Association of total homocysteine with blood pressure in a general population of Chinese adults: a cross-sectional study in Jiangsu province, China.

OBJECTIVES: We aimed to evaluate the relation of total homocysteine (tHcy) concentrations with systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels, and examine the possible modifiers in the association among a general population of Chinese adults. DESIGN: A cross-sectional study. SETTING: The study was conducted within 21 communities in Lianyungang of Jiangsu province, China. PARTICIPANTS: A total of 26 648 participants aged ≥35 years and with no antihypertensive drug use were included in the final analysis. RESULTS: Overall, there was a positive association between tHcy concentrations and SBP (per 5 µmol/L tHcy increase: adjusted ß=0.45 mm Hg; 95% CI 0.29 to 0.61) or DBP levels (per 5 µmol/L tHcy increase: adjusted ß=0.47 mm Hg; 95% CI 0.35 to 0.59). Compared with participants with tHcy <10 µmol/L, significantly higher SBP levels were found in those with tHcy concentrations of 10 to <15 (adjusted ß=0.80 mm Hg; 95% CI 0.32 to 1.28) and ≥15 µmol/L (adjusted ß=1.79 mm Hg; 95% CI 1.20 to 2.37; p for trend <0.001). Consistently, significantly higher DBP levels were found in participants with tHcy concentrations of 10 to <15 (adjusted ß=0.86 mm Hg; 95% CI 0.49 to 1.22) and ≥15 µmol/L (adjusted ß=2.01 mm Hg; 95% CI 1.57 to 2.46; p for trend <0.001), respectively as compared with those with <10 µmol/L. Furthermore, a stronger association between tHcy and SBP (p for interaction=0.009) or DBP (p for interaction=0.067) was found in current alcohol drinkers. CONCLUSION: Serum tHcy concentrations were positively associated with both SBP and DBP levels in a general Chinese adult population. The association was stronger in current alcohol drinkers.

Association between serum total homocysteine and arterial stiffness in adults: a community-based study.

Both increased arterial stiffness and higher total homocysteine (tHcy) are associated with an elevated risk for cardiovascular disease. However, the relationship between tHcy and arterial stiffness is still inconclusive. The authors aimed to test the relationship of tHcy with carotid-femoral pulse wave velocity (cfPWV) and examine the possible effect modifiers in adults. A study was conducted from July to September 2016 in Jiangsu Province, China. A total of 16 644 participants were enrolled in the final analysis. Increased arterial stiffness is defined as a cfPWV ≥10 m/s. Overall, there was a positive association between tHcy and cfPWV levels (per 5-µmol/L tHcy increase: ß = 0.10; 95% confidence interval [CI], 0.08-0.13) and increased arterial stiffness (per 5-µmol/L tHcy increase: odds ratio, 1.11; 95% CI, 1.07-1.14). Compared with participants with tHcy <10 µmol/L, the significantly higher cfPWV levels were observed in those with tHcy ≥15 µmol/L (ß = 0.37; 95% CI, 0.28-0.47). Accordingly, a higher prevalence of increased arterial stiffness was found in patients with tHcy10 to <15 µmol/L (odds ratio, 1.18; 95% CI, 1.05-1.33) and tHcy ≥15 µmol/L (odds ratio, 1.50; 95% CI, 1.32-1.71) as compared with participants with tHcy <10 µmol/L. Furthermore, the stronger positive association was found in participants who were older (≥60 years, P for interaction = .008), had low body mass index (<25 kg/m2 , P for interaction = .026), high systolic blood pressure levels (≥145 mm Hg [median], P for interaction = .048), or diabetes mellitus (P for interaction = .045). The present study demonstrated that serum tHcy concentrations were positively associated with cfPWV and the prevalence of increased arterial stiffness. These results suggest that the cardiovascular effects of tHcy may partly be mediated through arterial stiffness.

[The association between smoking status and carotid artery plaque in rural areas of Eastern part of China].

OBJECTIVE: To investigate the correlation between smoking status and carotid plaque in rural population residing in Eastern part of China. METHODS: Between July and September of 2013, an epidemiological survey was carried out in residents aged 40 or above men who were enrolled randomly in rural areas of Anqing, Anhui province and Lianyungang, Jiangsu province. The data on epidemiological characteristics including smoking status, physical examination were collected using standardized protocol, and carotid ultrasonography was applied to examine the incidence of carotid plaque among never smokers, former smokers and current smokers. Logistic regress analysis was performed to determine the effect of smoking on carotid plaque. RESULTS: In the study, a total of 625 male participants were included in the study. 51.4% (321 cases) were current smokers, 21.3% (133 cases) were former smokers, and 27.4% (171 cases) were never smokers. 32.0% (200/625) had carotid plaque. The incidence of carotid plaques was significantly higher in current smokers (35.2%, 113/321) than that in never smokers(23.4%,40/171) (χ(2) = 7.26, P = 0.007) and the incidence in former smokers (35.3%, 47/133) was also higher than that in never smokers (23.4%, 40/171) (χ(2) = 5.23, P = 0.022). Multiple logistic regression analysis showed that current cigarette smoking is significantly associated with the increased risk of carotid plaque (OR = 1.84, 95% CI: 1.13-2.98, P = 0.014) in comparison with never smokers, and there was an interaction between current smoking and age in association with carotid plaque. Compared with the young (≤60 years old) and never smoking group (8%, 3/40), prevalence of carotid plaque among the elderly (>70 years old) and smoking group (55%, 31/56) was significantly higher (OR = 8.06, 95% CI: 2.07-31.45) after adjusting for age, systolic blood pressure, diastolic blood pressure, blood glucose, total cholesterol, triglyceride high-density lipoprotein, body mass index, drinking and regional differences. CONCLUSION: It found that cigarette smoking was associated with increased risk of carotid plaque in rural elderly population residing in Eastern part of China.

Genetic and environmental influences on serum lipid tracking: a population-based, longitudinal Chinese twin study.

We conducted cross-sectional and longitudinal twin analysis to explore genetic and environmental contribution to serum lipid tracking during childhood and adolescence. The study sample was part of a population-based twin cohort that was recruited in the rural areas of the Anhui Province of China. The baseline recruitment of twins was carried out from 1998 through 2000 and the follow-up from 2005 through 2007. Serum lipids showed significant tracking during childhood and adolescence. Participants with lipids at the highest tertile at the baseline tended to remain high at follow-up across ages and Tanner stages, whereas subjects with lipids at the lowest tertile at the baseline tended to remain low at follow-up. Using twin modeling, we showed that genetic and environmental factors contributed to individual variations in lipid levels and tracking from the baseline to the follow-up visit. The estimated tracking correlations for total cholesterol, triglyceride, and LDL cholesterol were in the range of 0.25-0.53 and were predominantly influenced by genetic factors. In contrast, the phenotypic tracking of HDL cholesterol was influenced by both genetic and environmental factors. Our study underscores the importance of considering both environmental and genetic factors in studying the etiology of dyslipidemia.

Association of BDNF Val66Met polymorphism with both baseline HRQOL scores and improvement in HRQOL scores in Chinese major depressive patients treated with fluoxetine.

OBJECTIVE: To explore the association of brain-derived neurotrophic-factor (BDNF) Val66Met polymorphism with both baseline health related quality of life (HRQOL) scores and improvement in HRQOL scores in Chinese major depressive patients treated with fluoxetine. METHODS: Patients with major depressive disorder (MDD) took fluoxetine (20 mg/day) for 6 weeks. The HRQOL was measured with the Medical Outcomes Study Short Form-36 (SF-36) at baseline and at 6th week. Patients were genotyped for Val66Met polymorphism of BDNF gene. RESULTS: There was a significant association between social function (SF) and BDNF Val66Met polymorphism, and patients with Met/Met genotype had better SF (compared with Val/Val P = 0.004; compared with Val/Met P = 0.005). A significant association was found between improvement in SF and BDNF Val66Met polymorphism, and patients with Met/Met genotype had poorer improvement in SF (compared with Val/Val P = 0.010; compared with Val/Met P = 0.001). Similar association was found between improvement in mental component summary (MCS) and BDNF Val66Met polymorphism, and patients with Met/Met genotype had poorer improvement in MCS (compared with Val/Val P = 0.066; compared with Val/Met P = 0.006). CONCLUSIONS: These results indicate that there may be association between BDNF Val66Met polymorphism and both baseline HRQOL (SF) scores and improvement in HRQOL (SF, MCS) scores in Chinese major depressive patients treated with fluoxetine.

Association of brain-derived neurotrophic factor genetic Val66Met polymorphism with severity of depression, efficacy of fluoxetine and its side effects in Chinese major depressive patients.

BACKGROUND: Preclinical studies have shown that brain-derived neurotrophic factor (BDNF) may be involved in antidepressant action, and the BDNF gene has been suggested to be involved in the pharmacological treatment of major depressive disorder (MDD). In this study, the relationship between BDNF Val66Met polymorphism (Single Nucleotide Polymorphism Database ID: rs6265) and severity of depression, efficacy of fluoxetine and its side effects was tested in Chinese patients with MDD. METHODS: Patients with MDD took the oral selective serotonin reuptake inhibitor (SSRI) fluoxetine (20 mg/day) for 6 weeks. Its clinical efficacy and side effects were measured by the 17-item Hamilton Rating Scale for Depression and the Treatment-Emergent Symptoms Scale (TESS), respectively. The patients were genotyped for Val66Met polymorphism of the BDNF gene. RESULTS: In the multivariate regression analysis, there was no significant association between severity of depression and BDNF Val66Met polymorphism. There was no association between efficacy of fluoxetine and BDNF Val66Met polymorphism, but there was a marginal positive suggestion that heterozygous patients tended to have a better remission with fluoxetine in comparison with homozygous analogs. Insomnia and decreased sexual desire, side effects of fluoxetine, may have an association with the BDNF Val66Met polymorphism, and Met allele carriers showed a lower incidence of these side effects. CONCLUSIONS: These results indicate that there was a lack of association between severity of depression and BDNF Val66Met polymorphism in Chinese patients with MDD. The BDNF Val66Met polymorphism may play a major role in the efficacy and side effects of SSRI (fluoxetine) in Chinese patients with MDD.

Familial aggregation and heritability of electrocardiographic intervals and heart rate in a rural Chinese population.

BACKGROUND: Estimates of the genetic influences on electrocardiographic (ECG) parameters are inconsistent in previous reports, and no such studies have been performed in China. So we estimated genetic contributions to PR and QRS intervals and the rate-adjusted QT interval (Bazett's QTc) in a Chinese rural population. METHODS: A total of 2909 subjects from 847 families were enrolled in the current study. Genetic contributions to ECG parameters were estimated in two ways: correlation coefficients among family members (father-mother, parent-offspring, first sibling-other sibling) and the heritability of each of the ECG parameters. RESULTS: Our results showed significant correlations among family members on theses parameters: the correlation coefficients for PR interval, QRS duration, QTc interval, and HR, between parent-sibling, and sibling-sibling were 0.17 and 0.13, 0.18 and 0.23, 0.22 and 0.28, 0.19 and 0.18, respectively. The heritability for PR interval, QRS duration, QTc interval, and HR were estimated as 0.34, 0.43, 0.40, and 0.34, respectively. CONCLUSION: Genetic factors, together with the environmental and other cofactors contribute no more than 60% to the variance of the ECG intervals, supporting the concept that multiple factors, including gene-gene and gene-environment interactions could influence ECG interval phenotypes, and genetic factors play a major role.

Familial aggregation of metabolic syndrome and its components in a large Chinese population.

OBJECTIVE: To investigate the familial aggregation of metabolic syndrome (MetS) and its components in the Chinese. METHODS AND PROCEDURES: A total of 17,954 subjects from 5,224 families with multiple siblings aged 25-64 years old (mean age 45.8 years, 51.6% male) were enrolled from a rural area of Anhui Province of China during 2004-2005. Anthropometric measurement, body composition, blood pressure, plasma lipids, and fasting glucose and insulin, as well as a questionnaire interview, were obtained from each participant. RESULTS: Significant correlations among siblings were observed in all the traits examined, including BMI, waist circumference, total body and abdominal fat percentage, fasting plasma glucose (FPG) and insulin, insulin resistance index of homeostatic model assessment (HOMA-IR), total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and blood pressure, after adjustment for age, gender and some other covariates. The correlation coefficients varied from 0.18 for FPG to 0.42 for HDL-C. In stratified analyses, we found siblings with a smaller age gap among them had higher intraclass correlation coefficients (ICCs) for most of the above phenotypes than those with a greater age difference, and the correlation of systolic blood pressure (SBP) was stronger in male siblings than that in female. If the eldest sibling is affected by MetS or any of its components, younger siblings bear a twofold to threefold higher risk for developing MetS or any of its components than those with a healthy eldest sibling. DISCUSSION: Our study demonstrated a significant familial resemblance as regards MetS and its components among the Chinese. Further studies are warranted to investigate specific genetic and environmental factors related to MetS in this population.

Effects of age at menarche, reproductive years, and menopause on metabolic risk factors for cardiovascular diseases.

BACKGROUND: Early menarche is associated with increased adult body fatness, however, this association has been studied primarily in young women. The impact of changes in some metabolic risk factors of cardiovascular disease (CVD) after menopause remains controversial and ageing is an important confounder. OBJECTIVES: To investigate the effect of age at menarche, reproductive years, and years post-menopause on body composition and metabolic risk factors for CVD independent of the normal ageing process in a large sample size of Chinese women. DESIGN: Nine thousand ninety seven women aged 25-64 were recruited from Anhui, China in 2004-2005. Anthropometric measurement, body composition, blood pressure, plasma lipids, fasting glucose and insulin, as well as a questionnaire-based interview on menstruation and lifestyle information were obtained from each participant. RESULTS: After adjusting for age and other covariates, age at menarche was inversely associated with body fatness, HOMA-IR, triacylglycerol and the total number of metabolic syndrome components, and was positively associated with HDL-C (p<0.05). The number of reproductive years was associated with increased body fatness, decreased total cholesterol and HDL-C (p<0.05). Post-menopausal women had significantly lower BMI but higher abdominal fat percentage, increased plasma levels of triacylglycerol, total cholesterol, HDL-C, and LDL-C, and lower systolic blood pressure than pre-menopausal women (p<0.05). CONCLUSION: Age at menarche, reproductive years, and menopause status were significantly associated with body composition, insulin sensitivity and blood lipid levels.

Impact of seafood and fruit consumption on bone mineral density.

OBJECTIVES: Over the past decade, dietary choices and nutrition have proven to be major modulators of bone mineral density (BMD) in men and women. We investigated environmental determinants, specifically dietary habits, of BMD by using multiple regression models in a rural Chinese population. METHODS: BMDs were measured at the hip and total body in 5848 men and 6207 women, aged 25-64. Dietary and supplemental intakes were assessed by a simple, one-page questionnaire tailored to collect nutritional information from large rural populations. Another questionnaire was used to collect information on the subjects' age, disease history, smoking, alcohol consumption, physical activity as well as women's menstrual status and reproductive history. Multiple regression models were used to assess the relationships among dietary variables and BMD, after adjusting for age, BMI (body mass index), weight, occupation, smoking status, and alcohol consumption. RESULTS: Increasing seafood consumption was significantly associated with greater BMD in women (p<0.001), especially those consuming more than 250 g per week of seafood. One thousand and three hundred and twenty-four men and 1479 women consumed >250 g of fruit per week. Higher fruit intake was found to be significantly associated with higher BMD in both sexes (p<0.05). High vegetable consumption, however, did not positively impact BMD. CONCLUSIONS: This study with its large population size has identified preventive measures, as well as some risk factors, involved in bone loss and osteoporosis. Our results highlight the importance of several dietary variables as significant determinants of BMD. It also emphasizes the role of dietary intake in general and shows that specific foods, such as fruits and seafood, can positively impact BMD.

Prevalence of metabolic syndrome and its relation to body composition in a Chinese rural population.

OBJECTIVE: To investigate the prevalence of metabolic syndrome (MetS) with three different working definitions in a rural Chinese population and to examine its relation to body composition. RESEARCH METHODS AND PROCEDURES: A total of 18,630 adults 25 to 64 years old (mean age, 45.8 years; 51.2% men) from 5686 families were enrolled from Anhui province of China during 2004 to 2005. Anthropometric measurement, body composition, blood pressure, plasma lipids, and fasting glucose and insulin and a questionnaire-based interview were obtained from each participant. Three different working definitions for MetS, including the U.S. National Cholesterol Education Program's Adult Treatment Panel III, a modified Adult Treatment Panel III that adopts the World Health Organization's criterion for central obesity in Asian populations, and one recently proposed by the International Diabetes Federation, were used in the study. RESULTS: According to the three definitions, the age-adjusted prevalence of MetS for adults 25 to 64 years old was 3.2%, 4.9%, and 3.9% in men and 7.2%, 11.5%, and 10.9% in women, respectively. MetS prevalence increases significantly with age in women, but not in men. Body fat percentage and BMI and waist circumference were significantly associated with each component of MetS, especially with triglyceride level, insulin resistance index, and number of MetS components (r = 0.28 to 0.49). DISCUSSION: The age-adjusted prevalence of MetS in our study population is lower than that reported in other urban Chinese populations. Significant gender differences in MetS prevalence were observed. The waist circumference is a good surrogate for abdominal fat percentage.

G protein-coupled receptor 154 gene polymorphism is associated with airway hyperresponsiveness to methacholine in a Chinese population.

BACKGROUND: A new asthma susceptibility gene, the G protein-coupled receptor for asthma susceptibility (GPRA, GPR154), has recently been identified and the association was replicated in 2 white populations, but not in a Korean population. OBJECTIVE: To test the association between GPR154 gene polymorphisms and airway responsiveness to methacholine in a Chinese population. METHODS: Eight single nucleotide polymorphisms (SNPs) in the GPR154 gene were genotyped in 451 cases and 232 controls in stage I. The association of 1 SNP, rs324981, was tested in an additional 264 case and 241 control subjects in stage II. Both single marker and haplotype associations were tested. RESULTS: In stage I, we found that airway hyperresponsiveness to methacholine was associated with 2 single SNPs, rs324981 and rs324987, but not with the haplotypes of GPR154. The minor allele homozygotes of rs324981 (AA) and rs324987 (TT) were at a significantly lower risk of hyperresponsiveness to methacholine with odds ratios of 0.59 (P=.02) and 0.56 (P=.01), respectively. In stage II, we found a similar trend of association between rs324981 and airway hyperresponsiveness (P=.09). In the pooled analysis, the odds ratio of the AA homozygote of rs324981 was 0.61 (P=.004). The permutation test resulted in a study-wide empirical P value of .023, which meant that the association remained significant after adjustment for multiple tests. CONCLUSIONS: Our study supports a role of the GPR154 gene in asthma susceptibility and suggests that the AA homozygote of rs324981 is a protective factor for airway hyperresponsiveness to methacholine in a Chinese population. CLINICAL IMPLICATIONS: Our findings confirmed a role of GPR154 in the genetic susceptibility of asthma and suggest that GPR154 polymorphism should be taken into consideration to improve the assessment of an individual's risk of asthma.

Familial aggregation of bone mineral density and bone mineral content in a Chinese population.

Familial aggregation of bone mineral density (BMD) and bone mineral content (BMC) has been shown in twin and familial studies, but most sample sizes were small. We here report a large familial aggregation study in a Chinese population. A total of 13,973 siblings aged 25-64 years from 3,882 families were enrolled from Anhui, China. We assessed the whole-body, hip and lumbar spine BMD and BMC by dual-energy X-ray absorptiometry (DXA). Intra-class correlation coefficients of BMD and BMC between siblings varied among different skeletal sites and between different age groups of male sib-pairs and premenopausal and postmenopausal female sib-pairs, with a range of 0.228 to 0.397. The sibling recurrence risk ratio (lambdas) of osteoporosis was 2.6 in our population. We also evaluated the joint association of the BMD values of the first siblings and the second siblings with the risk of low BMD (defined as less than the 10th percentile of the same group population) of their younger siblings. If both the first and second siblings' BMDs were in the lowest tertile, the odd ratios (ORs) of low BMD in their subsequent siblings were 8.32 [95% confidence interval (CI) 5.59-12.39)], 8.71 (95% CI 5.74-13.22) and 5.90 (95% CI 3.57-9.76) for total body, total hip and lumbar spine, respectively. This study demonstrates a significant familial aggregation of BMD and BMC in a large sample of rural Chinese adults.