GooD4Mum: A general practice-based quality improvement collaborative for diabetes prevention in women with previous gestational diabetes.

AIMS: Gestational diabetes (GDM) and Type 2 diabetes pose tremendous health and economic burdens as worldwide incidence increases. Primary care-based systematic diabetes screening and prevention programs could be effective in women with previous GDM. GooD4Mum aimed to determine whether a Quality Improvement Collaborative (QIC) would improve postpartum diabetes screening and prevention planning in women with previous GDM in general practice. METHODS: Fifteen general practices within Victoria (Australia) participated in a 12-month QIC, consisting of baseline and four quarterly audits, guideline-led workshops and Plan-Do-Study-Act feedback cycles after each audit. The primary outcome measures were the proportion of women on local GDM registers completing a diabetes screening test and a diabetes prevention planning consultation within the previous 15 months. RESULTS: Diabetes screening increased with rates more than doubled from 26% to 61% and postpartum screening increased from 43%-60%. Diabetes prevention planning consultations did not show the same level of increase (0%-10%). The recording of body mass index improved overall (51%-69%) but the number of women with normal body mass index did not. CONCLUSIONS: GooD4Mum supported increased diabetes screening and the monitoring of high risk women with previous GDM in general practice.

Does abnormal insulin action or insulin secretion explain the increase in prevalence of impaired glucose metabolism with age in populations of different ethnicities?

BACKGROUND: Age is associated with both impaired glucose and insulin metabolism. To what extent the age-related changes in insulin resistance (IR) and beta-cell function contribute to the increase in prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) is less known, and this is investigated in this study. METHODS: This study included 6610 men and 7664 women of different ethnic groups aged 30-69 years. IR and beta-cell function were examined by the homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of beta-cell function (HOMA-B). Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression analysis adjusting for body mass index and study. RESULTS: In Chinese men, the ORs (95% CIs) for IFG were 2.69 (1.70, 4.26), 2.51 (1.49, 4.21) and 2.89 (1.68, 4.97), respectively, in age groups of 40-49, 50-59 and 60-69 years compared with 30-39 years (p < 0.001 for trend); the corresponding figures for IGT were 1.73 (1.25, 2.38), 2.54 (1.78, 3.63) and 3.57 (2.46, 5.19) (p < 0.001 for trend). Similar trends for IGT were observed also in Chinese women and other ethnic groups, but not for IFG in Mauritius Indian and Creole men. Adjustment for HOMA-IR and HOMA-B reduced the ORs in all age groups of all ethnicities for both IFG and IGT, but the risk gradient between age groups remained particularly for the IGT. CONCLUSIONS: The age-related increase in glucose intolerance may not be fully explained by the defect in HOMA-IR and HOMA-B. As HOMA-IR and HOMA-B are only surrogate measures of insulin sensitivity and insulin secretion, the results need to be further investigated.

Ethnic comparison of the association of undiagnosed diabetes with obesity.

OBJECTIVE: The aim of the study was to investigate the crude prevalence and estimated probability of undiagnosed diabetes in different ethnic groups, given the same level of obesity. DESIGN AND SUBJECTS: Cross-sectional data from 24 515 men and 29 952 women, aged >or=30 years, and free of previously diagnosed diabetes were included. Baseline body mass index (BMI) and waist circumference were measured. Diabetes was defined according to both fasting and 2-h 75-g glucose criteria. RESULTS: Prevalence of undiagnosed diabetes was the highest in Asian Indians, the lowest in Europeans and intermediate in others, given the same BMI or waist circumference category across the BMI or waist circumference ranges (P<0.001 for all BMI or waist categories). beta-Coefficients corresponding to a 1 s.d. increase in BMI were 0.34/0.28, 0.41/0.43, 0.42/0.61, 0.36/0.59 and 0.33/0.49 for the Asian Indians, Chinese, Japanese, Mauritian Indians and European men/women (homogeneity test: P>0.05 in men and P<0.001 in women), and in waist: 0.31/0.31, 0.30/0.46, 0.22/0.57 and 0.38/0.58 for the Asian Indians, Chinese, Mauritian Indians and Europeans, respectively (homogeneity test: P>0.05 in men and P<0.001 in women). CONCLUSION: Prevalence of undiagnosed diabetes increased with an increasing BMI or waist circumference to a similar degree in men in all ethnic groups but to a lesser degree in Asian Indian women than in others, regardless of the higher prevalence in Asian Indians than in others at the same BMI (or) waist circumference levels.

Blood lipid levels in relation to glucose status in seven populations of Asian origin without a prior history of diabetes: the DECODA study.

BACKGROUND: Dyslipidaemia commonly coexists with diabetes. We investigated the association of lipid profiles with glucose levels in populations of Asian origin without a prior history of diabetes. METHODS: Cross-sectional data of 10,374 men and 12,552 women aged 30-74 years from 14 cohorts, representing seven populations of Asian origin were jointly analysed. Multivariable adjusted linear regression analyses with standardized regression coefficients (beta) were performed to estimate relationships between lipids and plasma glucose. RESULTS: Within each glucose category, fasting plasma glucose (FPG) levels were correlated with increasing levels of triglycerides (TGs), total cholesterol (TC), TC to high-density lipoprotein (HDL) ratio and non-HDL cholesterol (non-HDL-C) (p < 0.05 in most of the ethnic groups) and inversely associated with HDL-C (p < 0.05 in some, but not all, of the populations). The association of lipids with 2-h plasma glucose (2hPG) followed a similar pattern as that for the FPG, except that an inverse relationship between HDL-C and glucose was more commonly observed for 2hPG than for FPG among different ethnic groups. CONCLUSIONS: Hyperglycaemia is associated with adverse lipid profiles in Asians without a prior history of diabetes. The 2hPG appears to be more closely associated with lipid profiles than does FPG. When assessing the risk of cardiovascular disease, the association of the dyslipidaemia with intermediate hyperglycaemia needs to be considered.

A socio-historical hypothesis for the diabetes epidemic in Chinese--preliminary observations from Hong Kong as a natural experiment.

It has been hypothesized that the emerging epidemic of diabetes in economically transitioning or recently transitioned populations is due to mismatch between developmental and mature environments. We took advantage of migration within an ethnically homogenous population to investigate this hypothesis, and the potentially modifying role of postnatal growth conditions, proxied by greater height. We used multivariable logistic regression in a population-based cross-sectional study from 1994 to 1996 of 2,341 long-term Hong Kong residents aged 25-74 years, either born in contemporaneously developed Hong Kong or migrants from economically undeveloped Guangdong. Migrant status was not associated with clinically diagnosed diabetes, odds ratio 1.05 (95% confidence interval 0.69-1.58) in adult migrants compared to Hong Kong-born natives and 1.22 (0.83-1.80) in preadult migrants, adjusted for age, sex, socio-economic position, and lifestyle. However, the association of diabetes with migrant status varied with height, suggesting a potentially complex relationship between indicators of prenatal and postnatal nutritional exposures. Compared to tall Hong Kong-born natives, the odds ratio of diabetes was 2.36 (1.20-4.61) in tall migrants, 1.94 (1.07-3.53) in short Hong Kong-born natives, but 1.04 (0.48-2.23) in short adult migrants. Additionally adjusting for body mass index and waist-hip ratio had little effect, apart from attenuating the association between short height and diabetes prevalence in Hong Kong-born natives. Whether the current epidemic of diabetes is a long-standing effect of such mismatch or a "first-generation through effect" generated by rapid economic development causing disproportionate growth remains to be determined.

BMI compared with central obesity indicators in relation to diabetes and hypertension in Asians.

OBJECTIVE: To compare BMI with waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) in association with diabetes or hypertension. METHODS AND PROCEDURES: Cross-sectional data from 16 cohorts from the DECODA (Diabetes Epidemiology: Collaborative Analysis of Diagnostic criteria in Asia) study, comprising 9,095 men and 11,732 women, aged 35-74 years, of different ethnicities were included in this meta-analysis. RESULTS: Age-adjusted odds ratios (ORs) for diabetes in men (women) for 1 s.d. increase in BMI, WC, WHR, and WSR were 1.52 (1.59), 1.54 (1.70), 1.53 (1.50), and 1.62 (1.70), respectively; and the corresponding ORs for hypertension were 1.68 (1.55), 1.66 (1.51), 1.45 (1.28), and 1.63 (1.50). Paired homogeneity tests (BMI with each of the three) adjusted for age and cohort showed that diabetes had stronger association with WSR than BMI (P=0.001) in men but with WC and WSR than BMI (both P<0.05) in women. Hypertension had stronger association with BMI than WHR in men (P<0.001) and had the strongest with BMI than the others (WHR P<0.001; WSR P<0.01; and WC P<0.05) in women. Areas under the receiver operating characteristic (ROC) curves adjusted for age and cohort were slightly larger for diabetes for WSR 0.735 (0.748) in men (women) and WC 0.749 (women only) than BMI 0.725 (0.742) while for hypertension larger for BMI 0.760 (0.766) than WHR 0.748 (0.751), but their 95% CIs were all overlapped. DISCUSSION: WSR was stronger than BMI in association with diabetes, but these indicators were equally strongly associated with hypertension in Asians.

Prevalence, detection and drug treatment of hypertension in a rural Australian population: the Greater Green Triangle risk factor study 2004-2006.

BACKGROUND: Hypertension is an important risk factor for cardiovascular disease; however, limited findings are available on its detection and management in rural Australia. AIM: To assess the prevalence, awareness and treatment of hypertension in a rural South-East Australian population. METHODS: Three cross-sectional surveys in Limestone Coast, Corangamite Shire and Wimmera regions during 2004-2006 using a random population sample (n = 3320, participation rate 49%) aged 25-74 years. Blood pressure was measured by trained nurses. Information on history of hypertension and medication was obtained by questionnaires. Hypertension was defined as systolic blood pressure >or=140 mmHg and/or diastolic blood pressure >or=90 mmHg and/or on antihypertensive drug treatment. RESULTS: Overall, one-third of participants had hypertension; of these, two-thirds, 54% (95% confidence interval (CI) 47-60) of men and 71% (95% CI 65-77) of women, were aware of their condition. Half of the participants with hypertension were treated and nearly half of these were controlled. Both treatment and control were more common in women (60%, 95% CI 54-67 and 55%, 95% CI 47-64) compared with men (42%, 95% CI 36-49 and 35%, 95% CI 26-44). Monotherapy was used by 55% (95% CI 48-61) of treated hypertensives. Angiotensin-converting enzyme inhibitors were the most frequently used class of antihypertensive drugs in men, whereas angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists and diuretics were all widely used among women. CONCLUSION: This study emphasizes suboptimal detection and treatment of hypertension, especially in men, in rural Australia.

Determinants of normoglycemia and contribution to cardiovascular risk factors in a Chinese population: the Hong Kong Cardiovascular Risk Factor Study.

BACKGROUND: Glucose intolerance is clearly associated with increasing risk of cardiovascular disease, but the association among increasing glycemia and cardiovascular risk factors, angina and coronary heart disease in normoglycemic subjects is less clear, particularly in Chinese. METHODS: A total of 2763 subjects were recruited and the prevalence of glucose intolerance investigated, using fasting or 2-h 75-g oral glucose tolerance test (OGTT), glucose levels. Subjects normoglycemic by both criteria were selected and the relationship between glycemia and cardiovascular risk factors investigated using analysis of variance and stepwise multiple linear regression analyses. RESULTS: 1931 (69.9%) subjects were normoglycemic by both tests. After adjustment for age and gender, quartiles of fasting and post-load glucose levels showed a clear positive relationship with cardiovascular risk factors, including obesity, blood pressure and lipid levels (p<0.001 for all). Additionally, other measures of glycemia and insulin resistance also dose-dependently increased with increasing fasting and post-load glucose levels (p<0.001 for all). Stepwise multiple regression showed that in females, age (standardised regression coefficient beta (beta)=0.23, p<0.001), insulin (beta=0.17, p<0.001), waist circumference (beta=0.11, p=0.007) were independently associated with fasting glucose levels; and body mass index (beta=0.17, p<0.001), age (beta=0.15, p<0.001) and triglycerides (beta=0.15, p<0.001) were independently associated with post-load glucose levels. In males, age (beta=0.19, p<0.001) and insulin (beta=0.18, p<0.001) were independently associated with fasting glucose levels; and waist circumference (beta=0.17, p<0.001), triglycerides (beta=0.16, p<0.001) and insulin (beta=0.12, p=0.001) were independently associated with post-load glucose levels.

Polymorphisms of the gene encoding adiponectin and glycaemic outcome of Chinese subjects with impaired glucose tolerance: a 5-year follow-up study.

AIMS/HYPOTHESIS: Polymorphisms of the gene encoding adiponectin (ADIPOQ) have previously been associated with type 2 diabetes in Europid and Japanese subjects, but not in Pima Indians. The aim of this study was to determine the contribution made by ADIPOQ gene variants to glycaemic status in southern Chinese individuals. SUBJECTS AND METHODS: Sixty unrelated subjects were screened for single-nucleotide polymorphisms (SNPs) in the ADIPOQ gene by direct sequencing. The association of tagging SNPs with the outcome of glycaemic status in 262 subjects with impaired glucose tolerance (IGT) was examined in a 5-year prospective study. RESULTS: We identified 15 polymorphisms in the ADIPOQ gene, ten of them constituting the tagging SNPs. At 5 years, 39.7% of the subjects with IGT had regressed to NGT, 41.2% had persistent IGT or impaired fasting glucose and 19.1% had developed diabetes. Only the T45G polymorphism was associated with persistent hyperglycaemia at 5 years (p=0.001). Haplotypes formed by the addition of other SNPs, as haplotype blocks or pairs, did not confer greater association than T45G alone. On logistic regression analysis, T45G independently predicted persistent hyperglycaemia at 5 years (OR=2.25, 95% CI 1.29-3.95, G carriers vs TT; p=0.005). It also predicted persistent hyperglycaemia in a nested case-control study involving 158 sex- and age-matched controls with persistent NGT (p=0.012, adjusted for BMI), and that of diabetes or glycaemia progression (p<0.05) in a meta-analysis that also included two published studies in Europid subjects. CONCLUSIONS/INTERPRETATION: Our findings support a significant role of this common ADIPOQ gene polymorphism in predicting glycaemic status in southern Chinese people.

Is a single definition of the metabolic syndrome appropriate?--A comparative study of the USA and Asia.

The metabolic syndrome has been identified as an increasingly important precursor to cardiovascular diseases in many Asian populations. Our objective was to compare the contribution of component risk factors to the diagnosis of the metabolic syndrome, as defined by the Third report of the National Cholesterol Education Program Expert Panel Adult Treatment Panel (NCEP-ATPIII), in the US and selected Asian populations. Nationally representative survey data from Hong Kong, Taiwan, Thailand and the US were used. Analyses were restricted to men and women aged > or = 35 years. The age-standardized prevalence of the NCEP-ATPIII defined metabolic syndrome was highest in the US (31% in men, 35% in women), and lowest in Taiwan (11% in men, 12% in women). The component risk factors that defined the presence of the metabolic syndrome varied between countries. As expected, abnormal waist circumference was considerably more prevalent among individuals with the metabolic syndrome in the US (72% in men, 94% in women) compared with their Asian counterparts, but substantial variation was also observed between the Asian populations (13-22% in men, 38-63% in women). Furthermore, the relative contribution of other risk factors to the metabolic syndrome was also substantially different between countries. The NCEP-ATPIII definition identifies a heterogeneous group of individuals with the metabolic syndrome in different populations.

Diet and glucose tolerance in a Chinese population.

BACKGROUND: Associations between dietary factors and glucose tolerance observed in Caucasian populations may not be applicable to Chinese populations, since the traditional Chinese diet contains plentiful vegetables and is rice-based (which has a lower glycemic index than potatoes). To address this question, the dietary patterns in 988 Hong Kong Chinese subjects with normal and impaired glucose tolerance, and diabetes, were examined in a cross sectional survey to determine if there is any association between diet and glucose tolerance. METHOD: A stratified random population sample of 988 subjects (488 male, 500 female) was recruited. A food frequency questionnaire was used to determine dietary intake, and glucose tolerance was examined using the glucose tolerance test and the WHO criteria used to classify subjects into the three glucose tolerance categories. RESULTS: Using the standardized world population of Segi, the prevalence rate for DM was 6.6% for men and 5.7% for women; and for IGT 10.3% for men and 15.4% for women aged 30-64 y. Abnormal glucose tolerance is associated with female gender, older age, lower educational attainment and higher body mass index (BMI). No clear pattern of association with dietary factors was observed after adjusting for confounding factors. However, if subjects with BMI>or=25 kg/m(2) were excluded, an increase in mean consumption of rice/noodles/pasta per week was observed in the DM group, after adjusting for total energy intake and other confounding factors. No association between dietary variety, which has been linked with body fatness, and glucose tolerance, was observed. CONCLUSION: Dietary habit may not be a strong risk factor for the development of glucose intolerance in Chinese populations, given the favorable features of the Chinese diet. The high consumption of rice in the DM subjects who are of normal BMI suggests that further studies examining glycemic indices of Chinese food items may be beneficial. Obesity still remains the most important predisposing factor.

Association between simple anthropometric indices and cardiovascular risk factors.

OBJECTIVE: To identify which of the three simple anthropometric indices, body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC), best predicts cardiovascular risk factors, and to determine if the association between the anthropometric indices and cardiovascular risk factors varies with gender. DESIGN AND METHODOLOGY: A cross-sectional population-based survey was carried out during 1995-1996. One thousand and ten Chinese people (500 men and 510 women) aged 25-74 y were recruited as subjects for the study. Metabolic profiles and anthropometric indices were measured. RESULTS: Partial correlation and co-variance analyses showed that WC exhibited the highest degree of association with almost all of the studied metabolic profiles for both men and women. We observed significant gender differences in the association between central or general obesity with cardiovascular risk factors. BMI had an independent and significant association with metabolic risks in men, but not in women, whereas WHR was more strongly correlated with metabolic risks for women than for men. Logistic regression analysis further confirmed the magnitude of the association between the obesity indices and metabolic risks. Among the studied metabolic variables, serum insulin showed the highest degree of association with the obesity indices, followed by plasma glucose, triglyceride, HDL and blood pressure. Total cholesterol and LDL-cholesterol had a small but significant correlation with obesity. No threshold values in the relation between either the anthropometric indices and metabolic values, or with hypertension, diabetes and dislipidemia were observed. CONCLUSION: The association of central or general obesity and metabolic syndrome varied with gender. In addition, the useful anthropometric predictors for cardiovascular risk factors were BMI and WC for men, and WC and WHR for women.

Sodium is the leading dietary factor associated with urinary calcium excretion in Hong Kong Chinese adults.

We conducted a cross-sectional population-based study comprising 1010 Hong Kong Chinese (500 men and 510 women) aged 25-74 years during 1995-6. The study examined the important dietary, lifestyle and anthropometric factors associated with urinary calcium excretion. Dietary intakes were assessed by means of food frequency questionnaire. Spot urine was collected to measure the urinary excretion profiles of calcium (Ca), sodium (Na), potassium (K) and creatinine (Cr). When expressed as ratios of cations to urinary Cr, significant relationships were noted between urinary Ca and Na (r: approximately 0.6), and between urinary Ca and K (r: 0.17-0.21). Stepwise multiple linear regression analyses were carried out separately in men and women aged below and above 50 years. We found that urinary Na/Cr was the leading independent factor associated with urinary Ca/Cr in all four age and sex groups. It accounted for 22% of urinary Ca/Cr variations in women aged below 50 years, and 35-43% in the other three age and sex groups. We estimated that urinary Ca excretion increased by about 1.4 (range 1.37-1.43) mmol per 100 mmol increase in urinary Na. Except in men aged 50 years and over, urinary K/Cr was inversely associated with urinary Ca/Cr in all groups. Age was independently and positively associated with urinary Ca/ Cr in subjects aged below 50 years. We did not observe any significant relation between urinary Ca/Cr and dietary protein, phosphorus, alcohol drinking and smoking. In conclusion, we found that urinary Na/Cr, but not dietary protein, Ca or phosphorus, is the most important factor influencing urinary Ca/Cr excretion in our population. Urinary K is a potential factor for Ca conservation.

Dietary habit of smokers in a Chinese population.

The objective of this study is to determine whether smokers have unhealthy dietary habits with respect to cardiovascular diseases and cancer. An age and sex stratified random sample of the Hong Kong Chinese population aged 25 to 74 years (500 men, 510 women) was recruited. A dietary assessment using a food frequency method over a 7 day period, together with a lifestyle questionnaire was administered by a trained interviewer. Approximately half the men were smokers, while only 19/510 women smoked. Smoking was related to lower education level. Male smokers had a lower mean daily consumption of fruits, lower carbohydrate and carbohydrate percentage calorie intake, higher fat and fat percentage calorie intake, and higher vitamin D intake compared with non-smokers. However, the differences were small compared with reported differences in Caucasian populations. No difference in dietary pattern was noted between female smokers and non-smokers. Although there is a tendency for male smokers to have an unhealthy dietary pattern with respect to cardiovascular disease and cancer, the differences between smokers and non-smokers are small, and together with the favourable health features of the Chinese diet, this difference is unlikely to add to the risk of these diseases in smokers or be a confounding factor in examining the aetiology of smoke-related diseases in this population.

Central obesity predicts the worsening of glycemia in southern Chinese.

AIMS: The association between obesity and type 2 diabetes has been found to be consistent across different ethnic populations. Our aim was to study the contribution of obesity to the development of type 2 diabetes in a non-obese Chinese population with a high prevalence of diabetes (9.8% in 1995-1996). METHODS: Six-hundred and forty-four non-diabetic subjects were recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study (1995-1996). This was a community-based population study which involved the use of a 75 g oral glucose tolerance test and 1985 World Health Organization diagnostic criteria. Their glycemic status was reassessed at 2 y. RESULTS: In subjects with impaired glucose tolerance (n=322), the annual progression rate to diabetes (4.8%; 95% CI 2.5-7.1%), was 8-fold that in control subjects (0.6%; 95% CI 0.0-1.4%; P<0.001). Baseline waist-hip ratio (WHR; OR per unit increase=1.05; 95% CI 1.02-1.07, P=0.0003) and post-load 2 h plasma glucose (OR per unit increase=2.02; 95% CI 1.76-2.34, P<0.0001) were significantly associated with glycemic status at 2 y in stepwise polytomous logistic regression analysis. Subjects with high baseline waist circumference or WHR (> or =median) were more likely to have worsening of glucose tolerance at 2 y than those with low waist circumference (

The prevalence of diabetes, association with cardiovascular risk factors and implications of diagnostic criteria (ADA 1997 and WHO 1998) in a 1996 community-based population study in Hong Kong Chinese. Hong Kong Cardiovascular Risk Factor Steering Committee. American Diabetes Association.

AIMS: While the American Diabetes Association (ADA) 1997 diagnostic criteria advocate the use of fasting plasma glucose only, the World Health Organization (WHO) criteria retain the use of the standard oral glucose tolerance test (OGTT). The present study evaluated the relative merit of the respective diagnostic criteria in Chinese. METHODS: Data collected for the Hong Kong Cardiovascular Risk Factor Prevalence Study was analysed. This was a representative population-based study, conducted from 1995 to 1996 among 2,900 Chinese subjects aged 25-74 years using a 75-g OGTT. RESULTS: The prevalence of diabetes (known plus unknown) was 6.2% (95% confidence interval 5.3-7.1%), 9.2% (8.1-10.3%), and 9.8% (8.7-10.9%) based on ADA 1997, WHO 1985 and WHO 1998 criteria, respectively, with a very high prevalence in older subjects. The 2,451 subjects classified as normal under ADA 1997 criteria were heterogenous: 15.3% had impaired glucose tolerance; 2.1% had diabetes under WHO 1998 criteria. These latter two smaller groups had cardiovascular risk profiles comparable to that found among the impaired fasting glucose subjects (under ADA), but worse than that among the concordant normal glucose tolerance subjects. CONCLUSIONS: The ADA criteria underestimate both diabetes prevalence and cardiovascular risk in this population. Hence fasting glucose alone is an inadequate approach and OGTT should be retained to identify at-risk individuals in both clinical diagnosis and epidemiological studies.

Fibrinogen, other cardiovascular risk factors and diabetes mellitus in Hong Kong: a community with high prevalence of Type 2 diabetes mellitus and impaired glucose tolerance.

AIMS: To determine the prevalence of Type 2 diabetes mellitus and impaired glucose tolerance (IGT) and their relationships to fibrinogen and other cardiovascular risk factors in Hong Kong Chinese. METHODS: A probability sample of 1,316 men and 1,348 women aged 25-74 years were examined in a population-based cross-sectional study. RESULTS: A total of 3.0% (95% confidence interval 2.1-3.9) of men had previously diagnosed (known) and 6.4% (5.0-7.8) newly diagnosed (unknown) diabetes, 14.4% (12.4-16.5) had IGT and 79.2% were normal by 1985 WHO diagnostic criteria; corresponding prevalences in women were 3.7% (2.7-4.7), 5.9% (4.6-7.2), 17% (14.8-19.2) and 73.4%. The age-standardized prevalence of Type 2 diabetes for the 35-64 age group was 9.5% (7.5-11.6) in men and 10.2% (8.0-12.4) in women. Age-adjusted mean fibrinogen levels in these four groups (normal/IGT/unknown diabetes/known diabetes) with decreasing degrees of glucose tolerance (diabetes status) were 2.80, 2.57, 2.51 and 2.47 g/l (P = 0.003) in men, and 2.86, 2.72, 2.67, 2.61 g/l (P = 0.005) in women. Age, obesity, systolic blood pressure and triglycerides were significantly associated with diabetes status in both sexes, fibrinogen in men only and high density lipoprotein cholesterol negatively in women. CONCLUSIONS: The prevalence of Type 2 diabetes mellitus was very high especially in older subjects, and fibrinogen was associated with increasing glucose intolerance in men but not in women. The detection and better control of cardiovascular risk factors, particularly hypertension in this developed Chinese community with a high prevalence of diabetes and glucose intolerance, is particularly important.

Intake of soy products is associated with better plasma lipid profiles in the Hong Kong Chinese population.

We describe the pattern of soy intake and its association with blood lipid concentrations in the Hong Kong Chinese population. Subjects were contacted by random telephone survey and invited to a hospital for a physical examination and blood tests. A total of 500 men and 510 women with an age range of 24-74 y completed the dietary intake study. The dietary assessment was based on a semiquantitative food frequency questionnaire that included 10 commonly consumed soy items. Many (88%) of the study population had consumed some soy products during the previous week. About 80% of the soy protein or isoflavones were obtained from different forms of tofu, and an additional 9% was obtained from soy milk. The mean weekly isoflavone intake was 102 +/- 107 mg in men and 77 +/- 90 mg in women. In men, soy intake and total plasma cholesterol were negatively correlated (r = -0.09, P: = 0.04), as were soy intake and LDL cholesterol (r = -0.11, P: = 0.02). The respective values in women <50 y old were r = -0.11, P: = 0.04 and r = -0.11, P: = 0.05. Soy protein remained significantly associated with these two lipid concentrations after adjustment for other social and dietary confounders. Higher soy intake seemed to be related to a better plasma lipid profile in men and in younger women, but more epidemiological studies and controlled clinical trials in this setting would help to confirm the optimal amount required for the prevention and treatment of hyperlipidemia.

Fibrinogen, angina and coronary heart disease in a Chinese population.

Although fibrinogen is an established risk factor of coronary heart disease (CHD), whether fibrinogen is associated with CHD in Chinese is not clear. This population-based cross-sectional study aimed to analyse this relationship in Hong Kong Chinese. Fibrinogen was measured by the Clauss method in 1348 men and 1385 women aged 25-74 years. Severity of CHD was defined as most serious if the subjects had medically diagnosed CHD, as less serious if they had angina only, and as normal if they had neither. The prevalence of angina and CHD was respectively 2.4% and 2.2% in men and 3.2% and 2.7% in women. In men the age-adjusted mean fibrinogen concentration was 2.47 (95% confidence interval (CI) 2.43-2.51) g/l in the normal group, 2.65 (95% CI 2.45-2.85) g/l in the angina group, and 2.78 (95% CI 2.56-3. 00) g/l in the CHD cases (P<0.01); in women it was respectively 2.61 (95% CI 2.59-2.63), 2.66 (95% CI 2.50-2.82), 2.90 (95% CI 2.72-3.08) g/l (P<0.01). The differences were significant after adjustment of other significant risk factors. We conclude that fibrinogen should be considered as a risk factor in Chinese.