Body mass index and the risk of mortality among Chinese adults with Type 2 diabetes

Interaction between body mass index and family history of cancer on the risk of female breast cancer

Both body mass index (BMI) and family history of cancer are established risk factors for female breast cancer. However, few studies explored the potential interaction between both factors. We assessed the association of BMI and its interaction with family cancer history on the risk of female breast cancer in Shanghai, China. Based on a population-based prospective cohort study started from 2008 to 2012 with 15,055 Chinese female participants in Minhang district, Shanghai. Cox regression models were used to estimate the association of BMI and its interaction with a family history of cancer on breast cancer risk. The additive interaction was evaluated by the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP), and the multiplicative interaction was assessed by the product term (BMI* family history of cancer) in the Cox regression model. Compared with BMI of < 24 kg/m2 and no family history of cancer, women with BMI of ≥ 24 kg/m2 and a family history of cancer had a higher risk for breast cancer with HR 2.06 (95% CI 1.39, 3.06). There was an additive interaction between BMI and family history of cancer on breast cancer incidence, with the RERI being 0.29 (95% CI 0.08, 0.51) and the AP being 0.37 (95% CI 0.08, 0.66). The coexistence of obesity and cancer family history may exacerbate breast cancer incidence risk, highlighting the importance of weight management in women with a family history of cancer.

Is Chinese Spring Festival a key point for glycemic control of patients with type 2 diabetes mellitus in China?

Objectives

This study aims to explore the long-term trend of fasting blood glucose (FBG) among urban patients with type 2 diabetes mellitus (T2DM) and the impacts of the Chinese Spring Festival on their glycemic control in urban China.

Methods

The general information and longitudinal monitoring data of patients with T2DM in Minhang District, Shanghai China from 15 December 2006 to 31 December 2015 were collected. The FBG records were grouped into three periods, namely, the preholiday period (2 months right before the Chinese Spring Festival), the holiday period (from 28 December to 7 January of the lunar calendar year), and the postholiday period (2 months after the Chinese Spring Festival). The Mann-Kendall trend test and Cochran-Armitage trend test were occupied to explore the long-term trend, and paired t-test and chi-square (χ²) test were used to determine the differences in glycemic level and control rate between the preholiday and postholiday periods, respectively.

Results

From 2007 to 2015, the glycemic control rate in patients with T2DM showed an upward trend (P < 0.001), and the FBG level showed a decreasing trend (P = 0.048). After the Chinese Spring Festival, the glycemic control rate decreased significantly (P < 0.001), and the FBG level increased significantly (P < 0.001) compared to those during the preholiday period. The incidence of hypoglycemia increased during holidays. Patients who were aged 60-69 years, overweight or obese, with hypertension, with a disease duration of <3 years, or with poor glycemic control in one previous year were more likely to be affected by the holiday.

Conclusion

Chinese Spring Festival is a key point for glycemic control of patients with T2DM in China. Intensive holiday-specific diabetic healthcare needs to be further improved, and community-based interventions should be developed and implemented to control the possible holiday effects.

Adiposity and risks of vascular and non-vascular mortality among Chinese adults with type 2 diabetes: a 10-year prospective study

INTRODUCTION

Among individuals with diabetes, high adiposity has been associated with lower cardiovascular disease (CVD) mortality (the so-called 'obesity paradox' phenomenon) in Western populations, for reasons that are still not fully elucidated. Moreover, little is known about such phenomena in Chinese adults with diabetes among whom very few were obese. We aimed to assess the associations of adiposity with vascular and non-vascular mortality among individuals with diabetes, and compare these with associations among individuals without diabetes.

RESEARCH DESIGN AND METHODS

In 2004-2008, the prospective China Kadoorie Biobank recruited >512 000 adults from 10 areas in China. After ~10 years of follow-up, 3509 deaths (1431 from CVD) were recorded among 23 842 individuals with diabetes but without prior major diseases at baseline. Cox regression yielded adjusted HRs associating adiposity with mortality.

RESULTS

Among people with diabetes, body mass index (BMI) (mean 25.0 kg/m²) was positively log linearly associated with CVD incidence (n=9943; HR=1.19 (95% CI 1.15 to 1.22) per 5 kg/m²), but showed U-shaped associations with CVD and overall mortality, with lowest risk at 22.5-24.9 kg/m². At lower BMI, risk of death (n=671) within 28 days of CVD onset was particularly elevated, with an HR of 3.26 (95% CI 2.29 to 4.65) at <18.5 kg/m² relative to 22.5-24.9 kg/m², but no higher mortality risk at BMI ≥25.0 kg/m². These associations were similar in self-reported and screen-detected diabetes, and persisted after extensive attempts to address reverse causality and confounding. Among individuals without diabetes (mean BMI 23.6 kg/m²; n=23 305 deaths), there were less extreme excess mortality risks at low BMI.

CONCLUSIONS

Among relatively lean Chinese adults with diabetes, there were contrasting associations of adiposity with CVD incidence and with mortality. The high mortality risk at low and high BMI levels highlights, if causal, the importance of maintaining normal weight among people with diabetes.

Association of BMI with cardiovascular disease incidence and mortality in patients with type 2 diabetes mellitus: A systematic review and dose-response meta-analysis of cohort studies

AIMS

The relation of body mass index (BMI) with cardiovascular disease (CVD) and mortality has been extensively investigated in the general population but is less clear in individuals with type 2 diabetes mellitus (T2DM). We performed a meta-analysis of cohort studies to quantitatively evaluate the association of BMI with CVD incidence and mortality in patients with T2DM.

DATA SYNTHESIS

PubMed and Embase databases were searched for relevant cohort articles published up to June 8, 2020. Restricted cubic splines were used to evaluate the potential linear or non-linear dose-response associations. We identified 17 articles (21 studies) with 1,349,075 participants and 57,725 cases (49,354 CVD incidence and 8371 CVD mortality) in the meta-analysis. We found a linear association between BMI and risk of CVD incidence (P_{non-linearity} = 0.182); the pooled RR for CVD incidence was 1.12 (95% CI, 1.04-1.20) with a 5-unit increase in BMI. We found an overall nonlinear relationship between BMI and CVD mortality (P_{non-linearity} < 0.001). The lowest risk was at BMI about 28.4 kg/m², with increased mortality risk for higher BMI values; the RR with a 5-unit increase in BMI was 0.87 (95% CI, 0.79-0.96) and 1.11 (95% CI, 1.04-1.18) for BMI ≤28.4 kg/m² and BMI >28.4 kg/m², respectively.

CONCLUSIONS

In individuals with T2DM, BMI may have a positive linear association with risk of CVD incidence but a nonlinear association with CVD mortality. Our results can provide evidence for weight control and lifestyle intervention for preventing and managing cardiovascular disease in T2DM.

Annual glycemic variations and risk of cancer among Chinese patients with type 2 diabetes mellitus: A population-based cohort study in Shanghai

BACKGROUND

Long-term glycemic variation in diabetes patients may have contributed to cancer incidence.

AIM

In this study we aimed at the association between annual glycemic variation and the risk of cancer in Chinese patients with type 2 diabetes mellitus (T2DM).

METHODS

Subjects of this study were from an established population-based cohort of T2DM patients in Minhang District of Shanghai, China. Incident cancer were obtained from the Shanghai Cancer Registry. Glycemic variation was evaluated using the annual fasting glucose coefficient of variation (FG-CV), which was used as a time-dependent variable in a Cox regression model to estimate the associations with the cancer risk. Restricted cubic splines were used to explore potential non-linear associations.

RESULTS

A total of 2,140 incident cancers (1100 men and 1040 women) were identified from the 46,202 diabetes patients during 12-year follow-up. The annual FG-CV remained significantly associated with an increased risk of cancer, even after adjusting for the annual mean FG level. A significant non-linear association was found in male T2DM patients, and a significant linear association in female patients.

CONCLUSIONS

The positive association of the annual FG-CV with the risk of cancer in T2DM patients indicate the importance to stabilize the FG level.

The Hypoglycemic and Renal Protection Properties of Crocin via Oxidative Stress-Regulated NF-κB Signaling in db/db Mice

Background

As the main ingredient of Crocus sativus L. (Iridaceae) extract, crocin- I (CR) has been reported to show various pharmacological activities. The aim of this study was to investigate the hypoglycemic and renal protection properties of CR in db/db mice.

Methods

Eight-week-old db/db mice were treated with metformin (Met) (100 mg/kg) and CR (50 mg/kg) for eight weeks.

Results

CR treatment showed hypoglycemic functions indicated by reduced bodyweight, food and water intake, plasma glucose, and serum levels of glycated hemoglobin A1c. Additionally, the CR group showed increased serum levels of insulin and pyruvate kinase, hypolipidemic functions indicated by the suppressed levels of total cholesterol and triglyceride, and enhanced levels of high-density lipoprotein cholesterol, which are also indicators of hypoglycemic functions. The renal protection function of CR was demonstrated by its protection of renal structures and its regulation of potential indicators of nephropathy. The anti-oxidation and anti-inflammation effects of CR were verified by enzyme-linked immunosorbent assay. In the kidneys of db/db mice, CR decreased the expression of phospho-IκBα and phospho-nuclear factor-κB (NF-κB), whereas it enhanced the expression of nuclear respiratory factor 2, manganese superoxide dismutase 1, heme oxygenase-1, and catalase.

Conclusions

The anti-diabetic and anti-diabetic nephritic effects of CR were related to its modulation of oxidative stress-mediated NF-κB signaling.

Anti-Diabetic Nephropathy Activities of Polysaccharides Obtained from Termitornyces albuminosus via Regulation of NF-κB Signaling in db/db Mice

Termitornyces albuminosus is a kind of traditional Chinese edible fungus rich in nutrients and medicinal ingredients, and it has anti-oxidative, analgesic and anti-inflammatory effects. However, the hypoglycemic and nephroprotective effects of polysaccharides separated from T. albuminosus (PTA) have not been reported. The properties of PTA were analyzed in a BKS.Cg-Dock7^m +/+ Lepr^db/JNju (db/db) mouse model of diabetes. After the administration of PTA for eight weeks, the hypoglycemic and hypolipidemic activities of PTA in the db/db mice were assessed. The results of a cytokine array combined with an enzyme-linked immunosorbent assay confirmed the anti-oxidative and anti-inflammatory activities of PTA. An eight-week administration of PTA caused hypoglycemic and hypolipidemic functioning, as indicated by suppressed plasma glucose levels, as well as the modulation of several cytokines related to glycometabolism, in the sera and kidneys of the mice. PTA treatment also had a protective effect on renal function, restoring renal structures and regulating potential indicators of nephropathy. In the kidneys of the db/db mice, PTA treatment reduced the activation of protein kinase B, the inhibitor of κB kinase alpha and beta, and the inhibitor of κB alpha and nuclear factor-κB (NF-κB). We establish the hypoglycemic, hypolipidemic, and anti-diabetic nephropathy effects of PTA, and we find that the renal protection effects of PTA may be related to anti-inflammatory activity via the regulation of NF-κB signaling.