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Oshidari Y, Salehi M, Kermani M, Jonidi Jafari A. Associations between long-term exposure to air pollution, diabetes, and hypertension in metropolitan Iran: an ecologic study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2476-2490. [PMID: 37674318 DOI: 10.1080/09603123.2023.2254713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
Epidemiological studies on air pollution, diabetes, and hypertension conflict. This study examined air pollution, diabetes, and hypertension in adults in 11 metropolitan areas of Iran (2012-2016). Local environment departments and the Tehran Air Quality Control Company provided air quality data. The VIZIT website and Stepwise Approach to Chronic Disease Risk Factor Surveillance study delivered chronic disease data. Multiple logistic regression and generalized estimating equations evaluated air pollution-related diabetes and hypertension. In Isfahan, Ahvaz, and Tehran, PM2.5 was linked to diabetes. In all cities except Urmia, Yasuj, and Yazd, PM2.5 was statistically related to hypertension. O3 was connected to hypertension in Ahvaz, Tehran, and Shiraz, whereas NO2 was not. BMI and gender predict hypertension and diabetes. Diabetes, SBP, and total cholesterol were correlated. Iran's largest cities' poor air quality may promote diabetes and hypertension. PM2.5 impacts many cities' outcomes. Therefore, politicians and specialists have to control air pollution.
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Affiliation(s)
- Yasaman Oshidari
- Research Center of Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Salehi
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Kermani
- Research Center of Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Jonidi Jafari
- Research Center of Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Yehualashet SS, Yesuf SA, Yezli S, Yiğit A, Yiğit V, Yigzaw ZA, Yismaw Y, Yon DK, Yonemoto N, Younis MZ, Yu C, Yu Y, Yusuf H, Zahid MH, Zakham F, Zaki L, Zaki N, Zaman BA, Zamora N, Zand R, Zandieh GGZ, Zar HJ, Zarrintan A, Zastrozhin MS, Zhang H, Zhang N, Zhang Y, Zhao H, Zhong C, Zhong P, Zhou J, Zhu Z, Ziafati M, Zielińska M, Zimsen SRM, Zoladl M, Zumla A, Zyoud SH, Vos T, Murray CJL. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2133-2161. [PMID: 38642570 PMCID: PMC11122111 DOI: 10.1016/s0140-6736(24)00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Pappachan JM, Fernandez CJ, Ashraf AP. Rising tide: The global surge of type 2 diabetes in children and adolescents demands action now. World J Diabetes 2024; 15:797-809. [PMID: 38766426 PMCID: PMC11099374 DOI: 10.4239/wjd.v15.i5.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/09/2024] [Accepted: 03/18/2024] [Indexed: 05/10/2024] Open
Abstract
Childhood-onset obesity has emerged as a major public healthcare challenge across the globe, fueled by an obesogenic environment and influenced by both genetic and epigenetic predispositions. This has led to an exponential rise in the incidence of type 2 diabetes mellitus in children and adolescents. The looming wave of diabetes-related complications in early adulthood is anticipated to strain the healthcare budgets in most countries. Unless there is a collective global effort to curb the devastation caused by the situation, the impact is poised to be pro-found. A multifaceted research effort, governmental legislation, and effective social action are crucial in attaining this goal. This article delves into the current epidemiological landscape, explores evidence concerning potential risks and consequences, delves into the pathobiology of childhood obesity, and discusses the latest evidence-based management strategies for diabesity.
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Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Cornelius James Fernandez
- Department of Endocrinology & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Ambika P Ashraf
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, United States
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Huang L, Wang Z, Pan Y, Zhou K, Zhong S. Correlation Between Blood Urea Nitrogen and Short- and Long-Term Glycemic Variability in Elderly Patients with Type 2 Diabetes Mellitus Who Were hospitalized:A Retrospective Study. Diabetes Metab Syndr Obes 2024; 17:1973-1986. [PMID: 38737386 PMCID: PMC11088827 DOI: 10.2147/dmso.s458084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Objective Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by insulin resistance and progressively impaired insulin secretion resulting in dynamic fluctuations in glucose levels.High blood urea nitrogen (BUN) levels have been linked to decreased insulin sensitivity, suppressed insulin synthesis and increased risk of incident diabetes mellitus in humans as well as insulin use in patients with T2DM.This study characterize the association between BUN levels and short-term and long-term glycemic variability(GV) in the elderly patients with T2DM who were hospitalized. Methods A total of 927 elderly patients with T2DM were included in the study. The short-term GV was quantified using parameters such as standard deviation (SD), coefficient of variation (CV), time in range (TIR), and mean amplitude of glycemic excursions (MAGE), based on multi-point fingertip blood glucose monitoring. The long-term GV was quantified using parameters such as SD, CV, variation independent of the mean (VIM), and average successive variability (ARV), based on fasting blood glucose(FPG). The relationship between BUN levels and short-term and long-term GV in elderly T2DM who were hospitalized was explored using methods such as Spearman correlation coefficient, linear regression analysis, logistic regression analysis, and interaction tests. Results In elderly patients with T2DM were hospitalized, there is a significant correlation between BUN levels and both short-term and long-term GV. BUN is negatively correlated with the GV parameter TIR (r=-0.12, P=0.000), and positively correlated with SD (r=0.12, P=0.000), CV (r=0.07, P=0.026), MAGE (r=0.11, P=0.001), FPG-SD (r=0.08, P=0.013), and FPG-CV (r=0.08, P=0.014).Furthermore, the association remains consistent across different age, gender, BMI, and haemoglobin A1c (HbA1c) subgroups (P interaction > 0.05). Conclusion In elderly patients with T2DM were hospitalized, BUN levels were positively associated with GV.Therefore, monitoring BUN levels were beneficial in assessing the degree of GV.
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Affiliation(s)
- Lining Huang
- Gusu School, Nanjing Medical University, the First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Zhaoxiang Wang
- Gusu School, Nanjing Medical University, the First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Ying Pan
- Gusu School, Nanjing Medical University, the First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
| | - Kaixin Zhou
- Guangzhou Laboratory, Guangzhou, 510005, People’s Republic of China
| | - Shao Zhong
- Gusu School, Nanjing Medical University, the First People’s Hospital of Kunshan, Kunshan, 215300, People’s Republic of China
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Gilden AH, Catenacci VA, Taormina JM. Obesity. Ann Intern Med 2024; 177:ITC65-ITC80. [PMID: 38739920 DOI: 10.7326/aitc202405210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Obesity is a common condition and a major cause of morbidity and mortality. Fortunately, weight loss treatment can reduce obesity-related complications. This review summarizes the evidence-based strategies physicians can employ to identify, prevent, and treat obesity, including best practices to diagnose and counsel patients, to assess and address the burden of weight-related disease including weight stigma, to address secondary causes of weight gain, and to help patients set individualized and realistic weight loss goals and an effective treatment plan. Effective treatments include lifestyle modification and adjunctive therapies such as antiobesity medications and metabolic and bariatric surgery.
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Affiliation(s)
- Adam H Gilden
- Anschutz Health and Wellness Center, and Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.H.G.); Anschutz Health and Wellness Center, and Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado (V.A.C.); Anschutz Health and Wellness Center, and Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado (J.M.T.)
| | - Victoria A Catenacci
- Anschutz Health and Wellness Center, and Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.H.G.); Anschutz Health and Wellness Center, and Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado (V.A.C.); Anschutz Health and Wellness Center, and Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado (J.M.T.)
| | - John Michael Taormina
- Anschutz Health and Wellness Center, and Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado (A.H.G.); Anschutz Health and Wellness Center, and Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado (V.A.C.); Anschutz Health and Wellness Center, and Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado (J.M.T.)
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Rocha T, Melson E, Zamora J, Fernandez-Felix BM, Arlt W, Thangaratinam S. Sex-Specific Obesity and Cardiometabolic Disease Risks in Low- and Middle-Income Countries: A Meta-Analysis Involving 3 916 276 Individuals. J Clin Endocrinol Metab 2024; 109:1145-1153. [PMID: 37930879 PMCID: PMC10940259 DOI: 10.1210/clinem/dgad599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 11/08/2023]
Abstract
CONTEXT There is limited knowledge about the disparities between the sexes in obesity prevalence and associated cardiovascular complications in low- and middle-income countries (LMICs). OBJECTIVE We undertook a systematic review and meta-analysis to assess sex-specific disparities in the prevalence of obesity and cardiometabolic diseases in LMICs, the burden in women, and variations by region, country's income status, setting, and time. METHODS We searched major databases from inception to March 2023. Two independent reviewers selected the studies, assessed their quality, and extracted data. We used DerSimonian and Laird random-effects models to obtain pooled estimates of odds ratios and 95% CI for the association between sex and obesity and cardiometabolic diseases, and multilevel random-effects logistic regression models to estimate the prevalence of relevant outcomes (PROSPERO CRD42019132609). RESULTS We included 345 studies (3 916 276 individuals). The odds of obesity were 2.72-fold higher in women than men (OR 2.72; 95% CI, 2.54-2.91). The sex-specific disparities varied by region, with the greatest disparities in Sub-Saharan Africa (OR 3.91; 95% CI, 3.49-4.39). Among women in LMICs, 23% (95% CI, 21%-25%) had obesity, 27% (95% CI, 24%-29%) had hypertension, and 7% (95% CI, 6%-9%) had type 2 diabetes. The prevalence of obesity and type 2 diabetes in women varied by region, country's income, and setting, with the highest prevalence in the Middle East and North Africa, upper-middle-income countries and urban settings. The odds of hypertension (OR 2.41; 95% CI, 1.89-3.08) and type 2 diabetes (OR 2.65; 95% CI, 1.76-3.98) were doubled in women with vs without obesity. CONCLUSION There is an urgent need for a women-centred and region-stratified approach to tackle obesity awareness, treatment, and prevention in women in LMICs.
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Affiliation(s)
- Thaís Rocha
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Eka Melson
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Javier Zamora
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid 28034, Spain
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
| | - Borja Manuel Fernandez-Felix
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid 28034, Spain
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham B15 2TQ, UK
- Medical Research Council London Institute of Medical Sciences (MRC LMS), London W12 0HS, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham B15 2TQ, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham B15 2TG, UK
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Xiao M, Wang Z, Li C, Zhang K, Hou Z, Sun S, Yang L. Recent advances in drug delivery systems based on natural and synthetic polymes for treating obesity. Int J Biol Macromol 2024; 260:129311. [PMID: 38218268 DOI: 10.1016/j.ijbiomac.2024.129311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
Obesity stands as a pervasive global public health issue, posing a formidable threat to human well-being as its prevalence continues to surge year by year. Presently, pharmacological treatment remains the favored adjunct strategy for addressing obesity. However, conventional delivery methods suffer from low bioavailability and the potential for side effects, underscoring the pressing need for more efficient and targeted delivery approaches. Recent research has delved extensively into emerging drug delivery systems employing polymers as carriers, with numerous preclinical studies contributing to the growing body of knowledge. This review concentrates on the utilization of natural polymers as drug delivery systems for the treatment of obesity, encompassing recent advancements in both natural and synthetic polymers. The comprehensive exploration includes an analysis of the advantages and disadvantages associated with these polymer carriers. The examination of these characteristics provides valuable insights into potential future developments in the field of drug delivery for obesity treatment.
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Affiliation(s)
- Miaomiao Xiao
- Research Center for Biomedical Materials, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, PR China; College of Exercise and Health, Shenyang Sport University, Shenyang 110102, PR China
| | - Zongheng Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116023, PR China
| | - Chang Li
- College of Sports Medicine, Wuhan Sports University, Wuhan 430079, PR China
| | - Kai Zhang
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, PR China
| | - Zhipeng Hou
- Research Center for Biomedical Materials, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, PR China.
| | - Siyu Sun
- Department of Gastroenterology, Endoscopic Center, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, PR China.
| | - Liqun Yang
- Research Center for Biomedical Materials, Engineering Research Center of Ministry of Education for Minimally Invasive Gastrointestinal Endoscopic Techniques, Shengjing Hospital of China Medical University, Shenyang 110004, PR China; Liaoning Research Institute for Eugenic Birth & Fertility, China Medical University, Shenyang, 110031, P.R.China.
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Wang Y, Pan L, He H, Li Z, Cui S, Yang A, Li W, Jia G, Han X, Wang X, Shan G. Prevalence, associated factors, and gene polymorphisms of obesity in Tibetan adults in Qinghai, China. BMC Public Health 2024; 24:305. [PMID: 38279121 PMCID: PMC10811834 DOI: 10.1186/s12889-023-17181-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/07/2023] [Indexed: 01/28/2024] Open
Abstract
OBJECTIVES To explore the prevalence and associated factors of obesity in Tibetan adults in Qinghai, China, and to determine the association between the FTO (rs1121980 and rs17817449) and MC4R gene (rs17782313 and rs12970134) polymorphisms with obesity. METHODS A cross-sectional survey was conducted in 2015 in Qinghai to selected Tibetan adults aged 20 to 80 years. Prevalence of obesity (BMI ≥ 28 kg/m2) and overweight (BMI 24 ~ 27.9 kg/m2) were evaluated. Multivariable logistic models were used to determine the associated factors. Pair-matched subjects of obesity cases and normal-weight controls were selected for the gene polymorphism analyses. Conditional logistic models were used to assess the association between gene polymorphisms with obesity. Additive and multiplicative gene-environment interactions were tested. RESULTS A total of 1741 Tibetan adults were enrolled. The age- and sex- standardized prevalence of obesity and overweight was 18.09% and 31.71%, respectively. Male sex, older age, heavy level of leisure-time exercise, current smoke, and heavy level of occupational physical activity were associated with both obesity and overweight. MC4R gene polymorphisms were associated with obesity in Tibetan adults. No significant gene-environment interaction was detected. CONCLUSION The prevalence of obesity and overweight in Tibetan adults was high. Both environmental and genetic factors contributed to the obesity prevalent.
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Affiliation(s)
- Ye Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, School of Basic Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, 5 Dong Dan San Tiao, Dong Cheng District, Beijing, 100005, China
| | - Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, School of Basic Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, 5 Dong Dan San Tiao, Dong Cheng District, Beijing, 100005, China
| | - Zhanquan Li
- Qinghai University Affiliated Hospital, Qinghai, China
| | - Sen Cui
- Qinghai University Affiliated Hospital, Qinghai, China
| | - Airong Yang
- Qinghai University Affiliated Hospital, Qinghai, China
| | - Wenfang Li
- Qinghai University Affiliated Hospital, Qinghai, China
| | - Guoqiang Jia
- Qinghai University Affiliated Hospital, Qinghai, China
| | - Ximing Han
- Qinghai University Affiliated Hospital, Qinghai, China
| | - Xianghua Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences, Peking Union Medical College, 236 Baidi Road, Nankai District, Tianjin, 300192, China.
| | - Guangliang Shan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, School of Basic Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, 5 Dong Dan San Tiao, Dong Cheng District, Beijing, 100005, China.
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Wang F, Ma B, Ma Q, Liu X. Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030. Int J Surg 2024; 110:01279778-990000000-01010. [PMID: 38265437 PMCID: PMC11020045 DOI: 10.1097/js9.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Hernias, particularly inguinal, femoral, and abdominal, present a global health challenge. While the Global Burden of Disease (GBD) study offers insights, systematic analyses of hernias remain limited. This research utilizes the GBD dataset to explore hernia implications, combining current statistics with 2030 projections and frontier analysis. METHODS We analyzed data from the 2019 GBD Study, focusing on hernia-related metrics: prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries, grouped into 21 GBD regions by the SDI (SDI). Data analysis incorporated relative change calculations, Annual Percentage Change (APC), Average Annual Percentage Change (AAPC), and Joinpoint Regression Analysis. The study also employed frontier analysis and the Bayesian Age-Period-Cohort model for trend prediction up to 2030. Analyses utilized R version 4.2.3. RESULTS From 1990 to 2019, global hernia cases surged by 36%, reaching over 32.5 million, even as age-standardized rates declined. A similar pattern was seen in mortality and DALYs, with absolute figures rising but age-standardized rates decreasing. Gender data between 1990 and 2020 showed consistent male dominance in hernia prevalence, even as rates for both genders fell. Regionally, Andean Latin America had the highest prevalence, with Qatar and Bulgaria noting significant increases and decreases, respectively. Frontier analyses across 204 countries linked higher SDIs with reduced hernia prevalence. Yet, some high SDI countries, like Qatar and the UK, deviated unexpectedly. Predictions up to 2030 anticipate increasing hernia prevalence, predominantly in males, while death rates are expected to decline. DALYs, after declining, are stabilizing. CONCLUSIONS Our analysis reveals a complex interplay between socio-demographic factors and hernia trends, emphasizing the need for targeted healthcare interventions. Despite advancements, vigilance and continuous research are essential for optimal hernia management globally.
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Affiliation(s)
- Fan Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| | - Bangzhen Ma
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Qiuyue Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| | - Xiaoli Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
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Kwan SH, Gonzalez de Mejia E. The Potential of the Adzuki Bean ( Vigna angularis) and Its Bioactive Compounds in Managing Type 2 Diabetes and Glucose Metabolism: A Narrative Review. Nutrients 2024; 16:329. [PMID: 38276567 PMCID: PMC10820388 DOI: 10.3390/nu16020329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 01/27/2024] Open
Abstract
Type 2 diabetes (T2D) is a common noncommunicable disease. In the United States alone, 37 million Americans had diabetes in 2017. The adzuki bean (Vigna angularis), a legume, has been reported to possess antidiabetic benefits. However, the extent and specific mechanisms through which adzuki bean consumption may contribute to T2D prevention and management remain unclear. Therefore, the aim of this narrative review is to analyze current evidence supporting the utilization of adzuki beans in the diet as a strategy for preventing and managing T2D. Animal studies have demonstrated a positive impact of adzuki beans on managing T2D. However, supporting data from humans are limited. Conversely, the potential of adzuki bean consumption in preventing T2D via modulating two T2D risk factors (obesity and dyslipidemia) also lacks conclusive evidence. Animal studies have suggested an inconsistent and even contradictory relationship between adzuki bean consumption and the management of obesity and dyslipidemia, in which both positive and negative relationships are reported. In sum, based on the existing scientific literature, this review found that the effects of adzuki bean consumption on preventing and managing T2D in humans remain undetermined. Consequently, human randomized controlled trials are needed to elucidate the potential benefits of the adzuki bean and its bioactive components in the prevention and management of T2D.
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Affiliation(s)
- Shu Hang Kwan
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA;
| | - Elvira Gonzalez de Mejia
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA;
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Champaign, IL 61801, USA
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Gu L, Ma Y, Zheng Q, Gu W, Ke T, Li L, Zhao D, Dai Y, Dong Q, Ji B, Xu F, Shi J, Peng Y, Zhang Y, Shen T, Du R, Yang J, Kang M, Peng Y, Wang Y, Wang W. The effects of economic status on metabolic control in type 2 diabetes mellitus at 10 metabolic management centers in China. J Diabetes 2024; 16:e13466. [PMID: 37670495 PMCID: PMC10809306 DOI: 10.1111/1753-0407.13466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE This study investigated the association of economic status with metabolic index control in type 2 diabetes mellitus (T2DM) patients. METHODS In total, 37 454 T2DM patients from 10 National Metabolic Management Centers in China were recruited and categorized into two groups: a high-gross domestic product (GDP) group (n = 23 993) and a low-GDP group (n = 13 461). Sociodemographic characteristics, medical histories, and lifestyle factors were recorded. Logistic regression and interaction analysis were performed to evaluate the association of economic status and healthy lifestyle with metabolic control. RESULTS Compared to the low-GDP group, there were fewer patients with glycated hemoglobin (HbA1c) levels ≥7% in the high-GDP group. Fewer patients with a high GDP had an abnormal metabolic state (HbA1c ≥ 7%, blood pressure [BP] ≥130/80 mm Hg, total cholesterol [TCH] ≥4.5 mmol/L or body mass index [BMI] ≥24 kg/m2 ). The risks of developing HbA1c ≥ 7% (odds ratios [OR] = 0.545 [95% CI: 0.515-0.577], p < .001), BP ≥ 130/80 mm Hg (OR = 0.808 [95% CI: 0.770-0.849], p < .001), BMI ≥ 24 kg/m2 (OR = 0.840 [95% CI: 0.799-0.884], p < .001), and an abnormal metabolic state (OR = 0.533 [95% CI: 0.444-0.636], p < .001) were significantly lower in the high-GDP group even after adjustment for confounding factors. Younger participants; those with a family history of diabetes, normal weight, and a physical activity level up to standard; and those who did not drink alcohol in the high-GDP group were predisposed to better glycemic levels. CONCLUSIONS T2DM patients in economically developed regions had better metabolic control, especially glycemic control. A healthy lifestyle had an additive effect on achieving glycemic goals, even among high-GDP patients.
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Affiliation(s)
- Liping Gu
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuhang Ma
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qidong Zheng
- Department of Internal medicineThe Second People's Hospital of YuhuanYuhuanChina
| | - Weiqiong Gu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tingyu Ke
- Department of EndocrinologyThe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Li Li
- Department of EndocrinologyThe First Affiliated Hospital of Ningbo UniversityNingboChina
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe HospitalCapital Medical UniversityBeijingChina
| | - Yuancheng Dai
- Department of Internal medicine of traditional Chinese medicineSheyang Diabetes HospitalYanchengChina
| | - Qijuan Dong
- Department of Endocrinology and MetabolismPeople's Hospital of Zhengzhou Affiliated Henan University of Chinese MedicineZhengzhouChina
| | - Bangqun Ji
- Department of EndocrinologyXingyi People's HospitalXingyiChina
| | - Fengmei Xu
- Department of Endocrinology and Metabolism, Hebi Coal (group). LTDGeneral hospitalHebiChina
| | - Juan Shi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ying Peng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yifei Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tingting Shen
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Rui Du
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jiaying Yang
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mei Kang
- Clinical Research Center, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yongde Peng
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yufan Wang
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Manne-Goehler J, Rahim N, van Empel E, de Vlieg R, Chamberlin G, Ihama A, Castle A, Mabweazara S, Venter WDF, Chandiwana N, Levitt NS, Siedner M. Perceptions of Health, Body Size, and Nutritional Risk Factors for Obesity in People with HIV in South Africa. AIDS Behav 2024; 28:367-375. [PMID: 37632604 PMCID: PMC10841992 DOI: 10.1007/s10461-023-04152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Abstract
Metabolic disease is increasing in people with HIV (PWH) in South Africa, but little is known about self-perceptions of body size, health, and nutritional behavior in this population. We performed a cross-sectional analysis of individual-level data from the 2016 South Africa Demographic and Health Survey. This survey measured HIV serostatus and body mass index (BMI). We categorized participants into six BMI groups: 18.5-22 kg/m2, 22-25 kg/m2, 25-27.5 kg/m2, 27.5-30 kg/m2, 30-35 kg/m2, and ≥ 35 kg/m2 and stratified them by HIV serostatus. Our outcomes were self-reported (1) body size and (2) health status among all participants, and intake of (3) chips and (4) sugar-sweetened beverages (SSB) in PWH. We described these metrics and used multivariable regression to evaluate the relationship between the nutritional behaviors and BMI ≥ 25 kg/m2 in PWH only, adjusting for age, sex, educational attainment, and household wealth quintile. Of 6138 participants, 1163 (19.7%) were PWH. Among PWH, < 10% with a BMI 25-30 kg/m2, < 20% with a BMI 30-35 kg/m2 and < 50% with a BMI ≥ 35 kg/m2 self-reported as overweight or obese. PWH reported being in poor health at higher rates than those without HIV at each BMI category except ≥ 35 kg/m2. In adjusted models, SSB consumption was associated with BMI ≥ 25 kg/m2 (1.13 [1.01-1.25], t-statistic = 2.14, p = 0.033) in PWH. Perceptions of body size may challenge efforts to prevent weight gain in PWH in South Africa. SSB intake reduction should be further explored as a modifiable risk factor for obesity.
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Affiliation(s)
- Jennifer Manne-Goehler
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Nicholas Rahim
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eva van Empel
- Foundation for General Practitioner Training, UMC Utrecht, Utrecht, The Netherlands
| | - Rebecca de Vlieg
- Foundation for General Practitioner Training, Maastricht University, Eindhoven, The Netherlands
| | - Grace Chamberlin
- University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | - Alison Castle
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Africa Health Research Institute, Kwazulu-Natal, South Africa
| | | | - Willem D F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomathemba Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mark Siedner
- Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Africa Health Research Institute, Kwazulu-Natal, South Africa
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13
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Bao C, Liu X, Li Y, Yang J, Wei F, Gong Y, Ma Z, Liu J. Region-specific hippocampal atrophy is correlated with poor glycemic control in type 2 diabetes: a cross-sectional study. Endocr J 2023; 70:1131-1140. [PMID: 37914275 DOI: 10.1507/endocrj.ej23-0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
To examine the association between prediabetes/type 2 diabetes mellitus (T2DM) and hippocampal subfields and to investigate the effects of glycemic control (HbA1c and FBG)/diabetes duration on the volume of hippocampal subfields in T2DM patients. This cross-sectional study included 268 participants from Tianjin Union Medical Center between August 2019 and July 2022. The participants were divided into three groups: T2DM, prediabetes and no diabetes. All participants underwent brain MRI examination on a 3T MRI scanner. FreeSurfer was performed to segment hippocampus automatically based on T1 MPRAGE images. The relationships between glycemic status/glycemic control/diabetes duration and hippocampal subfield volumes were estimated by multiple linear regression analysis/generalized additive modeling (GAM). Among all participants, 76 (28.36%) had prediabetes, and 96 (35.82%) had T2DM. In multi-adjusted linear regression models, those with prediabetes had a significantly lower volume of bilateral parasubiculum (βright = -5.540; βleft = -6.497). Those with diabetes had lower volume of parasubiculum (βleft = -7.868), presubiculum-head (βleft = -6.244) and fimbria (βleft = -7.187). We did not find relationship between diabetes duration and hippocampal subfield volumes. In stratified analysis, long duration with high FBG related with lower volume of right fimbria (βright = -15.583). Long duration with high HbA1c related with lower volume of presubiculum-head (βright = -19.693), subiculum-head (βright = -28.303), subiculum-body (βleft = -38.599), CA1-head (βright = -62.300, βleft = -47.922), CA1-body (βright = -19.043), CA4-body (βright = -14.392), GC-ML-DG-head (βright = -20.521), GC-ML-DG-body (βright = -16.293, βleft = -12.799), molecular_layer_HP-head (βright = -44.202, βleft = -26.071) and molecular_layer_HP-body, (βright = -31.368), hippocampal_tail (βleft = -80.073). Prediabetes related with lower bilateral parasubiculum volume, and T2DM related with lower left parasubiculum, presubiculum-head and fimbria. T2DM with chronic poor glycemic control had lower volume in multiple hippocampal subregions.
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Affiliation(s)
- Cuiping Bao
- Department of Radiology, Tianjin Union Medical Center, Nankai University, Tianjin 300121, China
| | - Xuehuan Liu
- Department of Radiology, Tianjin Union Medical Center, Nankai University, Tianjin 300121, China
| | - Yiming Li
- Department of Radiology, Tianjin Union Medical Center, Nankai University, Tianjin 300121, China
| | - Jun Yang
- Department of Radiology, Tianjin Union Medical Center, Nankai University, Tianjin 300121, China
| | - Feng Wei
- Department of Radiology, Tianjin Union Medical Center, Nankai University, Tianjin 300121, China
| | - Yi Gong
- Department of Radiology, Tianjin Union Medical Center, Nankai University, Tianjin 300121, China
| | - Zhihui Ma
- Department of Radiology, Tianjin Union Medical Center, Nankai University, Tianjin 300121, China
| | - Jun Liu
- The Fourth Central Clinical College, Tianjin Medical University, Tianjin 300140, China
- The Institute of Translational Medicine, Tianjin Union Medical Center, Nankai University, Tianjin 300121, China
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14
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Hou Y, Dai H, Chen N, Zhao Z, Wang Q, Hou T, Zheng J, Wang T, Li M, Lin H, Wang S, Zheng R, Lu J, Xu Y, Chen Y, Liu R, Ning G, Wang W, Bi Y, Wang J, Xu M. Whole Blood-based Transcriptional Risk Score for Nonobese Type 2 Diabetes Predicts Dynamic Changes in Glucose Metabolism. J Clin Endocrinol Metab 2023; 109:114-124. [PMID: 37555255 PMCID: PMC10735316 DOI: 10.1210/clinem/dgad466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/10/2023]
Abstract
CONTEXT The performance of peripheral blood transcriptional markers in evaluating risk of type 2 diabetes (T2D) with normal body mass index (BMI) is unknown. OBJECTIVE We developed a whole blood-based transcriptional risk score (wb-TRS) for nonobese T2D and assessed its contributions on disease risk and dynamic changes in glucose metabolism. METHODS Using a community-based cohort with blood transcriptome data, we developed the wb-TRS in 1105 participants aged ≥40 years who maintained a normal BMI for up to 10 years, and we validated the wb-TRS in an external dataset. Potential biological significance was explored. RESULTS The wb-TRS included 144 gene transcripts. Compared to the lowest tertile, wb-TRS in tertile 3 was associated with 8.91-fold (95% CI, 3.53-22.5) higher risk and each 1-unit increment was associated with 2.63-fold (95% CI, 1.87-3.68) higher risk of nonobese T2D. Furthermore, baseline wb-TRS significantly associated with dynamic changes in average, daytime, nighttime, and 24-hour glucose, HbA1c values, and area under the curve of glucose measured by continuous glucose monitoring over 6 months of intervention. The wb-TRS improved the prediction performance for nonobese T2D, combined with fasting glucose, triglycerides, and demographic and anthropometric parameters. Multi-contrast gene set enrichment (Mitch) analysis implicated oxidative phosphorylation, mTORC1 signaling, and cholesterol metabolism involved in nonobese T2D pathogenesis. CONCLUSION A whole blood-based nonobese T2D-associated transcriptional risk score was validated to predict dynamic changes in glucose metabolism. These findings suggested several biological pathways involved in the pathogenesis of nonobese T2D.
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Affiliation(s)
- Yanan Hou
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Huajie Dai
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Na Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qi Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Tianzhichao Hou
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jie Zheng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hong Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ruizhi Zheng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ruixin Liu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiqiu Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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15
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Guo C, Liu Z, Lin C, Fan H, Zhang X, Wang H, Han X, Li Y, Mu L, Yu S, Zhang T. Global epidemiology of early-onset liver cancer attributable to specific aetiologies and risk factors from 2010 to 2019. J Glob Health 2023; 13:04167. [PMID: 38085217 PMCID: PMC10715628 DOI: 10.7189/jogh.13.04167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Background Considering its emergence as a public health concern worldwide, with potential spatial-temporal heterogeneities, we aimed to determine the global burden of early-onset liver cancer attributable to aetiologies and concomitant risk factors. Methods We used data from the Global Burden of Diseases Study 2019 to determine age-standardised disability-adjusted life-year (DALY) rates for early-onset liver cancer by aetiologies and the population DALYs attributable to concomitant risk factors between 2010 and 2019. We also calculated estimated annual percentage changes (EAPCs) to measure temporal trends. Results There were 2.9 million DALYs related to early-onset liver cancer globally in 2019. East Asia contributed over half of DALYs, which increased annually by 1.23% (95% confidence interval (CI) = 0.71, 1.76) between 2010 and 2019. Non-alcoholic steatohepatitis was the only growing aetiology. The proportion of DALYs attributed to metabolic risks increased by 22.50% (95% CI = 14.33, 38.13), while behavioral risks remained stable. Obesity surpassed smoking as the most prevalent nondeterministic aetiological risk factor from 2010 to 2019, while the population DALY attributable to hepatitis B combined with obesity increased by 29.93% (95% CI = 8.49, 60.77) in the same period, making it the principal joint contributor. Conclusions Early-onset liver cancer poses considerable disability and continues to increase in many regions, especially in East Asia. Metabolic risk factors, particularly when hepatitis B and obesity coexist, are the fastest-growing contributors to this type of cancer. More targeted interventions are imperative to curb the growing burden of early-onset liver cancer due to metabolic risks.
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Affiliation(s)
- Chengnan Guo
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China
| | - Zhenqiu Liu
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Chunqing Lin
- National Clinical Research Center for Cancer, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Fan
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Xin Zhang
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China
| | - Haili Wang
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China
| | - Xinyu Han
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China
| | - Yi Li
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York (SUNY), Buffalo, New York, USA
| | - Shunzhang Yu
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Tiejun Zhang
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China
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16
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Thomas NJ, Jones AG. The challenges of identifying and studying type 1 diabetes in adults. Diabetologia 2023; 66:2200-2212. [PMID: 37728732 PMCID: PMC10628058 DOI: 10.1007/s00125-023-06004-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/14/2023] [Indexed: 09/21/2023]
Abstract
Diagnosing type 1 diabetes in adults is difficult since type 2 diabetes is the predominant diabetes type, particularly with an older age of onset (approximately >30 years). Misclassification of type 1 diabetes in adults is therefore common and will impact both individual patient management and the reported features of clinically classified cohorts. In this article, we discuss the challenges associated with correctly identifying adult-onset type 1 diabetes and the implications of these challenges for clinical practice and research. We discuss how many of the reported differences in the characteristics of autoimmune/type 1 diabetes with increasing age of diagnosis are likely explained by the inadvertent study of mixed populations with and without autoimmune aetiology diabetes. We show that when type 1 diabetes is defined by high-specificity methods, clinical presentation, islet-autoantibody positivity, genetic predisposition and progression of C-peptide loss remain broadly similar and severe at all ages and are unaffected by onset age within adults. Recent clinical guidance recommends routine islet-autoantibody testing when type 1 diabetes is clinically suspected or in the context of rapid progression to insulin therapy after a diagnosis of type 2 diabetes. In this moderate or high prior-probability setting, a positive islet-autoantibody test will usually confirm autoimmune aetiology (type 1 diabetes). We argue that islet-autoantibody testing of those with apparent type 2 diabetes should not be routinely undertaken as, in this low prior-prevalence setting, the positive predictive value of a single-positive islet antibody for autoimmune aetiology diabetes will be modest. When studying diabetes, extremely high-specificity approaches are needed to identify autoimmune diabetes in adults, with the optimal approach depending on the research question. We believe that until these recommendations are widely adopted by researchers, the true phenotype of late-onset type 1 diabetes will remain largely misunderstood.
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Affiliation(s)
- Nicholas J Thomas
- Department of Clinical and Biological Sciences, University of Exeter, Exeter, UK
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Angus G Jones
- Department of Clinical and Biological Sciences, University of Exeter, Exeter, UK.
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
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17
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Ohno R, Kaneko H, Ueno K, Aoki H, Okada A, Kamiya K, Suzuki Y, Matsuoka S, Fujiu K, Takeda N, Jo T, Ako J, Morita H, Node K, Yasunaga H, Komuro I. Association of Body Mass Index and Its Change With Incident Diabetes Mellitus. J Clin Endocrinol Metab 2023; 108:3145-3153. [PMID: 37350488 DOI: 10.1210/clinem/dgad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023]
Abstract
CONTEXT There have been insufficient data on the threshold of body mass index (BMI) for developing diabetes mellitus (DM) and the relationship between change in BMI and the subsequent risk of DM. OBJECTIVE We sought to clarify the association of BMI and its change with incident DM. METHODS We conducted a retrospective observational cohort study using the JMDC Claims Database between 2005 and 2021. We included 3 400 303 individuals without a prior history of DM or usage of glucose-lowering medications. The median age was 44 years, and 57.5% were men. We categorized the study participants into 4 groups: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obese (BMI ≥ 30 kg/m2). According to the change in BMI from the initial health check-up to the health check-up 1 year after that, we divided the study participants into 3 groups: ≤-5.0%, -5.0% to +5.0%, and ≥+5.0%. RESULTS The risk of developing DM increased steeply after BMI exceeded approximately 20 to 21 kg/m2. Compared with participants with stable BMI (-5.0% to +5.0%), the relative risk for DM among those whose BMI had increased by 5.0% or more was 1.33 (95% CI 1.31-1.36). In contrast, the relative risk for DM among those whose BMI decreased by 5.0% or more was 0.82 (95% CI 0.80-0.84). Moreover, people classified as normal weight, overweight, and obese reduced the risk of developing DM when they reduced their BMI, whereas the risk of developing DM for people classified as underweight increased when they reduced their BMI. CONCLUSION Our findings offer novel insights into improving an optimal bodyweight management strategy to prevent the development of DM.
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Affiliation(s)
- Ryusei Ohno
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Toyo, Japan
| | - Kensuke Ueno
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hiroyuki Aoki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Toyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
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18
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Zaccardi F, Ling S, Brown K, Davies M, Khunti K. Duration of Type 2 Diabetes and Incidence of Cancer: An Observational Study in England. Diabetes Care 2023; 46:1923-1930. [PMID: 37639691 DOI: 10.2337/dc23-1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To investigate the association between duration of type 2 diabetes and cancer incidence. RESEARCH DESIGN AND METHODS In the Clinical Practice Research Datalink database, we identified 130,764 individuals with type 2 diabetes aged ≥35 years at diagnosis who were linked to hospital and mortality records. We used sex-stratified Royston-Parmar models with two timescales to estimate incidence rates of all cancers, the four commonest cancers in the U.K. (colorectal, lung, prostate, breast), and the obesity-related cancers (e.g., liver, ovary) between 1 January 1998 and 14 January 2019, by age and diabetes duration. RESULTS During 1,089,923 person-years, 18,977 incident cancers occurred. At the same age, rates of all cancers in men and women did not vary across durations ranging from diagnosis to 20 years; conversely, for any duration, there was a strong, positive association between age and cancer rates. In men, the rate ratio (95% CI) comparing 20 with 5 years of duration was 1.18 (0.82-1.69) at 60 years of age and 0.90 (0.75-1.08) at 80 years; corresponding ratios in women were 1.07 (0.71-1.63) and 0.84 (0.66-1.05). This pattern was observed also for the four commonest cancers. For obesity-related cancers, although rates were generally higher in individuals with a higher BMI, there was no association with duration at any level of BMI. CONCLUSIONS In this study, we did not find evidence of an association between duration of type 2 diabetes and risk of cancer, with the higher risk observed for longer durations related to ageing.
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Affiliation(s)
- Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
- Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Suping Ling
- Inequalities in Cancer Outcomes Network Group, Department of Noncommunicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, U.K
| | - Karen Brown
- Leicester Cancer Research Centre, Leicester Royal Infirmary, University of Leicester, Leicester, U.K
| | - Melanie Davies
- Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
- National Institute for Health and Care Research, Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, U.K
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
- Leicester Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
- National Institute for Health and Care Research, Applied Research Collaboration East Midlands, University of Leicester, Leicester, U.K
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19
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Castle AC, Hoeppner SS, Manne-Goehler JM, Olivier S, Magodoro IM, Singh U, Edwards JA, Tanser F, Bassett IV, Wong EB, Siedner MJ. Identifying sex-specific anthropometric measures and thresholds for dysglycemia screening in an HIV-endemic rural South African population. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001698. [PMID: 37889883 PMCID: PMC10610455 DOI: 10.1371/journal.pgph.0001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Valid screening and diagnostic algorithms are needed to achieve 2030 targets proposed by the WHO's Global Diabetes Compact. We explored anthropometric thresholds to optimally screen and refer individuals for diabetes testing in rural South Africa. We evaluated screening thresholds for waist circumference (WC), body mass index (BMI), and waist-hip ratio (WHR) to detect dysglycemia based on a glycated hemoglobin (HbA1C) ≥6.5% among adults in a population-based study in South Africa using weighted, non-parametric ROC regression analyses. We then assessed the diagnostic validity of traditional obesity thresholds, explored optimal thresholds for this population, and fit models stratified by sex, age, and HIV status. The prevalence of dysglycemia in the total study population (n = 17,846) was 7.7%. WC had greater discriminatory capacity than WHR to detect dysglycemia in men (p-value<0.001) and women (p<0.001). WC had greater discriminatory capacity than BMI to detect dysglycemia in women (p<0.001). However, BMI and WC performed similarly for men (p = 0.589). Whereas traditional WC thresholds for women (>81cm) performed well (sensitivity 91%, positive predictive value [PPV] 14.9%), substantially lower thresholds were needed to achieve acceptable sensitivity and PPV among men (traditional >94cm, derived >79.5cm). WC outperforms BMI as an anthropometric screening measure for dysglycemia in rural South Africa. Whereas WC guideline thresholds are appropriate for women, male-derived WC cutoffs performed better at lower thresholds. In this rural South African population, thresholds that maximize specificity and PPV for efficient resource allocation may be preferred.
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Affiliation(s)
- Alison C. Castle
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Jennifer M. Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen Olivier
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Itai M. Magodoro
- Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Urisha Singh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Johnathan A. Edwards
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, United States of America
- School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
| | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
- Lincoln Institute for Health, University of Lincoln, Lincoln, United Kingdom
| | - Ingrid V. Bassett
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Emily B. Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, University of Alabama Birmingham, Birmingham, Alabama, United States of America
| | - Mark J. Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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20
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Rahim NE, Flood D, Marcus ME, Theilmann M, Aung TN, Agoudavi K, Aryal KK, Bahendeka S, Bicaba B, Bovet P, Diallo AO, Farzadfar F, Guwatudde D, Houehanou C, Houinato D, Hwalla N, Jorgensen J, Kagaruki GB, Mayige M, Wong-McClure R, Larijani B, Saeedi Moghaddam S, Mwalim O, Mwangi KJ, Sarkar S, Sibai AM, Sturua L, Wesseh C, Geldsetzer P, Atun R, Vollmer S, Bärnighausen T, Davies J, Ali MK, Seiglie JA, Manne-Goehler J. Diabetes risk and provision of diabetes prevention activities in 44 low-income and middle-income countries: a cross-sectional analysis of nationally representative, individual-level survey data. Lancet Glob Health 2023; 11:e1576-e1586. [PMID: 37734801 PMCID: PMC10560068 DOI: 10.1016/s2214-109x(23)00348-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The global burden of diabetes is rising rapidly, yet there is little evidence on individual-level diabetes prevention activities undertaken by health systems in low-income and middle-income countries (LMICs). Here we describe the population at high risk of developing diabetes, estimate diabetes prevention activities, and explore sociodemographic variation in these activities across LMICs. METHODS We performed a pooled, cross-sectional analysis of individual-level data from nationally representative, population-based surveys conducted in 44 LMICs between October, 2009, and May, 2019. Our sample included all participants older than 25 years who did not have diabetes and were not pregnant. We defined the population at high risk of diabetes on the basis of either the presence of impaired fasting glucose (or prediabetes in countries with a haemoglobin A1c available) or overweight or obesity, consistent with the WHO Package of Essential Noncommunicable Disease Guidelines for type 2 diabetes management. We estimated the proportion of survey participants that were at high risk of developing diabetes based on this definition. We also estimated the proportion of the population at high risk that reported each of four fundamental diabetes prevention activities: physical activity counselling, weight loss counselling, dietary counselling, and blood glucose screening, overall and stratified by World Bank income group. Finally, we used multivariable Poisson regression models to evaluate associations between sociodemographic characteristics and these activities. FINDINGS The final pooled sample included 145 739 adults (86 269 [59·2%] of whom were female and 59 468 [40·4%] of whom were male) across 44 LMICs, of whom 59 308 (40·6% [95% CI 38·5-42·8]) were considered at high risk of diabetes (20·6% [19·8-21·5] in low-income countries, 38·0% [37·2-38·9] in lower-middle-income countries, and 57·5% [54·3-60·6] in upper-middle-income countries). Overall, the reach of diabetes prevention activities was low at 40·0% (38·6-41·4) for physical activity counselling, 37·1% (35·9-38·4) for weight loss counselling, 42·7% (41·6-43·7) for dietary counselling, and 37·1% (34·7-39·6) for blood glucose screening. Diabetes prevention varied widely by national-level wealth: 68·1% (64·6-71·4) of people at high risk of diabetes in low-income countries reported none of these activities, whereas 49·0% (47·4-50·7) at high risk in upper-middle-income countries reported at least three activities. Educational attainment was associated with diabetes prevention, with estimated increases in the predicted probability of receipt ranging between 6·5 (3·6-9·4) percentage points for dietary fruit and vegetable counselling and 21·3 (19·5-23·2) percentage points for blood glucose screening, among people with some secondary schooling compared with people with no formal education. INTERPRETATION A large proportion of individuals across LMICs are at high risk of diabetes but less than half reported receiving fundamental prevention activities overall, with the lowest receipt of these activities among people in low-income countries and with no formal education. These findings offer foundational evidence to inform future global targets for diabetes prevention and to strengthen policies and programmes to prevent continued increases in diabetes worldwide. FUNDING Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program and the EU's Research and Innovation programme Horizon 2020.
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Affiliation(s)
- Nicholas Errol Rahim
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Maja E Marcus
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Behavioral Science for Disease Prevention and Health Care, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Taing N Aung
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Silver Bahendeka
- Diabetes and Endocrinology, Saint Francis Hospital Nsambya, Kampala, Uganda
| | - Brice Bicaba
- National Institute of Public Health, Ouagadougou, Burkina Faso
| | - Pascal Bovet
- University Center for General Medicine and Public Health (Unisanté), Lausanne, Switzerland; Ministry of Health, Victoria, Seychelles
| | - Alpha Oumar Diallo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Nahla Hwalla
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jutta Jorgensen
- Institute of Global Health, Department of Public Health and Epidemiology, Copenhagen University, Copenhagen, Denmark
| | | | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Kiel Institute for the World Economy, Kiel, Germany
| | | | - Kibachio Joseph Mwangi
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya; World Health Organization Country Office, Pretoria, South Africa
| | - Sudipa Sarkar
- Division of Endocrinology, Diabetes, and Metabolism, John Hopkins University, Baltimore, MD, USA
| | - Abla M Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA; Chan Zuckerberg Biohub-San Francisco, San Francisco, CA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Africa Health Research Institute, Somkhele, South Africa
| | - Justine Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Prevention Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jennifer Manne-Goehler
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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21
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Simmons SS. Strikes and Gutters: Biomarkers and anthropometric measures for predicting diagnosed diabetes mellitus in adults in low- and middle-income countries. Heliyon 2023; 9:e19494. [PMID: 37810094 PMCID: PMC10558610 DOI: 10.1016/j.heliyon.2023.e19494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
The management of diabetes necessitates the requirement of reliable health indices, specifically biomarkers and anthropometric measures, to detect the presence or absence of the disease. Nevertheless, limited robust empirical evidence exists regarding the optimal metrics for predicting diabetes in adults, particularly within low- and middle-income countries. This study investigates objective and subjective indices for screening diabetes in these countries. METHODS Data for this study was sourced from surveys conducted among adults (aged 18 years and above) in seventeen (17) countries. Self-reported diabetes status, fifty-four biomarkers, and twenty-six core and twenty-eight estimated anthropometric indices, including weight, waist circumference, body mass index, glycaemic triglycerides, and fasting blood glucose, were utilised to construct lasso regression models. RESULTS The study revealed variances in diabetes prediction outcomes across different countries. Central adiposity measures, fasting plasma glucose and glycaemic triglycerides demonstrated superior predictive capabilities for diabetes when compared to body mass index. Furthermore, fasting plasma or blood glucose, serving as a biomarker, emerged as the most accurate predictor of diabetes. CONCLUSIONS These findings offer critical insights into both general and context-specific tools for diabetes screening. The study proposes that fasting plasma glucose and central adiposity indices should be considered as routine screening tools for diabetes, both in policy interventions and clinical practice. By identifying adults with or at higher risk of developing diabetes and implementing appropriate interventions, these screening tools possess the potential to mitigate diabetes-related complications in low- and middle-income countries.
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Affiliation(s)
- Sally Sonia Simmons
- Department of Social Policy, London School of Economics and Political Science, London, WC2A 2AE, United Kingdom
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22
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Ochmann S, von Polenz I, Marcus ME, Theilmann M, Flood D, Agoudavi K, Aryal KK, Bahendeka S, Bicaba B, Bovet P, Campos Caldeira Brant L, Carvalho Malta D, Damasceno A, Farzadfar F, Gathecha G, Ghanbari A, Gurung M, Guwatudde D, Houehanou C, Houinato D, Hwalla N, Jorgensen JA, Karki KB, Lunet N, Martins J, Mayige M, Moghaddam SS, Mwalim O, Mwangi KJ, Norov B, Quesnel-Crooks S, Rezaei N, Sibai AM, Sturua L, Tsabedze L, Wong-McClure R, Davies J, Geldsetzer P, Bärnighausen T, Atun R, Manne-Goehler J, Vollmer S. Diagnostic testing for hypertension, diabetes, and hypercholesterolaemia in low-income and middle-income countries: a cross-sectional study of data for 994 185 individuals from 57 nationally representative surveys. Lancet Glob Health 2023; 11:e1363-e1371. [PMID: 37591584 PMCID: PMC10480389 DOI: 10.1016/s2214-109x(23)00280-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Testing for the risk factors of cardiovascular disease, which include hypertension, diabetes, and hypercholesterolaemia, is important for timely and effective risk management. Yet few studies have quantified and analysed testing of cardiovascular risk factors in low-income and middle-income countries (LMICs) with respect to sociodemographic inequalities. We aimed to address this knowledge gap. METHODS In this cross-sectional analysis, we pooled individual-level data for non-pregnant adults aged 18 years or older from nationally representative surveys done between Jan 1, 2010, and Dec 31, 2019 in LMICs that included a question about whether respondents had ever had their blood pressure, glucose, or cholesterol measured. We analysed diagnostic testing performance by quantifying the overall proportion of people who had ever been tested for these cardiovascular risk factors and the proportion of individuals who met the diagnostic testing criteria in the WHO package of essential noncommunicable disease interventions for primary care (PEN) guidelines (ie, a BMI >30 kg/m2 or a BMI >25 kg/m2 among people aged 40 years or older). We disaggregated and compared diagnostic testing performance by sex, wealth quintile, and education using two-sided t tests and multivariable logistic regression models. FINDINGS Our sample included data for 994 185 people from 57 surveys. 19·1% (95% CI 18·5-19·8) of the 943 259 people in the hypertension sample met the WHO PEN criteria for diagnostic testing, of whom 78·6% (77·8-79·2) were tested. 23·8% (23·4-24·3) of the 225 707 people in the diabetes sample met the WHO PEN criteria for diagnostic testing, of whom 44·9% (43·7-46·2) were tested. Finally, 27·4% (26·3-28·6) of the 250 573 people in the hypercholesterolaemia sample met the WHO PEN criteria for diagnostic testing, of whom 39·7% (37·1-2·4) were tested. Women were more likely than men to be tested for hypertension and diabetes, and people in higher wealth quintiles compared with those in the lowest wealth quintile were more likely to be tested for all three risk factors, as were people with at least secondary education compared with those with less than primary education. INTERPRETATION Our study shows opportunities for health systems in LMICs to improve the targeting of diagnostic testing for cardiovascular risk factors and adherence to diagnostic testing guidelines. Risk-factor-based testing recommendations rather than sociodemographic characteristics should determine which individuals are tested. FUNDING Harvard McLennan Family Fund, the Alexander von Humboldt Foundation, and the National Heart, Lung, and Blood Institute of the US National Institutes of Health.
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Affiliation(s)
- Sophie Ochmann
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
| | | | - Maja-Emilia Marcus
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine, and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | | | - Krishna Kumar Aryal
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Silver Bahendeka
- Saint Francis Hospital Nsambya, Uganda Martyrs University, Kampala, Uganda
| | - Brice Bicaba
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Pascal Bovet
- Ministry of Health, Victoria, Seychelles; University Center for General Medicine and Public Health (Unisanté), Lausanne, Switzerland
| | - Luisa Campos Caldeira Brant
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Deborah Carvalho Malta
- Postgraduate Program in Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mongal Gurung
- Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Nahla Hwalla
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jutta Adelin Jorgensen
- Global Health Section, Dept of Public Health, University of Copenhagen, Cophenhagen, Denmark
| | - Khem B Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
| | - Joao Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Dili, Timor-Leste
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Kiel Institute for the World Economy, Kiel, Germany
| | - Omar Mwalim
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway; Ministry of Health, Zanzibar City, Tanzania
| | - Kibachio Joseph Mwangi
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bolormaa Norov
- Nutrition Division, National Center for Public Health, Ulaanbaatar, Mongolia
| | | | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abla M Sibai
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Roy Wong-McClure
- Office of Epidemiology and Surveillance, Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, and University Hospital, Heidelberg University, Heidelberg, Germany; Harvard Center for Population and Development Studies, Cambridge, MA, USA; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rifat Atun
- Department of Global Health and Social Medicine, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany.
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Ramírez V, Weber L, Hernández M, Realini O, Bendek MJ, Busso D, Hoare A, Illanes SE, Chaparro A. Obesity is related to maternal periodontitis severity in pregnancy: a cross-sectional study. Clin Oral Investig 2023; 27:5509-5518. [PMID: 37505241 DOI: 10.1007/s00784-023-05170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To evaluate the relationship between obesity and periodontitis staging compared with periodontal healthy or gingivitis in pregnant women. MATERIALS AND METHODS An analytical cross-sectional study was conducted on pregnant women between 11 and 14 weeks of pregnancy. Sociodemographic, clinical, obstetric, and periodontal variables were studied. The exposure variable was obesity (body mass index [BMI] ≥ 30), and the primary outcome was periodontitis staging versus periodontal healthy/gingivitis. Data were analysed and estimated by multinomial logistic regression models. RESULTS The present study screened 1086 pregnancies and analysed 972 women with a median age of 29 years; 36.8% were diagnosed as obese. 26.9% of patients were diagnosed as periodontal healthy or gingivitis, 5.5% with stage I periodontitis, 38.6% with stage II periodontitis, 24% with stage III periodontitis, and 5.1% with stage IV periodontitis. After identifying and adjusting for confounding variables (educational level and plaque index), obesity had a relative risk ratio (RRR) of 1.66 (95% CI: 1.05-2.64; p = 0.03) and 1.57 (95% CI: 1.09-2.27; p = 0.015) for stage III periodontitis compared to periodontal healthy/gingivitis and stage II periodontitis, respectively. CONCLUSION Besides the already known risk indicators for periodontitis (age, smoking, and educational level), our study suggests a relationship between obesity and periodontitis staging in pregnancy. CLINICAL RELEVANCE Obesity can alter host immune responses, leading to increased susceptibility to infections and overactive host immunity, which could influence the prevalence and severity of maternal periodontitis in pregnancy.
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Affiliation(s)
- Valeria Ramírez
- Department of Biomedical Sciences, Ethics, Research and Education, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Laura Weber
- Department of Pathology and Conservative Dentistry, Faculty of Dentistry, Universidad de Los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile
| | - Marcela Hernández
- Department of Pathology, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Ornella Realini
- Department of Pathology and Conservative Dentistry, Faculty of Dentistry, Universidad de Los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile
| | - María José Bendek
- Department of Pathology and Conservative Dentistry, Faculty of Dentistry, Universidad de Los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile
- PhD Program in Biomedicine, School of Medicine, Universidad de los Andes, Santiago, Chile
| | - Dolores Busso
- Laboratory of Reproductive Biology, Biomedical Research and Innovation Center, Universidad de los Andes, Santiago, Chile
| | - Anilei Hoare
- Laboratory of Oral Microbiology, Department of Pathology and Oral Medicine, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Sebastián Enrique Illanes
- Laboratory of Reproductive Biology, Biomedical Research and Innovation Center, Universidad de los Andes, Santiago, Chile
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Alejandra Chaparro
- Department of Pathology and Conservative Dentistry, Faculty of Dentistry, Universidad de Los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile.
- Biomedical Research and Innovation Center, Santiago, Chile.
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24
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Cao Y, Jin C, Zhang J, Sun H, Ma B, Yang X, Liu T, Yang K, Li Y. Diabetes burden, trends, and inequalities in western pacific region, 1990-2019: A population-based study. Diabetes Metab Syndr 2023; 17:102852. [PMID: 37714053 DOI: 10.1016/j.dsx.2023.102852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
AIMS The aim was to describe the diabetes regional burden, trends, and inequalities in the Western Pacific region. METHODS The Global Burden of Disease 2019 study was used to evaluate the prevalence, incidence, mortality, disability-adjusted life year (DALY) rates and average annual percentage changes (AAPCs) in diabetes in the Western Pacific region from 1990 to 2019. Cross-country inequalities in the DALY rates of diabetes were estimated between 1990 and 2019. RESULTS The age-standardized incidence of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in the Western Pacific region increased from 2.6 to 3.8 per 100,000 population (AAPC, 0.97 [95% CI 0.84 to 1.1]) and from 174.8 to 207.3 per 100,000 population (AAPC, 0.63 [95% CI 0.48 to 0.77]) between 1990 and 2019, respectively. The most substantial increase in the incidence of T1DM and T2DM was found in the groups aged 70 years and older (AAPC, 2.38 [95% CI 2.19 to 2.58]) and 15-49 years (AAPC, 1.58 [95% CI 1.43 to 1.72]) from 1990 to 2019, respectively. Age-standardized DALYs for T1DM decreased but those for T2DM increased between 1990 and 2019. The relative concentration index of DALYs in T1DM and T2DM changed from 0.11 in 1990 to -0.08 in 2019 and from 0.03 in 1990 to -0.04 in 2019, respectively. CONCLUSIONS Over three decades, diabetes incidence in the Western Pacific region rose substantially, with inequalities among countries. The burden shifted from higher to lower sociodemographic index countries. Diabetes remains a public health challenge, especially among young populations. Urgent interventions for prevention and early detection are crucial.
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Affiliation(s)
- Yanli Cao
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Chenye Jin
- Department of Rheumatology and Immunology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jing Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Hao Sun
- Department of Clinical Epidemiology and Evidence-based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bing Ma
- Department of Clinical Epidemiology and Evidence-based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xue Yang
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tingting Liu
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kaijie Yang
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yongze Li
- Department of Endocrinology and Metabolism, The Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Disease, The First Hospital of China Medical University, Shenyang, Liaoning, China.
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25
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Zamani M, Nikbaf-Shandiz M, Aali Y, Rasaei N, Zarei M, Shiraseb F, Asbaghi O. The effects of acarbose treatment on cardiovascular risk factors in impaired glucose tolerance and diabetic patients: a systematic review and dose-response meta-analysis of randomized clinical trials. Front Nutr 2023; 10:1084084. [PMID: 37599681 PMCID: PMC10433190 DOI: 10.3389/fnut.2023.1084084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 06/27/2023] [Indexed: 08/22/2023] Open
Abstract
Acarbose (ACB) seems to be an effective drug in the management of cardiovascular risk factors. However, no previous meta-analysis of randomized controlled trials (RCTs) has been done to evaluate the effects of ACB on cardiovascular risk factors on impaired glucose tolerance (IGT), type 2 diabetes mellitus (T2D), and type 1 diabetes mellitus (T1D). We comprehensively searched electronic databases including Scopus, Web of Science, and PubMed for RCTs for related keywords up to September 2022. A random-effects model was used to estimate the weighted mean difference (WMD) and 95% confidence interval (CI). The pooled analysis demonstrated that ACB treatment had a significant effect on fasting blood glucose (FBG) (WMD = -3.55 mg/dL; 95%CI: -6.29, -0.81; p = 0.011), fasting insulin (WMD = -6.73 pmoL/L; 95%CI: -10.37, -3.10; p < 0.001), HbA1c [WMD = -0.32%; 95%CI: -0.45, -0.20; p < 0.001], body weight (WMD = -1.25 kg; 95%CI: -1.79, -0.75; p < 0.001), body mass index (BMI) (WMD = -0.64 kg/m2; 95%CI: -0.92, -0.37; p < 0.001), tumor necrosis factor-alpha (TNF-α) (WMD = -2.70 pg/mL, 95%CI: -5.25, -0.16; p = 0.037), leptin (WMD = -1.58 ng/mL; 95%CI: -2.82, -0.35; p = 0.012), alanine transaminase (ALT) (WMD = 0.71 U/L; 95%CI: -0.31, 1.85; p = 0.164), triglyceride (TG) (WMD = -13.89 mg/dL; 95%CI: -20.69, -7.09; p < 0.001), total cholesterol (TC) (WMD = -2.26 mg/dL; 95%CI: -4.18, -0.34; p = 0.021), systolic blood pressure (SBP) (WMD = -1.29 mmHg; 95%CI: -2.44, -0.15; p = 0.027), and diastolic blood pressure (DBP) (WMD = 0.02 mmHg; 95%CI: -0.41, 0.45; p = 0.925) in an intervention group, compared with a placebo group. The non-linear dose-response analysis showed that ACB reduces the TC in trial duration by >50 weeks, and 180 mg/day is more effective for the decrement of CRP. ACB can improve lipid profiles, glycemic indices, anthropometric indices, and inflammatory markers in T2D, T1D, and IGT patients.
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Affiliation(s)
- Mohammad Zamani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Yasaman Aali
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Niloufar Rasaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahtab Zarei
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Omid Asbaghi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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26
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Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, Dalton BE, Duprey J, Cruz JA, Hagins H, Lindstedt PA, Aali A, Abate YH, Abate MD, Abbasian M, Abbasi-Kangevari Z, Abbasi-Kangevari M, Abd ElHafeez S, Abd-Rabu R, Abdulah DM, Abdullah AYM, Abedi V, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Abu-Zaid A, Adane TD, Adane DE, Addo IY, Adegboye OA, Adekanmbi V, Adepoju AV, Adnani QES, Afolabi RF, Agarwal G, Aghdam ZB, Agudelo-Botero M, Aguilera Arriagada CE, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad R, Ahmad S, Ahmad A, Ahmadi A, Ahmadi K, Ahmed A, Ahmed A, Ahmed LA, Ahmed SA, Ajami M, Akinyemi RO, Al Hamad H, Al Hasan SM, AL-Ahdal TMA, Alalwan TA, Al-Aly Z, AlBataineh MT, Alcalde-Rabanal JE, Alemi S, Ali H, Alinia T, Aljunid SM, Almustanyir S, Al-Raddadi RM, Alvis-Guzman N, Amare F, Ameyaw EK, Amiri S, Amusa GA, Andrei CL, Anjana RM, Ansar A, Ansari G, Ansari-Moghaddam A, Anyasodor AE, Arabloo J, Aravkin AY, Areda D, Arifin H, Arkew M, Armocida B, Ärnlöv J, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Aryan Z, Asemu MT, Asghari-Jafarabadi M, Askari E, Asmelash D, Astell-Burt T, Athar M, Athari SS, Atout MMW, Avila-Burgos L, Awaisu A, Azadnajafabad S, B DB, Babamohamadi H, Badar M, Badawi A, Badiye AD, Baghcheghi N, Bagheri N, Bagherieh S, Bah S, Bahadory S, Bai R, Baig AA, Baltatu OC, Baradaran HR, Barchitta M, Bardhan M, Barengo NC, Bärnighausen TW, Barone MTU, Barone-Adesi F, Barrow A, Bashiri H, Basiru A, Basu S, Basu S, Batiha AMM, Batra K, Bayih MT, Bayileyegn NS, Behnoush AH, Bekele AB, Belete MA, Belgaumi UI, Belo L, Bennett DA, Bensenor IM, Berhe K, Berhie AY, Bhaskar S, Bhat AN, Bhatti JS, Bikbov B, Bilal F, Bintoro BS, Bitaraf S, Bitra VR, Bjegovic-Mikanovic V, Bodolica V, Boloor A, Brauer M, Brazo-Sayavera J, Brenner H, Butt ZA, Calina D, Campos LA, Campos-Nonato IR, Cao Y, Cao C, Car J, Carvalho M, Castañeda-Orjuela CA, Catalá-López F, Cerin E, Chadwick J, Chandrasekar EK, Chanie GS, Charan J, Chattu VK, Chauhan K, Cheema HA, Chekol Abebe E, Chen S, Cherbuin N, Chichagi F, Chidambaram SB, Cho WCS, Choudhari SG, Chowdhury R, Chowdhury EK, Chu DT, Chukwu IS, Chung SC, Coberly K, Columbus A, Contreras D, Cousin E, Criqui MH, Cruz-Martins N, Cuschieri S, Dabo B, Dadras O, Dai X, Damasceno AAM, Dandona R, Dandona L, Das S, Dascalu AM, Dash NR, Dashti M, Dávila-Cervantes CA, De la Cruz-Góngora V, Debele GR, Delpasand K, Demisse FW, Demissie GD, Deng X, Denova-Gutiérrez E, Deo SV, Dervišević E, Desai HD, Desale AT, Dessie AM, Desta F, Dewan SMR, Dey S, Dhama K, Dhimal M, Diao N, Diaz D, Dinu M, Diress M, Djalalinia S, Doan LP, Dongarwar D, dos Santos Figueiredo FW, Duncan BB, Dutta S, Dziedzic AM, Edinur HA, Ekholuenetale M, Ekundayo TC, Elgendy IY, Elhadi M, El-Huneidi W, Elmeligy OAA, Elmonem MA, Endeshaw D, Esayas HL, Eshetu HB, Etaee F, Fadhil I, Fagbamigbe AF, Fahim A, Falahi S, Faris MEM, Farrokhpour H, Farzadfar F, Fatehizadeh A, Fazli G, Feng X, Ferede TY, Fischer F, Flood D, Forouhari A, Foroumadi R, Foroutan Koudehi M, Gaidhane AM, Gaihre S, Gaipov A, Galali Y, Ganesan B, Garcia-Gordillo MA, Gautam RK, Gebrehiwot M, Gebrekidan KG, Gebremeskel TG, Getacher L, Ghadirian F, Ghamari SH, Ghasemi Nour M, Ghassemi F, Golechha M, Goleij P, Golinelli D, Gopalani SV, Guadie HA, Guan SY, Gudayu TW, Guimarães RA, Guled RA, Gupta R, Gupta K, Gupta VB, Gupta VK, Gyawali B, Haddadi R, Hadi NR, Haile TG, Hajibeygi R, Haj-Mirzaian A, Halwani R, Hamidi S, Hankey GJ, Hannan MA, Haque S, Harandi H, Harlianto NI, Hasan SMM, Hasan SS, Hasani H, Hassanipour S, Hassen MB, Haubold J, Hayat K, Heidari G, Heidari M, Hessami K, Hiraike Y, Holla R, Hossain S, Hossain MS, Hosseini MS, Hosseinzadeh M, Hosseinzadeh H, Huang J, Huda MN, Hussain S, Huynh HH, Hwang BF, Ibitoye SE, Ikeda N, Ilic IM, Ilic MD, Inbaraj LR, Iqbal A, Islam SMS, Islam RM, Ismail NE, Iso H, Isola G, Itumalla R, Iwagami M, Iwu CCD, Iyamu IO, Iyasu AN, Jacob L, Jafarzadeh A, Jahrami H, Jain R, Jaja C, Jamalpoor Z, Jamshidi E, Janakiraman B, Jayanna K, Jayapal SK, Jayaram S, Jayawardena R, Jebai R, Jeong W, Jin Y, Jokar M, Jonas JB, Joseph N, Joseph A, Joshua CE, Joukar F, Jozwiak JJ, Kaambwa B, Kabir A, Kabthymer RH, Kadashetti V, Kahe F, Kalhor R, Kandel H, Karanth SD, Karaye IM, Karkhah S, Katoto PDMC, Kaur N, Kazemian S, Kebede SA, Khader YS, Khajuria H, Khalaji A, Khan MAB, Khan M, Khan A, Khanal S, Khatatbeh MM, Khater AM, Khateri S, khorashadizadeh F, Khubchandani J, Kibret BG, Kim MS, Kimokoti RW, Kisa A, Kivimäki M, Kolahi AA, Komaki S, Kompani F, Koohestani HR, Korzh O, Kostev K, Kothari N, Koyanagi A, Krishan K, Krishnamoorthy Y, Kuate Defo B, Kuddus M, Kuddus MA, Kumar R, Kumar H, Kundu S, Kurniasari MD, Kuttikkattu A, La Vecchia C, Lallukka T, Larijani B, Larsson AO, Latief K, Lawal BK, Le TTT, Le TTB, Lee SWH, Lee M, Lee WC, Lee PH, Lee SW, Lee SW, Legesse SM, Lenzi J, Li Y, Li MC, Lim SS, Lim LL, Liu X, Liu C, Lo CH, Lopes G, Lorkowski S, Lozano R, Lucchetti G, Maghazachi AA, Mahasha PW, Mahjoub S, Mahmoud MA, Mahmoudi R, Mahmoudimanesh M, Mai AT, Majeed A, Majma Sanaye P, Makris KC, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Mamun AA, Mansouri B, Marateb HR, Mardi P, Martini S, Martorell M, Marzo RR, Masoudi R, Masoudi S, Mathews E, Maugeri A, Mazzaglia G, Mekonnen T, Meshkat M, Mestrovic T, Miao Jonasson J, Miazgowski T, Michalek IM, Minh LHN, Mini GK, Miranda JJ, Mirfakhraie R, Mirrakhimov EM, Mirza-Aghazadeh-Attari M, Misganaw A, Misgina KH, Mishra M, Moazen B, Mohamed NS, Mohammadi E, Mohammadi M, Mohammadian-Hafshejani A, Mohammadshahi M, Mohseni A, Mojiri-forushani H, Mokdad AH, Momtazmanesh S, Monasta L, Moniruzzaman M, Mons U, Montazeri F, Moodi Ghalibaf A, Moradi Y, Moradi M, Moradi Sarabi M, Morovatdar N, Morrison SD, Morze J, Mossialos E, Mostafavi E, Mueller UO, Mulita F, Mulita A, Murillo-Zamora E, Musa KI, Mwita JC, Nagaraju SP, Naghavi M, Nainu F, Nair TS, Najmuldeen HHR, Nangia V, Nargus S, Naser AY, Nassereldine H, Natto ZS, Nauman J, Nayak BP, Ndejjo R, Negash H, Negoi RI, Nguyen HTH, Nguyen DH, Nguyen PT, Nguyen VT, Nguyen HQ, Niazi RK, Nigatu YT, Ningrum DNA, Nizam MA, Nnyanzi LA, Noreen M, Noubiap JJ, Nzoputam OJ, Nzoputam CI, Oancea B, Odogwu NM, Odukoya OO, Ojha VA, Okati-Aliabad H, Okekunle AP, Okonji OC, Okwute PG, Olufadewa II, Onwujekwe OE, Ordak M, Ortiz A, Osuagwu UL, Oulhaj A, Owolabi MO, Padron-Monedero A, Padubidri JR, Palladino R, Panagiotakos D, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pantea Stoian AM, Pardhan S, Parekh T, Parekh U, Pasovic M, Patel J, Patel JR, Paudel U, Pepito VCF, Pereira M, Perico N, Perna S, Petcu IR, Petermann-Rocha FE, Podder V, Postma MJ, Pourali G, Pourtaheri N, Prates EJS, Qadir MMF, Qattea I, Raee P, Rafique I, Rahimi M, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Rahman MA, Rahman MHU, Rahman M, Rahman MM, Rahmani M, Rahmani S, Rahmanian V, Rahmawaty S, Rahnavard N, Rajbhandari B, Ram P, Ramazanu S, Rana J, Rancic N, Ranjha MMAN, Rao CR, Rapaka D, Rasali DP, Rashedi S, Rashedi V, Rashid AM, Rashidi MM, Ratan ZA, Rawaf S, Rawal L, Redwan EMM, Remuzzi G, Rengasamy KRR, Renzaho AMN, Reyes LF, Rezaei N, Rezaei N, Rezaeian M, Rezazadeh H, Riahi SM, Rias YA, Riaz M, Ribeiro D, Rodrigues M, Rodriguez JAB, Roever L, Rohloff P, Roshandel G, Roustazadeh A, Rwegerera GM, Saad AMA, Saber-Ayad MM, Sabour S, Sabzmakan L, Saddik B, Sadeghi E, Saeed U, Saeedi Moghaddam S, Safi S, Safi SZ, Saghazadeh A, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahoo SS, Sahoo H, Saif-Ur-Rahman KM, Sajid MR, Salahi S, Salahi S, Saleh MA, Salehi MA, Salomon JA, Sanabria J, Sanjeev RK, Sanmarchi F, Santric-Milicevic MM, Sarasmita MA, Sargazi S, Sathian B, Sathish T, Sawhney M, Schlaich MP, Schmidt MI, Schuermans A, Seidu AA, Senthil Kumar N, Sepanlou SG, Sethi Y, Seylani A, Shabany M, Shafaghat T, Shafeghat M, Shafie M, Shah NS, Shahid S, Shaikh MA, Shanawaz M, Shannawaz M, Sharfaei S, Shashamo BB, Shiri R, Shittu A, Shivakumar KM, Shivalli S, Shobeiri P, Shokri F, Shuval K, Sibhat MM, Silva LMLR, Simpson CR, Singh JA, Singh P, Singh S, Siraj MS, Skryabina AA, Sohag AAM, Soleimani H, Solikhah S, Soltani-Zangbar MS, Somayaji R, Sorensen RJD, Starodubova AV, Sujata S, Suleman M, Sun J, Sundström J, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaeizadeh SA, Tabish M, Taheri M, Taheri E, Taki E, Tamuzi JJLL, Tan KK, Tat NY, Taye BT, Temesgen WA, Temsah MH, Tesler R, Thangaraju P, Thankappan KR, Thapa R, Tharwat S, Thomas N, Ticoalu JHV, Tiyuri A, Tonelli M, Tovani-Palone MR, Trico D, Trihandini I, Tripathy JP, Tromans SJ, Tsegay GM, Tualeka AR, Tufa DG, Tyrovolas S, Ullah S, Upadhyay E, Vahabi SM, Vaithinathan AG, Valizadeh R, van Daalen KR, Vart P, Varthya SB, Vasankari TJ, Vaziri S, Verma MV, Verras GI, Vo DC, Wagaye B, Waheed Y, Wang Z, Wang Y, Wang C, Wang F, Wassie GT, Wei MYW, Weldemariam AH, Westerman R, Wickramasinghe ND, Wu Y, Wulandari RDWI, Xia J, Xiao H, Xu S, Xu X, Yada DY, Yang L, Yatsuya H, Yesiltepe M, Yi S, Yohannis HK, Yonemoto N, You Y, Zaman SB, Zamora N, Zare I, Zarea K, Zarrintan A, Zastrozhin MS, Zeru NG, Zhang ZJ, Zhong C, Zhou J, Zielińska M, Zikarg YT, Zodpey S, Zoladl M, Zou Z, Zumla A, Zuniga YMH, Magliano DJ, Murray CJL, Hay SI, Vos T. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 402:203-234. [PMID: 37356446 PMCID: PMC10364581 DOI: 10.1016/s0140-6736(23)01301-6] [Citation(s) in RCA: 355] [Impact Index Per Article: 355.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. FUNDING Bill & Melinda Gates Foundation.
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Nieto-Martinez R, Mechanick JI, González-Rivas JP, Ugel E, Iglesias R, Clyne M, Grekin C. Revised Case Finding Protocol for Dysglycemia in Chile: A Call for Action in Other Populations. Endocr Pract 2023:S1530-891X(23)00399-3. [PMID: 37270107 DOI: 10.1016/j.eprac.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Guidelines recommend case finding for dysglycemia (prediabetes and type 2 diabetes [T2D]) in adults or youth older than 10 years with overweight/obesity, but increased adiposity has not been associated with dysglycemia in some Hispanic populations. This study aims to determine the prevalence of dysglycemia in this population using simplified criteria independent of BMI and age to request an oral glucose tolerance test (OGTT). METHODS Cross-sectional retrospective analysis of medical records from a clinical center in Chile (2000-2007). OGTT was obtained from any patient with one cardiometabolic risk factor (CMRF) independent of age and BMI. RESULTS In total, 4,969 adults (mean age ± SD) 45.7 ± 15.9 years and 509 youths 16.6 ± 3.0 years were included. The prevalence (%, 95%CI) of prediabetes doubled that of T2D in youths (14.1%, 1.4-17.4 vs. 6.3%, 4.5-8.7) and tripled it in adults (36.0%, 34.7-37.4 vs. 10.7%, 9.8-11.5). In underweight and normal-weight adults, 22% (12.0-36.7) and 29.2% (26.4-32.1) had prediabetes, whereas 4.9% (1.3-16.1) and 8.8% (7.2-10.7) had T2D, respectively. In normal-weight youths, 10.5% (6.7-15.9) and 2.9% (1.2-6.6) had prediabetes and T2D, respectively. In adults, but not in youths, most dysglycemia categories were related to overweight/obesity. CONCLUSION This study supports a public health policy to identify more people at risk for cardiovascular disease by implementing a revised case-finding protocol for dysglycemia using OGTT in even normal-weight patients over 6 years of age when there is at least one CMRF. Re-analysis of case-finding protocols for cardiometabolic risk in other populations is warranted.
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Affiliation(s)
- Ramfis Nieto-Martinez
- Precision Care Clinic Corp, Saint Cloud, FL, USA; Department of Global Health and Population. Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela.
| | - Jeffrey I Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, and Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan P González-Rivas
- Department of Global Health and Population. Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela; International Clinical Research Center, St Anne's University Hospital (ICRC-FNUSA), Brno, Czech Republic
| | - Eunice Ugel
- Department of Global Health and Population. Harvard TH Chan School of Public Health. Harvard University, Boston, MA, USA; Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela; Public Health Research Unit, Department of Social and Preventive Medicine, School of Medicine, Universidad Centro-Occidental "Lisandro Alvarado", Barquisimeto, Venezuela
| | - Rocio Iglesias
- Foundation for Clinic, Public Health, and Epidemiology Research of Venezuela (FISPEVEN INC), Caracas, Venezuela
| | - Megan Clyne
- Department of Physiology and Biophysics, School of Medicine, Georgetown University, Washington DC, USA
| | - Carlos Grekin
- Nutrition and Diabetes Unit. Clínica Red Salud Vitacura, Santiago, Chile; Nutrition and Diabetes Service. Santiago Military Hospital, Chile; Universidad de Los Andes, Santiago de Chile, Chile.
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Ong J, Alswat K, Hamid S, El-Kassas M. Nonalcoholic Fatty Liver Disease in Asia, Africa, and Middle East Region. Clin Liver Dis 2023; 27:287-299. [PMID: 37024208 DOI: 10.1016/j.cld.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. The global prevalence of the disease varies according to the geographical region. Despite having distinct models for the western patterns of NAFLD, Africa, Asia, and the Middle East regions exhibited varying prevalence rates of NAFLD. The disease burden is anticipated to significantly increase in these areas. Furthermore, with an increase in NAFLD risk factors in these regions, the disease burden is expected to rise even more. Policies at the regional and international levels are required to address such growing burden of NAFLD consequences.
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Affiliation(s)
- Janus Ong
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Khalid Alswat
- Department of Medicine, Liver Disease Research Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saeed Hamid
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt.
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Endoscopic sleeve gastroplasty: is it time to prioritize minimally invasive interventions for the management of metabolic syndrome? Ann Med Surg (Lond) 2023; 85:331-332. [PMID: 36845765 PMCID: PMC9949856 DOI: 10.1097/ms9.0000000000000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 12/25/2022] [Indexed: 02/28/2023] Open
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Affiliation(s)
- Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Jin Y, So H, Cerin E, Barnett A, Mubarik S, Hezam K, Feng X, Wang Z, Huang J, Zhong C, Hayat K, Wang F, Wu AM, Xu S, Zou Z, Lim LL, Cai J, Song Y, Tam LS, Wu D. The temporal trend of disease burden attributable to metabolic risk factors in China, 1990-2019: An analysis of the Global Burden of Disease study. Front Nutr 2023; 9:1035439. [PMID: 36687675 PMCID: PMC9846330 DOI: 10.3389/fnut.2022.1035439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Background and aims The disease burden attributable to metabolic risk factors is rapidly increasing in China, especially in older people. The objective of this study was to (i) estimate the pattern and trend of six metabolic risk factors and attributable causes in China from 1990 to 2019, (ii) ascertain its association with societal development, and (iii) compare the disease burden among the Group of 20 (G20) countries. Methods The main outcome measures were disability-adjusted life-years (DALYs) and mortality (deaths) attributable to high fasting plasma glucose (HFPG), high systolic blood pressure (HSBP), high low-density lipoprotein (HLDL) cholesterol, high body-mass index (HBMI), kidney dysfunction (KDF), and low bone mineral density (LBMD). The average annual percent change (AAPC) between 1990 and 2019 was analyzed using Joinpoint regression. Results For all six metabolic risk factors, the rate of DALYs and death increased with age, accelerating for individuals older than 60 and 70 for DALYs and death, respectively. The AAPC value in rate of DALYs and death were higher in male patients than in female patients across 20 age groups. A double-peak pattern was observed for AAPC in the rate of DALYs and death, peaking at age 20-49 and at age 70-95 plus. The age-standardized rate of DALYs increased for HBMI and LBMD, decreased for HFPG, HSBP, KDF, and remained stable for HLDL from 1990 to 2019. In terms of age-standardized rate of DALYs, there was an increasing trend of neoplasms and neurological disorders attributable to HFPG; diabetes and kidney diseases, neurological disorders, sense organ diseases, musculoskeletal disorders, neoplasms, cardiovascular diseases, digestive diseases to HBMI; unintentional injuries to LBMD; and musculoskeletal disorders to KDF. Among 19 countries of Group 20, in 2019, the age-standardized rate of DALYs and death were ranked fourth to sixth for HFPG, HSBP, and HLDL, but ranked 10th to 15th for LBMD, KDF, and HBMI, despite the number of DALYs and death ranked first to second for six metabolic risk factors. Conclusions Population aging continuously accelerates the metabolic risk factor driven disease burden in China. Comprehensive and tight control of metabolic risk factors before 20 and 70 may help to mitigate the increasing disease burden and achieve healthy aging, respectively.
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Affiliation(s)
- Yingzhao Jin
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho So
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia,School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
| | - Kamal Hezam
- Nankai University School of Medicine, Tianjin, China,Department of Microbiology, Faculty of Applied Science, Taiz University, Taiz, Yemen
| | - Xiaoqi Feng
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, NSW, Australia,Population Wellbeing and Environment Research Lab (PowerLab), Wollonggong, NSW, Australia,The George Institute for Global Health, Newtown, NSW, Australia
| | - Ziyue Wang
- Department of Family Medicine, McGill University, Montreal, QC, Canada,China Centre for Health Development Studies, Peking University, Beijing, China
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Chenwen Zhong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan,Department of Pharmacy Administration and Clinical Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Fang Wang
- School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Ai-Min Wu
- Department of Orthopaedics, Wenzhou Medical University, Wenzhou, China
| | - Suowen Xu
- Department of Endocrinology, University of Science and Technology of China, Hefei, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, Peking University, Beijing, China
| | - Lee-Ling Lim
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China,Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jiao Cai
- Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China
| | - Yimeng Song
- School of the Environment, Yale University, New Haven, CT, United States
| | - Lai-shan Tam
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China,Lai-shan Tam ✉
| | - Dongze Wu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China,*Correspondence: Dongze Wu ✉
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Yuan C, Wang J, Zhang W, Yi H, Shu B, Li C, Liang Q, Liang D, Chen B, Xie X, Lin X, Wei X, Wang H, Chen P, Huang C, Xu H, Sun Y, Zhao Y, Shi Q, Tang D, Wang Y. Effects of obesity with reduced 25(OH)D levels on bone health in elderly Chinese people: a nationwide cross-sectional study. Front Immunol 2023; 14:1162175. [PMID: 37180138 PMCID: PMC10172581 DOI: 10.3389/fimmu.2023.1162175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
Background Obesity is often accompanied by lower 25(OH)D levels, whereas these two parameters exhibit opposite effects on bone health. It is uncertain what are the effects of lower 25(OH)D levels in obesity on bone health in elderly Chinese people. Methods A nationally representative cross-sectional analysis of China Community-based Cohort of Osteoporosis (CCCO) was performed from 2016 to 2021, which consisted of 22,081 participants. Demographic data, disease history, Body mass index (BMI), bone mineral density (BMD), the levels of the biomarkers of vitamin D status and those of bone metabolism markers were measured for all participants (N = 22,081). The genes (rs12785878, rs10741657, rs4588, rs7041, rs2282679 and rs6013897) related to 25(OH)D transportation and metabolism were performed in a selected subgroup (N = 6008). Results Obese subjects exhibited lower 25(OH)D levels (p < 0.05) and higher BMD (p < 0.001) compared with those of normal subjects following adjustment. The genotypes and allele frequency of rs12785878, rs10741657, rs6013897, rs2282679, rs4588 and rs7041 indicated no significant differences among three BMI groups following correction by the Bonferroni's method (p > 0.05). The levels of total 25(OH)D (ToVD) were significantly different among the GC1F, GC1S and GC2 haplotype groups (p < 0.05). Correlation analysis indicated that ToVD levels were significantly correlated with parathyroid hormone levels, BMD, risk of osteoporosis (OP) and the concentration levels of other bone metabolism markers (p < 0.05). Generalized varying coefficient models demonstrated that the increasing BMI, ToVD levels and their interactions were positively associated with BMD outcomes (p < 0.001), whereas the reduced levels of ToVD and BMI increased the risk of OP, which was noted notably for the subjects with reduced ToVD levels (less than 20.69 ng/ml) combined with decreased BMI (less than 24.05 kg/m2). Conclusion There was a non-linear interaction of BMI and 25(OH)D. And higher BMI accompanied by decreased 25(OH)D levels is associated with increased BMD and decreased incidence of OP, optimal ranges exist for BMI and 25(OH)D levels. The cutoff value of BMI at approximately 24.05 kg/m2 combined with an approximate value of 25(OH)D at 20.69 ng/ml are beneficial for Chinese elderly subjects.
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Affiliation(s)
- Chunchun Yuan
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Jing Wang
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - Weiqiang Zhang
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Human Phenome Institute, Fudan University, Shanghai, China
| | - Honggang Yi
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Bing Shu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - Chenguang Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - Qianqian Liang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bolai Chen
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xingwen Xie
- The Second People’s Hospital of Gansu Province, Gansu, Lanzhou, China
- Affiliated Hospital of Northwest University for Nationalities, Gansu, Lanzhou, China
| | - Xinchao Lin
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xu Wei
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hui Wang
- State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peizhan Chen
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Huang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Hao Xu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Yueli Sun
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Yongjian Zhao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
| | - Qi Shi
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
| | - Dezhi Tang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
- *Correspondence: Yongjun Wang, ; Dezhi Tang,
| | - Yongjun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education (Shanghai University of Traditional Chinese Medicine), Shanghai, China
- Academic Research Center of Shixiaoshan’ Traumatology, Shanghai, China
- *Correspondence: Yongjun Wang, ; Dezhi Tang,
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Smith MH, Myrick JW, Oyageshio O, Uren C, Saayman J, Boolay S, van der Westhuizen L, Werely C, Möller M, Henn BM, Reynolds AW. Epidemiological correlates of overweight and obesity in the Northern Cape Province, South Africa. PeerJ 2023; 11:e14723. [PMID: 36788809 PMCID: PMC9922494 DOI: 10.7717/peerj.14723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/19/2022] [Indexed: 02/11/2023] Open
Abstract
Background In the past several decades, obesity has become a major public health issue worldwide, associated with increased rates of chronic disease and death. Like many developing nations, South Africa is experiencing rapid increases in BMI, and as a result, evidence-based preventive strategies are needed to reduce the increasing burden of overweight and obesity. This study aimed to determine the prevalence and predictors of overweight and obesity among a multi-ethnic cohort from the rural Northern Cape of South Africa. Methods These data were collected as part of a tuberculosis (TB) case-control study, with 395 healthy control participants included in the final analysis. Overweight and obesity were defined according to WHO classification. Multivariate linear models of BMI were generated using sex, age, education level, smoking, alcohol consumption, and diabetes as predictor variables. We also used multivariable logistic regression analysis to assess the relationship of these factors with overweight and obesity. Results The average BMI in our study cohort was 25.2. The prevalence of overweight was 18.0% and the prevalence of obesity was 25.0%. We find that female sex, being older, having more years of formal education, having diabetes, and being in a rural area are all positively associated with BMI in our dataset. Women (OR = 5.6, 95% CI [3.3-9.8]), rural individuals (OR = 3.3, 95% CI [1.9-6.0]), older individuals (OR = 1.02, 95% CI [1-1.04]), and those with more years of education (OR = 1.2, 95% CI [1.09-1.32]) were all more likely to be overweight or obese. Alternatively, being a smoker is negatively associated with BMI and decreases one's odds of being overweight or obese (OR = 0.28, 95% CI [0.16-0.46]). Conclusions We observed a high prevalence of overweight and obesity in this study. The odds of being overweight and obese were higher in women, those living in rural areas, and those with more education, and increases with age. Community-based interventions to control obesity in this region should pay special attention to these groups.
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Affiliation(s)
| | - Justin W Myrick
- Department of Anthropology and UC Davis Genome Center, University of California, Davis, Davis, United States
| | - Oshiomah Oyageshio
- Center for Population Biology, University of California, Davis, Davis, United States
| | - Caitlin Uren
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Centre for Bioinformatics and Computational Biology, University of Stellenbosch, Cape Town, South Africa
| | - Jamie Saayman
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Sihaam Boolay
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Lena van der Westhuizen
- Department of Anthropology and UC Davis Genome Center, University of California, Davis, Davis, United States
| | - Cedric Werely
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Marlo Möller
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Centre for Bioinformatics and Computational Biology, University of Stellenbosch, Cape Town, South Africa
| | - Brenna M Henn
- Department of Anthropology and UC Davis Genome Center, University of California, Davis, Davis, United States
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Zhang S, Zong Y, Hu Y, Sheng Y, Xiao G. High HBV-DNA serum levels are associated with type 2 diabetes in adults with positive HBsAg: An observational study. Front Endocrinol (Lausanne) 2023; 14:1146798. [PMID: 37077357 PMCID: PMC10106711 DOI: 10.3389/fendo.2023.1146798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The prevalence of diabetes is higher in hepatitis B virus (HBV)-infected population. We aimed to examine the relationship between different serum HBV-DNA levels and type 2 diabetes in adults with positive HBV surface antigen (HBsAg). METHODS We conducted cross-sectional analyses of data obtaining from the Clinical Database System of Wuhan Union Hospital. Diabetes was defined by self-report of type 2 diabetes, fasting plasma glucose (FPG) ≥7mmol/L, or glycated hemoglobin (HbA1c) ≥6.5%. Binary logistic regression analyses were performed to investigate the factors associated with diabetes. RESULTS Among 12,527 HBsAg-positive adults, 2,144 (17.1%) were diabetic. Patients with serum HBV-DNA <100, 100-2000, 2000-20000 and ≥20000 IU/mL accounted for 42.2% (N=5,285), 22.6% (N=2,826), 13.3% (N=1,665) and 22.0% (N=2,751), respectively. The risk of type 2 diabetes, FPG ≥7mmol/L and HbA1c ≥6.5% in individuals with highly elevated serum HBV-DNA level (≥20000 IU/mL) were 1.38 (95% confidence interval [CI]: 1.16 to 1.65), 1.40 (95% CI: 1.16 to 1.68) and 1.78 (95% CI: 1.31 to 2.42) times relative to those with negative or lowly elevated serum HBV-DNA (<100 IU/mL). However, the analyses showed no association of moderately (2000-20000 IU/mL) to slightly (100-2000 IU/mL) raised serum HBV-DNA levels with type 2 diabetes (OR=0.88, P=0.221; OR=1.08, P=0.323), FPG ≥7mmol/L (OR=1.00, P=0.993; OR=1.11, P=0.250) and HbA1c ≥6.5% (OR=1.24, P=0.239; OR=1.17, P=0.300). CONCLUSION In HBsAg-positive adults, highly elevated level rather than moderately to slightly raised levels of serum HBV-DNA is independently associated with an increased risk of type 2 diabetes.
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Manne-Goehler J, Theilmann M, Flood D, Marcus ME, Andall-Brereton G, Agoudavi K, Arboleda WAL, Aryal KK, Bicaba B, Bovet P, Brant LCC, Brian G, Chamberlin G, Chen G, Damasceno A, Dorobantu M, Dunn M, Ebert C, Farzadfar F, Gurung MS, Guwatudde D, Houehanou C, Houinato D, Hwalla N, Jorgensen JMA, Karki KB, Labadarios D, Lunet N, Malta DC, Martins JS, Mayige MT, McClure RW, Saeedi Moghaddam S, Mwangi KJ, Mwalim O, Norov B, Quesnel-Crooks S, Rhode S, Seiglie JA, Sibai A, Silver BK, Sturua L, Stokes A, Supiyev A, Tsabedze L, Zhumadilov Z, Jaacks LM, Atun R, Davies JI, Geldsetzer P, Vollmer S, Bärnighausen TW. Data Resource Profile: The Global Health and Population Project on Access to Care for Cardiometabolic Diseases (HPACC). Int J Epidemiol 2022; 51:e337-e349. [PMID: 35762972 DOI: 10.1093/ije/dyac125] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/24/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Harvard Center for Population and Development Studies, Harvard University, Boston, MA, USA.,Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | - Maja E Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | | | | | - William Andres Lopez Arboleda
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Krishna K Aryal
- Nepal Health Sector, Programme 3, Monitoring Evaluation and Operational Research Project, Abt Associates, Kathmandu, Nepal
| | - Brice Bicaba
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Pascal Bovet
- Ministry of Health, Victoria, Seychelles.,University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Luisa Campos Caldeira Brant
- Internal Medicine Department, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Garry Brian
- The Fred Hollows Foundation New Zealand, Auckland, New Zealand
| | - Grace Chamberlin
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Geoffrey Chen
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Albertino Damasceno
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Department of Public and Forensic Health Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Maria Dorobantu
- Department of Cardiology, Emergency Hospital of Bucharest, Bucharest, Romania
| | | | - Cara Ebert
- RWI-Leibniz Institute for Economic Research, Essen (Berlin, Office), Germany
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Godomey, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Godomey, Benin
| | - Nahla Hwalla
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Khem B Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nuno Lunet
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.,Department of Public and Forensic Health Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Deborah Carvalho Malta
- Department of Maternal-Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Graduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - João S Martins
- Faculty of Medicine and Health Sciences, National University of East Timor, Rua, Jacinto Candido, Dili, Timor-Leste
| | - Mary T Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Roy Wong McClure
- Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kibachio J Mwangi
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya.,Faculté de médecine, Université de Genève, Geneva, Switzerland
| | - Omar Mwalim
- Zanzibar Ministry of Health, Mnazi Mmoja, Zanzibar
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | | | - Sabrina Rhode
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Jacqueline A Seiglie
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Harvard Center for Population and Development Studies, Harvard University, Boston, MA, USA
| | - Abla Sibai
- Epidemiology and Population Health Department, Faculty of Health Sciences American University of Beirut, Beirut, Lebanon
| | - Bahendeka K Silver
- St. Francis Hospital, Nsambya, Kampala, Uganda.,Uganda Martyrs University, Kampala, Uganda
| | - Lela Sturua
- Non-Communicable Diseases Department, National Center for Disease Control and Public Health, Tbilisi, Georgia.,Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Adil Supiyev
- Laboratory of Epidemiology and Public Health, Center for Life Sciences, Nazarbayev University, Astana, Kazakhstan
| | | | | | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Security, The University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Public Health Foundation of India, New Delhi, India
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Pascal Geldsetzer
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Till W Bärnighausen
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Africa Health Research Institute, Somkhele and Durgban, South Africa
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Okada A, Kaneko H, Matsuoka S, Itoh H, Suzuki Y, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Yamaguchi S, Node K, Yamauchi T, Yasunaga H, Komuro I. Association of cardiovascular health metrics with annual incidence of prediabetes or diabetes: Analysis of a nationwide real-world database. J Diabetes Investig 2022; 14:452-462. [PMID: 36495057 PMCID: PMC9951564 DOI: 10.1111/jdi.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS/INTRODUCTION Little is known about the relationship between cardiovascular health (CVH) metrics and the risk of developing prediabetes or diabetes. We examined the association of CVH metrics with the annual risk of developing prediabetes or diabetes. MATERIALS AND METHODS We carried out this study including 403,857 participants aged 18-71 years with available data on fasting plasma glucose (FPG) data for five consecutive years and with normal FPG (<100 mg/dL) at the initial health checkup. We identified the following ideal CVH metrics: non-smoking, body mass index of <25 kg/m2 , maintaining physical activity, taking breakfast, untreated blood pressure of <120/80 mmHg and untreated total cholesterol of <200 mg/dL. We defined the primary end-point as prediabetes (FPG 100-125 mg/dL) or diabetes (FPG ≥126 mg/dL or use of antihyperglycemic medications). We examined the relationship of CVH metrics with the annual incidence of prediabetes or diabetes. Additionally, we examined the association of 1-year changes in CVH metrics with the risk for prediabetes or diabetes. RESULTS The median age was 44 years, and 65.6% were men. An increasing number of non-ideal CVH metrics was associated with an elevated risk of prediabetes or diabetes. A non-ideal body mass index was most strongly associated with the risk of prediabetes or diabetes. The risk of developing prediabetes or diabetes rose as the number of non-ideal CVH metrics increased over 1 year. CONCLUSIONS CVH metrics could stratify the risk of the annual development of prediabetes or diabetes. The risk of developing prediabetes or diabetes might be reduced by improving CVH metrics.
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Affiliation(s)
- Akira Okada
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hidehiro Kaneko
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan,The Department of Advanced CardiologyThe University of TokyoTokyoJapan
| | - Satoshi Matsuoka
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan,Department of CardiologyNew Tokyo HospitalMatsudoJapan
| | - Hidetaka Itoh
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Yuta Suzuki
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan,Department of Rehabilitation Science, Graduate School of Medical SciencesKitasato UniversityKanagawaJapan
| | - Katsuhito Fujiu
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan,The Department of Advanced CardiologyThe University of TokyoTokyoJapan
| | - Nobuaki Michihata
- The Department of Health Services ResearchThe University of TokyoTokyoJapan
| | - Taisuke Jo
- The Department of Health Services ResearchThe University of TokyoTokyoJapan
| | - Norifumi Takeda
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Hiroyuki Morita
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle‐Related Diseases, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Koichi Node
- Department of Cardiovascular MedicineSaga UniversitySagaJapan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
| | - Issei Komuro
- The Department of Cardiovascular MedicineThe University of TokyoTokyoJapan
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Sun L. Effects of blood flow restriction training on anthropometric and blood lipids in overweight/obese adults: Meta-analysis. Front Physiol 2022; 13:1039591. [DOI: 10.3389/fphys.2022.1039591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract: Purpose: To systematically evaluate the effects of blood flow restriction training (BFRT) on anthropometric indicators and blood lipids in overweight/obese adults.Methods: A literature search was conducted on PubMed, Web of Science, Embase, Scopus, SPORTDiscus and Cochrane Library databases to determine the final literature based on inclusion and exclusion criteria. Review Manager 5.4.1 was used to evaluate the quality of the literature based on the Cochrane bias risk assessment tool, and Stata 17.0 software was used for Meta-analysis.Results: A total of 3,985 articles were screened, and five of the studies were included in the Meta-analysis, with a total 66 participants. In each study, subjects were measured before and after BFRT. Meta-results showed that BFRT significantly reduced BMI, lowered body weight, body fat % and waist circumference, significantly reduced total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) level, lowered triglycerides, and increased high-density lipoprotein cholesterol (HDL-C) level in overweight/obese adults.Conclusion: BFRT can be used as a safe and effective exercise prescription for personalized weight/fat loss. BFRT significantly reduces BMI by reducing body weight, body fat %, and waist circumference and has the effect of improving body composition. It also significantly reduced TC and LDL-C and tends to decrease TG and increase HDL-C in overweight/obese adults, potentially reducing the incidence of cardiovascular disease.
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Visceral Adipose Tissue Assessment Enhances the Prognostic Value of GLIM Criteria in Patients with Gastric Cancer Undergoing Radical Gastrectomy after Neoadjuvant Treatment. Nutrients 2022; 14:nu14235047. [PMID: 36501076 PMCID: PMC9740239 DOI: 10.3390/nu14235047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/20/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) criteria has been recently published for diagnosing malnutrition in adults. However, the validity of the GLIM criteria has not been well-established in patients with gastric cancer (GC) treated with neoadjuvant treatment (NT) followed by radical gastrectomy. The present study aimed to explore the prognostic value of GLIM-defined malnutrition before NT and after NT in GC patients and to investigate whether additional visceral adipose tissue (VAT) assessment could improve the predictive power of the GLIM criteria for NT-related adverse events (AEs) and long-term survival. METHODS GC patients who underwent radical surgery after NT from June 2016 to June 2020 were enrolled in this study. The cross-sectional areas of total skeletal muscle (TSM) and VAT were measured using computed tomography (CT) before NT and after NT. GLIM-defined malnutrition was diagnosed using the two-step approach, including nutritional risk screening and diagnostic assessment. Low VAT was also added to the diagnosis of malnutrition in this study. The predictive value of these malnutrition diagnoses for NT-related AEs, and long-term survival was evaluated in GC patients. RESULTS A total of 182 GC patients were included in this study, of which 66 (36.3%) patients before NT and 55 (30.2%) patients after NT were diagnosed with GLIM-defined malnutrition, respectively. In addition to GLIM-defined malnutrition, 54 (29.7%) patients had additional low VAT before NT, and 39 (21.4%) patients had additional low VAT after NT. GLIM-defined malnutrition alone before NT was not associated with NT-related AEs in GC patients. The addition of low VAT to GLIM-defined malnutrition led to a significant predictive value for NT-related AEs. Furthermore, GLIM-defined malnutrition before NT and after NT were both identified as independent risk factors for overall survival (OS) and disease-free survival (DFS). The combination of low VAT and GLIM-defined malnutrition showed a higher hazard ratio for the prediction of OS and DFS both before NT and after NT. CONCLUSIONS The addition of VAT assessment using CT improved the predictive value of GLIM-defined malnutrition for NT-related AEs and long-term survival in GC patients treated with NT followed by radical gastrectomy, which further supports the prognostic importance of assessing adipose tissue simultaneously during the routine nutritional assessment in patients with cancer.
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Wu TY, Bessire R, Ford O, Rainville AJ, Man Chong C, Caboral-Stevens M. Food Insecurity and Diabetes: An Investigation of Underserved Asian Americans in Michigan. Health Promot Pract 2022; 23:67S-75S. [DOI: 10.1177/15248399221116088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Asian Americans are at increased risk for nutrition-related chronic diseases, including type 2 diabetes. The prevalence of type 2 diabetes among Asian Americans in the United States is 16.7% compared to 11.3% among the general U.S. population. Genetic factors such as higher body fat and lower muscle mass result in a predisposition for the development of diabetes at a lower body mass index (BMI). Social determinants including food insecurity and physical environment may also impact risk and need further examination. This study investigated type 2 diabetes–related indicators and food insecurity and satisfaction with types and quality of foods provided through food box distributions with a focus on Asian American populations in Michigan. Data were collected via a survey implemented in partnership with community organizations that administer food box distributions. Nearly half of respondents were not aware that Asian Americans are at increased risk of developing type 2 diabetes. The mean BMI for overall study participants was 25.6, and 61.8% of participants had a BMI of ≥23. Food insecurity was also negatively associated with BMI with study participants who were overweight reporting less food insecurity. Overall, participants reported being satisfied with both the types and quality of foods provided in the food boxes. Findings support the need for increased diabetes education and testing among Asian Americans and assessment of the types of culturally relevant foods offered by food distribution organizations.
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Affiliation(s)
- Tsu-Yin Wu
- Eastern Michigan University, Ypsilanti, MI, USA
| | | | - Olivia Ford
- Eastern Michigan University, Ypsilanti, MI, USA
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Sagastume D, Siero I, Mertens E, Cottam J, Colizzi C, Peñalvo JL. The effectiveness of lifestyle interventions on type 2 diabetes and gestational diabetes incidence and cardiometabolic outcomes: A systematic review and meta-analysis of evidence from low- and middle-income countries. EClinicalMedicine 2022; 53:101650. [PMID: 36119561 PMCID: PMC9475282 DOI: 10.1016/j.eclinm.2022.101650] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND As lifestyle modification offers a unique strategy to prevent diabetes, we evaluated the effectiveness of lifestyle interventions in the prevention of type 2 diabetes and gestational diabetes in low- and middle-income countries (LMICs). METHODS We did a systematic literature review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and Cochrane Library for randomised controlled trials published in English, Spanish, French, and Portuguese between 1 January 2000 and 15 June 2022, evaluating multi-target and multi-component lifestyle interventions in at-risk populations conducted in LMICs. The main outcomes were incidence of type 2 diabetes and gestational diabetes, and indicators of glycaemic control. We assessed the methodological quality of the studies using the Cochrane risk of bias tool. Inverse-variance random-effects meta-analyses estimated the overall effect sizes. Sources of heterogeneity and study bias were evaluated. The study protocol was registered in PROSPERO (CRD42021279174). FINDINGS From 14 330 abstracts, 48 (0·3%) studies with 50 interventions were eligible of which 56% were conducted in lower-middle-income countries, 44% in upper-middle, and none in low-income. 54% of the studies were assessed as moderate risk of bias and 14% as high risk. A median of 246 (IQR 137-511) individuals participated in the interventions with a median duration of 6 (3-12) months. Lifestyle interventions decreased the incidence risk ratio of type 2 diabetes by 25% (0·75 [95% CI 0·61 to 0·91]), and reduced the levels of HbA1c by 0·15% [-0·25 to -0·05], fasting plasma glucose by 3·44 mg/dL [-4·72 to -2·17], and 2-hr glucose tolerance by 4·18 mg/dL [-7·35 to -1·02]. No publication bias was suggested for these outcomes. High levels of heterogeneity (I²≥ 81%) were found in most meta-analyses. Exploration using meta-regressions could not identify any explanatory variable, except for fasting glucose for which the quality score of the articles seems to be an effect modifier decreasing slightly the heterogeneity (72%) in the low risk of bias pooled estimate. The effect on gestational diabetes could not be evaluated due to the scarcity of available studies. INTERPRETATION Comprehensive lifestyle interventions are effective strategies to prevent type 2 diabetes among at-risk populations in LMICs. The heterogeneity identified in our results should be considered when using these interventions to address the onset of type 2 diabetes. FUNDING None.
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Affiliation(s)
- Diana Sagastume
- Corresponding author at: Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium.
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Pan XF, Chen ZZ, Wang TJ, Shu X, Cai H, Cai Q, Clish CB, Shi X, Zheng W, Gerszten RE, Shu XO, Yu D. Plasma metabolomic signatures of obesity and risk of type 2 diabetes. Obesity (Silver Spring) 2022; 30:2294-2306. [PMID: 36161775 PMCID: PMC9633360 DOI: 10.1002/oby.23549] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 06/12/2022] [Accepted: 07/14/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The mechanisms linking obesity to type 2 diabetes (T2D) are not fully understood. This study aimed to identify obesity-related metabolomic signatures (MESs) and evaluated their relationships with incident T2D. METHODS In a nested case-control study of 2076 Chinese adults, 140 plasma metabolites were measured at baseline, linear regression was applied with the least absolute shrinkage and selection operator to identify MESs for BMI and waist circumference (WC), and conditional logistic regression was applied to examine their associations with T2D risk. RESULTS A total of 32 metabolites associated with BMI or WC were identified and validated, among which 14 showed positive associations and 3 showed inverse associations with T2D; 8 and 18 metabolites were selected to build MESs for BMI and WC, respectively. Both MESs showed strong linear associations with T2D: odds ratio (95% CI) comparing extreme quartiles was 4.26 (2.00-9.06) for BMI MES and 9.60 (4.22-21.88) for WC MES (both p-trend < 0.001). The MES-T2D associations were particularly evident among individuals with normal WC: odds ratio (95% CI) reached 6.41 (4.11-9.98) for BMI MES and 10.38 (6.36-16.94) for WC MES. Adding MESs to traditional risk factors and plasma glucose improved C statistics from 0.79 to 0.83 (p < 0.001). CONCLUSIONS Multiple obesity-related metabolites and MESs strongly associated with T2D in Chinese adults were identified.
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Affiliation(s)
- Xiong-Fei Pan
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zsu-Zsu Chen
- Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas J. Wang
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Xiang Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Clary B. Clish
- Metabolomics Platform, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Xu Shi
- Broad Institute of Massachusetts Institute of Technology and Harvard & Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert E. Gerszten
- Broad Institute of Massachusetts Institute of Technology and Harvard & Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Ettehad-Marvasti F, Ejtahed HS, Siadat SD, Soroush AR, Hoseini-Tavassol Z, Hasani-Ranjbar S, Larijani B. Effect of garlic extract on weight loss and gut microbiota composition in obese women: A double-blind randomized controlled trial. Front Nutr 2022; 9:1007506. [PMID: 36352899 PMCID: PMC9638143 DOI: 10.3389/fnut.2022.1007506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Objective From a nutritional perspective, garlic extract could be a prebiotic product, which is useful for obese subjects, and one of its health-promoting underlying mechanisms is modulating gut microbiota composition. In this randomized double-blind clinical trial, the goal was to determine the effect of Allium (garlic extract) on anthropometric indices and gut microbiota composition in obese women following a low-calorie diet. Materials and methods Forty-three obese women were randomly divided into garlic extract (400 mg Allium sativum powder containing 1,100 mcg allicin/tablet) or placebo groups. During the 2 months of the study, each participant took two tablets per day. At the beginning and at the end of the clinical trial, anthropometric measurements were done and blood and fecal samples were collected. We evaluated the gut microbiota composition using quantitative real-time PCR. Results In total, 16 subjects in each group completed the 2-month trial. Allium and placebo groups’ participants had mean ages of 37.8 ± 7.4 and 34.2 ± 6.8 years, respectively (P > 0.05). Baseline body mass index (BMI) was significantly different between groups, subjects in the placebo group had lower BMI compared with the Allium group (P < 0.05). Allium and placebo caused a 1.7% and 2.7% decrease in BMI from the baseline values, respectively (P < 0.01). Fasting insulin level significantly decreased in the both groups (P < 0.01). Level of homeostasis model assessment of insulin resistance (HOMA-IR) has decreased significantly in the Allium group (P = 0.007). The frequency of Akkermansia had decreasing trend while the abundance of Faecalibacterium and Bifidobacterium showed increasing trend in the Allium group. Conclusion In the both groups, a decrease in BMI and other anthropometric indices has been observed. Despite weight loss after following a low-calorie diet and taking Allium, slight changes have been shown in the composition of gut microbiota in obese women. Trial registration This trial was registered in the Iranian Registry of Clinical Trials (IRCT) (code: IRCT090420001825N2).
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Affiliation(s)
- Fateme Ettehad-Marvasti
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Hanieh-Sadat Ejtahed,
| | | | - Ahmad-Reza Soroush
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Hoseini-Tavassol
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Hasani-Ranjbar
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Shirin Hasani-Ranjbar,
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Kagaruki GB, Mahande MJ, Kreppel KS, Mbata D, Kilale AM, Shayo EH, Mfinanga SG, Bonfoh B. Barriers to the implementation, uptake and scaling up of the healthy plate model among regular street food consumers: a qualitative inquiry in Dar-es-Salaam city, Tanzania. BMC Nutr 2022; 8:110. [PMID: 36203200 PMCID: PMC9541087 DOI: 10.1186/s40795-022-00589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The healthy plate model is considered one of the practical approaches to reduce the average portion of staple food in main meals, consequently reducing the risks associated with diabetes and other Non-communicable Diseases (NCDs). Despite its potential benefits, studies on the implementation of the healthy plate model are limited in Africa. An inquiry explored barriers to implementation, uptake, and scaling up of the healthy plate model among street food vendors and consumers in three districts of Dar-es-Salaam city in Tanzania. Methods A qualitative research design was adopted. Qualitative data collection techniques were employed including; Key Informant Interviews (KIIs) with purposefully selected food and nutrition stakeholders at the National, Regional, District and Ward levels. Focus Group Discussions (FGDs) were conducted with purposefully selected street food consumers and vendors. A total of (13) KIIs were conducted as well as (6) FGDs with street food vendors (2 FGDs) and consumers (4 FGDs). Interview data was managed using Nvivo 12 Software and analyzed thematically. Results Three key themes emerged from participants’ accounts: (i) strategic policy barriers, (ii) food production and preparation environment barriers (producers and vendors), and (iii) individual barriers (consumers and vendors). The strategic policy barriers included absence of guidelines and regulations that focus on NCDs linked to nutrition and lack of education guidance for vendors and consumers. The food production and preparation environment barriers included safety and risks concerns regarding the quality of water used for irrigation and washing fruits and vegetables and the areas where vegetables and fruits are grown and prepared. Individual barriers included low consumer income, knowledge on nutrition, unhealthy eating practices and; low vendors’ knowledge as well as low investment capital. Conclusion Implementation, uptake and scaling up of the healthy plate model for street food consumers in Dar es Salaam City continues to be constrained by barriers in policy, food production and preparation environment, and individual obstacles. Strengthening of food and nutrition policies, ensuring safety of the food production and preparation environment and, consumer and vendor awareness creation and income generation efforts, provide useful entry points for the successful scaling up of a healthy plate model. This could consequently contribute towards prevention of diet related NCDs, including diabetes.
Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00589-6.
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Affiliation(s)
- Gibson B Kagaruki
- Research Programs, National Institute for Medical Research, Tukuyu Medical Research Centre, Tukuyu, Box 538, Mbeya, Tanzania. .,Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania.
| | - Michael J Mahande
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania
| | - Katharina S Kreppel
- School of Life Science and Bioengineering, the Nelson Mandela African Institution of Science and Technology, Box 447, Arusha, Tanzania.,Department of Public Health, Institute of Tropical Medicine, Antwerp Belgium, Antwerp, Belgium
| | - Doris Mbata
- Research Programs, National Institute for Medical Research, Headquarters, Box 9653, Dar es Salaam, Tanzania
| | - Andrew M Kilale
- Research Programs, National Institute for Medical Research, Muhimbili Centre, Box 3436, Dar es Salaam, Tanzania
| | - Elizabeth H Shayo
- Research Programs, National Institute for Medical Research, Headquarters, Box 9653, Dar es Salaam, Tanzania
| | - Sayoki G Mfinanga
- Research Programs, National Institute for Medical Research, Muhimbili Centre, Box 3436, Dar es Salaam, Tanzania.,Department of Epidemiology & Biostatistics, Public Health Muhimbili University of Health and Allied Sciences, Box 65001, Dar es Salaam, Tanzania
| | - Bassirou Bonfoh
- Departiment of Research and Development, Centre Suisse de Recherches Scientifiques en Côte d'Ivoir, Abidjan, Côte d'Ivoire
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Cabrera Zapata LE, Cambiasso MJ, Arevalo MA. Epigenetic modifier Kdm6a/Utx controls the specification of hypothalamic neuronal subtypes in a sex-dependent manner. Front Cell Dev Biol 2022; 10:937875. [PMID: 36268511 PMCID: PMC9577230 DOI: 10.3389/fcell.2022.937875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Kdm6a is an X-chromosome-linked H3K27me2/3 demethylase that promotes chromatin accessibility and gene transcription and is critical for tissue/cell-specific differentiation. Previous results showed higher Kdm6a levels in XX than in XY hypothalamic neurons and a female-specific requirement for Kdm6a in mediating increased axogenesis before brain masculinization. Here, we explored the sex-specific role of Kdm6a in the specification of neuronal subtypes in the developing hypothalamus. Hypothalamic neuronal cultures were established from sex-segregated E14 mouse embryos and transfected with siRNAs to knockdown Kdm6a expression (Kdm6a-KD). We evaluated the effect of Kdm6a-KD on Ngn3 expression, a bHLH transcription factor regulating neuronal sub-specification in hypothalamus. Kdm6a-KD decreased Ngn3 expression in females but not in males, abolishing basal sex differences. Then, we analyzed Kdm6a-KD effect on Ascl1, Pomc, Npy, Sf1, Gad1, and Th expression by RT-qPCR. While Kdm6a-KD downregulated Ascl1 in both sexes equally, we found sex-specific effects for Pomc, Npy, and Th. Pomc and Th expressed higher in female than in male neurons, and Kdm6a-KD reduced their levels only in females, while Npy expressed higher in male than in female neurons, and Kdm6a-KD upregulated its expression only in females. Identical results were found by immunofluorescence for Pomc and Npy neuropeptides. Finally, using ChIP-qPCR, we found higher H3K27me3 levels at Ngn3, Pomc, and Npy promoters in male neurons, in line with Kdm6a higher expression and demethylase activity in females. At all three promoters, Kdm6a-KD induced an enrichment of H3K27me3 only in females. These results indicate that Kdm6a plays a sex-specific role in controlling the expression of transcription factors and neuropeptides critical for the differentiation of hypothalamic neuronal populations regulating food intake and energy homeostasis.
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Affiliation(s)
| | - María Julia Cambiasso
- Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
- Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
- *Correspondence: María Julia Cambiasso, , Maria Angeles Arevalo,
| | - Maria Angeles Arevalo
- Instituto Cajal (IC), CSIC, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: María Julia Cambiasso, , Maria Angeles Arevalo,
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Cechin L, Norcross C, Oliveira A, Hopkins D, McGowan B, Post FA. Obesity and diabetes in people of African ancestry with HIV. HIV Med 2022; 24:380-388. [PMID: 36196017 DOI: 10.1111/hiv.13413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
Obesity is a chronic disease with multiple adverse effects on health. The prevalence of obesity is increasing worldwide, and people of African ancestry are disproportionally affected. Several widely used antiretrovirals have been associated with weight gain and contribute to the rising burden of obesity in people with HIV. Obesity and weight gain on antiretroviral therapy are risk factors for the development of type 2 diabetes mellitus, a condition which also disproportionally affects black populations. In this review, we discuss recent data on weight gain in relation to initiating or switching antiretroviral therapy and advances in the management of obesity. Availability of highly effective treatments for obesity have the potential to address, and potentially reverse, the epidemics of obesity and diabetes mellitus in people with HIV.
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Affiliation(s)
- Laura Cechin
- King's College Hospital NHS Foundation Trust, London, UK
| | - Claire Norcross
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | - David Hopkins
- King's College Hospital NHS Foundation Trust, London, UK.,Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Barbara McGowan
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.,Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
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Association of Body Mass Index with Risk of Household Catastrophic Health Expenditure in China: A Population-Based Cohort Study. Nutrients 2022; 14:nu14194014. [PMID: 36235667 PMCID: PMC9571178 DOI: 10.3390/nu14194014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Catastrophic health expenditure (CHE) is a major obstacle to achieving universal health coverage, and body mass index (BMI) is linked to both health and economy. We aimed to explore the association of BMI with the risk of CHE to provide advice for reducing CHE. We used national cohort data from the China Family Panel Studies, which comprised 33,598 individuals (14,607 households) from 25 provinces between 2010 to 2018. We used multivariate Cox proportional hazard models to estimate adjusted hazard ratios (aHRs) and 95% confident interval (CI) for CHE in participants at underweight, overweight, and obesity, compared with those at normal weight. Restricted cubic splines were employed to model the association of continuous BMI scale with risk of CHE. We found that families with female household heads at underweight had a 42% higher risk of CHE (aHR = 1.42, 95%CI: 1.16–1.75), and those at overweight had a 26% increased risk of CHE (aHR = 1.26, 95%CI: 1.09–1.47), compared with those at normal weight. A weak U-shaped curve for the association of continuous BMI with risk of CHE in female-headed households (p for non-linear = 0.0008) was observed, which was not significant in male-headed households (p for non-linear = 0.8725). In female-headed households, underweight and overweight BMI are connected with a higher risk of CHE. Concerted efforts should be made to keep a normal BMI to prevent CHE.
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Zhang S, Li W, Jia X, Zhang J, Jiang H, Wang L, Wang H, Zhang B, Wang Z, Ding G. Association of obesity profiles with type 2 diabetes in Chinese adults: Findings from the China health and nutrition survey. Front Nutr 2022; 9:922824. [PMID: 36176634 PMCID: PMC9513418 DOI: 10.3389/fnut.2022.922824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
AimsTo examine longitudinal associations of obesity profiles, continuous BMI, and waist circumference (WC) with the risk of type 2 diabetes in Chinese adults.MethodsData were derived from three waves (2009, 2015, and 2018) of the China Health and Nutrition Survey, and 3,595 adults aged 18–65 years who participated in at least two waves of the survey and had completed data were analyzed. Obesity profiles included BMI- or WC-related single obesity and combined obesity. Combined obesity was categorized into six groups including Group 1 with normal BMI and WC, Group 2 with normal BMI but pre-abdominal obesity, Group 3 with normal BMI but abdominal obesity, Group 4 with abnormal BMI (overweight and general obesity) and normal WC, Group 5 with abnormal BMI and pre-abdominal obesity, and Group 6 with abnormal BMI and abdominal obesity. Three-level mixed-effects logistic regressions with random intercept stratified by gender and restricted cubic splines were performed to examine ORs and 95%CIs for the risk of type 2 diabetes.ResultsIn men, compared with subjects of Group 1, those in Group 3 had higher risk, with an OR of 4.83 (95% CI: 1.99–11.74), followed by those in Group 6 (OR = 4.05, 95%CI: 2.32–7.08) and Group 5 (OR = 2.98, 95%CI: 1.51–5.87) after adjusting for all potential confounders. For women, the subject of Group 6 had highest risk (OR = 8.79, 95%CI: 4.04–19.12), followed by Group 3 (OR = 3.30, 95%CI: 1.23–8.86) and Group 5 (OR = 3.16, 95%CI: 1.21–8.26). No significant association between abnormal BMI and normal WC (Group 4) was observed in both genders. Type 2 diabetes risk increased steeply at BMI of 23.5 kg/m2 and 22.5 kg/m2 or higher, and WC of 82.0 cm and 83.0 cm or higher in Chinese adult men and women, respectively (p for overall <0.001).ConclusionChinese adults with pre-abdominal or abdominal obesity had a relative high risk of type 2 diabetes independent of BMI levels. Lower BMI (≤23.5 kg/m2 for men and ≤22.5 kg/m2 for women) and lower WC (82.0 cm for men and ≤83.0 cm for women) values than the current Chinese obesity cut-offs were found to predict the risk of type 2 diabetes. These findings urge to inform WC modification and optimization of early screening guidelines.
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Liu Y, Wen H, Bai J, Shi F, Bi R, Yu C. Burden of diabetes and kidney disease attributable to non-optimal temperature from 1990 to 2019: A systematic analysis from the Global Burden of Disease Study 2019. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156495. [PMID: 35671854 DOI: 10.1016/j.scitotenv.2022.156495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This study quantitatively described the disease burden of diabetes and kidney disease attributable to non-optimal temperatures and explored the influencing factors. METHODS We quantitatively described the mortality burden of diabetes and kidney disease attributable to non-optimal temperatures in six countries (China, USA, South Africa, Australia, Iraq, Portugal), and compare trends in mortality in six countries from 1990 to 2019. We used the APC model to analyse age, period, and cohort effects on mortality in six countries. We used restricted cubic splines and quantile regression to analyse the association of SDI with mortality and YLL using data from 21 regions in the world. RESULTS The mortality rates of diabetes and kidney disease in the six countries in 2019 were 1.72% (Australia), 1.83% (China), 2.99% (USA), 3% (Portugal), 7.45% (South Africa) and 8.71% (Iraq) attributable to non-optimal temperatures. Cold was more harmful than heat. The mortality, YLLs of diabetes and kidney disease of male were higher than females. The mortality rate showed an upwards trend with age. The period effect had little changes or showed a slight upwards trend. The cohort effect showed a downwards trend. The regions with higher mortality or YLLs rates were mainly had SDI values of 0.45-0.80. CONCLUSIONS Among the death burdens of diabetes and kidney disease attributed to non-optimal temperatures, cold had a greater burden than heat. The burden of death was affected by sex, age, period, cohort, and SDI.
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Affiliation(s)
- Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Ran Bi
- College of Letter and Science, University of California, Davis, CA 95618, the United States of America
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China.
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Clinical Evaluation of a Novel Tablet Formulation of Traditional Thai Polyherbal Medicine Named Nawametho in Comparison with Its Decoction in the Treatment of Hyperlipidemia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2530266. [PMID: 35966727 PMCID: PMC9365582 DOI: 10.1155/2022/2530266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
In the traditional medical system in Thailand, medicinal plants and polyherbal medicines have been prescribed as lipid-lowering agents, including Nawametho decoction. This polyherbal formulation is described in the Worayokasan scripture. It consists of nine medicinal plants (Aegle marmelos (L.), Carthamus tinctorius L., Hibiscus sabdariffa Linn., Phyllanthus emblica L., Piper longum L., Piper nigrum L., Terminalia bellirica (Gaertn.) Roxb., Terminalia chebula Retz., and Zingiber officinale Roscoe). Apart from its utilization in Thai traditional medicine, there is a lack of evidence supporting its use. This research work thereby aims to formulate and evaluate the tablet containing Nawametho decoction. The feasibility of Nawametho decoction and NawaTab for patients with borderline hyperlipidemia was additionally examined using a prospective, open-label, randomized, parallel-group design. The dry granulation technique was employed to formulate the polyherbal tablets. The tablets were developed using the spray-dried Nawametho decoction as the active ingredient in addition to other excipients. The chosen formulation, the FB (NawaTab), consisted of 385 milligrams of the extract, 12% w/w of a diluent (lactose), 8% w/w of a lubricant (magnesium stearate), 5% w/w of a disintegrant (microcrystalline cellulose), and 5% w/w of an anti-adherent (talcum). Their hardness, friability, and disintegration time were 4.4 ± 0.32 kg, 0.05 ± 0.02%, and 4.60 ± 0.05 min, respectively. Accelerated stability study results revealed that NawaTab was stable for six months at 40°C/75% RH and 25°C/60% RH. Even though taking NawaTabs (500 mg twice daily) for eight consecutive weeks was unable to improve the lipid profile of the patients, the administration of Nawametho decoction (30 mL twice daily) was associated with a significant decrease in serum triglycerides of the patients. The results show that the dry granulation technique is suitable for the formulation of NawaTab based on the tablet evaluation. Furthermore, the triglyceride-lowering effect of Nawametho decoction was reported for the first time.
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Yu S, Kong L, Gu L, Zhu Y, Liu X, Sang Y, Wang Q, Wang S, Zhang D, Cao H, Tao F, Liu K. Typical antibiotic exposure and dysglycemia risk in an elderly Chinese population. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:59701-59711. [PMID: 35394631 DOI: 10.1007/s11356-022-20056-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
Studies examined the connection between antibiotic exposure in urine and dysglycemia risk (including prediabetes and diabetes) in the elderly were limited. Multiple linear regression, binary logistic regression, restricted cubic splines (RCS), and stratified analysis were applied to analyze the relationship between antibiotic exposure and dysglycemia risk. We observed that sulfaclozine exposure 0.07 (95% confidence interval [CI]: 0.01-0.23) significantly increased fasting blood glucose (FBG) level. By mechanism, usage, and antimicrobial action, sulfonamides 0.08 (95% CI: 0.06-0.36), veterinary antibiotics (VA) 0.07 (95% CI: 0.01-0.30), or bacteriostatic antibiotics 0.07 (95% CI: 0.02-0.29) significantly increased FBG level. Additionally, sulfaclozine exposure 1.54 (95% CI: 1.02-2.33) resulted in a higher dysglycemia risk, while doxycycline exposure 0.53 (95% CI: 0.30-0.95) resulted in a lower dysglycemia risk. By mechanism, usage, and antimicrobial action, sulfonamides 1.44 (95% CI: 1.02-2.04), VA 1.68 (95% CI: 1.21-2.35), or bacteriostatic antibiotics 1.40 (95% CI: 1.02-1.93) exposure had a higher dysglycemia risk. Taken together, exposure to sulfonamides, VA, especially sulfaclozine, was correlated with a higher dysglycemia risk in the elderly. Exposure to bacteriostatic antibiotics was associated with a higher dysglycemia risk in the female.
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Affiliation(s)
- Shuixin Yu
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Li Kong
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Lvfen Gu
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yitian Zhu
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xinji Liu
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yanru Sang
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Qunan Wang
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Sufang Wang
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Dongmei Zhang
- School of Health Management, Anhui Medical University, Hefei, 230032, China
| | - Hongjuan Cao
- Lu'an Center of Disease Control and Prevention, Lu'an, Anhui, 237000, China
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Kaiyong Liu
- School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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