not include 0, the interactions are statistically significant.</p><p><b>RESULTS</b>In the study subjects, 660 patients (254 males and 406 females) were new cases, who developed hypertension by the follow-up investigation. The mean of WC, BMI and WHtR were (23.3 ± 3.2) kg/m(2), (77.7 ± 9.0) cm and 0.49 ± 0.06, were higher than that in normal subjects ((22.4 ± 3.0) kg/m², (74.8 ± 8.5) cm and 0.47 ± 0.05, all P values < 0.001). After adjustment for age, sex, smoking status, family history of hypertension, the hazard ratio of EH for participants with obesity, high WC, high WHtR and alcohol consumption were higher, the HR (95% CI) were 2.12 (1.46-3.10), 1.64 (1.32-2.03), 2.80 (1.73-4.59) and 1.65 (1.29-2.12). HR (95% CI) of subjects with both abnormal BMI and current alcohol consumption was 2.76 (2.45-3.17), SI (95% CI) was 1.60 (0.48-5.28), RERI(95%CI) was 0.66 (-0.47-1.79) and AP was 0.24 (-0.22-0.69), HR (95% CI) of subjects with both high WC and current alcohol consumption was 4.93 (2.87-8.49), SI(95% CI) was 4.49(1.97-10.22), RERI (95%CI) was 3.06 (0.48-5.64) and AP(95% CI) was 0.62 (0.41-0.83), HR (95% CI) of subjects with both high WHtR and current alcohol consumption was 2.80 (1.73-4.59), SI (95% CI) was 2.14 (0.88-5.17), RERI was 0.96 (0.48-5.64) and AP (95% CI) was 0.34 (0.03-0.68).</p><p><b>CONCLUSION</b>Both obesity, high WC, high WHtR, and alcohol consumption were strong risk factors of EH, and impact of an additive interaction of alcohol consumption and high WC on EH risk existed.</p>

Association and interaction between 10 SNP of peroxisome proliferator-activated receptor and non-HDL-C / 中华预防医学杂志

<p><b>OBJECTIVE</b>To examine the main effect of 10 Peroxisome proliferators-activated receptor (PPAR) SNP in contribution to non-HDL-C and study whether there is an interaction in the 10 SNPs.</p><p><b>METHODS</b>Participants were recruited within the framework of the PMMJS (Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu province) cohort-population-survey, which was initiated from April 1999 to June 2004, and 5-year follow-up data from total 4 582 subjects were obtained between March 2006 and October 2007. A total of 4 083 participants received follow-up examination. After excluding subjects who had experienced stroke or exhibited cardiovascular disease, type 2 diabetes or a BMI <18.5 kg/m(2), a total of 820 unrelated individual subjects were selected from 3 731 subjects on October of 2009. Blood samples which were collected at the baseline were subjected to PPARα, PPARδ and PPARγ 10 SNPs genotype analysis. Logistic regression model was used to examine the association between 10 SNPs in the PPARs and non-HDL-C. Interactions within the 10 SNP were explored by using the Generalized Multifactor Dimensionality Reduction (GMDR).</p><p><b>RESULTS</b>A total of 820 participants (mean age was 50.05±9.41) were included in the study and 270 were males and 550 were females. Single-locus analysis showed that after adjusting gender, age, smoking, alcohol consumption, physical activity, high-fat diet and low-fiber diet factors, rs1800206-V and rs3856806-T were significantly associated with higher non-HDL-C levels. V allele (LV + VV genotype) carriers of rs1800206 have a average non-HDL-C levels on (3.15 ± 0.89)mg/L (F = 15.01, P = 0.002); T allele (CT+TT genotype) carriers of rs3856806 have a average non-HDL-C levels on (3.03±1.01) mg/L (F = 9.87, P = 0.005). GMDR model analysis showed that after adjusting the same factors, two-locus model, five-locus model, six-locus model and seven-order interaction models were all statistically significant (P<0.05), and the seven-locus model (rs1800206, rs3856806, rs135539, rs4253778, rs2016520, rs1805192, rs709158) was the best model (P = 0.001), the cross-validation consistency was 10/10 and testing accuracy was 0.656.</p><p><b>CONCLUSION</b>Rs1800206 and rs3856806 were significantly associated with non-HDL-C. And there was an gene-gene interaction among rs1800206, rs3856806, rs1800206, rs135539, rs4253778, rs2016520, rs1805192, rs3856806 and rs709158 which could influence the non-HDL-C levels.</p>

Association between peroxisome proliferator-activated receptor and gene-gene interactions with the apolipoprotein A I/apolipoprotein B100 ratio / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the association between ten single nucleotide polymorphisms (SNPs) in the peroxisome proliferator-activated receptors (PPARα, β, γ) with apolipoprotein A I/apolipoprotein B100 (ApoA I/ApoB100) ratio and the additional role of a gene-gene interactions among the 10 SNPs.</p><p><b>METHODS</b>Participants were recruited under the framework of the Prevention of Multiple Metabolic Disorders and Metabolic Syndrome in Jiangsu Province (PMMJS) cohort population survey in the urban community of Jiangsu province of China.A total of 630 subjects were randomly selected and no individual was related.Ten SNPs (rs135539, rs4253778, rs1800206, rs2016520, rs9794, rs10865710, rs1805192, rs709158, rs3856806 and rs4684847) were selected from the HapMap database,which covered PPARα, PPARβ and PPARγ. A linear regression model was used to analyze the relations between ten SNPs in the PPARs and ApoA I/ApoB100 ratio level. Mean difference and 95% CI were calculated. Interactions were explored by using the method of Generalized Multifactor Dimensionality Reduction (GMDR).</p><p><b>RESULTS</b>After adjusting for age, gender, smoking status, alcohol consumption, occupational physical activity, high-fat diet as well as low-fiber diet, both rs1800206 and rs3856806 were significantly associated with a decreased level of ApoA I/ApoB100 ratio, mean difference (95% CI) values were -1.19 (-1.88 to -0.50) and -0.77 (-1.40 to -0.14). Whereas rs4253778 was significantly associated with an increased level of ApoA I/ApoB100 ratio, Mean difference (95% CI) values was 0.80 (0.08 to 1.52). GMDR analysis showed a significant gene-gene interaction among rs4253778, rs1800206 of PPARα, rs9794, rs2016520 of PPARβ and rs10865710, rs3856806, rs709158, rs1805192 of PPARγ for eight-dimension models (P = 0.01), in which prediction accuracy was 0.624 and cross-validation consistency was 7/10.</p><p><b>CONCLUSIONS</b>The rs1800206 of PPARα and rs3856806 of PPARγ are significantly associated with a decreased level of ApoA I/ApoB100 ratio while rs4253778 of PPARα is associated with an increased level of ApoA I/ApoB100 ratio. There is a gene-gene interaction between multiple SNPs.</p>

Comparison of the suitability of 2 years change in waist circumference and body mass index in predicting hypertension risk: a prospective study in Chinese-Han

Currently, obesity has become a worldwide health problem and yet little is known about the impact of changes in obesity indicator on incident hypertension. The aim of this study was to compare the impact of changes in the WC and BMI on incident hypertension in a cohort population. After a baseline investigation, we conducted the first and the second follow-up assessments for subjects after 2 and 5 years, respectively. The associations between the changes in the WC and BMI [measured as the D-value, i.e., the value at the first follow-up minus the value at baseline] and the hazard ratio [HR] of incident hypertension were analyzed with a multilevel Cox proportional hazards regression model. Among 2778 participants without hypertension, 660 developed hypertension between the first and the second follow-up assessments. When both the BMI and WC D-values were included in the regression model, the WC D-value was a predictor of hypertension incidence in both sexes [OR= 1.03 and P values < 0.05 for men and women], but the BMI D-value was no longer a predictor of hypertension incidence in either sex [OR=1.04 for men and 1.01 for women, both P values >0.05]. In both sexes, hypertension risk was higher for subjects whose BMI was modified but WC was categorically increasing than for subjects whose WC and BMI were both modified. Both WC and BMI changes were associated with hypertension, but a change in the WC was a better predictor of the hypertension

Predictive power for type 2 diabetes mellitus using dynamic change of metabolic syndrome, dynamic change of fasting plasma glucose, metabolic syndrome and fasting plasma glucose

The aim was to compare the predictive power for Type 2 Diabetes mellitus [T2DM] using dynamic change [Difference] of metabolic syndrome [MS], Difference of fasting plasma glucose [FPG], baseline MS and FPG in cohort study. Overall, 3461 subjects were recruited from Prevention of Multiple Metabolic disorders and MS in Jiangsu of China Study with 3.8 years follow-up. Cox proportional-hazards regression and receiver operating characteristic were used to evaluate the predictive power for T2DM using Difference MS, Difference of FPG, baseline MS and FPG. Adjusted relative risk [[a]RR 5.24, 95% CI 4.28-6.42] of Difference of FPG to T2DM was highest than other. Difference of FPG owns the largest AUC [0.89, P<0.05], the highest sensitivity [96.25%] and specificity [80.49%] demonstrating that Difference of FPG can provide strongest predictive information to T2DM, Difference of MS comes second. Between FPG related tools, sensitivity of Difference of FPG almost was twice than baseline FPG[96.25% vs. 54.38%] suggesting that using baseline FPG would missed found 46% T2DM patients. Among MS related indicators, sensitivity of Difference of MS almost was twice than baseline MS [sensitivity 66.25% vs. 39.38%] suggesting that using baseline would missed found 61% T2DM patients. Dynamic change of FPG had the highest predictive power for T2DM in Chinese than Dynamic Change of MS, baseline MS and FPG

Gene-gene interactions among Ppar alpha/delta/gamma polymorphisms for apolipoprotein [Apo] A-I/ apob ratio in Chinese han population

The peroxisome proliferator-activated receptors [PPARs] -alpha, -delta/beta and -gamma are the ligand-activated tran-scription factors involved in the regulation of fatty acid and lipoprotein metabolism, energy balance, cell proliferation and differentiation and atherosclerosis, etc. We investigated the associations of 10 single-nucleotide polymorphisms [SNPs] in PPARs with apolipoprotein [apo] A-I/ apoB ratio in Chinese Han population. Overall, 630 subjects [212 males, 418 females] were randomly selected from the Prevention of Metabolic Syndrome and Multiple Metabolic Disorders in Jiangsu Province of China Study Cohort. Population analyzed was as the general population which involved healthy people and individuals with disorders of apoA-I or apoB. 10 SNPs [rs1800206, rs135539, rs4253778, rs2016520, rs9794, rs10865710, rs1805192, rs709158, rs3856806 and rs4684847] were genotyped. Mean difference [Difference] and 95% confident interval [95%CI] were calculated. After covariates adjustment, rs1800206-V allele [LV+VV] and rs3856806-T allele [CT+TT] were significantly associated with a decreased apoA-I/ apoB ratio than those wild type carriers, Difference [95%CI] were -1.29[-1.96 tilde -0.62]and -0.8 [-1.42 tilde -0.17], respectively. Rs4253778-C allele was significantly associated with an increased apoA-I/ apoB ratio compared to the wild type carriers [GG], Difference [95%CI] was 0.76 [0.04 tilde 1.48]. Generalized multifactor dimensionality reduction analysis showed that three-to-eight-locus models were significant with apoA-I/ apoB ratio [P<0.05]. We chose the seven-locus model [P=0.0010] as the best GMDR model [cross-validation consistency was 7/10 and testing accuracy was 62.97%]. Our data provided the evidence that PPARs polymorphisms might be involved in regulation of apoA-I/ apoB ratio in independently and/or in an interactive manner

Association between polymorphisms, haplotypes of peroxisome proliferators activated receptor α gene and the level of lipoprotein (a) / 中华流行病学杂志

Objective The aim of this study was to investigate the association between three single-nucleotide polymorphisms (SNP) of in the peroxisome proliferator-activated receptor (PPAR)α gene and the level of lipoprotein (a) [Lp (a)].Methods Participants were recruited under the framework of a cohort populations survey from the PMMJS (Prevention of Multiple Metabolic Disorders and MS in Jiangsu Province) which was conducted in the urban community of Jiangsu province from 1999 to 2007.644 subjects (234 males,410 females) were randomly selected and genotyped for three polymorphisms which were used as genetic marker for PPARα gene (rs 1800206,rs4253778 and rs135539).Data related to individual polymorphism and haplotype were available for analysis.x2 test was used to determine if the whole population was in Hardy-Weinberg genetic equilibrium.Linear regression models were used to analyze the association between SNPs in PPARα gene and the level of Lp(a).Associations between PPARα haplotypes and serum Lp(a) levels were analyzed by the SNPstats software.Results In the dominant model,after factors as sex,age,smoking,alcohol and BMI were adjusted,the presence of the V162 allele of L162V appeared associated with a high level of Lp(a) (mean difference was 57.70 mg/L(95％CI:32.03-83.37 mg/L),P＜0.001.Data from the haplotype analysis revealed that A-G-V and C-G-V haplotype (established by 1A＞C,7G＞C L162V) were significantly associated with a higher level of Lp(a) (P=0.012 0 and 0.009 7).Conclusion Results from our study might help to clarify the role ofPPARα gene in regulation of Lp (a) and the evaluation of its polymorphisms and haplotypes which were characterized as genetic factors for Lp (a).