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1.
Article in English | WPRIM | ID: wpr-921329

ABSTRACT

Objective@#This study aimed to examine the association of visit-to-visit variabilities in metabolic factors with chronic kidney disease (CKD) in Shanghai community residents.@*Methods@#We used data from a cohort study of community residents who participated in three examinations in 2008, 2009, and 2013, respectively. Fasting plasma glucose (FPG) level, blood pressure (BP), and lipid levels were determined in 2,109 participants at all three visits, and CKD was evaluated between the second and the third visits. Visit-to-visit variabilities in metabolic factors were described by coefficients of variation (CV) at three visits. A variability score was calculated by adding the numbers of metabolic factors with a high variability defined as the highest quartile of CV. CKD was defined as the estimated glomerular filtration rate < 60 mL/min per 1.73 m @*Results@#A total of 200 (9.5%) participants had CKD at the third visit. Compared with the lowest quartile of CV, the highest quartile was associated with a 70% increased risk of CKD for FPG [odds ratio, @*Conclusion@#The visit-to-visit variabilities in metabolic factors were significantly associated with the risks of CKD in Shanghai community residents.


Subject(s)
Aged , Aged, 80 and over , China/epidemiology , Cohort Studies , Female , Glomerular Filtration Rate , Humans , Incidence , Male , Middle Aged , Renal Insufficiency, Chronic/physiopathology
2.
Article in English | WPRIM | ID: wpr-878316

ABSTRACT

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.


Subject(s)
Aged , Asian Continental Ancestry Group , Blood Glucose/analysis , China/epidemiology , Cohort Studies , Diabetes Mellitus/blood , Female , Glucose Tolerance Test , Glycated Hemoglobin A/analysis , Glycemic Index , Humans , Male , Middle Aged , Uric Acid/blood
3.
Article in Chinese | WPRIM | ID: wpr-870045

ABSTRACT

The metabolic chamber system is a new-developed method of energy metabolism examination by indirect calorimetry. Recently, metabolic chambers have been applied in energy expenditure affected by the changes of diet, sleep and physical activities, and metabolic diseases such as obesity and type 2 diabetes mellitus, to underlie the potential mechanisms. This review is aimed to summarize the applications of metabolic chambers in China and abroad in researches on energy metabolism involved in physiology, endocrine diseases and energy metabolism disorders. A more extensive use of metabolic chambers in clinical practice is well expected in the foreseeable big-data era.

4.
Article in Chinese | WPRIM | ID: wpr-870021

ABSTRACT

Delineation of the relationship between insulin resistance, β cell dysfunction, and obesity is crucial for the prevention and effective management of diabetes. Previous studies have indicated that, compared with type 2 diabetes in Caucasian, type 2 diabetes in East Asians is characterized primarily by β cell dysfunction rather than insulin resistance. This pathophysiological characterization of diabetes in East Asians is mainly derived from Japanese and Asian-American populations, whereas data from mainland China are scarce. Over the past four decades, China has witnessed a substantial rise in obesity, in parallel with the transitions from principally active lifestyles and calorie-restricted diets to sedentary life styles and energy-dense, western diets. Obesity is an insulin resistance state and the major factor driving the worldwide epidemic of diabetes. It is unknown whether, and if so how, obesity affects the two primary mechanisms, insulin resistance and β cell dysfunction, responsible for the development of diabetes in the Chinese population. Recently, the Lancet Diabetes & Endocrinology published an original research paper from the China Cardiometabolic Disease and Cancer Cohort Study (4C). From a public health perspective, the results of this study reinforce the urgency of tackling obesity as a major preventive strategy for the epidemic of type 2 diabetes in China.

5.
Article in English | WPRIM | ID: wpr-773380

ABSTRACT

OBJECTIVE@#The association between lipoprotein (a) [Lp(a)] levels and metabolic syndrome (MetS) remains uncertain, especially in the Asian population. The purpose of this study was to demonstrate the association between Lp(a) levels and MetS in a middle-aged and elderly Chinese cohort.@*METHODS@#A cross-sectional study of 10,336 Chinese adults aged 40 years or older was conducted in Jiading District, Shanghai, China. Logistic regression analysis was used to evaluate the association between serum Lp(a) levels and MetS.@*RESULTS@#In the overall population, 37.5% of participants had MetS. Compared with individuals in the lowest quartile of serum Lp(a) levels, those in the highest quartile had a lower prevalence of MetS (30.9% vs. 46.9%, P for trend < 0.0001). Multivariate logistic regression analyses showed that compared with participants in the bottom quartile of serum Lp(a) levels, those in the top quartile had decreased odds ratio (OR) for prevalent MetS [multivariate-adjusted OR 0.45 (95% confidence interval 0.39-0.51); P < 0.0001]. Additionally, Lp(a) level was conversely associated with the risk of central obesity, high fasting glucose, high triglycerides, and low HDL cholesterol, but not with hypertension. Stratified analyses suggested that increasing levels of Lp(a) was associated with decreased risk of MetS in all the subgroups.@*CONCLUSION@#Serum Lp(a) level was inversely associated with the risk of prevalent MetS in a middle-aged and elderly Chinese cohort.


Subject(s)
Aged , Asian Continental Ancestry Group , China , Epidemiology , Cross-Sectional Studies , Female , Humans , Lipoprotein(a) , Blood , Male , Metabolic Syndrome , Blood , Epidemiology , Middle Aged
6.
Article in Chinese | WPRIM | ID: wpr-806777

ABSTRACT

The primary impetus for the development of medicine is invariably the scientific research, no matter it is in the era of evidence-based medicine, translational medicine, precision medicine, intelligent medicine, or big data-based medicine. The basic medical research unravels the nature of life and the clinical research addresses the health issues in humans. It is necessary to establish a kind of close relationship between basic researchers and clinical investigators under an organized framework, thus to open a new medical research dimension with innovative ideas and consecutive breakthroughs. (Chin J Endocrinol Metab, 2018, 34: 537-538)

7.
Article in Chinese | WPRIM | ID: wpr-772454

ABSTRACT

Obstructive sleep apnea syndrome (OSAS) is a common clinical disease with high incidence and low treating proportion, difficult evaluation, and complicated nosogenesis. OSAS can cause systematic impairments. Various treatment methods were applied in clinical setting with the tendency of cross-disciplinary promotion. Oral treatment plays an exceedingly important role in OSAS research and therapy. This study reports the oral treatment involving OSAS therapy.


Subject(s)
Humans , Sleep Apnea, Obstructive , Therapeutics
8.
Article in Chinese | WPRIM | ID: wpr-734690

ABSTRACT

Fasting is a dietary intervention based on restricted energy intake, which has different forms of frequency and intensity, and is effective at reducing body weight and improving metabolic health. The cellular and molecular mechanisms of fasting involve lipolysis, increase of thermogenesis, regulation of autophagy, modulation of β cell regeneration and suppression of inflammation. This review focuses on the updates of patterns, benefits, and mechanisms of fasting.

9.
Frontiers of Medicine ; (4): 601-607, 2018.
Article in English | WPRIM | ID: wpr-771276

ABSTRACT

The incidence of obesity has been rapidly increasing, and this condition has become a major public health threat. A substantial shift in environmental factors and lifestyle, such as unhealthy diet, is among the major driving forces of the global obesity pandemic. Longitudinal studies and randomized intervention trials have shown that genetic susceptibility to obesity may interact with dietary factors in relation to the body mass index and risk of obesity. This review summarized data from recent longitudinal studies and intervention studies on variations and diets and discussed the challenges and future prospects related to this area and public health implications.


Subject(s)
Body Mass Index , Diet , Gene-Environment Interaction , Genetic Predisposition to Disease , Humans , Life Style , Obesity , Epidemiology , Genetics , Observational Studies as Topic , Randomized Controlled Trials as Topic
10.
Article in Chinese | WPRIM | ID: wpr-710027

ABSTRACT

Objective To analyze clinical characteristics and gene mutation of two patients diagnosed with P450 oxidoreductase deficiency(PORD). Methods Clinical data of 2 patients with PORD was collected from Ruijin hospital. POR gene mutation was analyzed by PCR-Sanger sequencing. A retrospective analysis of literatures concerning PORD was performed. Results Patient 1, female, 16 years old, with 46,XX karyotype, presented with anorectal anomalies, clitoral hypertrophy at birth and irregular menstruation; Patient 2, female, 32 years old, with 46,XX karyotype, showed irregular menstruation and infertility, both without obvious skeletal deformity. Genetic test of POR gene mutation revealed that patient 1 carried a homozygous missense mutation (R457H) and patient 2 carried a heterozygous mutation (R223X/ Y607C). The two mutations (R223X and Y607C) are reported for the first time in China. Conclusion P450 oxidoreductase deficiency which caused by mutations in POR gene has a variety of clinical manifestations, including abnormal steroid hormone synthesis with or without Antley-Bixler syndrome. The affirmative diagnosis should rely on steroid hormone measurement and POR gene analysis.

11.
Article in Chinese | WPRIM | ID: wpr-710022

ABSTRACT

Polycystic ovary syndrome( PCOS) is one of the most common endocrine disorders in women of reproductive age, resulting in several health complications such as menstrual dysfunction, infertility, hirsutism, acne, obesity, and metabolic syndrome. PCOS is recognized to be a complex polygene disease. Although the cause of PCOS has not been fully clarified, hyperandrogenism is one of the key pathogenesises of PCOS. In this article, we reviewed the effects of genes related to androgen biosynthesis,metabolism,reserve,action and regulation on the pathogenesis of PCOS based on the research progress in the candidate gene studies, genome wide association studies, as well as its epigenetics.

12.
Article in Chinese | WPRIM | ID: wpr-710009

ABSTRACT

Objective To investigate the association of age at menarche with the risks of diabetes and metabolic syndrome ( MS) in adulthood in Shanghai community postmenopausal women. Methods A total of 10375 residents over 40 years in Jiading, Shanghai were identified by a cluster sampling method. After taking standardized questionnaire surveys, physical examinations, and biochemical parameters testing, we gathered their lifestyle and medicine information. A total of 4723 postmenopausal women were enrolled in the study. The population was divided into three groups according to age at menarche, and their risks of MS and diabetes in various groups were compared. Results After multivariate adjustment, postmenopausal women with a menarche age<15 years had a 29%increased risk of diabetes(95%CI 1.03-1.61) and a 45% increased risk of MS(95% CI 1.20-1.76) in adulthood, compared with those with menarcheal age at 15-18 years. Among the five components of MS, earlier age of menarche was associated with higher risks of hypertriglyceridemia, low high density lipoprotein-cholesterol, and central obesity. Conclusions In Shanghai Jiading community postmenopausal women, age at menarche is associated with the risk of diabetes and MS, independent of the body mass index in adulthood.

13.
Article in Chinese | WPRIM | ID: wpr-709995

ABSTRACT

Objective To investigate the methods and efficacy of treatment on severe adrenal Cushing′s syndrome. Methods The clinical data of 22 cases with severe adrenal Cushing′s syndrome ( severe group) , and 136 cases with mild or moderate adrenal Cushing′s syndrome ( non-severe group) were reviewed. The clinical features were analyzed by comparing the differences between these two groups when patients were admitted to hospital. We discussed the clinical managements of patients with severe adrenal Cushing′s syndrome by comparing the differences with non-severe group after preoperative preparation, and with themselves before and after preoperative preparation. The effects of surgery were evaluated by comparing the differences between pre-operation and post-operation on patients with severe adrenal Cushing′s syndrome. Results At admission, serum/urine cortisol, disease course, and blood pressure were significantly higher in the severe group than those in non-severe group ( P<0.05 or P<0.01) , serum potassium and ACTH level were decreased significantly in the severe group than those innon-severegroup[(3.01±0.75vs3.62±0.48)mmol/L,P<0.01;(6.47±2.91vs8.21±3.22)pg/ml,P<0.01] . However, no significant difference was observed in diastolic blood pressure, serum potassium, and fasting plasma glucose between these two groups after preoperative preparation (all P>0.05). And then, we performed adrenalectomy. The symptoms of 22 cases with severe adrenal Cushing′s syndrome were obviously alleviated after 3 months. During follow-up, 5 cases of primary bilateral macronodular adrenal hyperplasia ( BMAH) and 1 case of primary pigmented nodular adrenocortical disease ( PPNAD ) were treated with contralateral adrenalectomy. Conclusion Sufficient preoperative preparation is essential for patients with severe adrenal Cushing′s syndrome because of its high level serum cortisol with severe complications. If preparation fails before surgery, cortisol-lowering medication or emergency unilateral adrenalectomy is necessary. Severe patients with BMAH and PPNAD were firstly performed unilateral adrenalectomy and followed-up closely, and then, contralateral adrenalectomy is needed when the recurrence of hypercortisolism recognized.

14.
Article in Chinese | WPRIM | ID: wpr-709937

ABSTRACT

Objective To investigate whether brachial-ankle pulse wave velocity(baPWV),independently and jointly with the level of body mass index(BMI),affect the risk of incident diabetes with hypertension. Methods The effects of baPWV and BMI level on incident diabetes with hypertension were evaluated using Kaplan-Meier curves (log-rank test) and multi logistical regression models after adjustment for various confounding factors. Results A total of 2 222 participants were recruited in this study. Higher baPWV (Q4) was associated with a greater risk of incident diabetes with hypertension simultaneously compared with baPWV in the lower quartiles(Q1-Q3),with HR 4.16(95% CI 2.14,8.09)in the crude model,2.52(95% CI 1.10,5.78) in modelI,and 2.45(95% CI 1.05, 5.70)in modelⅡ.The highest risk of diabetes with hypertension simultaneously was in the group with high baPWV and BMI≥25 kg/m2,with HR 11.50(95% CI 4.5,29.9)in the crude model,4.20(95% CI 1.4,13.1)in modelI,and 4.30(95% CI 1.4,13.3) in modelⅡ. Conclusions The joint effect of baPWV and BMI level on incident diabetes with hypertension simultaneously is a better predictor than their independent effect. The risk of incident diabetes with hypertension markedly increases in the subjects with BMI≥25 kg/m2and higher baPWV.

15.
Article in Chinese | WPRIM | ID: wpr-709912

ABSTRACT

Pre-diabetes is at increased risk of development of type 2 diabetes and future cardiovascular events. Preventing the progression of pre-diabetic populations to diabetes is important. The Acarbose Cardiovascular Evaluation(ACE) trial was the largest pre-diabetes intervention study conducted in China. The study found that acarbose treatment can significantly reduce the risk of new-onset diabetes in IGT patients with CVD on the basis of life interventions,but the cardiovascular benefits for the population are not significant. ACE study showed that acarbose can prevent the conversion of IGT to diabetes,which plays a key role in the prevention of diabetes.

16.
Article in Chinese | WPRIM | ID: wpr-662665

ABSTRACT

To improve the recognition and treatment of the combination of classical congenital adrenal hyperplasia (CAH) and Turner's syndrome. A case of 21-hydroxylase deficiency (21-OHD) in 45,X[3] / 46,XX [47] was reported,and the related literatures were reviewed. A 29-year-old woman with 45,X[3] / 46,XX[47] was referred with clitorimegaly and primary amenorrhea. Her height was 150 cm with a weight of 56 kg. Physical examination revealed a Tanner stage Ⅵ for both breast development and pubic hair development. She showed a little signs of Turner' s syndrome, such as cubitus valgus. Lab findings: sex hormones are significantly increased, including progesterone, testosterone, dehydroepiandrosterone, 17 hydroxyprogesterone, dihydrotestosterone, and androstendione. Enhanced CT scan showed bilateral adrenal hyperplasia. Gynecological ultrasound showed that the size of the uterus and ovary were near normal and the endometrium was not clear. By gene mutation screening, two mutation sites were found in CYP21A2 gene, such as IVS2-13C/ A→G and p. Ile173Asn( c. 518T→A). Taken together, the patient was diagnosed as a combination of 21-OHD and Turner syndrome. A total of ten patients associated with CAH in Turner's syndrome have been reported so far. The findings showed that routine karyotyping during investigations of patients presenting with ambiguous genitalia or with a diagnosis of CAH may reveal the concomitant presence of Turner's syndrome. We should make a definite diagnosis and give early treatment as soon as possible.

17.
Article in Chinese | WPRIM | ID: wpr-660511

ABSTRACT

To improve the recognition and treatment of the combination of classical congenital adrenal hyperplasia (CAH) and Turner's syndrome. A case of 21-hydroxylase deficiency (21-OHD) in 45,X[3] / 46,XX [47] was reported,and the related literatures were reviewed. A 29-year-old woman with 45,X[3] / 46,XX[47] was referred with clitorimegaly and primary amenorrhea. Her height was 150 cm with a weight of 56 kg. Physical examination revealed a Tanner stage Ⅵ for both breast development and pubic hair development. She showed a little signs of Turner' s syndrome, such as cubitus valgus. Lab findings: sex hormones are significantly increased, including progesterone, testosterone, dehydroepiandrosterone, 17 hydroxyprogesterone, dihydrotestosterone, and androstendione. Enhanced CT scan showed bilateral adrenal hyperplasia. Gynecological ultrasound showed that the size of the uterus and ovary were near normal and the endometrium was not clear. By gene mutation screening, two mutation sites were found in CYP21A2 gene, such as IVS2-13C/ A→G and p. Ile173Asn( c. 518T→A). Taken together, the patient was diagnosed as a combination of 21-OHD and Turner syndrome. A total of ten patients associated with CAH in Turner's syndrome have been reported so far. The findings showed that routine karyotyping during investigations of patients presenting with ambiguous genitalia or with a diagnosis of CAH may reveal the concomitant presence of Turner's syndrome. We should make a definite diagnosis and give early treatment as soon as possible.

18.
Article in Chinese | WPRIM | ID: wpr-506953

ABSTRACT

Objective To explore more suitable calculation method of the insulin dosage in insulin hypoglycemia-growth hormone stimulation test(insulin tolerance test, ITT). Methods Fifty-six subjects suspected of growth hormone deficiency were divided into primary and secondary onset groups. All the patients took oral glucose tolerance test and ITT. Homeostasis model of assessment for insulin resistance index ( HOMA-IR) and insulin sensitivity index ( ISI), area under insulin curve ( AUCINS ) and the area under glucose curve ( AUCPG ) were calculated. The insulin dosages during ITT between two groups were compared and the main factors influencing the insulin dosage were analyzed. Results There was no difference in the insulin dosage during ITT between primary and secondary groups. The actual dosage of insulin in this cohort study revealed a significant difference from the initial insulin dosage recommended by the guideline. Multiple linear regression analysis found that AUCINS and body mass index were the independent factors affecting the insulin dosage. Then the optimized coefficient of ITT ( γ) were found. Conclusion The insulin dosage used in our study was inconsistent with the guidelines-recommended ones. In order to make ITT more efficient and safer, a more optimized calculation method to improve the successful rate of insulin-induced hypoglycemia in ITT is proposed.

19.
Article in Chinese | WPRIM | ID: wpr-513585

ABSTRACT

Diabetes has been an epidemic in China. Developing economic levels, changes in diet, increasing of obesity, aging, and other factors are thought to be the main contributors. In the new situation for preventing and managing diabetes, several key issues should be seriously considered. We need to carry out high quality multi-center clinical researches based on a well-established nationwide collaborative research network; to identify and validate novel, sensitive and reliable diabetes risk factors and predictors using the new data collection system, and the omics technology based on the large-scale prospective cohorts with a long-term follow up; to reclassify diabetes based on the molecular and functional annotation, and finally to in-depth understand and update the pathogenesis of the disease. Furthermore, using the artificial intelligence and other advanced technologies combined with big medical and research data, etc., we should build new types of diabetes prediction models and systems, as well as machine-assisted diagnosis and treatment systems. Finally, we should carry out translational researches, as well as to develop early detection technologies and clinical pathways suitable for all levels of medical institutions.

20.
Article in English | WPRIM | ID: wpr-296507

ABSTRACT

This current cross-sectional study investigates the relationship between thyroid hormones and peripheral artery disease (PAD) among euthyroid Chinese population aged 40 years and above. Serum free triiodothyronine (FT3), free thyroxin (FT4), thyroid-stimulating hormone (TSH), and thyroid antibodies were measured. PAD was defined as ankle-brachial index (ABI) < 0.9. There were 91 (2.9%) PAD cases among the 3,148 euthyroid study participants. Participants in the highest quartile of FT3 and free-triiodothyronine-to-free-thyroxin (FT3/FT4 ratio) had a decreased risk of prevalent PAD (multivariate-adjusted odds ratio, 95% confidence interval: 0.32, 0.15-0.62, P for trend = 0.01 and 0.31, 0.13-0.66, P for trend = 0.004, respectively) compared to those in the lowest quartile. To conclude, FT3 levels and the FT3/FT4 ratio was inversely associated with prevalent PAD in euthyroid Chinese population aged 40 years and above.


Subject(s)
Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Odds Ratio , Peripheral Arterial Disease , Blood , Risk Factors , Thyroxine , Blood , Triiodothyronine , Blood
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