Six-year follow-up study on the association between white blood cell count and fasting blood glucose level in Chinese adults: A community-based health examination survey

Nonlinear association between hemoglobin glycation index and mortality in ischemic stroke Patients: Insights from the MIMIC-IV database

AIMS

Hemoglobin glycation index (HGI) is closely associated with adverse outcomes in several diseases. However, few studies have investigated the correlation between HGI and prognosis in patients with critical ischemic stroke.

METHODS

A cohort of patients was established from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Kaplan-Meier analysis, multivariate regression models, and restricted cubic splines (RCS) were used to investigate the associations between HGI and different outcomes. Mediation models were constructed to determine the mediating role of white blood cell (WBC) counts.

RESULTS

This study included 2,332 participants. In-hospital mortality differs significantly across HGI groups (24.43 %, 11.82 %, and 10.14 %, P < 0.001). Multivariate regression analyses found that lower HGI was significantly associated with greater mortality risk. Nonlinear analyses revealed an L-shaped association between HGI and short-term mortality (30-day and in-hospital), while a reverse J-shaped relationship emerged for long-term (365-day) mortality. Mediation analysis revealed that WBC counts mediated the association with proportions (%) of 33.73, 19.65, and 30.00, respectively.

CONCLUSION

Lower HGI is consistently related to poorer outcomes in patients with critical ischemic stroke. Higher HGI could be a protective factor in the short term but might increase mortality risk in the long term. WBC counts significantly mediate the association.

Association Between Monocyte-to-High-Density Lipoprotein Ratio and Prediabetes: A Cross-Sectional Study in Chinese Population

Background

The monocyte-to-high-density lipoprotein cholesterol (MHR) ratio has been linked to metabolic disorders. However, there is limited research on the predisposition to MHR and prediabetes. Hence, we conducted a study to investigate the relationship between MHR and the prevalence of prediabetes.

Methods

In total, 85,293 participants were included in our cross-sectional observational study. Multivariable regression analysis, subgroup analyses, and interaction testing were used to determine the relationship between MHR and prediabetes. To explore the non-linear association of MHR with prediabetes risk, generalized additive model (GAM) and smoothing splines were applied. The threshold effect analysis of MHR on the risk of prediabetes was further employed to identify the turning point.

Results

After controlling for covariates, the results indicated that a positive correlation persisted between MHR and prediabetes (odds ratio (OR) =1.64, 95% confidence interval (CI), 1.48-1.82), and subgroup analyses found a more robust correlation between MHR and prediabetes in individuals with lower age, SBP, DBP, TG, TC and higher values of BMI and LDL-C than in their counterparts. Additionally, the correlation between MHR and the risk of prediabetes was found to be non-linear, with a turning point of -0.4 (Log-Likelihood Ratio, P< 0.001). The impact of variables on the two sides of the turning point were 1.94 (1.72, 2.19) and 0.88 (0.69, 1.14).

Conclusion

The positive correlation between MHR and the risk of prediabetes in Chinese participants was observed to be non-linear, and MHR ≤ -0.4 was strongly positively correlated with prediabetes risk.

Neutrophil/HDL-C, Lymphocyte/HDL-C and Monocyte/HDL-C in subjects with asymptomatic carotid atherosclerosis

BACKGROUND

Leukocyte count is a prognostic marker for cardiovascular diseases, with key role in atherosclerosis development. Specific number of neutrophils, lymphocytes and monocytes can predict cardiovascular risk, also in asymptomatic subjects. Among the lipoprotein fractions, HDL-C is a protective factor in the cardiovascular disorders. For the above reason, we have examined the peripheral count of leukocytes, neutrophils, lymphocytes and monocytes, and the ratios between neutrophils/HDL-cholesterol, lymphocytes/HDL-cholesterol, and monocytes/HDL-cholesterol, to evaluate the possible utility of the obtained values in progression of asymptomatic carotid atherosclerosis.

METHODS

We performed our analysis in a cohort of 100 subjects with asymptomatic carotid atherosclerosis, of which 43 men and 57 women. The data were expressed as medians and IQR. To analyse the differences in leukocyte, neutrophil, lymphocyte, monocytes count and their ratio with HDL-cholesterol the Mann-Whitney test was employed.

RESULTS

The peripheral count of leukocyte subtypes and the ratios, they change in relation to the number of cardiovascular risk factors and the degree of insulin resistance.

CONCLUSIONS

In this cohort of subjects, the percentage of observed cardiovascular risk factors significantly affect some leukocyte parameters. These results, allow us to underline the importance of the leukocyte indices in the evaluation of subjects with asymptomatic vascular atherosclerosis.

The changes that occur in the immune system during immune activation in pre-diabetic patients of all ethnicities, from the age of 25- to 45-years: A systematic review and meta-analysis

BACKGROUND

Pre-diabetes is an intermediate state between normoglycaemia and type 2 diabetes (T2D). This condition has been shown to be asymptomatic thus making it hard to investigate the changes that occur in the body during this state. Recent findings stipulate that in this state, there are changes that are often associated with T2D. These include changes in concentration of immune cells and inflammatory markers. This systematic review will provide a synthesis of the data that is available reporting on the changes in the concentration of immune cells and selected markers during prediabetes. It will also give clarity of the variation of the complications of the condition among the various demographic groups.

METHODS

The assembly of this systematic review was through strict adherance to the PRISMA 2020 guidelines for reporting systematic reviews. This systematic review has been registered with the International Prospective Registry of Systematic Reviews (PROSPERO), registration number "CRD42020184828" dated 05-07-2020). In this systematic review, published clinical studies articles that involve observational reports, whether it is case-control, cross-sectional, and comparative cross-sectional will be used. Cohort study designs that involve normal/non-diabetic and pre-diabetes reports will be used in this systematic review and meta-analysis. Clinical MeSH headings to search on MEDLINE, COCHRANE library, EMBASE, and ICTRP and African Journal Online will be a tool used to achieve the required report. Reviewers (NCM, AMS, and AK) will screen all the results and select the studies that will be eligible by guidance according to eligibility criteria. Downs and Black Checklist will be used to check the risk of bias and then for meta-analysis Review Manager v5.4 Forrest plot will be used. Additionally, the Forrest plot will also be used for sensitivity analysis. The strength of evidence will then be assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Only 4 reports were eligible and risk of bias checked. The results indicated the outcomes even though there were only few reports.

DISCUSSION AND CONCLUSION

This systematic review will give an indication on the available data on this research area and lay a foundation for future studies.

Interaction analysis of lipid accumulation product and family history of diabetes on impaired fasting glucose and diabetes risk in population with normotension in Eastern China: a community-based cross-sectional survey

BACKGROUND

Lipid accumulation product (LAP) is considered to be a new convenient useful indicator to assess the visceral fat. Therefore, we aimed to evaluate the risk factors of impaired fasting glucose (IFG) and diabetes, and explore the possible interacting influences of LAP with other factors on the risk of IFG and diabetes among Chinese normotension adults.

METHODS

A multistage stratified cluster sampling method was conducted to select urban residents in Bengbu, China. For each eligible participant, data on questionnaire survey, anthropometric measurements and laboratory tests were obtained. The effects of body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR) and LAP for predicting IFG and diabetes were performed by multiple logistic regressions and receiver operating characteristic (ROC) analyses. The interaction effects were evaluated by relative excess risk of interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI).

RESULTS

Six thousand, four hundred sixty-seven normotension subjects (2695 men and 3772 women) were enrolled in our study, the prevalence of IFG and diabetes were 9.37% and 14.33%, respectively. When assessed using ROC curve analysis, LAP exhibited higher diagnostic accuracy for identifying IFG and diabetes than BMI, the area under the AUC curve was 0.650 (95% CI: 0.637 to 0.662). After adjustment for age, sex, educational level and other confounding factors, multivariate logistic regression analyses indicated that subjects with the fourth quartile of LAP were more likely to develop IFG (adjusted OR: 2.735, 95% CI: 1.794-4.170) and diabetes (adjusted OR: 1.815, 95% CI: 1.297-2.541) than those with the first quartile. A significant interaction between LAP and family history of diabetes was observed in participants (RERI = 1.538, 95%CI: 0.167 to 3.612; AP = 0.375, 95%CI: 0.118 to 0.631; SI = 1.980, 95%CI: 1.206 to 3.251). However, a significant interaction between LAP and abdominal obesity was indicated by the value of RERI (1.492, 95%CI: 0.087 to 3.723) and AP (0.413, 95%CI: 0.014 to 0.756), but not the value of SI (1.824, 95%CI: 0.873 to 3.526).

CONCLUSION

Our results demonstrated that there might be synergistic effect between LAP and family history of diabetes on the risk of IFG and diabetes.

Multi-dimensional characterization of prediabetes in the Project Baseline Health Study

Background

We examined multi-dimensional clinical and laboratory data in participants with normoglycemia, prediabetes, and diabetes to identify characteristics of prediabetes and predictors of progression from prediabetes to diabetes or reversion to no diabetes.

Methods

The Project Baseline Health Study (PBHS) is a multi-site prospective cohort study of 2502 adults that conducted deep clinical phenotyping through imaging, laboratory tests, clinical assessments, medical history, personal devices, and surveys. Participants were classified by diabetes status (diabetes [DM], prediabetes [preDM], or no diabetes [noDM]) at each visit based on glucose, HbA1c, medications, and self-report. Principal component analysis (PCA) was performed to create factors that were compared across groups cross-sectionally using linear models. Logistic regression was used to identify factors associated with progression from preDM to DM and for reversion from preDM to noDM.

Results

At enrollment, 1605 participants had noDM; 544 had preDM; and 352 had DM. Over 4 years of follow-up, 52 participants with preDM developed DM and 153 participants reverted to noDM. PCA identified 33 factors composed of clusters of clinical variables; these were tested along with eight individual variables identified a priori as being of interest. Six PCA factors and six a priori variables significantly differed between noDM and both preDM and DM after false discovery rate adjustment for multiple comparisons (q < 0.05). Of these, two factors (one comprising glucose measures and one of anthropometry and physical function) demonstrated monotonic/graded relationships across the groups, as did three a priori variables: ASCVD risk, coronary artery calcium, and triglycerides (q < 10^–21 for all). Four factors were significantly different between preDM and noDM, but concordant or similar between DM and preDM: red blood cell indices (q = 8 × 10^-10), lung function (q = 2 × 10^-6), risks of chronic diseases (q = 7 × 10^-4), and cardiac function (q = 0.001), along with a priori variables of diastolic function (q = 1 × 10^-10), sleep efficiency (q = 9 × 10^-6) and sleep time (q = 6 × 10^-5). Two factors were associated with progression from prediabetes to DM: anthropometry and physical function (OR [95% CI]: 0.6 [0.5, 0.9], q = 0.04), and heart failure and c-reactive protein (OR [95% CI]: 1.4 [1.1, 1.7], q = 0.02). The anthropometry and physical function factor was also associated with reversion from prediabetes to noDM: (OR [95% CI]: 1.9 [1.4, 2.7], q = 0.02) along with a factor of white blood cell indices (OR [95% CI]: 0.6 [0.4, 0.8], q = 0.02), and the a priori variables ASCVD risk score (OR [95% CI]: 0.7 [0.6, 0.9] for each 0.1 increase in ASCVD score, q = 0.02) and triglycerides (OR [95% CI]: 0.9 [0.8, 1.0] for each 25 mg/dl increase, q = 0.05).

Conclusions

PBHS participants with preDM demonstrated pathophysiologic changes in cardiac, pulmonary, and hematology measures and declines in physical function and sleep measures that precede DM; some changes predicted an increased risk of progression to DM. A factor with measures of anthropometry and physical function was the most important factor associated with progression to DM and reversion to noDM. Future studies may determine whether these changes elucidate pathways of progression to DM and related complications and whether they can be used to identify individuals at higher risk of progression to DM for targeted preventive interventions.

Trial registration ClinicalTrials.gov NCT03154346

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-022-01565-x.

The role of systemic inflammation in the association between serum 25-hydroxyvitamin D and type 2 diabetes mellitus

BACKGROUND & AIMS

The association between serum 25-hydroxyvitamin D [25(OH)D] and type 2 diabetes mellitus (T2DM) remains inconclusive. Moreover, whether inflammatory biomarkers are involved in this association has not been explored. This study aims to investigate serum 25(OH)D in relation to T2DM in a Chinese population and provide clues for the inflammatory mechanism whereby serum 25(OH)D deficiency increases T2DM risk.

METHODS

A cross-sectional study of 47,803 participants aged 18-96 years was performed in a health management center in 2017. Multivariate linear or logistic regression models and mediation analysis were used to examine the relationships between serum 25(OH)D, inflammatory biomarkers (white blood cell counts and mean platelet volume), and T2DM.

RESULTS

Of the 47,803 participants included, 5.2% were diabetic and 51.4% were serum 25(OH)D deficient. The study revealed a significant inverse association between serum 25(OH)D and T2DM risk after adjustment for potential confounders (P for trend = 0.002); the multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) across serum 25(OH)D levels (sufficiency, insufficiency, and deficiency) were 1.00 (reference), 1.17 (1.03-1.33), and 1.25 (1.09-1.43), respectively. This study also showed a significant indirect effect of serum 25(OH)D on T2DM risk through total white blood cell count, neutrophil count, lymphocyte count, and monocyte count (P values < 0.05); the proportions mediated were 9.89%, 7.51%, 2.94%, and 2.82%, respectively.

CONCLUSIONS

Serum 25(OH)D deficiency was independently associated with an elevated risk of T2DM in a Chinese adult population and low-grade systemic inflammation might be one of its biological mechanisms.

Epidemiology of Isolated Impaired Glucose Tolerance Among Adults Aged Above 50 Years in Rural China

INTRODUCTION

Isolated impaired glucose tolerance (i-IGT) is a subtype of prediabetes in which an individual demonstrates elevated 2-h post-glucose load glucose levels but normal fasting plasma glucose levels. However, few studies have explored the prevalence and risk factors of i-IGT among adults in rural China. Thus, we aimed to explore the prevalence and risk factors of i-IGT among adults ≥50 years old in a low-income, rural population in China.

MATERIALS AND METHODS

Individuals aged ≥50 years with normal fasting plasma glucose levels were included in the final analysis. Fasting and 2-h venous blood samples were collected to assess the selected parameter measurements.

RESULTS

A total of 2175 individuals were included in this study. The i-IGT prevalence was 22.9% and significantly higher among females than among males (P<0.05). Older age [odds ratio (OR), 1.606; 95% confidence interval (CI), 1.101-2.342; P=0.014), hypertension (OR, 1.554; 95% CI, 1.152-2.019; P=0.004), and central obesity (OR, 1.395; 95% CI, 1.099-1.771; P=0.006) were associated with i-IGT. Moreover, white blood cell (OR, 1.089; 95% CI, 1.009-1.175; P=0.029), high-sensitivity C-reactive protein (OR, 1.049; 95% CI, 1.020-1.078; P=0.001), serum uric acid (OR, 1.0003; 95% CI, 1.001-1.004; P=0.001), triglyceride (OR, 1.540; 95% CI, 1.105-2.147; P=0.011), and alanine aminotransferase (OR, 1.012; 95% CI, 1.004-1.021; P=0.004) levels were also linked to i-IGT in the analyzed population.

CONCLUSION

Health promotion education and a standardized approach to managing body weight, BP, and lipid and uric acid levels would benefit this low-income population in rural China for reducing the risk of cardiovascular disease.

Relationship Between Serum Gamma-Glutamyl Transferase Level and Impaired Fasting Glucose Among Chinese Community-Dwelling Adults: A Follow-Up Observation of 6 Years

Objective: We aimed to investigate the relationship between serum gamma-glutamyl transferase (GGT) and fasting blood glucose (FBG) levels, as well as the cumulative risk of impaired fasting glucose (IFG) regulation in the Chinese adult population after 6 years of follow-up. Methods: A total of 1360 apparently healthy Chinese men and women who completed a community-based health examination survey and did not have IFG in central China in 2010 and 2016 were included in this study. The patients were divided into four groups according to their baseline GGT (in quartiles). The relationship between GGT levels and FBG levels was examined using general linear regression models. The effect of the GGT level on the risk of IFG was analyzed using multivariate logistic regression. The first quartile group of GGT levels was set as the dummy variable in the model, and the odds ratios and 95% confidence intervals of the remaining quartile groups relative to the first quartile group were obtained. Results: After 6 years of follow-up, 16.4% (188/1148) of participants were diagnosed with IFG. The cumulative incidence of IFG in the four groups according to their baseline GGT levels (in quartiles) was 7.7%, 16.1%, 15.8%, and 26.8%, respectively. Based on the Cox multiple regression, the hazard ratio for IFG increased by 28.9% for each unit of increase in the baseline GGT level after adjusting for the confounding factors. The GGT levels of participants in the first quartile were used as the reference group. The relative risks of IFG in the second, third, and fourth quartiles of GGT were 1.70, 1.55, and 2.46, respectively (P = 0.005). Conclusions: GGT was positively associated with the risk of IFG and can be used as an indicator to assess whether a patient may develop prediabetes.

The Product of Red Blood Cells and Hematocrit Can Be Used as a Novel Indicator of Impaired Fasting Blood Glucose Status

OBJECTIVE

To explore whether the red blood cell count multiplied by hematocrit index (RBCHct) in blood routine parameters can indicate the risk of impaired fasting blood glucose (IFG), and whether it is related to insulin resistance and inflammation.

METHODS

In this cross-sectional study, previous history of diabetes was excluded, and people with normal and impaired IFG were included. We use Spearman analysis to evaluate the correlation between RBCHct index and fasting plasma glucose, insulin resistance homeostasis model assessment (HOMA-IR), and hypersensitive C-reactive protein (hs-CRP). Binary logistic regression analysis was used to evaluate the RBCHct index for assessing the potential risk of IFG, and the receiver operating characteristic (ROC) curve was used to evaluate the RBCHct index for diagnosing insulin resistance and chronic low-grade inflammatory efficacy among those with IFG.

RESULTS

Correlation analysis showed that the RBCHct index and fasting plasma glucose (r=0.088, P=0.003); HOMA-IR (r=0.199, P<0.001); and hs-CRP (r=0.097, P=0.001) were positively correlated. After adjusting for confounding factors, the risk of IFG in the third and fourth quartiles of the RBCHct index increased to 1.889 and 3.048 times. The area under the ROC curve of the RBCHct index for diagnosis of insulin resistance state (HOMA-IR) was 0.695 (p<0.001), and the area under the ROC curve of the RBCHct index for the diagnosis of chronic low-inflammatory state (hs-CRP) was 0.641 (P=0.010).

CONCLUSION

The RBCHct index may be a potential indicator for assessing the risk of prediabetes and is closely related to whether the body is in a state of insulin resistance and inflammation under IFG.

Prevalence of Diabetes, Prediabetes, and Associated Factors in an Adult Chinese Population: Baseline of a Prediabetes Cohort Study

PURPOSE

To report baseline information of a prediabetes mellitus (PDM) cohort with the aim of exploring related factors for the progression of PDM and its complications.

METHODS

This study is an exploratory and cross-sectional analysis of the baseline data from a cohort study. Residents aged 18 to 70 years from Houtang Village, Nanyue Town, Yueqing City, Zhejiang Province, China, were invited to participate between October 1, 2018 and July 1, 2019. Blood samples were collected for analysis, and questionnaire interviews were conducted to assess behavioral characteristics. The study participants were divided into DM, PDM, and normal groups for comparisons based on their blood work, and multiple multinomial logistic regression analyses were used to assess the risk factors for DM and PDM.

RESULTS

Data from 406 participants were used in the baseline analysis, with a mean age of 51.2 ± 11.0 years and 160 (33.0%) males. The number of participants in the DM, PDM, and normal group was 58 (14.3%), 166 (40.9%), and 182 (44.8%), respectively. The prevalence of DM was 14.3%, and the prevalence of PDM was 40.9%. The regression analysis showed that older age (relative risk ratio (RRR) = 1.06; 95% CI, 1.01-1.11, P = 0.018), higher systolic blood pressure (RRR = 1.04; 95% CI, 1.004-1.08, P = 0.030), higher BMI (RRR = 1.20; 95% CI, 1.06-3.06, P = 0.004), higher TG (RRR = 1.80; 95% CI, 1.06-3.06, P = 0.029), and higher WBC count (RRR = 1.32; 95% CI, 1.07-1.64, P = 0.010) were significantly associated with a higher risk of DM. Meanwhile, higher systolic blood pressure (RRR = 1.03; 95% CI, 1.004-1.06, P = 0.025) was the only factor significantly associated with a higher risk of PDM.

CONCLUSION

The prevalence of DM and PDM is relatively high in this wealthy East China village population. Many modifiable risk factors exist for DM and PDM, which will be closely monitored during our longitudinal observation.

Six-year follow-up study on the association between white blood cell count and fasting blood glucose level in Chinese adults: A community-based health examination survey

BACKGROUND

Pre-diabetes is considered to be an important reversible stage of type 2 diabetes (T2DM); thus, early identification of pre-diabetes may help in the prevention of T2DM. This study aimed to explore the relationship between white blood cell (WBC) counts and the cumulative risk of impaired fasting glucose (IFG) regulation at 6 years.

METHODS

A community-based health examination survey was conducted among individuals who were randomly selected from 1300 residents living in China in 2010 to 2016. The participants were divided into four groups according to WBC baseline level. This study initially conducted a cross-sectional analysis of the population who underwent physical examination to explore the relationship between WBC count and FBG levels. Then, a follow-up study was conducted on the population who underwent IFG normal physical examination to explore the relationship between baseline WBC count and changes in FBG levels and the cumulative risk of 6-year IFG.

RESULTS

During the 6-year cohort follow-up, 17.2% of the participants developed IFG, and the cumulative incidence rates of IFG in the four groups were 14.7%, 16.3%, 15.8%, and 22.2%. By Cox multiple regression equation the hazard ratio (HR) of the IFG increased by 18.7% for each additional unit of baseline WBC count with no adjustment of any factor. After adjusting factors, HR increased by 8.4%.

CONCLUSION

Increased WBC counts are associated with risk of IFG, suggesting chronic inflammation may be involved in the development and progression of IFG.