The prevalence and risk factor control associated with noncommunicable diseases in China, Japan, and Korea

Machine learning models for prediction of double and triple burdens of non-communicable diseases in Bangladesh

Increasing prevalence of non-communicable diseases (NCDs) has become the leading cause of death and disability in Bangladesh. Therefore, this study aimed to measure the prevalence of and risk factors for double and triple burden of NCDs (DBNCDs and TBNCDs), considering diabetes, hypertension, and overweight and obesity as well as establish a machine learning approach for predicting DBNCDs and TBNCDs. A total of 12,151 respondents from the 2017 to 2018 Bangladesh Demographic and Health Survey were included in this analysis, where 10%, 27.4%, and 24.3% of respondents had diabetes, hypertension, and overweight and obesity, respectively. Chi-square test and multilevel logistic regression (LR) analysis were applied to select factors associated with DBNCDs and TBNCDs. Furthermore, six classifiers including decision tree (DT), LR, naïve Bayes (NB), k-nearest neighbour (KNN), random forest (RF), and extreme gradient boosting (XGBoost) with three cross-validation protocols (K2, K5, and K10) were adopted to predict the status of DBNCDs and TBNCDs. The classification accuracy (ACC) and area under the curve (AUC) were computed for each protocol and repeated 10 times to make them more robust, and then the average ACC and AUC were computed. The prevalence of DBNCDs and TBNCDs was 14.3% and 2.3%, respectively. The findings of this study revealed that DBNCDs and TBNCDs were significantly influenced by age, sex, marital status, wealth index, education and geographic region. Compared to other classifiers, the RF-based classifier provides the highest ACC and AUC for both DBNCDs (ACC = 81.06% and AUC = 0.93) and TBNCDs (ACC = 88.61% and AUC = 0.97) for the K10 protocol. A combination of considered two-step factor selections and RF-based classifier can better predict the burden of NCDs. The findings of this study suggested that decision-makers might adopt suitable decisions to control and prevent the burden of NCDs using RF classifiers.

Prevalence and Clustering of Cardiovascular Disease Risk Factors among Adults Along the Lancang-Mekong River: A Cross-Sectional Study from Low- and Middle-Income Countries

Background

Progress in cardiovascular health is increasingly concentrated in high-income countries, while the burden of cardiovascular disease (CVD) is high in low- and middle-income countries, a clear health inequity that must be urgently addressed.

Objective

This study aims to evaluate the prevalence and clustering of CVD risk factors in the three Lancang-Mekong regions.

Methods

We conducted a population-based cross-sectional survey from January 2021 to March 2023 in China, Laos, and Cambodia. We compared the prevalence and clustering of CVD risk factors-including hypertension, dyslipidemia, diabetes mellitus, overweight/obesity, current smoking status, current drinking status, inadequate vegetable and fruit intake, and insufficient physical activity-across the three regions, further stratifying the data by gender and age. Multivariate logistic regression models were performed to explore factors influencing the aggregation of CVD risk factors (≥2, ≥3, ≥4).

Results

A total of 11,005 adults were included in the study. Hypertension emerged as the primary metabolic risk factor in Laos (36.8%) and Cambodia (23.5%), whereas overweight/obesity was the primary risk factor in China (37.6%). In terms of behavioral risk factors, participants in all three regions showed insufficient vegetable and fruit intake. The prevalence of individuals without CVD risk factors was 10% in China, 1.9% in Laos, and 5.2% in Cambodia. Meanwhile, the prevalence of two or more risk factors was 64.6% in China, 79.2% in Laos, and 76.0% in Cambodia. Multivariate logistic regression models revealed that the propensity for CVD risk factors clustering was higher in men and increased with age in all three countries.

Conclusions

CVD risk factors and multiple clustering are pressing health threats among adults in low- and middle-income areas along the Lancang-Mekong River Basin. This study highlights the urgent need for proactive tailored strategies to control CVD risk factors.

Clinical Characteristics, Treatment Patterns, and Effectiveness in Chinese Patients with Angina Pectoris Using Electronic Patient-Reported Outcomes: Protocol for a Multicenter, Prospective, Cohort Study (GREAT)

BACKGROUND

Angina pectoris (AP) is the initial and the most common manifestation of coronary artery disease (CAD). Therefore, management and control of AP can help prevent further complications associated with CAD. However, there is under-reporting of angina symptoms in clinical practice, resulting in under-treatment and reduced quality of life (QoL). Prospective and standardized monitoring is needed to support timely and appropriate treatment.

OBJECTIVES

To establish a large cohort of Chinese patients with AP and compare the effectiveness of different anti-angina regimens with the help of electronic patient-reported outcomes (e-PROs), using the Seattle Angina Questionnaire (SAQ) to assess health status.

METHODS

The registry study (GREAT) is a multicenter, prospective, observational, cohort study. Patients diagnosed with AP will be enrolled from 10 hospitals and assessed based on the different anti-anginal regimens. Patients will be followed up every 3 months from baseline to 12 months to observe the difference in the therapeutic effectiveness of the drugs. Data will be collected in the form of e-PROs combined with on-site visit records.

PLANNED OUTCOMES

The change in SAQ summary score (SAQ SS) at Month 12 from baseline will be the primary outcome. The secondary measures will include changes in SAQ SS at Months 3, 6, and 9 from baseline, changes in retest results of vascular stenosis imaging at Month 12 from baseline, and medication adherence based on the proportion of days covered. Safety data will be evaluated based on the incidence of adverse events (AEs).

CONCLUSION

This study will evaluate the effectiveness of anti-anginal regimens using ePROs in real-world settings in China. The results from this study may provide a new perspective on treatment patterns and the effectiveness of different anti-anginal regimens for patients with AP.

STUDY REGISTRATION NUMBER

NCT05050773.

Research on Korean Translation in the Context of Epidemic Prevention and Control

An emergency like COVID-19 requires a theoretical framework for policy implementation that involves public and private sector collaborations. After policy failures, new institutions have formed that trigger PPP's later, allowing the incumbent administration to continue in office longer. It focuses on novel approaches to dealing with pandemics. The present administration put these rules in place to keep COVID-19 under control. When it comes to Real Time - polymerase chain reaction (RT-PCR) testing, South Korea's government and corporations partnered to swiftly raise the quantity of testing in the country. Models of policy change are shown to be dynamic, cyclical, and recursive. During the COVID-19 outbreak in South Korea, an empirical content research was conducted. Even though South Korea's leader was at risk of losing public support to the point where impeachment was mentioned as a possible option, he dramatically reversed public mood to win general elections by a wide margin in April 2020, while the pandemic scenario persisted. To win reelection, democratic administrations are under more pressure to effectively perform crisis management when faced with a crisis. As a result, they are under even more pressure to immediately mobilize public and private resources. The emergency use authorization (EUA) protocol for test kits is an example of "leapfrogging actors" – up-and-coming innovators – who helped turn a pandemic tragedy into a possibility for sustained leadership and for them. The results based on infected premises culling rate ratio is 82.3%, number of measles cases report is 86.4%, spread and epidemic ratio is 84.2%, important of epidemiology is 89.35%, transmission potential of COVID-19 is 91.24% and illustration of epidemic control is 92.45. The results based on infected premises culling rate ratio is 82.3%, number of measles cases report is 86.4%, spread and epidemic ratio is 84.2%, important of epidemiology is 89.35%, transmission potential of COVID-19 is 91.24% and illustration of epidemic control is 92.45.

Deaths and disability-adjusted life years of hypertension in China, South Korea, and Japan: A trend over the past 29 years

Background

Hypertension has been confirmed as an independent risk factor for cardiovascular disease and death. Few data were analyzed on deaths and disability-adjusted life years (DALYs) caused by hypertension in East Asia. We aimed to provide an overview of burden attributable to high blood pressure in China in the past 29 years, compared with those in Japan and South Korea.

Methods

Data were collected from the 2019 Global Burden of Disease study on diseases due to high systolic blood pressure (SBP). We retrieved the age-standardized mortality rate (ASMR) and DALYs rate (ASDR) by gender, age, location, and sociodemographic index. The death and DALY trends were evaluated by estimated annual percentage change, with 95% confidence interval.

Findings

Considerable differences were detected in the diseases attributable to high SBP in China, Japan, and South Korea. In 2019, the ASMR and ASDR of diseases due to high SBP in China were 153.34 (126.19, 182.49) per 100,000 population and 2,844.27 (2,391.91, 3,321.12) per 100,000 population, respectively, which was about 3.50-fold of those in another two countries. The elders and males had higher ASMR and ASDR in the three countries. Between 1990 and 2019, the declining trends were less pronounced in China for both the deaths and DALYs.

Conclusions

The deaths and DALYs due to hypertension declined in China, Japan, and South Korea in the past 29 years, with China having the greatest burden.

How efficacious are traditional Chinese medicine injections in treating angina pectoris? A network meta-analysis of randomized controlled trials

ETHNOPHARMACOLOGICAL RELEVANCE

Over 50 million adults in China suffer from angina pectoris, which are often treated with traditional Chinese medicine injections (TCMIs). However, the efficacies of TCMIs and conventional drugs as determined by randomized controlled trials (RCTs) were not rigorously compared with one another by network meta-analysis (NMA). This PRISMA-compliant NMA aimed to compare the efficacy and assess the evidence strengths of 24 TCMIs in treating adults with angina pectoris of RCTs.

MATERIALS AND METHODS

Following the protocol (PROSPERO registration number CRD42018117720), the RCTs that compared any TCMI with another TCMI or conventional drug on outcome measures including symptomatic and electrocardiography improvements were included. The quality of included RCTs was assessed with the Cochrane's risk of bias 2 tool. Frequentist statistical analyses were performed, including NMA, pairwise meta-analysis (PMA), subgroup analysis, sensitivity analysis, meta-regression, and publication bias analysis. The certainty of evidence was assessed with the GRADE approach.

RESULTS

Totally, 556 eligible RCTs with 57015 participants were identified while the quality of all but five included RCTs was poor. The significant efficacy estimates and insignificant heterogeneity assessment from PMA and NMA indicated that nearly all TCMIs were more efficacious than conventional treatments for angina pectoris. Adequate subgroup and sensitivity analyses found the robust and consistent results. However, the evidence strengths of meta-analyses were assessed as very low to low due to the high risk of RCTs. The comprehensive efficacy estimates suggested that 4 TCMIs (HH, Honghua injection; HHH, Honghua Huangsesu injection; GLP, Gualoupi injection; and SM, Shenmai injection) was the best anti-anginal drugs for adults with angina pectoris.

CONCLUSION

TCMIs appear to be efficacious for angina pectoris, although evidence evaluation of high-quality RCTs of TCMIs would be necessary. In particular, randomization and blinding procedures of the RCTs should be explicated to meet the CONSORT requirements.

Association between Tai Chi Yuttari Exercise and Longevity and Prevention of Long-Term Care Need: Survival Analysis in Kitakata City, Japan

This study examined whether participation in Tai Chi Yuttari exercise is associated with a delay in the death and new certification for long-term care need of older adults. Individuals who participated in Tai Chi Yuttari exercise classes in 2011-2015 (participation group) were compared with individuals from the Basic Resident Register of Kitakata City (non-participation group). Death and new certification for long-term care need were selected to evaluate the effectiveness of participation in Tai Chi Yuttari exercise classes. The periods from the start date of the observation to each person's date of occurrence of events were calculated. The Kaplan-Meier method and log-rank test were used to compare survival curves between the groups. A total of 105 and 202 individuals in the participation and non-participation groups, respectively, were observed. Survival duration (χ2 = 8.782, p = 0.003) and the period before receiving certification for long-term care (χ2 = 5.354, p = 0.021) were longer in the participation group than in the non-participation group. In the stratified analysis by sex, survival duration was longer in the participation group in men only (χ2 = 7.875, p = 0.005). Participation in Tai Chi Yuttari exercise might be effective in delaying death, especially in men, and new certification for long-term care.

Patterns of Risky Health Behaviors and Associations With Chronic Diseases Among Young Adult Nursing Students: A Latent Class Analysis

BACKGROUND

Little is known about how health behaviors cluster to form meaningful patterns that influence health outcomes in young adult nursing students.

PURPOSE

The purpose of this study was to identify the unique health behavior patterns among young adult nursing students in China and examine the associations between health behaviors and chronic diseases.

METHODS

Using an electronic app, the achievements of an exercise target, sedentary behavior, smoking and drinking, and dietary patterns were assessed in 1,480 nursing student participants aged 18-24 years from two medical universities in Eastern China.

RESULTS

A four-class model was developed using latent class analysis that included the "failure to achieve exercise target, alcohol-drinking, and insufficient fruit and vegetable group" (Group 1, n = 187, 12.6%), the "alcohol-drinking and sedentary behavior group" (Group 2, n = 290, 19.6%), the "sedentary behavior only group" (Group 3, n = 721, 48.7%), and the "failure to achieve exercise target only group" (Group 4, n = 282, 19.1%). Logistic regressions indicated that nursing students in Group 2 (odds ratio [ OR ] = 0.42), Group 3 ( OR = 0.51), and Group 4 ( OR = 0.30) were less likely to have chronic diseases than those in Group 1 after adjusting for sociodemographic variables.

CONCLUSIONS

The health behaviors were clustered in different patterns among young adult nursing students. Tailoring interventions to specific groups is suggested to improve health outcomes.

Comparison of Buyang Huanwu granules and Naoxintong capsules in the treatment of stable angina pectoris: rationale and design of a randomized, blinded, multicentre clinical trial

BACKGROUND

Stable angina pectoris (SAP) currently seriously threatens the health of humans, and mortality is continuously rising. Current treatment strategies mainly include pharmaceutical therapy and revascularization. In China, Buyang Huanwu granules (BYHW) and Naoxintong capsules (NXT) have been used in the treatment of SAP, but it is not clear which agent is better in terms of relieving symptoms and improving quality of life. Therefore, we designed a clinical trial to compare the efficacy and safety of NXT and BYHW in the treatment of SAP.

METHODS

This is a randomized, blinded, parallel controlled, multicentre clinical trial protocol. On the basis of standardized Western medicine treatment, a total of 128 SAP patients will be randomly divided into intervention group 1 (NXT group), intervention group 2 (BYHW group), and a control group (placebo group) at a 2:1:1 ratio. A 2-week run-in period is required prior to randomization, and a 1-week baseline period and 4-week treatment period are included in this study. The primary outcome is the efficacy rate of stable angina symptom score improvement; the secondary outcomes include the effect on electrocardiograms, Seattle Angina Questionnaire scores, and nitroglycerine consumption.

DISCUSSION

This study will evaluate the efficacy and safety of NXT and BYHW in the treatment of SAP. The results will provide critical evidence for using Chinese herbal medicines to treat SAP.

TRIAL REGISTRATION

Chinese Clinical Trials Registry ChiCTR1800015191. Registered on 13 March 2018. http://www.chictr.org.cn/showproj.aspx?proj=25818 . All the registration items can be found within the protocol.

Prevalence and Associated Risk Factors of Hypertension for the Middle-Aged Population (30-59 Years) in Iran: A National Cross-Sectional Study

INTRODUCTION

The prevalence of hypertension (HTN) is increasing in the middle-aged population, but few studies have examined the prevalence and risk factors associated with hypertension in this age group.

AIM

To estimate the prevalence of HTN and its associated demographic risk factors in the middle-aged population (30-59 years) of Iran.

METHODS

In this cross-sectional study, 4112 middle-aged people from five provinces of the country were selected by multi-stage sampling and entered into the study. HTN or high blood pressure (HBP) was defined as systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg. The relationship between demographic risk factors and the prevalence of HTN was assessed by multivariate logistic regression in Stata software version 14.

RESULTS

The prevalence of HTN was 17.8% (95% CI 16.5-19.0) and was higher in women than men (19.1% vs. 16.5%). The prevalence of HTN in three studied age groups including 30-39, 40-49 and 50-59 years were 7.2, 18.7 and 38.0%, respectively. The frequency of HTN in urban residents was higher than rural residents (18.4% vs. 15.6%). The chance of developing hypertension in urban residents (OR 1.25), overweight (OR 3.94) and obese persons (OR 7.54) was higher.

CONCLUSIONS

Hypertension has a relatively high prevalence in the middle-aged Iranian population. According to our results, age, living in urban regions, being illiterate, overweight and obesity are independent risk factors for HBP. It seems that the administration of prevention programs in general population especially in younger ages based on existing risk factors is a necessity.

Double and triple burden of non-communicable diseases and its determinants among adults in Bangladesh: Evidence from a recent demographic and health survey

BACKGROUND

Globally, non-communicable diseases (NCDs) are a significant public health problem. NCDs are the leading cause of death in Bangladesh. This study aimed to estimate the prevalence of double burden of NCDs (DBNCDs) and triple burden of NCDs (TBNCDs) such as hypertension, diabetes and overweight or obesity and to explore the risk factors of DBNCDs and TBNCDs in Bangladesh.

MATERAILS AND METHODS

This study included 12 685 participants (5465 male and 7220 female) from 2017 - 2018 nationally representative Bangladesh Demographic and Health Survey. Descriptive statistics were calculated for the distribution and prevalence of DBNCDs and TBNCDs. Bivariate and multilevel logistic regression analyses were used to assess the individual- and community-level determinants of DBNCDs and TBNCDs.

RESULTS

The prevalence of DBNCDs and TBNCDs was 21.4% and 6.1%, respectively. At individual-level, higher age, female, currently and formerly/ever married, richest, higher education were more likely to suffer from the DBNCDs and TBNCDs. Furthermore, at the community level, the division had a significant association with DBNCDs and TBNCDs. In addition, family size had a significant effect on DBNCDs, and caffeinate drinks and poverty significantly affected TBNCDs.

CONCLUSION

Overall, there is a low prevalence of TBNCDs compared with DBNCDs in Bangladesh. Age, gender, marital status, wealth index, education level and division are significantly associated with DBNCDs and TBNCDs. The government and non-government health organisations should pay proper attention to handle the burden of NCDs in Bangladesh.

Dietary quality is associated with reduced risk of diabetes among adults in Northern China: a cross-sectional study

In this study, we analysed the prevalence of diabetes in Inner Mongolia and explored the relationship between dietary patterns and diabetes using the Chinese Dietary Balance Index-16 (DBI-16). This study was a surveillance survey of Chronic Disease and Nutrition Monitoring among Chinese Adults in Inner Mongolia in 2015. Dietary data were collected using the 24-h dietary recall and weighing method over three consecutive days. Dietary quality was evaluated via the DBI-16. A generalised linear model was used to examine the associations between the DBI-16 and dietary patterns. The relationship between dietary patterns and diabetes was analysed using logistic regression. In Inner Mongolia, the diabetes prevalence was 8·5 % and the estimated standardised prevalence was 6·0 %. Four major dietary patterns were identified: 'meat/dairy products', 'traditional northern', 'high cereal/tuber' and 'high-salt/alcohol'. Generalised linear models showed that the 'meat/dairy product' pattern was relatively balanced (βLBS = -1·993, βHBS = -0·206, βDQD = -2·199; all P < 0·05) and was associated with a lower diabetes risk (OR 0·565; 95 % CI 0·338, 0·945; P < 0·05) after adjusting for potential confounders. The other three dietary patterns (i.e. 'traditional northern', 'high cereal/tuber' and 'high-salt/alcohol') exhibited relatively unbalanced dietary quality and were unassociated with diabetes risk. Diabetes prevalence in Inner Mongolia was moderate. The dietary quality of the 'meat/dairy product' pattern was relatively balanced and was correlated with a decreased risk of diabetes prevalence, suggesting that dietary quality may help decrease diabetes prevalence and provide a suggestion for local dietary guidelines.

The Clustering of Health-Related Behaviors in the Adult Japanese Population

BACKGROUND

Research findings indicate that four health-related behaviors (HRBs), smoking, alcohol, diet, and physical activity, do not co-occur within individuals by chance and therefore cluster. To date, there is a lack of research investigating the clustering of these HRBs in the Japanese population.

METHODS

The Japanese National Health and Nutrition Survey 2010 was used, containing information on 8,015 community-dwelling adults. Latent profile analysis identified distinct cluster patterns of four HRBs: smoking status, alcohol consumption, calorie intake, and the number of steps per day.

RESULTS

For men, four distinct HRB clusters were identified. The largest cluster (54%) was characterized by drinking more than Japan's recommended alcohol guidelines and walking an inadequate number of steps per day. A small cluster (4%) also emerged, characterized by smoking, high calorie intake, and exceeding alcohol guidelines. Members of these clusters had higher systolic blood pressure than those in the remaining clusters. For women, five distinct HRB clusters were identified. The largest cluster (57%) was characterized by not smoking or drinking and walking an inadequate number of steps per day. For both genders, there was a relationship between cluster membership and age. Cluster membership was associated with income and health status among men but not women.

CONCLUSION

Detecting distinct clusters of HRBs in a Japanese population-based survey provides a person-centered understanding of Japanese lifestyles. This approach can assist policy makers in Japan and overseas to identify new strategies for targeting behavioral risk factors and make health promotion policies more effective in their respective countries.

Prevalence of Chronic Fatigue Syndrome (CFS) in Korea and Japan: A Meta-Analysis

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term disabling illness accompanied by fatigue unsolved by rest. However, ME/CFS is a poorly understood illness that lacks a universally accepted pathophysiology and treatment. A lack of CFS-related studies have been conducted in Asian countries. This study aimed to estimate and compare the prevalence of ME/CFS in Korea and Japan and conducted a meta-analysis. Methods: We searched PubMed, EMBASE, Cochrane, and KMBASE for population-based prevalence studies of the two countries and synthesized the data according to the Fukuda case definition. Results: Of the eight studies (five in Korea, three in Japan) included, the total prevalence rate of Korean studies was 0.77% (95% CI 0.34–1.76), and 0.76% (95% CI 0.46–1.25) for the Japanese studies. The prevalence rate in females was approximately two-fold higher than males in Korean studies (1.31% female vs. 0.60% male), while the gender difference was less obvious in Japanese studies (0.76% female vs. 0.65% male). Conclusions: Further epidemiology studies on the female ME/CFS prevalence rate between countries may be required.

Efficacy and safety of Suxiao Jiuxin Pill in the treatment of stable angina (Qi stagnation and blood stasis syndrome): study protocol of a randomized, double-blind, placebo-controlled, multi-center clinical trial

Background

Coronary heart disease (CHD) has become one of the biggest health problems in the world. Stable angina is a common clinical type of CHD with poor prognosis and high mortality. Although there are various interventions for stable angina, none of them can significantly reduce mortality. Both basic and clinical research have shown that Suxiao Jiuxin Pill (SJP) can relieve the symptoms of angina pectoris and improve the clinical efficacy, but there is a lack of high-quality clinical research to provide research-based evidence. We design a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of SJP for stable angina.

Methods/design

This is a prospective, randomized, double-blind, placebo-controlled, and multicenter trial. The trial will enroll 324 participants with chronic stable angina (Qi Stagnation and Blood Stasis syndrome). All participants will have received the conventional therapy of chronic stable angina. Participants will be randomized into two groups, conventional therapy plus SJP group and conventional therapy plus placebo group. Eligible participants will receive either SJP or placebo (five pills administered orally, three times daily) in addition to conventional treatment for 24 weeks. The primary outcomes are the symptom improvement rate of angina from baseline to 4 weeks after inclusion and major adverse cardiovascular events (MACE). The secondary outcomes are angina classification (CCS), improvement of traditional Chinese medicine (TCM) syndromes, Seattle Angina Scale score, the dosage of emergency drugs and the stopping rate, and electrocardiogram (EKG) efficacy. Adverse events will be monitored throughout the trial.

Discussion

Integrated traditional Chinese and Western Medicine is commonly used for angina in China. This study will evaluate the clinical effectiveness and safety of SJP for angina. The results of the trial will provide high-level clinical research-based evidence for the application of SJP instable angina.

Trial registration

This study protocol was registered on 14 March 2019. The registration number is ChiCTR1900021876 on the Chinese Clinical Trial Registry.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05448-6.

Regularity of Clinical Visits and Medication Adherence of Patients with Hypertension or Diabetes in Rural Yunnan Province of China

Chronic diseases can be controlled through effective self-management. The purpose of this study is to explore the regularity of clinical visits and medication adherence of patients with hypertension or diabetes (PWHD), and its association with the first experience with care and individual factors in rural Southwestern China. This cross-sectional study was carried out in Yunnan province in 2018 and recruited 292 PWHD and 122 village clinics from 122 villages in 10 counties. Participants were interviewed using a structured questionnaire. Results show around 39% of hypertensive and 25% of diabetic patients neither visited physicians nor took medicine regularly during the preceding three months of the interview date. The regression results further indicated that individual characteristics of the PWHD, including patient age, health status, and economic level, as well as their first experience with care, were significantly associated with their regular healthcare behavior. In addition to providing medical services, on average each sample village clinic, with around two physicians, simultaneously managed 180 hypertensive and 45 diabetic patients. This study revealed the need for further reforms in terms of improving self-management and thus recommends an increase in the quantity and the quality of human resources in the primary healthcare realm in rural China.

Changes in the Gut Microbiota are Associated with Hypertension, Hyperlipidemia, and Type 2 Diabetes Mellitus in Japanese Subjects

The human gut microbiota is involved in host health and disease development. Therefore, lifestyle-related diseases such as hypertension (HT), hyperlipidemia (HL), and type 2 diabetes mellitus (T2D) may alter the composition of gut microbiota. Here, we investigated gut microbiota changes related to these diseases and their coexistence. This study involved 239 Japanese subjects, including healthy controls (HC). The fecal microbiota was analyzed through the isolation of bacterial genomic DNA obtained from fecal samples. Although there were no significant differences in the microbial structure between groups, there was a significant difference in the α-diversity between HC and the patients in whom two diseases coexisted. Moreover, Actinobacteria levels were significantly increased, whereas Bacteroidetes levels were significantly decreased in all disease groups. At the genus level, Bifidobacterium levels were significantly increased in the HL and T2D groups, as were those of Collinsella in all disease groups. In contrast, Alistipes levels were significantly lower in the HL group. Furthermore, metabolic enzyme families were significantly increased in all disease groups. Interestingly, the structure and function of the gut microbiota showed similar profiles in all the studied diseases. In conclusion, several changes in the structure of the gut microbiota are associated with T2D, HT, and HL in Japanese subjects.

Effects of the amount and type of carbohydrates used in type 2 diabetes diets in animal models: A systematic review

Type 2 diabetes mellitus (T2DM) is among the most prevalent diseases in the world, affecting over 420 million people. The disease is marked by a poor metabolic effect of insulin leading to chronic hyperglycaemia, which can result in microvascular complications. It is widely known that postprandial glycaemia is reliant on the total carbohydrate content of a meal. However, the importance of the amount and the source of these carbohydrates remains controversial due to mechanisms other than insulin secretion. Oxidative stress, inflammation, pyruvate production and the quality of the intestinal microbiota, resulting in plasma lipopolysaccharides and short-chain fatty acids production, play an important role in blood sugar control and consequently in type 2 diabetes. Thus, we systematically reviewed the preclinical evidences on the impact of the amount and type of carbohydrate found in different diets and its influence on blood glucose levels in diabetic animals. We used a comprehensive and structured search in biomedical databases Medline (PubMed), Scopus and Web of Science, recovering and analyzing 27 original studies. Results showed that sucrose-rich diets deteriorated diabetic condition in animal models regardless of the total dietary carbohydrate content. On the other hand, fiber, particularly resistant starch, improved blood glucose parameters through direct and indirect mechanisms, such as delayed gastric emptying and improved gut microbiota. All studies used rodents as animal models and male animals were preferred over females. Improvements in T2DM parameters in animal models were more closely related to the type of dietary carbohydrate than to its content on a diet, i. e., resistant starch seems to be the most beneficial source for maintaining normoglycemia. Results show that current literature is at high risk of bias due to neglecting experimental methods.

A cross-sectional research of iodine status of pregnant women in Chongqing, south-west China

OBJECTIVE

To investigate whether implementation of a universal salt iodization (USI) programme has sufficient effects on pregnant women in Chongqing, the present study evaluated the iodine nutritional status of pregnant women living in Chongqing by spot urinary iodine concentration (UIC), to provide scientific suggestions to better meet the specific iodine needs of this vulnerable group.

DESIGN

Cross-sectional design.

SETTING

A random spot urine sample and household table salt sample were provided by each participant.

PARTICIPANTS

A total of 2607 pregnant women from twenty-six of thirty-nine districts/counties in Chongqing participated.

RESULTS

The overall median UIC of pregnant women was 171·80 μg/l (interquartile range (IQR) = 113·85-247·00 μg/l) and 40·97 % (n 1057) of participants were iodine insufficient. The median iodine in table salt samples was 25·40 mg/kg (IQR = 23·10-28·30 mg/kg); 93·26 % (n 2406) of samples examined were found to be adequately iodized. Iodine nutritional status was not significantly different according to table salt iodization category. Trimester was identified to be statistically associated with UIC (P < 0·01). Seven districts/counties had median UIC below 150 μg/l and one district had median UIC of 277·40 μg/l.

CONCLUSIONS

The USI programme in Chongqing prevents iodine deficiency generally, but does not maintain iodine status within adequate and recommended ranges throughout pregnancy. Usage of non-iodized or unqualified iodized salt and the slight change of dietary habits of iodized salt in Chongqing may present a substantial challenge to fight iodine-deficiency disorders; more efforts are needed to ensure adequate iodine intake during pregnancy besides the USI programme.

Prevalence of cardiovascular risk factors in non-menopausal and postmenopausal inpatients with type 2 diabetes mellitus in China

BACKGROUND

To investigate the prevalence of cardiovascular disease (CVD) risk factors and assess the 10-year risk of CVD in non-menopausal and postmenopausal women with type 2 diabetes mellitus (T2DM).

METHODS

A total of 569 patients with T2DM at a Chinese tertiary hospital were investigated using the Framingham Risk Score (FRS). We evaluated the 10-year risk of CVD, clinical and menopause characteristics in all subjects.

RESULTS

Among the 569 diabetic patients, the incidence of smoking, dyslipidemia, hypertension, overweight or obesity, and nonalcoholic fatty liver disease (NAFLD) was 0.7, 36.2, 38.1 56.6 and 58.2%, respectively. The usage rate of hypoglycemic agents, antihypertensive agents, lipid modulators and antithrombotic drugs was 88.6, 78.3, 50.0 and 27.1%, respectively. However, only 1.2% of inpatients achieved the three target goals for the control of blood glucose (HbA_1c < 7%), blood pressure (systolic blood pressure < 130 mmHg, diastolic blood pressure < 80 mmHg), and blood lipids (total cholesterol < 174 mg/dL). The 10-year risk of CVD was (1.6 ± 1.5%) and tended to increase along with age (F = 27.726, P <  0.001). For all subjects (n = 569), multiple linear regression analysis showed that menopause (β = 0.275, P <  0.001), low-density lipoprotein cholesterol (LDL-C) (β = 0.212, P <  0.001), fasting plasma glucose (FPG) (β = 0.093, P = 0.018) and waist-to-hip-ratio (β = - 0.078, P = 0.047) were risk factors of 10-year risk of CVD, which may explain the variance of 14.3%. In the postmenopausal group (n = 397), LDL-C (β = 0.227, P <  0.001), FPG (β = 0.139, P = 0.003) and time since menopause (β = 0.230, P <  0.001) were found to be associated with CVD, which may explain the variance of 14.6%.

CONCLUSION

The incidence of dyslipidmia, hypertension, overweight or obesity and NAFLD is high. The level of control of blood glucose, blood pressure, and blood lipids was found to be extremely low and the treatment status was not ideal. Besides menopause, LDL-C, FPG and time since menopause were found to be independent risk factors for the 10-year risk of CVD. Therefore, it is necessary to focus on comprehensive control of multiple risk factors, such as plasma glucose, blood pressure and serum lipid.

Efficacy and safety of Xinnaoning capsule in treating chronic stable angina (qi stagnation and blood stasis syndrome): Study protocol for a multicenter, randomized, double-blind, placebo-controlled trial

BACKGROUND

Chronic stable angina (CSA) is a cardiovascular disease with high prevalence. At present, drug treatment is still the main measure of stable angina pectoris. Traditional Chinese medicine has a long history in the treatment of CSA. Qi stagnation and Blood stasis syndrome is a common syndrome of CSA. Xinnaoning (XNN) capsule is considered as an effective adjuvant treatment for CSA with the efficacy of promoting qi and blood circulation but lack of high-quality clinical evidence. The purpose of this study is to evaluate the efficacy and safety of XNN capsule compared with placebo by clinical trial.

METHODS

This multicenter, randomized, double-blind, placebo-controlled trial will be conducted with a total of 240 participants diagnosed with chronic stable angina (qi stagnation and blood stasis syndrome). The participants will be randomized (1:1) into groups receiving either XNN or placebo for 12 weeks. After a 2-week run-in period, they will receive either XNN or placebo (3 pills, 3 times daily) for 12 weeks on the basis of conventional therapy. The primary outcomes include changes in the integral scores of angina symptoms. The secondary outcome measures include changes in the total score of traditional Chinese medicine syndrome, severity grading of angina pectoris, the number of angina pectoris per week, nitroglycerin dosage, score of seattle angina scale, serum homocysteine, incidence of cardiovascular events. Safety outcomes will also be assessed. Adverse events will be monitored throughout the trial.

RESULTS

This study will investigate whether XNN capsule can alleviate clinical symptoms, and improve quality of life of patients with chronic stable angina (qi stagnation and blood stasis syndrome). The results of this study will provide clinical evidence for the application of XNN capsule in the treatment of chronic stable angina.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03914131.

The effectiveness of moxibustion for stable angina pectoris: A meta-analysis and trial sequential analysis protocol

BACKGROUDS

Moxibusion is a famous traditional Chinese medicine (TCM) treatment, which can be used to treat stable angina pectoris for many years. We will conduct this study to explore the efficacy and safety of moxibustion as an additional therapy and to provide more reliable evidence for clinical practice.

METHODS

We will go through 8 databases until July 2019 to identify related randomized controlled trials that compared moxibustion with the control group. The main result is the clinical effective rate. RevMan (V.5.3) and test sequential analysis (V.0.9) will be used for mata analysis and trial sequential analysis.

RESULTS

This study will provide a high-quality synthesis of current evidence of moxibustion and we have a specific opportunity to determine the efficacy and safety of moxibustion in patients with stable angina pectoris.

CONCLUSIONS

This study will explore whether or not moxibustion can be used as one of the non-drug therapies to prevent or treat stable angina pectoris, especially in the elderly population with related risk factors.

REGISTRATION NUMBER

CRD42018112830.

Temporal Trends and Geographic Disparity in Hypertension Care in China

BACKGROUND

This study examines trends and geographic disparities in the diagnosis, treatment, and control of hypertension in China and investigates the association between regional factors and hypertension care.

METHODS

Blood pressure data and data relating to health care for hypertension were used for this study. The data were sourced from baseline and follow-up surveys of the China Health and Retirement Longitudinal Study, which was conducted in 2011, 2013, and 2015. To estimate the geographical disparities in diagnosis, treatment, and control of hypertension, random-effects models were also applied after controlling for sociodemographic characteristics.

RESULTS

Among hypertensive individuals in China, the trends showed decreases in undiagnosed, untreated, and uncontrolled hypertension: 44.1%, 51.6%, and 80.7% in 2011; 40.0%, 47.4%, and 77.8% in 2013; and 31.7%, 38.0%, and 71.4% in 2015, respectively. The number of undiagnosed, untreated, and uncontrolled hypertensive residents living in urban areas in 2015 was more than 10% lower than the number in rural areas and among rural-to-urban immigrant individuals in China. The poorest socio-economic regions across China were 8.5 times more likely to leave their residents undiagnosed, 2.8 times more likely to leave them untreated, and 2.6 times more likely to leave hypertension uncontrolled.

CONCLUSIONS

Although China has made impressive progress in addressing regional inequalities in hypertension care over time, it needs to increase its effort to reduce geographic disparities and to provide more effective treatments and higher quality care for patients with hypertension.

Prevalence of, and biochemical and anthropometric risk factors for, dyslipidemia in children and adolescents aged 7 to 18 years in China: A cross-sectional study

OBJECTIVE

This study aimed to investigate the prevalence of dyslipidemia and its risk factors in children and adolescents aged 7 to 18 years in China.

METHODS

A cross-sectional study was conducted from November, 2013 to July, 2014. A total of 2283 children and adolescents from urban and rural areas in Hainan (South China) and Shaanxi Provinces (Northwest China) were selected using multi-stage stratified cluster sampling method. Each participant underwent anthropometric and serum biochemical tests which included serum lipids and hepatitis B virus surface antigen (HBsAg).

RESULTS

The overall prevalence of high total cholesterol (TC), high triglyceride (TG), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), hyperlipidemia and dyslipidemia were 6.5%, 7.5%, 5.2%, 9.1%, 14.3%, and 20.6%, respectively. After standardization by age, girls had higher prevalence of high TC (8.2%), high LDL-C (6.6%), and hyperlipidemia (16.4%), but lower prevalence of low HDL-C (8.21%) than boys (4.2%, 3.4%, 11.9%, and 11.3%, respectively). The risk of dyslipidemia increased with age (OR = 1.067, 95% CI: 1.030-1.106). Boys had a decreased risk of dyslipidemia (OR = 0.798, 95% CI: 0.640-0.994). The restricted cubic spline revealed a linear relationship between BMI and the risk of dyslipidemia (P < .001). Subjects who were HBsAg positive had higher risk of dyslipidemia (OR = 1.550, 95% CI: 1.050-2.287) compared with those who were HBsAg negative.

CONCLUSIONS

Our study highlights the high prevalence of dyslipidemia in youth in China, and is the first study to reveal a positive association between positive status for HBsAg and abnormal lipid levels in children and adolescents.

Guanxinjing capsule in the treatment of chronic stable angina: study protocol for a randomized controlled trial

Background

Stable angina is a common cardiovascular disease with high mortality and a poor prognosis. Although there are various interventions against stable angina, none are able to significantly reduce the mortality rate. Guanxinjing capsule (GXJ) is made from the classical Chinese prescription Xuefuzhuyutang (血府逐瘀汤). Both basic research and clinical studies have shown that GXJ can relieve the symptoms of angina, but currently, the effects of GXJ lack high-quality clinical evidence. The aim of this study was to evaluate the clinical effectiveness and safety of GXJ compared with placebo.

Methods/design

This multicentre, blinded, randomized trial will be conducted with a total of 120 participants diagnosed with chronic stable angina (Qi deficiency and blood stasis syndrome). Using a central randomization system, participants will be randomized (1:1) into groups receiving either GXJ or placebo for 8 weeks. After a 2-week run-in period, eligible patients will receive either GXJ or placebo (4 pills, three times daily) for 8 weeks in addition to conventional treatment. The primary outcomes include changes in the total exercise time on exercise tolerance tests and changes in the integral scores of angina symptoms. The secondary outcome measures include changes in the maximal estimated workload, changes in time to a 1 mm ST-segment depression or raise, changes in the time to onset of angina during exercise tolerance testing, changes in the total score of traditional Chinese medicine syndrome, and changes in the total score of the Generalized Anxiety Disorder 7-item assessment between baseline and week 8. Other outcome measures will also be assessed. All exercise tolerance tests use a standard Bruce multistage exercise test protocol. Adverse events will be monitored throughout the trial.

Discussion

This study will investigate whether GXJ can alleviate clinical symptoms, increase the angina-free walking time, and improve quality of life in patients with chronic stable angina (Qi deficiency and blood stasis syndrome). The results of this study will provide clinical evidence for the application of GXJ to the treatment of stable angina.

Trial registration

Chinese Clinical Trial Registry, ChiCTR1800014258. Registered on 2 January 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2950-7) contains supplementary material, which is available to authorized users.

Circulating levels of adipose tissue-derived inflammatory factors in elderly diabetes patients with carotid atherosclerosis: a retrospective study

BACKGROUND

Inflammation has been recognized as a key feature of both type 2 diabetes mellitus (T2DM) and atherosclerosis. However, the relationships between circulating levels of novel adipose tissue-derived inflammatory factors, including resistin, vaspin, and visfatin, and the severity of atherosclerosis have not been determined. Moreover, the associations between these inflammatory factors and obesity and insulin resistance in elderly patients remain to be clarified.

METHODS

A cross-sectional study of 256 elderly patients with T2DM admitted in our center was performed. Baseline circulating levels of resistin, vaspin and visfatin were measured with enzyme-linked immunosorbent assays. Ultrasonic evaluations of the carotid arteries of the patients were performed to reflect the severity of systemic atherosclerosis. Patients were classified as having mild, moderate, or severe atherosclerosis according to the results of carotid ultrasonic examination. Circulating levels of the inflammatory factors listed above also were correlated with body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA-IR).

RESULTS

With more severe carotid atherosclerosis, circulating levels of resistin (mild: 2.01 ± 0.23; moderate: 2.89 ± 1.01; severe: 3.12 ± 1.12; p < 0.05) and visfatin (mild: 11.63 ± 7.48; moderate: 15.24 ± 2.19; severe: 17.54 ± 2.98; p < 0.05) gradually increased, while level of vaspin decreased (mild: 317 ± 23.12; moderate: 269 ± 32.12; severe: 229 ± 14.24; p < 0.05). Subsequent results of Pearson coefficient analyses indicated that all of the tested adipose tissue-derived inflammatory factors were positively correlated with the BMI and HOMA-IR of the patients (all p < 0.05), even after adjustment for hs-CRP.

CONCLUSIONS

The adipose tissue-derived inflammatory factors resistin, vaspin and visfatin may be involved in the pathogenesis of atherosclerosis in elderly T2DM patients.

Impact of fish consumption by subjects with prediabetes on the metabolic risk factors: using data in the 2015 (6th) Korea National Health and Nutrition Examination Surveys

BACKGROUND/OBJECTIVES

The effects of fish consumption by subjects with prediabetes on the metabolic risk factors were examined based on the data from the 6^th Korea National Health and Nutrition Examination Surveys in 2015.

SUBJECTS/METHODS

A total of 1,520 subjects who agreed to participate in a blood test and dietary intake survey were divided into a prediabetes group and normal blood glucose group, and the level of the subjects' fish consumption was divided into ≤ 17.0 g/day, 18.0–93.0 g/day, and ≥ 94 g/day. The correlation between the level of fish intake and the metabolic risk factors was evaluated by multinomial logistic regression analysis.

RESULTS

A significant difference in the gender distribution was observed in the prediabetes group, which is a group with a high risk of non-communicable diseases, according to the fish intake, and there were significant differences in the total energy intake, protein intake, n-3 fatty acids intake, and the intakes of sodium and micro-nutrients according to the intake group (P < 0.05). In addition, the blood total cholesterol (TC) decreased 0.422 fold in model 1 (unadjusted) [95% confidence interval (CI): 0.211–0.845] and 0.422 fold in model 2 (adjusted for sex) (95% CI: 0.210–0.846) in those with a fish intake of 18.0–93.0 g/day (P < 0.05) compared to those with a fish intake of ≤ 17.0 g/day. The blood TC decreased 0.555 fold (95% CI: 0.311–0.989) in model 1 and 0.549 fold (95% CI: 0.302–0.997) in model 2 in those with a fish intake of ≥ 94 g/day compared to those with a fish intake of ≤ 17.0 g/day (P < 0.05).

CONCLUSIONS

Subjects with prediabetes or the metabolic risk factors can maintain their blood low density lipoprotein cholesterol (LDL-C) and blood TC concentrations at the optimal level by consuming fish (18.0–93.0 g/day).

Gaps in awareness and control of hypertension: a cross-sectional study in Chinese urban adults

Hypertension is a serious public health threat worldwide. This study sought to explore gaps in urban Chinese adults' awareness and control of hypertension. A cross-sectional study was carried out in eight Chinese cities in 2016. Participants were organized into four groups on the basis of blood pressure (BP) and self-reported disease history: healthy group (63.0%), well-controlled BP group (9.1%), unaware hypertension group (14.0%), and poorly controlled BP group (13.9%). Multinomial logistic regression with the healthy group as the reference group showed that younger age and body mass index <24 kg/m² were negatively associated with lack of awareness of hypertension and poor control of BP. Lower salt intake, but not sodium intake, was associated with poor control of BP. Other factors associated with lack of awareness of hypertension included low fish and seafood intake. Low sodium intake contributed to good control of BP. In conclusion, there are gaps in urban Chinese adults' awareness and control of hypertension. A comprehensive strategy for enhancing awareness of hypertension and changing behaviors associated with the condition should be developed and implemented.