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Mina T, Xie W, Low DY, Wang X, Lam BCC, Sadhu N, Ng HK, Aziz NA, Tong TYY, Kerk SK, Choo WL, Low GL, Ibrahim H, Lim L, Tai ES, Wansaicheong G, Dalan R, Yew YW, Elliott P, Riboli E, Loh M, Ngeow J, Lee ES, Lee J, Best J, Chambers J. Adiposity and metabolic health in Asian populations: an epidemiological study using dual-energy x-ray absorptiometry in Singapore. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00195-5. [PMID: 39217997 DOI: 10.1016/s2213-8587(24)00195-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Type 2 diabetes, cardiovascular disease, and related cardiometabolic disturbances are increasing rapidly in the Asia-Pacific region. We investigated the contribution of excess adiposity, a key determinant of type 2 diabetes and cardiovascular risk, to unfavourable cardiometabolic profiles among Asian ethnic subgroups. METHODS The Health for Life in Singapore (HELIOS) Study is a population-based cohort comprising multiethnic Asian men and women living in Singapore, aged 30-84 years. We performed a cross-sectional analysis of data from individuals who had assessment of body composition by dual-energy x-ray absorptiometry and metabolic characterisation. In a subset of participants on no medication for type 2 diabetes, hypertension, and hypercholesterolaemia, we tested the relationship of BMI and visceral fat mass index (vFMI) with cardiometabolic phenotypes (glycaemic indices, lipid levels, and blood pressure), disease outcomes (type 2 diabetes, hypercholesterolaemia, and hypertension), and metabolic syndrome score with multivariable regression analyses. FINDINGS Between April 2, 2018, and Jan 28, 2022, 10 004 individuals consented to be part of the HELIOS cohort, of whom 9067 were included in the study (5404 [59·6%] female, 3663 [40·4%] male; 6224 [68·6%] Chinese, 1169 [12·9%] Malay, 1674 [18·5%] Indian; mean age 52·8 years [SD 11·8]). The prevalence of type 2 diabetes, hypercholesterolaemia, and hypertension was 8·2% (n=744), 27·2% (n=2469), and 18·0% (n=1630), respectively. Malay and Indian participants had 3-4-times higher odds of obesity and type 2 diabetes, and showed adverse metabolic and adiposity profiles, compared with Chinese participants. Excess adiposity was associated with adverse cardiometabolic health indices including type 2 diabetes (p<0·0001). However, while vFMI explained the differences in triglycerides and blood pressure between the Asian ethnic groups, increased vFMI did not explain higher glucose levels, reduced insulin sensitivity, and increased risk of type 2 diabetes among Indian participants. INTERPRETATION Visceral adiposity is an independent risk factor for metabolic disease in Asian populations, and accounts for a large fraction of type 2 diabetes cases in each of the ethnic groups studied. However, the variation in insulin resistance and type 2 diabetes risk between Asian subgroups is not consistently explained by adiposity, indicating an important role for additional mechanisms underlying the susceptibility to cardiometabolic disease in Asian populations. FUNDING Nanyang Technological University-the Lee Kong Chian School of Medicine, National Healthcare Group, and National Medical Research Council, Singapore.
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Affiliation(s)
- Theresia Mina
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Wubin Xie
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Dorrain Yanwen Low
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Xiaoyan Wang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Benjamin Chih Chiang Lam
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Integrated Care for Obesity & Diabetes, Khoo Teck Puat Hospital, Singapore
| | - Nilanjana Sadhu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Hong Kiat Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Nur-Azizah Aziz
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Terry Yoke Yin Tong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Swat Kim Kerk
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Wee Lin Choo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Guo Liang Low
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Halimah Ibrahim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Liming Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Gervais Wansaicheong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Rinkoo Dalan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Yik Weng Yew
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Research Division, National Skin Centre, Singapore
| | - Paul Elliott
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marie Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Joanne Ngeow
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Division of Medical Oncology, National Cancer Centre, Singapore
| | - Eng Sing Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; National Healthcare Group Polyclinic, Singapore
| | - Jimmy Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; North Region, Institute of Mental Health, Singapore
| | - James Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | - John Chambers
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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Seah JYH, Yao J, Hong Y, Lim CGY, Sabanayagam C, Nusinovici S, Gardner DSL, Loh M, Müller-Riemenschneider F, Tan CS, Yeo KK, Wong TY, Cheng CY, Ma S, Tai ES, Chambers JC, van Dam RM, Sim X. Risk prediction models for type 2 diabetes using either fasting plasma glucose or HbA1c in Chinese, Malay, and Indians: Results from three multi-ethnic Singapore cohorts. Diabetes Res Clin Pract 2023; 203:110878. [PMID: 37591346 DOI: 10.1016/j.diabres.2023.110878] [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: 06/10/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023]
Abstract
AIMS To assess three well-established type 2 diabetes (T2D) risk prediction models based on fasting plasma glucose (FPG) in Chinese, Malays, and Indians, and to develop simplified risk models based on either FPG or HbA1c. METHODS We used a prospective multiethnic Singapore cohort to evaluate the established models and develop simplified models. 6,217 participants without T2D at baseline were included, with an average follow-up duration of 8.3 years. The simplified risk models were validated in two independent multiethnic Singapore cohorts (N = 12,720). RESULTS The established risk models had moderate-to-good discrimination (area under the receiver operating characteristic curves, AUCs 0.762 - 0.828) but a lack of fit (P-values < 0.05). Simplified risk models that included fewer predictors (age, BMI, systolic blood pressure, triglycerides, and HbA1c or FPG) showed good discrimination in all cohorts (AUCs ≥ 0.810), and sufficiently captured differences between the ethnic groups. While recalibration improved fit the simplified models in validation cohorts, there remained evidence of miscalibration in Chinese (p ≤ 0.012). CONCLUSIONS Simplified risk models including HbA1c or FPG had good discrimination in predicting incidence of T2D in three major Asian ethnic groups. Risk functions with HbA1c performed as well as those with FPG.
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Affiliation(s)
- Jowy Yi Hong Seah
- Centre for Population Health Research and Implementation, SingHealth, Singapore 150167, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Jiali Yao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Yueheng Hong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Charlie Guan Yi Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore
| | - Daphne Su-Lyn Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore
| | - Marie Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; Research Division, National Skin Centre, Singapore 308205, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore 169609, Singapore; Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore; Center for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore
| | - Stefan Ma
- Epidemiology & Disease Control Division, Ministry of Health, Singapore 169854, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117597, Singapore
| | - John C Chambers
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, United States.
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
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Seah JYH, Sim X, Khoo CM, Tai ES, van Dam RM. Differences in type 2 diabetes risk between East, South, and Southeast Asians living in Singapore: the multi-ethnic cohort. BMJ Open Diabetes Res Care 2023; 11:e003385. [PMID: 37507146 PMCID: PMC10387644 DOI: 10.1136/bmjdrc-2023-003385] [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: 03/01/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Prospective data on differences in type two diabetes (T2D) risk between Asian ethnic groups are sparse. We, therefore, compared T2D risk for East (Chinese), South (Indian), and Southeast (Malay) Asians and examined biological factors that may contribute to ethnic differences. RESEARCH DESIGN AND METHODS We included 7427 adults of Chinese, Malay, and Indian origin participating in the Singapore multi-ethnic cohort. Information on sociodemographic, lifestyle, and biological risk factors (body mass index (BMI), waist circumference, blood lipids, blood pressure, C reactive protein, adiponectin, and homeostasis model assessment for insulin resistance and beta-cell function) were collected using standardized interviews and physical examinations. T2D cases were based on physician diagnoses, a national medical registry, fasting plasma glucose, or glycated hemoglobin A1c. We used multivariable logistic association and mediation analyses. RESULTS During an average follow-up of 7.2 years (SD 2.2 years), we documented 595 cases of incident diabetes. Ethnic Malays (OR 2.08, 95% CI 1.69 to 2.56) and Indians (OR 2.22, 95% CI 1.80 to 2.74) had an approximately twofold higher risk of T2D compared with ethnic Chinese. Higher BMI explained the higher risk for Malay compared with Chinese ethnicity. Higher BMI, waist circumference, inflammation, and insulin resistance, and lower beta-cell function and high-density lipoprotein-cholesterol significantly contributed to the higher T2D risk for Indian compared with Chinese ethnicity. However, part of the higher T2D risk associated with Indian ethnicity remained unexplained. Despite their lower diabetes risk, Chinese participants had the lowest adiponectin levels. CONCLUSIONS Different Asian ethnic groups have unique biological risk factor profiles related to T2D development that may warrant targeted approaches for prevention and treatment.
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Affiliation(s)
- Jowy Yi Hoong Seah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - E Shyong Tai
- Division of Endocrinology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Duke-NUS Medical School, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Departments of Exercise and Nutrition Sciences and Epidemiology, The George Washington University, Washington, District of Columbia, USA
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Shen Q, He T, Li T, Szeto IMY, Mao S, Zhong W, Li P, Jiang H, Zhang Y. Synergistic effects of overweight/obesity and high hemoglobin A1c status on elevated high-sensitivity C-reactive protein in Chinese adults: a cross-sectional study. Front Nutr 2023; 10:1156404. [PMID: 37215204 PMCID: PMC10196946 DOI: 10.3389/fnut.2023.1156404] [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: 02/01/2023] [Accepted: 03/31/2023] [Indexed: 05/24/2023] Open
Abstract
Background High-sensitivity C-reactive protein (hs-CRP) is an inflammatory marker that has been suggested as a predictor of cardiovascular diseases. High glycated hemoglobin (HbA1c) levels and overweight/obesity are independently associated with elevated hs-CRP; meanwhile, high HbA1c levels are frequently accompanied by overweight or obesity. However, their joint effect on elevated hs-CRP levels has not been well-established. Therefore, we evaluated whether overweight/obesity modified the association between high HbA1c levels and elevated hs-CRP. Methods Based on cross-sectional data from the Chinese Urban Adults Diet and Health Study (CUADHS) in 2016, we included 1,630 adults aged 18-75 years (mean age 50.16 years and 33.6% male). Elevated hs-CRP was defined as serum hs-CRP ≥ 3 and <10 mg/L. The interactive effects of BMI and HbA1c levels on the risk of elevated hs-CRP levels were calculated by using multiple logistic regression models, followed by strata-specific analyses. Results Individuals with elevated hs-CRP had a higher rate of HbA1c level than those without elevated (25.3 vs. 11.3%, P < 0.001), as well as a higher rate of overweight/obesity (67.1 vs. 43.5%, P < 0.001). Higher HbA1c levels were independently associated with an increased risk of elevated hs-CRP [adjusted odds ratio (aOR) = 2.31, 95% confidence interval (CI): 1.47, 3.65], as well as overweight/obesity with the risk of elevated hs-CRP (aOR = .31, 95% confidenc-3.73). Furthermore, overweight/obesity showed a significant synergistic effect on high HbA1c levels with a higher aOR of 5.25 (2.77, 9.95) (Pinteraction < 0.001). This synergistic effect was more prominent when stratified by age (in 18-44 years old, aOR, 95% CI = 30.90, 4.40-236.47 for interaction vs. 6.46, 1.38-30.23 for high HbA1c only) and gender (in women, aOR, 95% CI = 8.33, 3.80-18.23 for interaction vs. 2.46,1.38-4.40 for high HbA1c only). Conclusion There are synergistic effects of high HbA1c levels and overweight/obesity on the risk of elevated hs-CRP in Chinese adults, with more significant effects in adults aged 18-44 years or females. Intervention strategies for preventing high blood glucose levels and body weight simultaneously may be important for reducing hs-CRP-related diseases. Further studies are needed to confirm this finding in other populations, and its molecular mechanisms need to be elucidated.
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Affiliation(s)
- Qianqian Shen
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Tingchao He
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot, China
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
| | - Ting Li
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot, China
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
| | - Ignatius Man-Yau Szeto
- Inner Mongolia Dairy Technology Research Institute Co., Ltd., Hohhot, China
- National Center of Technology Innovation for Dairy, Hohhot, China
| | - Shuai Mao
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Wuxian Zhong
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Hua Jiang
- School of Nursing, Peking University, Beijing, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
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Bril F, Sanyal A, Cusi K. Metabolic Syndrome and Its Association with Nonalcoholic Steatohepatitis. Clin Liver Dis 2023; 27:187-210. [PMID: 37024202 DOI: 10.1016/j.cld.2023.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
The relationship between insulin resistance, metabolic syndrome (MetS), and nonalcoholic fatty liver disease (NAFLD) is complicated. Although insulin resistance is almost universal in people with NAFLD and MetS, NAFLD may be present without features of MetS and vice versa. While NAFLD has a strong correlation with cardiometabolic risk factors, these are not intrinsic components of this condition. Taken together, our knowledge gaps call for caution regarding the common assertion that NAFLD is the hepatic manifestation of the MetS, and for defining NAFLD in broad terms as a "metabolic dysfunction" based on a diverse and poorly understood constellation of cardiometabolic features.
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Affiliation(s)
- Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Arun Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine Internal Medicine, Virginia Commonwealth University
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
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Lam BCC, Lim AYL, Chan SL, Yum MPS, Koh NSY, Finkelstein EA. The impact of obesity: a narrative review. Singapore Med J 2023; 64:163-171. [PMID: 36876622 PMCID: PMC10071857 DOI: 10.4103/singaporemedj.smj-2022-232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Obesity is a disease with a major negative impact on human health. However, people with obesity may not perceive their weight to be a significant problem and less than half of patients with obesity are advised by their physicians to lose weight. The purpose of this review is to highlight the importance of managing overweight and obesity by discussing the adverse consequences and impact of obesity. In summary, obesity is strongly related to >50 medical conditions, with many of them having evidence from Mendelian randomisation studies to support causality. The clinical, social and economic burdens of obesity are considerable, with these burdens potentially impacting future generations as well. This review highlights the adverse health and economic consequences of obesity and the importance of an urgent and concerted effort towards the prevention and management of obesity to reduce the burden of obesity.
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Affiliation(s)
- Benjamin Chih Chiang Lam
- Family and Community Medicine, Khoo Teck Puat Hospital; Integrated Care for Obesity and Diabetes, Khoo Teck Puat Hospital, Singapore
| | - Amanda Yuan Ling Lim
- Singapore Association for the Study of Obesity; Division of Endocrinology, Department of Medicine, National University Hospital, Singapore
| | - Soo Ling Chan
- Division of Endocrinology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
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Ho WE, Sun L, Goh HJ, Tint MT, Sun L, Leow MKS. Brown adipose tissue influences adiponectin and thyroid hormone changes during Graves' disease therapy. Adipocyte 2022; 11:389-400. [PMID: 35894647 PMCID: PMC9336474 DOI: 10.1080/21623945.2022.2104509] [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] [Indexed: 11/02/2022] Open
Abstract
Thyroid hormones (TH), adiponectin and brown adipose tissue (BAT) are regulators of energy homoeostasis. Influence of BAT activity on the relationship between TH and adiponectin remains unexplored. The aim of the study was to identify the relationship between TH and adiponectin and to clarify the impact of active BAT on the metabolic effects of adiponectin before and after the correction of thyrotoxicosis. Twenty-one patients with newly diagnosed hyperthyroidism from Graves' disease were recruited. A titration dosing regimen of thionamide anti-thyroid drug (ATD) was used to establish euthyroidism over 12-24 weeks. Anthropometric, biochemical and adipocytokine parameters were measured before and after control of hyperthyroidism. BAT activity was quantified by fusion 18 F-fluorodeoxyglucose (18 F-FDG) PET/MR imaging, and patients were grouped based on BAT status. Plasma adiponectin level was significantly increased following correction of hyperthyroidism in the overall sample. Free thyroxine (FT4) was also identified as a predictor of adiponectin level in thyroid dysfunction. However, significant changes in adiponectin level and correlations involving adiponectin were absent in BAT-positive patients but maintained in BAT-negative patients. BAT activity diminishes the correlative relationship with body composition and abolishes TH and adiponectin relationships when transitioning from a hyperthyroid to euthyroid state.
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Affiliation(s)
- Wei-En Ho
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore, Singapore
| | - Lijuan Sun
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A *STAR), Singapore
| | - Hui Jen Goh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A *STAR), Singapore
| | - Mya Thway Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A *STAR), Singapore.,Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lei Sun
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
| | - Melvin Khee Shing Leow
- Lee Kong Chian School of Medicine, Nanyang Technological University (NTU), Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A *STAR), Singapore.,Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Endocrinology, Division of Medicine, Tan Tock Seng Hospital (TTSH), Singapore
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Zhang Y, Wang M, Zuo Y, Su X, Wen J, Zhai Q, He Y. Comparison of the predictive power of adiposity indices and blood lipid indices for diagnosis of prediabetes. Hormones (Athens) 2022; 21:683-690. [PMID: 36166170 DOI: 10.1007/s42000-022-00398-3] [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] [Received: 12/12/2021] [Accepted: 09/14/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The purpose of this study is to explore the association between adiposity indices and blood lipid indices and prediabetes. We compare the predictive value of new adiposity indices and traditional adiposity indices and blood lipid indices in the diagnosis of prediabetes. METHODS This is a prospective cohort study of 7953 participants. The follow-up time was 3 years. The eight adiposity indices included the following: body mass index (BMI), waist circumference (WC), body roundness index (BRI), A Body Shape Index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP), fatty liver index (FLI), and triglyceride-to-glucose fasting index (TyG), as well as four blood lipid indices as follows: total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C).The association between adiposity indices and blood lipid indices for diagnosis of prediabetes was estimated using a logistic regression model to obtain the odds ratio (OR) and its 95% confidence interval (CI). We calculated the area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis to measure the predictive value of adiposity indices and blood lipid indicators for the diagnosis of prediabetes in the general population stratified by gender. RESULTS The median age of the participants was 56 years old, men accounting for 35.3% of the final group. After adjusting for confounding factors, association of BMI, BRI, VAI, LAP, TyG, TC, TG, and LDL-C with prediabetes status was assessed at both baseline and follow-up. TyG (AUC, overall: 0.677 (95% CI, 0.665, 0.689), male: 0.645 (95% CI, 0.624-0.667), and female: 0.693 (95% CI, 0.678-0.708)) have better diagnostic value for prediabetes than VAI, LAP, FLI, TC, TG, HDL-C, and LDL-C. The predictive value of the combination of TyG, BRI, VAI, and TG significantly improves the power of any single index in the diagnosis of prediabetes. The AUC and corresponding 95% CI of TyG, BRI, VAI, and TG and the combination of these four indicators to diagnose prediabetes were 0.677 (0.665, 0.689), 0.630 (0.617, 0.643), 0.618 (0.606, 0.631), 0.622 (0.609, 0.635), and 0.728 (0.716, 0.739), respectively. CONCLUSIONS Among the eight adiposity indices and four blood lipid indices evaluated in the study, TyG had the highest diagnostic value for prediabetes in isolated indexes, and the combination of TyG, BRI, VAI, and TG significantly improved the diagnostic value for prediabetes of any single indicator.
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Affiliation(s)
- Yibo Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China
| | - Meiping Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China
| | - Xin Su
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China
- School of Public Health, Baotou Medical College, Baotou, Inner Mongolia, China
| | - Jing Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China
| | - Qi Zhai
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing, China.
- Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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Prevalence and predictors of metabolically healthy obesity in severely obese Asian children. Pediatr Res 2022; 92:1374-1380. [PMID: 35132129 DOI: 10.1038/s41390-022-01941-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Obese individuals who have little or no metabolic syndrome components are proposed to be "metabolically healthy obese (MHO)". This study aim to evaluate the prevalence of MHO and examine the predictors associated with MHO in a multi-ethnic Asian cohort of severely obese children. METHODS This study included a cross-sectional cohort of 406 Chinese, Malay and Indian children aged 5-20 years old with BMI for age ≥ 97th percentile. Metabolic syndrome (MS) and metabolic health (MH) definitions based on the presence or absence of metabolic abnormalities (High triglycerides, low HDL cholesterol, elevated blood pressure and high glucose) were used to define MHO in the cohort. RESULTS The prevalence of MHO is 63.5% by MS definition and 22.4% by MH definition. Maternal healthy metabolic status (OR: 2.47), age (OR: 0.83, 0.80), paternal obesity (OR: 0.48, 0.53), Malay (OR: 1.97) and Indian ethnicity (OR: 6.38, 3.21) (compared to Chinese ethnicity) are independent predictors for MHO phenotype based on different MHO definitions. CONCLUSIONS Adiposity measures are not associated with MHO phenotype, but instead younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype in a multi-ethnic Asian cohort of severely obese children. IMPACT The prevalence of metabolically healthy obese (MHO) in our multi-ethnic Asian cohort of severely obese children is 63.5% and 22.4%, respectively, based on different MHO definitions. Adiposity measures are not associated with the MHO phenotype. There are other factors that contribute to the metabolic phenotype in obese individuals. Younger age, maternal healthy metabolic status, absence of paternal obesity, Malay and Indian ethnicity are independent predictors for MHO phenotype. Parental influence is important in predicting metabolic health in obese individuals.
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10
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Tan K, Tint MT, Michael N, Yap F, Chong YS, Tan KH, Godfrey KM, Larbi A, Lee YS, Chan SY, Fortier MV, Eriksson JG, Karnani N. Determinants of cord blood adipokines and association with neonatal abdominal adipose tissue distribution. Int J Obes (Lond) 2022; 46:637-645. [PMID: 34864815 PMCID: PMC8873009 DOI: 10.1038/s41366-021-00975-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 09/09/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cord blood leptin and adiponectin are adipokines known to be associated with birth weight and overall infant adiposity. However, few studies have investigated their associations with abdominal adiposity in neonates. We examined maternal factors associated with cord blood leptin and adiponectin, and the association of these adipokines with neonatal adiposity and abdominal fat distribution measured by magnetic resonance imaging (MRI) in an Asian mother-offspring cohort. METHODS Growing Up in Singapore Towards healthy Outcomes (GUSTO), is a prospective mother-offspring birth cohort study in Singapore. Cord blood plasma leptin and adiponectin concentrations were measured using Luminex and Enzyme-Linked Immunosorbent Assay respectively in 816 infants. A total of 271 neonates underwent MRI within the first 2-weeks after delivery. Abdominal superficial (sSAT), deep subcutaneous (dSAT), and intra-abdominal (IAT) adipose tissue compartment volumes were quantified from MRI images. Multivariable regression analyses were performed. RESULTS Indian or Malay ethnicity, female sex, and gestational age were positively associated with cord blood leptin and adiponectin concentrations. Maternal gestational diabetes (GDM) positively associated with cord blood leptin concentrations but inversely associated with cord blood adiponectin concentrations. Maternal pre-pregnancy body mass index (BMI) showed a positive relationship with cord blood leptin but not with adiponectin concentrations. Each SD increase in cord blood leptin was associated with higher neonatal sSAT, dSAT and IAT; differences in SD (95% CI): 0.258 (0.142, 0.374), 0.386 (0.254, 0.517) and 0.250 (0.118, 0.383), respectively. Similarly, each SD increase in cord blood adiponectin was associated with higher neonatal sSAT and dSAT; differences in SD (95% CI): 0.185 (0.096, 0.274) and 0.173 (0.067, 0.278), respectively. The association between cord blood adiponectin and neonatal adiposity was observed in neonates of obese mothers only. CONCLUSIONS Cord blood leptin and adiponectin concentrations were associated with ethnicity, maternal BMI and GDM, sex and gestational age. Both adipokines showed positive association with neonatal abdominal adiposity.
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Affiliation(s)
- Karen Tan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
| | - Mya Thway Tint
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Navin Michael
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
| | - Fabian Yap
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- Department of Pediatric Endocrinology, KK Women's and Children's Hospital, Singapore, Singapore
- National Technological University (NTU)-Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- National Technological University (NTU)-Lee Kong Chian School of Medicine, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital, Southampton, United Kingdom
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Neerja Karnani
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR) Singapore, Singapore, Singapore.
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
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11
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Wang B, Yang Y, Li X. Interaction of Hypertension and Insulin Resistance Exacerbates the Occurrence of Diabetes Mellitus in Healthy Individuals. J Diabetes Res 2022; 2022:9289812. [PMID: 35493612 PMCID: PMC9042628 DOI: 10.1155/2022/9289812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Hypertension and type 2 diabetes are common complications. Patients with hypertension often show insulin resistance. The purpose of this study was to investigate the correlations between different blood pressure levels and different degrees of insulin resistance, as well as their interactions, with newly diagnosed diabetes mellitus. METHODS We conducted a retrospective study on 1251 adult medical examiners who were examined in the Physical Examination Center of Zhongshan Hospital, Fudan University (Shanghai, China) during 2015. All human subjects had no history of diabetes. General clinical data, including blood pressure, fasting glucose and 2-h post-load glucose levels, and lipid profiles, were collected. HOMA-IR was separately calculated. Statistical analyses were carried out by using SPSS software (version 13.0). RESULTS In 1251 physical examination subjects, a total of 166 cases of newly diagnosed diabetes were detected, with a total detection rate of 13.3%. The rates of newly diagnosed diabetes in the normal blood pressure group, high-normal blood pressure group, and hypertension group were 4.9%, 10.6%, and 19.0%, respectively. Compared with the normal blood pressure group, the proportion of newly diagnosed diabetes in the hypertension group was significantly increased [OR: 2.956, 95% CI 1.736-5.032, P < 0.001]. According to the stratification of HOMA-IR level, with the first quartile group (HOMA-IR<1.21) as a reference, the risk of newly diagnosed diabetes in the fourth quartile group (HOMA-IR ≥2.68) was significantly increased. After adjusting for gender and age, for every unit increase in HOMA-IR, the risk of developing newly diagnosed diabetes increased 9.67 times [OR: 9.670, 95% CI 5.086-18.384, P < 0.001]. When hypertension was combined with insulin resistance (HOMA-IR ≥2.68), the risk of newly diagnosed diabetes was 38.32 times compared with the control group [OR: 38.315, 95% CI 9.227-159.108, P < 0.001]. CONCLUSIONS Elevated blood pressure levels and insulin resistance levels were associated with the risk of newly diagnosed diabetes. Hypertension was an independent risk factor for newly diagnosed diabetes, and the combination of hypertension with insulin resistance further increased the risk of newly diagnosed diabetes.
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Affiliation(s)
- Baomin Wang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yumei Yang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaomu Li
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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12
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Chu AHY, Yuan WL, Loy SL, Soh SE, Bernard JY, Tint MT, Ho-Lim SST, Goh H, Ramasamy A, Kumar M, Goh C, Ang LT, Shek LPC, Chong YS, Tan KH, Su LL, Biswas A, Yap F, Lee YS, Chi C, Godfrey KM, Eriksson JG, Chan SY. Maternal height, gestational diabetes mellitus and pregnancy complications. Diabetes Res Clin Pract 2021; 178:108978. [PMID: 34303772 PMCID: PMC7611603 DOI: 10.1016/j.diabres.2021.108978] [Citation(s) in RCA: 6] [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: 04/09/2021] [Revised: 06/30/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022]
Abstract
AIMS To explore the glucose-overload hypothesis of artefactual gestational diabetes (GDM) diagnosis in shorter women during oral glucose tolerance testing (OGTT), by investigating associations between height and maternal glycemia; and GDM and pregnancy complications in height-groups. METHODS Women from GUSTO (n = 1100, 2009-2010) and NUH (n = 4068, 2017-2018) cohorts underwent a mid-gestation two and three time-point 75 g 2-hour OGTT, respectively. GDM-related complications (hypertensive disorders of pregnancy, preterm delivery, emergency cesarean section, neonatal intensive care unit admission, macrosomia, birthweight) were compared within shorter and taller groups, dichotomized by ethnic-specific median height. RESULTS Using WHO-1999 criteria, 18.8% (GUSTO) to 22.9% (NUH) of women were diagnosed with GDM-1999; and by WHO-2013 criteria, 21.9% (NUH) had GDM-2013. Each 5-cm height increment was inversely associated with GDM-1999 (adjusted odds ratio [aOR, 95% CI] = 0.81 [0.76-0.87], 2-h glycemia (adjusted β [aβ, 95% CI] = -0.171 mmol/L [-0.208, -0.135]) and 1-h glycemia (aβ = -0.160 mmol/L [-0.207, -0.112]). The inverse association between height and 2-h glycemia was most marked in "Other" ethnicities (Eurasians/Caucasians/mixed/other Asians) and Indians, followed by Chinese, then Malays. Compared with non-GDM, GDM-1999 was associated with preterm delivery (aOR = 1.76 [1.19-2.61]) and higher birthweight (aβ = 57.16 g [20.95, 93.38]) only among taller but not shorter women. CONCLUSIONS Only taller women had an increased odds of GDM-related pregnancy complications. An artefactual GDM diagnosis due to glucose-overload among shorter women is plausible.
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Affiliation(s)
- Anne H Y Chu
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Wen Lun Yuan
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - Shu E Soh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Centre for Research in Epidemiology and StatisticS (CRESS), Université de Paris, Inserm, INRAE, Paris, France
| | - Mya-Thway Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Huecin Goh
- Department of Nursing, National University Hospital, Singapore
| | - Adaikalavan Ramasamy
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Mukkesh Kumar
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Claire Goh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Li Ting Ang
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore; Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Lin Lin Su
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Arijit Biswas
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Fabian Yap
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Claudia Chi
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
| | - Johan Gunnar Eriksson
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of General Practice and Primary Health Care, University of Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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13
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Kokiwar P. Assessment of diabetes risk using Indian Diabetes Risk Score among medical students at a medical college in Telangana, India. JOURNAL OF DIABETOLOGY 2021. [DOI: 10.4103/jod.jod_82_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
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14
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Maternal plasma metabolic markers of neonatal adiposity and associated maternal characteristics: The GUSTO study. Sci Rep 2020; 10:9422. [PMID: 32523012 PMCID: PMC7287081 DOI: 10.1038/s41598-020-66026-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/12/2020] [Indexed: 11/23/2022] Open
Abstract
Infant adiposity may be related to later metabolic health. Maternal metabolite profiling reflects both genetic and environmental influences and allows elucidation of metabolic pathways associated with infant adiposity. In this multi-ethnic Asian cohort, we aimed to (i) identify maternal plasma metabolites associated with infant adiposity and other birth outcomes and (ii) investigate the maternal characteristics associated with those metabolites. In 940 mother-offspring pairs, we performed gas chromatography-mass spectrometry and identified 134 metabolites in maternal fasting plasma at 26–28 weeks of gestation. At birth, neonatal triceps and subscapular skinfold thicknesses were measured by trained research personnel, while weight and length measures were abstracted from delivery records. Gestational age was estimated from first-trimester dating ultrasound. Associations were assessed by multivariable linear regression, with p-values corrected using the Benjamini-Hochberg approach. At a false discovery rate of 5%, we observed associations between 28 metabolites and neonatal sum of skinfold thicknesses (13 amino acid-related, 4 non-esterified fatty acids, 6 xenobiotics, and 5 unknown compounds). Few associations were observed with gestational duration, birth weight, or birth length. Maternal ethnicity, pre-pregnancy BMI, and diet quality during pregnancy had the strongest associations with the specific metabolome related to infant adiposity. Further studies are warranted to replicate our findings and to understand the underlying mechanisms.
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15
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Sundström-Poromaa I, Thu WPP, Kramer MS, Logan S, Cauley JA, Yong EL. Risk factors for insulin resistance in midlife Singaporean women. Maturitas 2020; 137:50-56. [PMID: 32498937 DOI: 10.1016/j.maturitas.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To understand the extent to which risk factors for insulin resistance are mediated by body mass index (BMI), visceral adipose tissue (VAT), physical activity and performance, and the inflammatory markers interleukin (IL)-6, tumor necrosis factor (TNF)- α, and high-sensitivity C-reactive protein (hs-CRP). STUDY DESIGN A wide range of socio-demographic characteristics of Chinese, Malay and Indian women attending routine gynecologic care in Singapore were prospectively collected. Physical performance was objectively measured by hand grip strength and the Short Physical Performance Battery. Percent VAT was determined by dual-energy X-ray absorptiometry. Fasting serum concentrations of glucose, insulin, IL-6, TNF- α, and hs-CRP were measured. MAIN OUTCOME MEASURE was insulin resistance, expressed as the homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS 1159 women were analyzed, mean age 56.3 (range 45-69) years, comprising women of Chinese (84.0%), Indian (10.2%), and Malay (5.7%) ethnic origins. The adjusted mean differences for obesity (0.66, 95% CI 0.32-1.00), VAT area in the highest vs lowest tertile (1.03, 95% CI 0.73-1.34), low physical performance (0.63, 95% CI 0.05-1.24), and highest vs lowest tertile of TNF- α (0.35, 95% CI 0.13-0.57) were independently associated with HOMA-IR. Women of Malay and Indian ethnicity had higher crude HOMA-IR than Chinese women. However, after adjustment for obesity, VAT, physical performance, and TNF- α, no differences in mean HOMA-IR remained, when comparing Chinese women with those of Malay ethnicity (0.27, 95% CI -0.12 to 0.66) and with those of Indian ethnicity (0.30, 95% CI -0.01 to 0.66). CONCLUSIONS Insulin resistance was independently associated with obesity, high VAT, low physical performance, and high levels of TNF- α in midlife Singaporean women. These variables entirely explained the significant differences in insulin resistance between women of Chinese, Malay and Indian ethnicity.
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Affiliation(s)
- Inger Sundström-Poromaa
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228; Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Win Pa Pa Thu
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228
| | - Michael S Kramer
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228; Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, QC H3G 1Y6, Canada
| | - Susan Logan
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, United States
| | - Eu-Leong Yong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore 119228.
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Liew LQ, Teo WW, Seet E, Lean LL, Paramasivan A, Tan J, Lim I, Wang J, Ti LK. Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery - a retrospective cohort study. BMC Surg 2020; 20:11. [PMID: 31931774 PMCID: PMC6956490 DOI: 10.1186/s12893-019-0654-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While short-term perioperative outcomes have been well studied in Western surgical populations, the aim of this study is to look at the one-year perioperative mortality and its associated factors in an Asian surgical population after non-cardiac surgery. METHODS A retrospective cohort study of 2163 patients aged above 45 undergoing non-cardiac surgery in a university-affiliated tertiary hospital from January to July 2015 was performed. Relevant demographic, clinical and surgical data were analysed to elicit their relationship to mortality at one year after surgery. A univariate analysis was first performed to identify significant variables with p-values ≤ 0.2, which were then analysed using Firth multiple logistic regression to calculate the adjusted odds ratio. RESULTS The one-year mortality in our surgical population was 5.9%. The significant factors that increased one-year mortality include smoking (adjusted OR 2.17 (1.02-4.45), p = 0.044), anaemia (adjusted OR 1.32 (1.16-1.47), p < 0.001, for every 1 g/dL drop in haemoglobin level), lower BMI (adjusted OR 0.93 (0.87-0.98), p = 0.005, for every 1 point increase in BMI), Malay and Indian ethnicity (adjusted OR 2.68 (1.53-4.65), p = 0.001), peripheral vascular disease (adjusted OR 4.21 (1.62-10.38), p = 0.004), advanced age (adjusted OR 1.04 (1.01-1.06), p = 0.004, for every one year increase in age), emergency surgery (adjusted OR 2.26 (1.29-3.15), p = 0.005) and malignancy (adjusted OR 3.20 (1.85-5.52), p < 0.001). CONCLUSIONS Our study shows that modifiable risk factors such as malnutrition, anaemia and smoking which affect short term mortality extend beyond the immediate perioperative period into longer term outcomes. Identification and optimization of this subset of patients are therefore vital. Further similar large studies should be done to develop a risk scoring system for post-operative long-term outcomes. This would aid clinicians in risk stratification, counselling and surgical planning, which will help in patients' decision making and care planning.
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Affiliation(s)
- Lydia Q. Liew
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Wei Wei Teo
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Edwin Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828 Singapore
| | - Lyn Li Lean
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Ambika Paramasivan
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Joanna Tan
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Irene Lim
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
| | - Jiexun Wang
- Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828 Singapore
| | - Lian Kah Ti
- Department of Anaesthesia, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074 Singapore
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Chen CYA, Goh KK, Chen CH, Lu ML. The Role of Adiponectin in the Pathogenesis of Metabolic Disturbances in Patients With Schizophrenia. Front Psychiatry 2020; 11:605124. [PMID: 33551872 PMCID: PMC7854923 DOI: 10.3389/fpsyt.2020.605124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
Antipsychotic-induced metabolic disturbance is a common adverse event occurring in patients treated with antipsychotic drugs. The mechanisms underlying metabolic dysregulation are complex, involving various neurochemical and hormonal systems, the interaction of genetic and lifestyle risk factors, and the antipsychotic drug prescribed. Recently, there has been increasing interest in the relationship between antipsychotic-induced metabolic disturbances and body weight regulatory hormones such as adiponectin. Adiponectin, an adipocyte-derived protein related to insulin sensitivity, weight gain, and anti-inflammation, has attracted great attention because of its potential role of being a biomarker to predict cardiovascular and metabolic diseases. Previous studies regarding the effects of antipsychotics on blood adiponectin levels have shown controversial results. Several factors might contribute to those inconsistent results, including different antipsychotic drugs, duration of antipsychotic exposure, age, sex, and ethnicity. Here we summarize the existing evidence on the link between blood adiponectin levels and metabolic disturbances related to antipsychotic drugs in patients with schizophrenia. We further discuss the effects of individual antipsychotics, patients' gender, ethnicity, age, and treatment duration on those relationships. We propose that olanzapine and clozapine might have a time-dependent biphasic effect on blood adiponectin levels in patients with schizophrenia.
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Affiliation(s)
- Cynthia Yi-An Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kah Kheng Goh
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chun-Hsin Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Lee PC, Tham KW, Ganguly S, Tan HC, Eng AKH, Dixon JB. Ethnicity Does Not Influence Glycemic Outcomes or Diabetes Remission After Sleeve Gastrectomy or Gastric Bypass in a Multiethnic Asian Cohort. Obes Surg 2019; 28:1511-1518. [PMID: 29280058 DOI: 10.1007/s11695-017-3050-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND In Asia, metabolic-bariatric surgery (MBS) rates have grown rapidly in parallel with rising prevalence of obesity and type 2 diabetes (T2D). OBJECTIVE The objective of this study was to identify factors that influence glycemic outcomes and diabetes remission 12 months after sleeve gastrectomy (SG) or gastric bypass (GB) in a multiethnic Asian cohort. SETTING The study's setting was in a tertiary hospital in Singapore. METHODS Data from 145 T2D patients who had SG (37%) or GB (63%) and at least 1-year follow-up were analyzed. Diabetes remission was defined as hemoglobin A1c ≤ 6.0% without diabetes medications. Analysis involved binary logistic regression to identify predictors and general linear regression for variables associated with glycemic improvement after surgery. RESULTS Baseline parameters are as follows: BMI 40.0 ± 7.6 kg/m2, A1c 8.4 ± 1.6%, diabetes duration 9.3 years, ethnic composition: Chinese (51.7%), Malay (23.4%), Indian (20.7%), Others (4.1%). 55.9% achieved diabetes remission at 1 year. Baseline A1c, baseline BMI, and diabetes duration were significant pre-operative factors for remission (cumulative R 2 = 0.334). At 12 months, percentage weight loss was similar after SG (24.1 ± 7.4%) and GB (25.4 ± 7.4%, p = 0.31). Greater A1c decrease was seen with GB compared to SG (2.7 ± 1.6 vs 2.0 ± 1.5%, p = 0.006), significant even after adjustment for weight loss, age, BMI, baseline A1c, and diabetes duration (p = 0.033). Weight loss at 12 months also correlated independently with A1c reduction. Ethnicity did not influence weight loss, diabetes remission, or glycemic control after MBS. CONCLUSION Baseline A1c, baseline BMI, and diabetes duration independently predict diabetes remission after MBS. GB is more effective in controlling T2D compared to SG despite similar weight loss, whereas ethnicity does not play a significant role in the multiethnic Asian cohort.
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Affiliation(s)
- Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, 20 College Rd, Singapore, 169856, Singapore.
| | - Kwang Wei Tham
- Department of Endocrinology, Singapore General Hospital, 20 College Rd, Singapore, 169856, Singapore
| | - Sonali Ganguly
- Department of Endocrinology, Singapore General Hospital, 20 College Rd, Singapore, 169856, Singapore
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, 20 College Rd, Singapore, 169856, Singapore
| | - Alvin Kim Hock Eng
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - John B Dixon
- Clinical Obesity Research, Baker Heart and Diabetes Institute, Melbourne, Australia
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Msollo SS, Martin HD, Mwanri AW, Petrucka P. Prevalence of hyperglycemia in pregnancy and influence of body fat on development of hyperglycemia in pregnancy among pregnant women in urban areas of Arusha region, Tanzania. BMC Pregnancy Childbirth 2019; 19:315. [PMID: 31455272 PMCID: PMC6712730 DOI: 10.1186/s12884-019-2463-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Hyperglycemia in pregnancy is a medical condition resulting from either pre-existing diabetes or insulin resistance developed during pregnancy. This study aimed to determine the prevalence of hyperglycemia in pregnancy and influence of body fat percentage and other determinants on developing hyperglycemia in pregnancy among women in Arusha District, Tanzania. Methods A cross–sectional study was conducted between March and December 2018 at selected health facilities in Arusha District involving 468 pregnant women who were not known to have diabetes before pregnancy. Blood glucose was tested by Gluco-Plus™ using the World Health Organization criteria at fasting and 2 h after consuming 75 g of glucose dissolved in 300 ml of water. Body fat was measured using a bioelectric impedance analyzer, mid-upper arm circumference using a regulated tape, weight using SECA™, blood pressure using a GT-868UF Geratherm™ machine, and height using a stadiometer. Demographic and maternal characteristics were collected through face to face interviews using a structured questionnaire. Results The participants’ mean age was 28 years (SD ± 6), mid-upper arm circumference 27 cm (SD ± 3.7), body fat 33.72% (SD ± 7.2) and pre-pregnancy body mass index 25.6 kg/m2 (SD ± 5.5). One-third of participants had mid-upper arm circumferences ≥28 cm with 25% being overweight and 22.7% obese before pregnancy. Prevalence of hyperglycemia in pregnancy was 16.2% (n = 76) of which 13% had gestational diabetes and 3.2% diabetes in pregnancy. Hyperglycemia in pregnancy was significantly associated with body fat percentage (AOR 1.33; 95% CI: 1.22–1.44), family history of Type 2 diabetes mellitus (AOR 6.95, 95% CI: 3.11–15.55), previous delivery of babies ≥4 kg (AOR 2.3, 95% CI: 1.00–5.28), mid-upper arm circumference ≥ 28 cm (AOR 1.2, 95% CI: 1.09–1.32), and Type 2 diabetes mellitus symptoms (AOR 2.83, 95% CI: 1.53–6.92). Conclusion The prevalence of hyperglycemia in pregnancy was high, particularly among women with history of delivering ≥4-kg babies, increased body fat, mid-upper arm circumference, symptoms and/or family history of Type 2 diabetes mellitus. These findings identify opportunities to further explore the utility of body fat percentage and other determinants for rapid screening and management of hyperglycemia in pregnancy.
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Affiliation(s)
- Safiness Simon Msollo
- Department of Food Biotechnology and Nutritional Sciences in School of Life Sciences, Nelson Mandela African Institution of Science and Technology, P. O. Box 477, Arusha, Tanzania. .,Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Haikael David Martin
- Department of Food Biotechnology and Nutritional Sciences in School of Life Sciences, Nelson Mandela African Institution of Science and Technology, P. O. Box 477, Arusha, Tanzania
| | - Akwilina Wendelin Mwanri
- Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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20
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Lyu YS, Kim SY, Bae HY, Kim JH. Prevalence and Risk Factors for Undiagnosed Glucose Intolerance Status in Apparently Healthy Young Adults Aged <40 Years: The Korean National Health and Nutrition Examination Survey 2014-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132393. [PMID: 31284480 PMCID: PMC6651181 DOI: 10.3390/ijerph16132393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/21/2023]
Abstract
Background: Early-onset diabetes results in longer lifetime hyperglycemic exposure that consequently leads to earlier chronic diabetes complications and premature death. The aim of this study was to quantify the prevalence and risk factors of undiagnosed diabetes and undiagnosed prediabetes in apparently healthy young adults aged <40 years. Methods: This study used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey conducted by the Korean Ministry of Health and Welfare from 2014 to 2017. A total of 4442 apparently healthy young adults enrolled in this study. Multivariate logistic regression analyses were conducted separately to evaluate associated risk factors with undiagnosed diabetes and undiagnosed prediabetes in groups stratified by sex. Results: The prevalence of undiagnosed diabetes and undiagnosed prediabetes was 1.2% and 25.0%, respectively. Obesity (body mass index ≥ 30.0 kg/m2) was a significant risk factor of undiagnosed diabetes regardless of sex (men, odds ratio (OR): 9.808, 95% confidence interval (CI): 1.619–59.412; women, OR: 7.719, 95% CI: 1.332–44.747). Family history of diabetes was significantly associated with undiagnosed diabetes (OR: 3.407, 95% CI: 1.224–9.481) in women only. Increased age, obesity status, and family history of diabetes were significant risk factors for undiagnosed prediabetes. Alcohol consumption was found to be negatively associated with undiagnosed prediabetes in women. Conclusions: Increased attention and implementation of precise strategies for identifying young adults at high risk for undiagnosed diabetes would allow for increased wellbeing as well as reduced healthcare burdens associated with diabetes.
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Affiliation(s)
- Young Sang Lyu
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea
| | - Sang Yong Kim
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea
| | - Hak Yeon Bae
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea
| | - Jin Hwa Kim
- Department of Endocrinology and Metabolism, Chosun University Hospital, Gwangju 61453, Korea.
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21
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Ahn N, Baumeister SE, Amann U, Rathmann W, Peters A, Huth C, Thorand B, Meisinger C. Visceral adiposity index (VAI), lipid accumulation product (LAP), and product of triglycerides and glucose (TyG) to discriminate prediabetes and diabetes. Sci Rep 2019; 9:9693. [PMID: 31273286 PMCID: PMC6609728 DOI: 10.1038/s41598-019-46187-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/20/2019] [Indexed: 11/08/2022] Open
Abstract
The present study evaluated the ability of the visceral adiposity index (VAI), the lipid accumulation product (LAP), and product of triglycerides and glucose (TyG), three novel, insulin resistance-related markers, to discriminate prediabetes/diabetes in the general German population. Altogether 2,045 Germans (31-72 years, 53.3% women) without known diabetes and a history of Myocardial Infarction (MI)/stroke from the Cooperative Health Research in the Region of Augsburg (KORA) F4 Study were eligible. The discriminatory accuracy of the markers for oral glucose tolerance test (OGTT)-defined prediabetes/diabetes according to the American Diabetes Association (ADA) criteria was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). The Youden Index (YI) was used to determine optimal cut-off values, and a non-parametric ROC regression was used to examine whether the discriminatory accuracy varied by sex and age. 365 men (38.2%) and 257 women (23.6%) were newly diagnosed with prediabetes/diabetes. AUCs for TyG, LAP and VAI were 0.762 (95% CI 0.740-0.784), 0.743 (95% CI 0.720-0.765), and 0.687 (95% CI 0.662-0.712), respectively. The optimal cut-off values for the LAP and TyG were 56.70 and 8.75 in men, and 30.40 and 8.53 in women. In conclusion, TyG and LAP provide good discrimination of persons with prediabetes/diabetes.
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Affiliation(s)
- Nayeon Ahn
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany.
- The Institute of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Sebastian E Baumeister
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Ute Amann
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Cornelia Huth
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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22
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Gurung RL, M Y, Liu S, Liu JJ, Chan SM, Moh MC, Ang K, Tang WE, Sum CF, Tavintharan S, Lim SC. Ethnic disparities in relationships of obesity indices with telomere length in Asians with type 2 diabetes. J Diabetes 2019; 11:386-393. [PMID: 30281200 DOI: 10.1111/1753-0407.12864] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/20/2018] [Accepted: 09/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Obesity and shorter telomeres increase the risk for diabetes complications and mortality. However, the relationship between obesity and telomere length in diverse Asian populations with type 2 diabetes (T2D) is not well understood. This study examined the association of baseline and changes in obesity indices with telomere length in multiethnic Asian populations with T2D. METHODS Leukocyte telomere length (LTL) was measured by quantitative polymerase chain reaction in the SMART2D cohort (n = 1431 at baseline, n = 1039 after 3.2 years median follow-up). Associations between obesity indices and LTL were assessed by linear regression. RESULTS Compared with Chinese, LTL was longer in Malays (P < 0.0001) and similar in Indians. Cross-sectionally, body mass index (BMI)-adjusted (residual) visceral fat area (VFA; β = -0.004, P = 0.006), and waist-to-hip ratio (β = -1.95, P = 0.030) were significantly associated with LTL in Chinese but not in Malays and Indians. Changes in BMI (r = -0.080; P = 0.053) and VFA (r = -0.126; P = 0.002) were inversely correlated with changes in LTL only in Chinese. Furthermore, in Chinese, 1-SD incremental changes in BMI (β = -0.070; P = 0.040) and VFA (β = -0.088, P = 0.028) were significantly associated with larger telomere attrition, independent of age, sex, diabetes condition, baseline LTL, obesity, and inflammation markers. CONCLUSIONS Three-year changes in BMI and VFA were associated with telomere dynamics in Chinese but not in Malays and Indians with T2D. Reducing obesity may reduce the risk of diabetes complications associated with shorter LTL in the Chinese population.
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Affiliation(s)
| | - Yiamunaa M
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Sylvia Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Jian-Jun Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Si Min Chan
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Mei Chung Moh
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Keven Ang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | | | | | | | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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23
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Choi H, Koh HWL, Zhou L, Cheng H, Loh TP, Parvaresh Rizi E, Toh SA, Ronnett GV, Huang BE, Khoo CM. Plasma Protein and MicroRNA Biomarkers of Insulin Resistance: A Network-Based Integrative -Omics Analysis. Front Physiol 2019; 10:379. [PMID: 31024340 PMCID: PMC6460474 DOI: 10.3389/fphys.2019.00379] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/19/2019] [Indexed: 12/20/2022] Open
Abstract
Although insulin resistance (IR) is a key pathophysiologic condition underlying various metabolic disorders, impaired cellular glucose uptake is one of many manifestations of metabolic derangements in the human body. To study the systems-wide molecular changes associated with obesity-dependent IR, we integrated information on plasma proteins and microRNAs in eight obese insulin-resistant (OIR, HOMA-IR > 2.5) and nine lean insulin-sensitive (LIS, HOMA-IR < 1.0) normoglycemic males. Of 374 circulating miRNAs we profiled, 65 species increased and 73 species decreased in the OIR compared to the LIS subjects, suggesting that the overall balance of the miRNA secretome is shifted in the OIR subjects. We also observed that 40 plasma proteins increased and 4 plasma proteins decreased in the OIR subjects compared to the LIS subjects, and most proteins are involved in metabolic and endocytic functions. We used an integrative -omics analysis framework called iOmicsPASS to link differentially regulated miRNAs with their target genes on the TargetScan map and the human protein interactome. Combined with tissue of origin information, the integrative analysis allowed us to nominate obesity-dependent and obesity-independent protein markers, along with potential sites of post-transcriptional regulation by some of the miRNAs. We also observed the changes in each -omics platform that are not linked by the TargetScan map, suggesting that proteins and microRNAs provide orthogonal information for the progression of OIR. In summary, our integrative analysis provides a network of elevated plasma markers of OIR and a global shift of microRNA secretome composition in the blood plasma.
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Affiliation(s)
- Hyungwon Choi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Institute of Molecular and Cell Biology, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Hiromi W L Koh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - He Cheng
- MiRXES, Pte. Ltd., Singapore, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Ehsan Parvaresh Rizi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sue Anne Toh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gabriele V Ronnett
- Janssen Research & Development US, World Without Disease Accelerator, Spring House, NJ, United States
| | - Bevan E Huang
- Janssen Research & Development US, South San Francisco, CA, United States
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Yu JN, Kim SK, Sagong J, Ryu SH, Chae B. Identification of microsatellite markers and their application in yellow catfish ( Pseudobagrus fulvidraco Richardson, 1846) population genetics of Korea. J Genet 2019; 98:2. [PMID: 30945683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Microsatellite markers from a fresh water yellow catfish, Pseudobagrus fulvidraco, were developed by whole-genome sequencing in the Ion S5 system. Of the 40 chosen sets of microsatellite markers, with tetra-repeat and penta-repeat motifs, from a total 19,743 sequence, only 13 markers were successfully applied in 78 individual fish sampled to detect genomic variability from four natural populations of Korea. On an average, the number of alleles per marker was 6.7. The observed heterozygosity varied from 0.048 to 0.810. Twelve microsatellite markers conformed to Hardy-Weinberg equilibrium and none exhibited significant linkage disequilibrium. In yellow catfish, genetic differentiation among four natural populations was further supported by FST (P < 0.05) and STRUCTURE analysis. The microsatellite markers identified could facilitate genetic diversity and population structure studies and thus aid in conservation of the yellow catfish.
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Affiliation(s)
- Jeong-Nam Yu
- Nakdonggang National Institute of Biological Resources, 137, Donam 2-gil, Sangju-si, Gyeongsangbuk-do 37242, South Korea.
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Prasad G, Giri AK, Basu A, Tandon N, Bharadwaj D. Genomewide association study for C-reactive protein in Indians replicates known associations of common variants. J Genet 2019. [DOI: 10.1007/s12041-019-1065-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Pek SLT, Cheng AKS, Lin MX, Wong MS, Chan EZL, Moh AMC, Sum CF, Lim SC, Tavintharan S. Association of circulating proinflammatory marker, leucine-rich-α2-glycoprotein (LRG1), following metabolic/bariatric surgery. Diabetes Metab Res Rev 2018; 34:e3029. [PMID: 29883055 DOI: 10.1002/dmrr.3029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obesity confers substantial excess risk for morbidity and mortality, especially for type 2 diabetes (T2D). Leucine-rich-α2-glycoprotein 1 (LRG1), a novel proinflammatory factor, was recently reported to be higher in patients with T2D with complications of peripheral arterial disease. Association of LRG1, obesity, and weight loss is unknown. We examined whether plasma LRG1 is associated with obesity in health screening participants and if it predicts future weight loss in morbidly obese patients after metabolic/bariatric surgery. METHODS Cohort 1 was a cross-sectional study from a Health Screening program (n = 616) in a tertiary hospital. Cohort 2 was a prospective study of morbidly obese patients (n = 231) who underwent metabolic/bariatric surgery with follow-up weight measurements. Anthropometric data, baseline fasting glucose, plasma adiponectin, high sensitivity C-reactive protein (HsCRP), and LRG1 were measured. Postsurgery blood, after metabolic/bariatric surgery, were available for LRG1and HsCRP measurements in 57 patients. RESULTS In the group with highest tertile of LRG1, body mass index (BMI), waist circumference, and HsCRP were significantly higher, while total cholesterol, high-density lipoprotein, low-density lipoprotein, and adiponectin were lower than tertiles 1 and 2. Generalized linear model analysis showed that female gender (P < .0001), non-Chinese ethnicity (P < .019), and higher HsCRP (P < .0001) levels were independent and significant determinants of higher plasma LRG1 levels. After adjustment for age, gender, ethnicity, and baseline BMI, female gender (P = .020), higher presurgery BMI (P = .001), and lower presurgery LRG1 (P = .002) remained statistically significant predictors for greater weight loss. Plasma LRG1 increased significantly [from 28.2 (21.9-36.8) to 34.9 (22.6-49.5)] μg/mL (P = .003) within 1.5 months, after metabolic/bariatric surgery. CONCLUSIONS Our study demonstrates that LRG1 level is positively associated with obesity and a lower level of plasma LRG1 predicts weight loss in metabolic/bariatric surgery. Our novel findings suggest LRG1, itself or in combination with other known factors, is a potential biomarker of inflammation and obesity.
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Affiliation(s)
| | | | | | - Moh Sim Wong
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore
| | | | | | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Singapore
- Division of Endocrinology, Khoo Teck Puat Hospital, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
- Diabetes Centre, Admiralty Medical Centre, Singapore
- Division of Endocrinology, Khoo Teck Puat Hospital, Singapore
- Saw Swee Hock School of Public Health, Singapore
| | - Subramaniam Tavintharan
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
- Diabetes Centre, Admiralty Medical Centre, Singapore
- Division of Endocrinology, Khoo Teck Puat Hospital, Singapore
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Chen Y, Zhang XP, Yuan J, Cai B, Wang XL, Wu XL, Zhang YH, Zhang XY, Yin T, Zhu XH, Gu YJ, Cui SW, Lu ZQ, Li XY. Association of body mass index and age with incident diabetes in Chinese adults: a population-based cohort study. BMJ Open 2018; 8:e021768. [PMID: 30269064 PMCID: PMC6169758 DOI: 10.1136/bmjopen-2018-021768] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/03/2018] [Accepted: 07/25/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Type 2 diabetes mellitus is increasing in young adults, and greater adiposity is considered a major risk factor. However, whether there is an association between obesity and diabetes and how this might be impacted by age is not clear. Therefore, we investigated the association between body mass index (BMI) and diabetes across a wide range of age groups (20-30, 30-40, 40-50, 50-60, 60-70 and ≥70 years old). DESIGN We performed a retrospective cohort study using healthy screening programme data. SETTING A total of 211 833 adult Chinese persons >20 years old across 32 sites and 11 cities in China (Shanghai, Beijing, Nanjing, Suzhou, Shenzhen, Changzhou, Chengdu, Guangzhou, Hefei, Wuhan, Nantong) were selected for the study; these persons were free of diabetes at baseline. PRIMARY AND SECONDARY OUTCOME MEASURES Fasting plasma glucose levels were measured and information regarding the history of diabetes was collected at each visit. Diabetes was diagnosed as fasting plasma glucose ≥7.00 mmol/L and/or self-reported diabetes. Patients were censored at the date of diagnosis or the final visit, whichever came first. RESULTS With a median follow-up of 3.1 years, 4174 of the 211 833 participants developed diabetes, with an age-adjusted incidence rate of 7.35 per 1000 persons. The risk of incident diabetes increased proportionally with increasing baseline BMI values, with a 23% increased risk of incident diabetes with each kg/m2 increase in BMI (95% CI 1.22 to 1.24). Across all age groups, there was a linear association between BMI and the risk of incident diabetes, although there was a stronger association between BMI and incident diabetes in the younger age groups (age×BMI interaction, p<0.0001). CONCLUSIONS An increased BMI is also independently associated with a higher risk of developing diabetes in young adults and the effects of BMI on incident diabetes were accentuated in younger adults.
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Affiliation(s)
- Ying Chen
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Ping Zhang
- Department of Health Examination, Rich Healthcare Group, Shanghai, China
| | - Jie Yuan
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
| | - Bo Cai
- Nantong Center for Chronic and Noncommunicable Disease Control and Prevention, Center for Disease Control and Prevention, Nantong, China
| | - Xiao-Li Wang
- Department of Health Examination, Rich Healthcare Group, Shanghai, China
| | - Xiao-Li Wu
- Department of Health Examination, Rich Healthcare Group, Shanghai, China
| | - Yue-Hua Zhang
- Department of Health Examination, Rich Healthcare Group, Shanghai, China
| | - Xiao-Yi Zhang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
| | - Tong Yin
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiao-Hui Zhu
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
| | - Yun-Juan Gu
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
| | - Shi-Wei Cui
- Department of Endocrinology and Metabolism, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhi-Qiang Lu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Ying Li
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
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28
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Zhang R, Dong SY, Wang F, Ma C, Zhao XL, Zeng Q, Fei A. Associations between Body Composition Indices and Metabolic Disorders in Chinese Adults: A Cross-Sectional Observational Study. Chin Med J (Engl) 2018; 131:379-388. [PMID: 29451141 PMCID: PMC5830821 DOI: 10.4103/0366-6999.225059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Obesity induces dyslipidemia, hypertension, glucose intolerance, and inflammatory state, which results in atherogenic processes, diabetes, and cardiovascular disease. We usually use body composition indices, such as body mass index (BMI), body fat percentage (BFP), waist circumference-height ratio (WHtR), and waist-hip ratio (WHR) to reflect the obesity. The aim of this large population-based cross-sectional study was to investigate the associations between body composition indices and metabolic parameters in Chinese adults. Methods A total of 12,018 Chinese adults were included. Body composition indices, such as BMI, BFP, WHtR, and WHR, and metabolic parameters, such as systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), fasting blood glucose (FBG), 2 h postprandial blood glucose (2h PBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), insulin resistance index (HOMA-IR), high-sensitivity C-reactive protein (hs-CRP), and white blood cell count (WBC), were measured and analyzed. All analyses were stratified by gender. Results All body composition indices and metabolic parameters except 2h PBG differed significantly between males and females (all P < 0.001). BMI was positively associated with SBP, DBP, LDL-C, TC, TG, FBG, 2h PBG, HbA1c, FINS, HOMA-IR, hs-CRP, and WBC, and inversely associated with HDL-C; similar relationships were identified between the metabolic parameters and BFP, WHtR, and WHR. In the multivariate analysis, the odds of impaired glucose regulation, dyslipidemia, insulin resistance, and increased hs-CRP were 1.36, 1.92, 3.44, and 1.27 times greater in the overweight group than those in the normal weight group, respectively, and 1.66, 3.26, 7.53, and 1.70 times greater in the obese group than those in the normal weight group, respectively. The odds of dyslipidemia and hs-CRP were 1.29 and 1.38 times greater in the BFP ≥28.0% group than in the BFP <28.0% group, respectively. The odds of dyslipidemia, HOMA-IR, and hs-CRP were 1.55, 1.26, and 1.48 times greater in the WHtR ≥0.96 group than in the WHtR <0.96 group, respectively. Among males, the odds of HOMA-IR were 1.46 times greater in the WHR ≥0.54 group than in the WHR <0.54 group. Similar results were observed in females. Conclusions This study identified positive associations between all evaluated body composition indices and metabolic parameters in Chinese adults. Among the body composition indices, BMI predicted four of the five evaluated metabolic disorders in both gender groups.
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Affiliation(s)
- Rong Zhang
- International Medical Center, Health Management Institute, Chinese PLA General Hospital, Beijing 100853; Department of Cardiology, Chinese Navy General Hospital, Beijing 100048, China
| | - Sheng-Yong Dong
- Department of Healthcare, Agency for Offices Administration of PLA, Beijing 100048, China
| | - Fei Wang
- International Medical Center, Health Management Institute, Chinese PLA General Hospital, Beijing 100853, China
| | - Cong Ma
- International Medical Center, Health Management Institute, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiao-Lan Zhao
- Department of Health Management Center, Health Management Institute, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Qiang Zeng
- International Medical Center, Health Management Institute, Chinese PLA General Hospital, Beijing 100853, China
| | - Ao Fei
- Navy Institutional Organization, Beijing 100841, China
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Huri HZ, Huey CC, Mustafa N, Mohamad NF, Kamalden TA. Association of glycemic control with progression of diabetic retinopathy in type 2 diabetes mellitus patients in Malaysia. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000217484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hasniza Zaman Huri
- University of Malaya, Malaysia; University Malaya Medical Centre, Malaysia
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Radwan H, Hashim M, Shaker Obaid R, Hasan H, Naja F, Al Ghazal H, Jan Jan Mohamed H, Rizk R, Al Hilali M, Rayess R, Izzaldin G. The Mother-Infant Study Cohort (MISC): Methodology, challenges, and baseline characteristics. PLoS One 2018; 13:e0198278. [PMID: 29851999 PMCID: PMC5978878 DOI: 10.1371/journal.pone.0198278] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/16/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The United Arab Emirates (UAE) exhibits alarming high prevalence of Non-Communicable Diseases (NCDs) and their risk factors. Emerging evidence highlighted the role of maternal and early child nutrition in preventing later-onset NCDs. The objectives of this article are to describe the design and methodology of the first Mother and Infant Study Cohort (MISC) in UAE; present the baseline demographic characteristics of the study participants; and discuss the challenges of the cohort and their respective responding strategies. METHODS The MISC is an ongoing two-year prospective cohort study which recruited Arab pregnant women in their third trimester from prenatal clinics in Dubai, Sharjah and Ajman. Participants will be interviewed six times (once during pregnancy, at delivery, and at 2, 6, 12 and 24months postpartum). Perinatal information is obtained from hospital records. Collected data include socio-demographic characteristics, lifestyle, dietary intake and anthropometry; infant feeding practices, cognitive development; along with maternal and infant blood profile and breast milk profile. RESULTS The preliminary results reported that 256 completed baseline assessment (mean age: 30.5±6.0 years; 76.6% multiparous; about 60% were either overweight or obese before pregnancy). The prevalence of gestational diabetes was 19.2%. Upon delivery, 208 women-infant pairs were retained (mean gestational age: 38.5±1.5 weeks; 33.3% caesarean section delivery; 5.3% low birthweight; 5.7% macrosomic deliveries). Besides participant retention, the main encountered challenges pertained to cultural complexity, underestimation the necessary start-up time, staff, and costs, and biochemical data collection. CONCLUSIONS Despite numerous methodological, logistical and sociocultural challenges, satisfactory follow-up rates are recorded. Strategies addressing challenges are documented, providing information for planning and implementing future birth cohort studies locally and internationally.
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Affiliation(s)
- Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Mona Hashim
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Reyad Shaker Obaid
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hayder Hasan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Farah Naja
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hessa Al Ghazal
- Family Health Promotion Center, Sharjah, United Arab Emirates
| | | | - Rana Rizk
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie (INSPECT-LB), The Lebanese University, Beirut, Lebanon
| | - Marwa Al Hilali
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Rana Rayess
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Ghamra Izzaldin
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences(RIMHS), University of Sharjah, Sharjah, United Arab Emirates
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Tan HC, Yew TW, Chacko S, Tai ES, Kovalik JP, Ching J, Myo Thant S, Khoo CM. Comprehensive assessment of insulin resistance in non-obese Asian Indian and Chinese men. J Diabetes Investig 2018; 9:1296-1303. [PMID: 29582571 PMCID: PMC6215953 DOI: 10.1111/jdi.12844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/08/2018] [Accepted: 03/18/2018] [Indexed: 11/26/2022] Open
Abstract
Aims/Introduction Indian individuals are more insulin resistant (IR) than Chinese individuals, even among those with a non‐obese body mass index (BMI). However, BMI often underestimates body fat in Indian individuals, and it remains unclear whether Indians would remain more IR than Chinese individuals when both BMI and body fat are equally matched. Materials and Methods Using the hyperinsulinemic‐euglycemic clamp with stable‐isotope infusion, we comprehensively assessed IR between 13 non‐obese Indian men with 13 Chinese men matched for age, BMI and body fat. We further compared the differences in insulin metabolic clearance rate (MCR) between the two groups and its relationship with various metabolic parameters. The response of lipid and amino acid metabolism to insulin stimulation was also evaluated using metabolomic profiling. Results The rates of endogenous glucose production during fasting were similar, and endogenous glucose production was completely suppressed during insulin clamp for both ethnic groups. Glucose disappearance during insulin clamp was also similar between the two groups, even after accounting for differences in insulin concentration. Metabolomic profiles of amino acids and various acylcarnitines were similar during both fasting and insulin clamp. However, plasma insulin during clamp was significantly higher in Indian men, indicating that insulin MCR was lower. Insulin MCR correlated significantly with total adiposity and skeletal muscle insulin sensitivity. Conclusion When equally matched for body fat, non‐obese Indian men had similar skeletal muscle insulin sensitivity and endogenous glucose production to Chinese men. The effects of insulin on lipid and amino acid metabolism were also similar. Low insulin MCR is associated with greater adiposity and lower skeletal muscle insulin sensitivity.
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Affiliation(s)
- Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Tong Wei Yew
- Department of Medicine, National University Health System, Singapore
| | - Shaji Chacko
- Children's Nutrition and Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - E Shyong Tai
- Department of Medicine, National University Health System, Singapore
| | - Jean-Paul Kovalik
- Cardiovascular Metabolic Program, DUKE-NUS Graduate Medical School, Singapore
| | - Jianhong Ching
- Cardiovascular Metabolic Program, DUKE-NUS Graduate Medical School, Singapore
| | - Sandi Myo Thant
- Department of Medicine, National University Health System, Singapore
| | - Chin Meng Khoo
- Department of Medicine, National University Health System, Singapore
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Tan KHX, Tan LWL, Sim X, Tai ES, Lee JJM, Chia KS, van Dam RM. Cohort Profile: The Singapore Multi-Ethnic Cohort (MEC) study. Int J Epidemiol 2018; 47:699-699j. [PMID: 29452397 DOI: 10.1093/ije/dyy014] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/15/2018] [Accepted: 01/25/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | - E Shyong Tai
- Saw Swee Hock School of Public Health and.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | | | | | - Rob M van Dam
- Saw Swee Hock School of Public Health and.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
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Meshkini M, Alaei-Shahmiri F, Mamotte C, Dantas J. Ethnic Variations in Adiponectin Levels and Its Association with Age, Gender, Body Composition and Diet: Differences Between Iranians, Indians and Europeans Living in Australia. J Immigr Minor Health 2018; 20:1362-1372. [DOI: 10.1007/s10903-018-0706-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Parvaresh Rizi E, Loh TP, Baig S, Chhay V, Huang S, Caleb Quek J, Tai ES, Toh SA, Khoo CM. A high carbohydrate, but not fat or protein meal attenuates postprandial ghrelin, PYY and GLP-1 responses in Chinese men. PLoS One 2018; 13:e0191609. [PMID: 29385178 PMCID: PMC5792004 DOI: 10.1371/journal.pone.0191609] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/08/2018] [Indexed: 12/22/2022] Open
Abstract
It is known that the macronutrient content of a meal has different impacts on the postprandial satiety and appetite hormonal responses. Whether obesity interacts with such nutrient-dependent responses is not well characterized. We examined the postprandial appetite and satiety hormonal responses after a high-protein (HP), high-carbohydrate (HC), or high-fat (HF) mixed meal. This was a randomized cross-over study of 9 lean insulin-sensitive (mean±SEM HOMA-IR 0.83±0.10) and 9 obese insulin-resistant (HOMA-IR 4.34±0.41) young (age 21–40 years), normoglycaemic Chinese men. We measured fasting and postprandial plasma concentration of glucose, insulin, active glucagon-like peptide-1 (GLP-1), total peptide-YY (PYY), and acyl-ghrelin in response to HP, HF, or HC meals. Overall postprandial plasma insulin response was more robust in the lean compared to obese subjects. The postprandial GLP-1 response after HF or HP meal was higher than HC meal in both lean and obese subjects. In obese subjects, HF meal induced higher response in postprandial PYY compared to HC meal. HP and HF meals also suppressed ghrelin greater compared to HC meal in the obese than lean subjects. In conclusion, a high-protein or high-fat meal induces a more favorable postprandial satiety and appetite hormonal response than a high-carbohydrate meal in obese insulin-resistant subjects.
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Affiliation(s)
- Ehsan Parvaresh Rizi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Health System, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Health System, Singapore
| | - Sonia Baig
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vanna Chhay
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shiqi Huang
- Food Science and Technology Program, Department of Chemistry, Faculty of Science, National University of Singapore, Singapore
| | - Jonathan Caleb Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E. Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Health System, Singapore
- Duke-National University of Singapore Medical School, Singapore
| | - Sue-Anne Toh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Health System, Singapore
- Duke-National University of Singapore Medical School, Singapore
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Chin Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Health System, Singapore
- * E-mail:
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35
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Wang Y, Meng RW, Kunutsor SK, Chowdhury R, Yuan JM, Koh WP, Pan A. Plasma adiponectin levels and type 2 diabetes risk: a nested case-control study in a Chinese population and an updated meta-analysis. Sci Rep 2018; 8:406. [PMID: 29321603 PMCID: PMC5762808 DOI: 10.1038/s41598-017-18709-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 12/15/2017] [Indexed: 01/12/2023] Open
Abstract
Results from previous prospective studies assessing the relation between adiponectin and type 2 diabetes (T2D) were not entirely consistent, and evidence in Chinese population is scarce. Moreover, the last meta-analysis did not examine the impact of metabolic variables on the adiponectin-T2D association. Therefore, we prospectively evaluated the adiponectin-T2D association among 571 T2D cases and 571 age-sex-matched controls nested within the Singapore Chinese Health Study (SCHS). Furthermore, we conducted an updated meta-analysis by searching prospective studies on Pubmed till September 2016. In the SCHS, the odds ratio of T2D, comparing the highest versus lowest tertile of adiponectin levels, was 0.30 (95% confidence interval: 0.17, 0.55) in the fully-adjusted model. The relation was stronger among heavier participants (body mass index ≥23 kg/m2) compared to their leaner counterparts (P for interaction = 0.041). In a meta-analysis of 34 prospective studies, the pooled relative risk was 0.53 (95% confidence interval: 0.47, 0.61) comparing the extreme tertiles of adiponectin with moderate heterogeneity (I2 = 48.7%, P = 0.001). The adiponectin-T2D association remained unchanged after adjusting for inflammation and dyslipidemia markers, but substantially attenuated with adjustment for insulin sensitivity and/or glycaemia markers. Overall evidence indicates that higher adiponectin levels are associated with decreased T2D risk in Chinese and other populations.
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Affiliation(s)
- Yeli Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rui-Wei Meng
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Setor K Kunutsor
- Translational Health Sciences, Bristol Medical School, University of Bristol Southmead Hospital, Bristol, United Kingdom
| | - Rajiv Chowdhury
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jian-Min Yuan
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health and State Key Laboratory of Environmental Health (incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
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36
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Hwang HR, Jeong DW, Kim YJ, Lee S, Lee JG, Kang YH, Yi YH, Cho YH, Tak YJ, Zo A. Comparison of insulin resistance and metabolic syndrome criteria in metabolically obese, normal weight (MONW) individuals in the prediction of cardiovascular disease risk: analysis of the Korean National Health and Nutrition Examination Survey (KNHANES) in 2010–2012. Int J Diabetes Dev Ctries 2018; 38:88-94. [DOI: 10.1007/s13410-016-0543-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Geng X, Geng L, Zhang Y, Lu H, Shen Y, Chen R, Fang P, Tao M, Wang C, Jia W. Fetal sex influences maternal fasting plasma glucose levels and basal β-cell function in pregnant women with normal glucose tolerance. Acta Diabetol 2017; 54:1131-1138. [PMID: 29098391 DOI: 10.1007/s00592-017-1055-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/18/2017] [Indexed: 11/30/2022]
Abstract
AIMS Fetal sex has recently emerged as a new factor that is related to maternal glucose homeostasis during pregnancy. The present study aimed to investigate the effect of fetal sex on maternal glucose metabolism in women with normal glucose tolerance (NGT) during pregnancy in the Chinese population. METHODS A total of 877 pregnant women with NGT were recruited at 24-28 weeks of gestation and underwent a 75-g oral glucose tolerance test (OGTT). Pregnant women were divided into two groups according to fetal sex. Physical examinations and laboratory tests were performed. Pancreatic β-cell function and insulin sensitivity were evaluated using OGTT-derived indices. RESULTS Compared with women bearing female fetuses, women who delivered male fetuses had higher fasting plasma glucose (FPG) concentrations [4.5 (4.2-4.8) vs. 4.4 (4.2-4.7) mmol/L, P < 0.05], but lower HOMA-β [161.9 (118.2-238.8) vs. 181.0 (131.7-260.9), P < 0.05] and Stumvoll first phase of insulin secretion [1230.2 (1077.9-1433.7) vs. 1290.9 (1134.0-1493.2), P < 0.05]. Multiple linear regression analysis indicated that the sex of the fetus was independently associated with maternal FPG and HOMA-β. Further binary logistic regression analyses revealed that the presence of a male fetus was significantly associated with elevated FPG [odds ratio (OR) 1.50; 95% confidence interval (CI) 1.12-2.00; P = 0.006] and lower HOMA-β (OR 0.70; 95% CI 0.52-0.94; P = 0.018) even after adjustment for potential confounders. CONCLUSIONS This study provided evidence that maternal glucose metabolism could be affected by fetal sex even in NGT pregnant women. Our results suggest that the presence of male fetuses was independently associated with maternal elevated FPG and lower basal β-cell function.
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Affiliation(s)
- Xinqian Geng
- Shanghai Key Laboratory of Diabetes, The Metabolic Diseases Biobank, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Lulu Geng
- Shanghai Key Laboratory of Diabetes, The Metabolic Diseases Biobank, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Yinan Zhang
- The Metabolic Diseases Biobank, Center for Translational Medicine, Shanghai Key Laboratory of Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, People's Republic of China
| | - Huijuan Lu
- Shanghai Key Laboratory of Diabetes, The Metabolic Diseases Biobank, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Yixie Shen
- Shanghai Key Laboratory of Diabetes, The Metabolic Diseases Biobank, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Ruihua Chen
- Shanghai Key Laboratory of Diabetes, The Metabolic Diseases Biobank, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Pingyan Fang
- Shanghai Key Laboratory of Diabetes, The Metabolic Diseases Biobank, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Minfang Tao
- Department of Obstetrics and Gynecology, Shanghai Clinical Center for Severe Maternal Rescue, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
| | - Congrong Wang
- Shanghai Key Laboratory of Diabetes, The Metabolic Diseases Biobank, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
| | - Weiping Jia
- Shanghai Key Laboratory of Diabetes, The Metabolic Diseases Biobank, Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
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Li Y, Wang DD, Ley SH, Vasanti M, Howard AG, He Y, Hu FB. Time Trends of Dietary and Lifestyle Factors and Their Potential Impact on Diabetes Burden in China. Diabetes Care 2017; 40:1685-1694. [PMID: 29046327 PMCID: PMC5862128 DOI: 10.2337/dc17-0571] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 09/19/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the secular trends in risk factors, estimate their impact on type 2 diabetes burden from 1991 to 2011, and project trends in the next 20 years. RESEARCH DESIGN AND METHODS Risk factor distributions were based on data from the China Health and Nutrition Survey 1991-2011. Diabetes cases attributable to all nonoptimal levels of each risk factor were estimated by applying the comparative risk assessment method. RESULTS In 2011, high BMI was the leading individual attributable factor for diabetes cases in China responsible for 43.8 million diabetes cases with a population-attributable fraction of 46.8%. Low whole-grain intake and high refined grain intake were the leading dietary risk factors in China responsible for 37.8 million and 21.8 million diabetes-attributable cases, respectively. The number of attributable diabetes cases associated with low physical activity, high blood pressure, and current smoking was 29.5, 21.6, and 9.8 million, respectively. Although intakes of low-fat dairy products, nuts, fruit, vegetables, and fish and seafood increased moderately over time, the average intake was below optimal levels in 2011 and were responsible for 15.8, 11.3, 9.9, 6.0, 3.6, and 2.6 million diabetes cases, respectively. Meanwhile, intakes of processed meat, red meat, and sugar-sweetened beverage showed increasing trends over time and were responsible for 2.8, 1.8, and 0.5 million diabetes cases, respectively, in 2011. CONCLUSIONS A high BMI and low intake of whole grains but high intake of refined grains are the most important individual risk factors related to Chinese diabetes burden; low physical activity and high blood pressure also significantly contributed.
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Affiliation(s)
- Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Dong D Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sylvia H Ley
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Malik Vasanti
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Annie Green Howard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Yuna He
- Department of Nutritional Epidemiology, National Institute of Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Zhou J, Wang Y, Lian F, Chen D, Qiu Q, Xu H, Liang L, Yang X. Physical exercises and weight loss in obese patients help to improve uric acid. Oncotarget 2017; 8:94893-94899. [PMID: 29212275 PMCID: PMC5706921 DOI: 10.18632/oncotarget.22046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023] Open
Abstract
Objective to assess the impact of longitudinal change of the overweight and physical activity on hyperuricemia. Methods We performed a retrospective cohort study. Demographic information, clinical features, laboratory findings, body weight and physical exercises pattern were documented. Results Altogether 4678 cases of hyperuricemia were enrolled. The median aged males were most affected. Individuals in the middle age had the highest prevalence of being overweight (2501/3382, 74.0%). Middle aged with BMI≥25 kg/m2 were more likely to lose weight (963/2807, 34.3%). BMI and waist circumference control helped to reduce serum uric acid. Overweight population was more likely to use urate-lowering or uricosuric medication (3025/3382, 89.4%). Intermediate and heavy activity were associated with bigger SUA improvement. Patients in the age of 35-60 were more likely to do physical exercises than the others. Conclusion Being overweight is strongly associated with hyperuricemia. Successful weight control was correlated with significant uric acid reduction. Intermediate to heavy physical activity helps to reduce waist circumference and SUA. In the hyperuricemia population, obese, middle aged men were the most affected, and also the most likely to do more exercises and get their bodyweight back to normal.
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Affiliation(s)
- Jun Zhou
- Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Fan Lian
- Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Dongying Chen
- Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Qian Qiu
- Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Hanshi Xu
- Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Liuqin Liang
- Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiuyan Yang
- Department of Rheumatology & Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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Chen X, Wu Z, Chen Y, Wang X, Zhu J, Wang N, Jiang Q, Fu C. Risk score model of type 2 diabetes prediction for rural Chinese adults: the Rural Deqing Cohort Study. J Endocrinol Invest 2017; 40:1115-1123. [PMID: 28474301 DOI: 10.1007/s40618-017-0680-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/26/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Risk score (RS) model is a cost-effective tool to identify adults who are at high risk for diabetes. This study was to develop an RS model of type 2 diabetes (T2DM) prediction specifically for rural Chinese adults. METHODS A prospective whole cohort study (n = 28,251) and a sub-cohort study (n = 3043) were conducted from 2006-2014 and 2006-2008 to 2015 in rural Deqing, China. All participants were free of T2DM at baseline. Incident T2DM cases were identified through electronic health records, self-reported and fasting plasma glucose testing for the sub-cohort, respectively. RS models were constructed with coefficients (β) of Cox regression. Receiver-operating characteristic curves were plotted and the area under the curve (AUC) reflected the discriminating accuracy of an RS model. RESULTS By 2015, the incidence of T2DM was 3.3 and 7.7 per 1000 person-years in the whole cohort and the sub-cohort, respectively. Based on data from the whole cohort, the non-invasive RS model included age (4 points), overweight (2 points), obesity (4 points), family history of T2DM (3 points), meat diet (3 points), and hypertension (2 points). The plus-fasting plasma glucose (FPG) model added impaired fasting glucose (4 points). The AUC was 0.705 with a positive predictive value of 2.5% for the non-invasive model, and for the plus-FPG model the AUC was 0.754 with a positive predictive value of 2.5%. These models performed better as compared with 12 existing RS models for the study population. CONCLUSIONS Our non-invasive RS model can be used to identify individuals who are at high risk of T2DM as a simple, fast, and cost-effective tool for rural Chinese adults.
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Affiliation(s)
- X Chen
- School of Public Health, Key Laboratory of Public Health Safety and Pudong Institute of Preventive Medicine, Fudan University, Shanghai, 200032, China
| | - Z Wu
- School of Public Health, Key Laboratory of Public Health Safety and Pudong Institute of Preventive Medicine, Fudan University, Shanghai, 200032, China
| | - Y Chen
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - X Wang
- Deqing County Center of Disease Prevention and Control, Huzhou, Zhejiang, China
| | - J Zhu
- Deqing County Center of Disease Prevention and Control, Huzhou, Zhejiang, China
| | - N Wang
- School of Public Health, Key Laboratory of Public Health Safety and Pudong Institute of Preventive Medicine, Fudan University, Shanghai, 200032, China
| | - Q Jiang
- School of Public Health, Key Laboratory of Public Health Safety and Pudong Institute of Preventive Medicine, Fudan University, Shanghai, 200032, China
| | - C Fu
- School of Public Health, Key Laboratory of Public Health Safety and Pudong Institute of Preventive Medicine, Fudan University, Shanghai, 200032, China.
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Tan KHX, Barr ELM, Koshkina V, Ma S, Kowlessur S, Magliano DJ, Söderberg S, Chia KS, Zimmet P, Lim WY. Diabetes mellitus prevalence is increasing in South Asians but is stable in Chinese living in Singapore and Mauritius. J Diabetes 2017; 9:855-864. [PMID: 27778460 DOI: 10.1111/1753-0407.12497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/11/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Asia is experiencing a type 2 diabetes epidemic, but prevalence differs by ethnicity and level of socioeconomic development. Singapore and Mauritius have implemented comprehensive campaigns to address this public health problem. We compared diabetes and obesity prevalence trends among Chinese and South Asians living in Singapore and Mauritius to determine the contribution of ethnicity and economic development to diabetes. METHODS Age-specific data from serial national population-based surveys in Singapore and Mauritius between 1987 and 2010 were used to estimate age-standardized diabetes and obesity prevalence. Modified Breslow-Cox proportional hazard models were used to obtain rate ratios for diabetes risk factors. RESULTS In Singapore, the age-standardized prevalence of diabetes remained stable for Chinese (men: 14% in 1992, 13% in 2010; women: 12% in 1992, 10% in 2010), but increases were observed for South Asians (men: 20% in 1992, 26% in 2010; women: 18% in 1992, 20% in 2010). There were similar patterns in Mauritius. In both countries, obesity prevalence trends were stable for Chinese women, but increased for Chinese men and South Asians. Associations between obesity and diabetes were stronger in Chinese than South Asians regardless of country. CONCLUSIONS Despite different socioeconomic settings in Singapore and Mauritius, we observed rising diabetes prevalence among South Asians but stable prevalence in Chinese in both countries. This provides further evidence that ethnicity contributes to the development of diabetes, and that there should be an increased emphasis on future prevention strategies targeting South Asian populations in these countries.
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Affiliation(s)
- Kristin H X Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Elizabeth L M Barr
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Wellbeing and Preventable Chronic Disease Division Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Vira Koshkina
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stefan Ma
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health Singapore, Singapore, Singapore
| | - Sudhir Kowlessur
- Non-Communicable Diseases and Health Promotion Division, Ministry of Health and Quality of Life, Port Louis, Mauritius
| | - Dianna J Magliano
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Paul Zimmet
- Population Health Research Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Khan MM, Sonkar GK, Alam R, Mehrotra S, Khan MS, Kumar A, Sonkar SK. Validity of Indian Diabetes Risk Score and its association with body mass index and glycosylated hemoglobin for screening of diabetes in and around areas of Lucknow. J Family Med Prim Care 2017; 6:366-373. [PMID: 29302549 PMCID: PMC5749088 DOI: 10.4103/2249-4863.220010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The present study aimed to assess the validity of Indian Diabetes Risk Score (IDRS) and its association with body mass index (BMI) and glycosylated hemoglobin (HbA1c) for screening of diabetes and obesity. METHODOLOGY A cross-sectional study was designed, and samples were randomly enrolled from Lucknow and its adjoining areas. Totally, 405 subjects were included in the study. We used diabetes risk factors (age, waist circumference, physical activity, and family history of diabetes) for screening of diabetes and abdominal obesity (AO) and BMI for screening of general obesity. HbA1c was used for confirming the diabetes patients in this population. Statistical analysis was applied to all data using SPSS software (version 20.0). P < 0.05 was considered statistically significant. RESULTS All 405 subjects were assessed for diabetic risk factors, BMI, and glycated hemoglobin. Of these, 56.3% subjects were aged ≥50 years. 1° and 2° AO was found in 47.9% and 40% subjects, respectively. About 27.1% subjects were found to have sedentary lifestyle, and 72.6% were found to have no family history of diabetes. According to IDRS, 272 subjects (67.2%) were found at high risk of diabetes (score ≥60). Based on BMI calculation, 198 subjects were obese, of which 79.3% were found at high risk for diabetes. A significant association was found between subjects with higher risk score and BMI (P < 0.001). Assessment of HbA1c showed that 97 (23.9%) were prediabetic and 204 (50.4%) were diabetic, of which 63.9% and 77%, respectively was at high risk for diabetes as per IDRS. A significant association was found between subjects with higher risk score and HbA1c (P < 0.001). CONCLUSION Our study fully supports the validity of IDRS, as it can be used as a cost-effective tool for primary mass screening of diabetes. Moreover, its combination with BMI value and HbA1c can be used for strict monitoring for diabetes and obesity at primary health care centers to reduce the early development of diabetes complications and severe obesity comorbidities.
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Affiliation(s)
- Mohammad Mustufa Khan
- Department of Biochemistry, Integral Institute of Medical Sciences and Research, Integral University, Lucknow, Uttar Pradesh, India
| | - Gyanendra Kumar Sonkar
- Department of Biochemistry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Roshan Alam
- Department of Biochemistry, Integral Institute of Medical Sciences and Research, Integral University, Lucknow, Uttar Pradesh, India
| | - Sudhir Mehrotra
- Department of Medicine, Integral Institute of Medical Sciences and Research, Integral University, Lucknow, Uttar Pradesh, India
| | - M. Salman Khan
- Department of Biosciences, Integral University, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar
- Department of Biochemistry, Integral Institute of Medical Sciences and Research, Integral University, Lucknow, Uttar Pradesh, India
| | - Satyendra Kumar Sonkar
- Department of Medicine, Hemodialysis Unit, King George's Medical University, Lucknow, Uttar Pradesh, India
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Cai S, Tan S, Gluckman PD, Godfrey KM, Saw SM, Teoh OH, Chong YS, Meaney MJ, Kramer MS, Gooley JJ. Sleep Quality and Nocturnal Sleep Duration in Pregnancy and Risk of Gestational Diabetes Mellitus. Sleep 2017; 40:2662319. [PMID: 28364489 DOI: 10.1093/sleep/zsw058] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/20/2022] Open
Abstract
Study Objectives To examine the influence of maternal sleep quality and nocturnal sleep duration on risk of gestational diabetes mellitus (GDM) in a multiethnic Asian population. Methods A cohort of 686 women (376 Chinese, 186 Malay, and 124 Indian) with a singleton pregnancy attended a clinic visit at 26-28 weeks of gestation as part of the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort study. Self-reported sleep quality and sleep duration were assessed using the Pittsburgh Sleep Quality Index (PSQI). GDM was diagnosed based on a 75-g oral glucose tolerance test administered after an overnight fast (1999 WHO criteria). Multiple logistic regression was used to model separately the associations of poor sleep quality (PSQI score > 5) and short nocturnal sleep duration (<6 h) with GDM, adjusting for age, ethnicity, maternal education, body mass index, previous history of GDM, and anxiety (State-Trait Anxiety Inventory score). Results In the cohort 296 women (43.1%) had poor sleep quality and 77 women (11.2%) were categorized as short sleepers; 131 women (19.1%) were diagnosed with GDM. Poor sleep quality and short nocturnal sleep duration were independently associated with increased risk of GDM (poor sleep, adjusted odds ratio [OR] = 1.75, 95% confidence interval [CI] 1.11 to 2.76; short sleep, adjusted OR = 1.96, 95% CI 1.05 to 3.66). Conclusions During pregnancy, Asian women with poor sleep quality or short nocturnal sleep duration exhibited abnormal glucose regulation. Treating sleep problems and improving sleep behavior in pregnancy could potentially reduce the risk and burden of GDM.
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Affiliation(s)
- Shirong Cai
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Sara Tan
- Program in Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Peter D Gluckman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust Southampton, England
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Oon Hoe Teoh
- Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Michael J Meaney
- Department of Psychiatry, McGill University Faculty of Medicine, Montreal, Canada
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada
| | - Joshua J Gooley
- Program in Neuroscience and Behavioral Disorders, Duke-NUS Medical School, Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Hu PL, Koh YLE, Tan NC. The utility of diabetes risk score items as predictors of incident type 2 diabetes in Asian populations: An evidence-based review. Diabetes Res Clin Pract 2016; 122:179-189. [PMID: 27865165 DOI: 10.1016/j.diabres.2016.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/27/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes mellitus is rising, with many Asian countries featured in the top 10 countries with the highest numbers of persons with diabetes. Reliable diabetes risk scores enable the identification of individuals at risk of developing diabetes for early intervention. OBJECTIVES This article aims to identify common risk factors in the risk scores with the highest discrimination; factors with the most influence on the risk score in Asian populations, and to propose a set of factors translatable to the multi-ethnic Singapore population. METHODS A systematic search of PubMed and EMBASE databases was conducted to identify studies published before August 2016 that developed risk prediction models for incident diabetes. RESULTS 12 studies were identified. Risk scores that included laboratory measurements had better discrimination. Coefficient analysis showed fasting glucose and HbA1c having the greatest impact on the risk score. CONCLUSION A proposed Asian risk score would include: family history of diabetes, age, gender, smoking status, body mass index, waist circumference, hypertension, fasting plasma glucose, HbA1c, HDL-cholesterol and triglycerides. Future research is required on the influence of ethnicity in Singapore. The risk score may potentially be used to stratify individuals for enrolment into diabetes prevention programmes.
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Ikezaki H, Ai M, Schaefer EJ, Otokozawa S, Asztalos BF, Nakajima K, Zhou Y, Liu CT, Jacques PF, Cupples LA, Furusyo N. Ethnic Differences in Glucose Homeostasis Markers between the Kyushu-Okinawa Population Study and the Framingham Offspring Study. Sci Rep 2016; 6:36725. [PMID: 27830830 PMCID: PMC5103215 DOI: 10.1038/srep36725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/20/2016] [Indexed: 11/21/2022] Open
Abstract
We compared markers of glucose homeostasis and their association with diabetes and impaired fasting glucose (IFG) in Fukuoka, Japanese subjects (n = 1108) and age-, gender- and menopausal status-matched participants in the Framingham Offspring Study (n = 1096). The markers examined included fasting glucose, insulin, adiponectin, and glycated albumin, as well as body mass index (BMI), use of medications, and history of diabetes. The results showed that IFG prevalence in Japanese men (15.9%) and women (7.4%) were 50% less than those observed in Framingham men (34.5%) and women (21.4%) (P < 0.001). However, the diabetes prevalence in Japanese men at 13.3% was twice as high (P < 0.01) as the rate in Framingham men at 6.5%, while these rates were similar in women. Median insulin levels in Japanese men (4.6 μIU/mL) and women (4.3 μIU/mL) were about 50% lower (P < 0.001) than those in Framingham men (10.8 μIU/mL) and women (9.9 μIU/mL), as were insulin resistance values (P < 0.001). These population differences were also observed after subjects were stratified by glucose levels. In conclusion, our data indicate that there is significantly less IFG, lower insulin levels, and insulin resistance, but higher diabetes prevalence in Fukuoka men than in Framingham men, indicating that insulin deficiency may be an important cause of diabetes in Japan.
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Affiliation(s)
- Hiroaki Ikezaki
- Cardiovascular Nutrition Laboratory, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA.,Nutritional Epidemiology Program, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA.,Department of General Internal Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan
| | - Masumi Ai
- Department of Insured Medical Care Management, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510 Japan
| | - Ernst J Schaefer
- Cardiovascular Nutrition Laboratory, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA
| | - Seiko Otokozawa
- Department of Public Health, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo 060-8556 Japan
| | - Bela F Asztalos
- Cardiovascular Nutrition Laboratory, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA
| | - Katsuyuki Nakajima
- Department of Clinical Laboratory Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Yanhua Zhou
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue CT3, Boston, MA 02118 USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue CT3, Boston, MA 02118 USA
| | - Paul F Jacques
- Nutritional Epidemiology Program, Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, 711 Washington Street, Boston, MA 02111 USA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue CT3, Boston, MA 02118 USA
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582 Japan
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Ding C, Chan Z, Magkos F. Lean, but not healthy: the 'metabolically obese, normal-weight' phenotype. Curr Opin Clin Nutr Metab Care 2016; 19:408-417. [PMID: 27552473 DOI: 10.1097/mco.0000000000000317] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Obesity is commonly associated with metabolic dysfunction but there are obese persons who are metabolically healthy. On the opposite side of the coin, there are lean persons who carry multiple cardiometabolic risk factors, typically referred to as metabolically obese, normal-weight (MONW). This has called into question our understanding of obesity and metabolic dysfunction, as an appearance of normal weight may mask significant comorbidities and delay health interventions. RECENT FINDINGS High heterogeneity in MONW prevalence rates has been observed, with estimates ranging from as low as 5% to as high as 45%. Reasons for this include sample size effects, differences in MONW definition, social and demographic factors, as well as assumptions made in establishing normal weight. MONW study participants are often characterized by excess visceral adipose tissue and ectopic fat deposition, adipose tissue inflammation, altered inflammatory and adipokine profiles, reduced skeletal muscle mass and low cardiorespiratory fitness. However, more often than not, groups of MONW study participants have been somewhat 'fatter' than the control groups of metabolically healthy lean study participants, which in itself could be responsible for some of the observed differences. Very limited data are available regarding interventions to improve metabolic function in MONW study participants. SUMMARY There is a need for more research to better understand the characteristics of the MONW phenotype, the cause of metabolic dysfunction in the absence of obesity, and evaluate potential therapies so as to facilitate the establishment of clinical guidelines.
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Affiliation(s)
- Cherlyn Ding
- aClinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) bDepartment of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Yoon YS, Choi HS, Kim JK, Kim YI, Oh SW. Differences in the associations of anthropometric measures with insulin resistance and type 2 diabetes mellitus between Korean and US populations: Comparisons of representative nationwide sample data. Obes Res Clin Pract 2016; 10:642-651. [PMID: 26750428 DOI: 10.1016/j.orcp.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/15/2015] [Accepted: 11/02/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUNDS Variation among ethnic groups in the association between obesity and insulin resistance (IR)/diabetes has been suggested, but studies reported inconsistent results. We evaluated ethnic differences in the association between obesity and insulin resistance (IR)/diabetes. METHODS We conducted a cross-sectional analysis using Korea (n=18,845) and the USA (n=4657) National Health and Nutrition Examination Survey(NHANES) 2007-2010. We performed statistical comparisons of AUC-ROC (area under the curve in a receiver operating characteristic curve) values for body mass index (BMI), waist circumference (WC) and homeostasis model assessment of insulin resistance (HOMA-IR) to predict IR or diabetes among different ethnic groups. RESULTS AUC-ROC values for BMI and WC for predicting IR were highest in Whites (0.8324 and 0.8468) and lowest in Koreans (0.7422 and 0.7367). Whites showed the highest AUC-ROC values for BMI (0.6869) and WC (0.7421) for predicting diabetes, while the AUC-ROC for HOMA-IR was highest in Koreans (0.8861). Linear regression showed significant interactions between ethnicity and the main effects (all P<0.0001). Increases in BMI were associated with a larger increase in HOMA-IR in Whites (β=0.0719) and WC in Hispanics (β=0.0324), while BMI was associated with a larger increase in fasting glucose in Koreans (β=0.8279) and WC in Blacks (β=0.4037). In addition, the slope for fasting glucose with increasing HOMA-IR was steeper in Koreans (β=16.5952, P<0.001) than in other groups. CONCLUSION The ability of BMI and WC to predict IR and diabetes was highest in Whites, while the ability of HOMA-IR to predict diabetes was highest in Koreans.
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Affiliation(s)
- Yeong Sook Yoon
- Department of Family Medicine, Inje University Ilsan Paik Hospital, Goyang-Si, Gyeonggi-Do, South Korea
| | - Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jin Kuk Kim
- Department of Neurosurgery, Seoul Na Eun Hospital, Seoul, South Korea; Department of Family Medicine, Center for Obesity, Metabolism and Nutrition, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea
| | - Yu Il Kim
- Department of Family Medicine, Center for Obesity, Metabolism and Nutrition, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea
| | - Sang Woo Oh
- Department of Family Medicine, Center for Obesity, Metabolism and Nutrition, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea; Channelopathy Research Center, Dongguk University College of Medicine, Goyang-Si, Gyeonggi-Do, South Korea.
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Chng CL, Lim AYY, Tan HC, Kovalik JP, Tham KW, Bee YM, Lim W, Acharyya S, Lai OF, Chong MFF, Yen PM. Physiological and Metabolic Changes During the Transition from Hyperthyroidism to Euthyroidism in Graves' Disease. Thyroid 2016; 26:1422-1430. [PMID: 27465032 DOI: 10.1089/thy.2015.0602] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The serum metabolomic profile and its relationship to physiological changes during hyperthyroidism and restoration to euthyroidism are not known. This study aimed to examine the physiological, adipokine, and metabolomic changes that occur when subjects with Graves' disease transition from hyperthyroidism to euthyroidism with medical treatment. METHODS Chinese women between 21 and 50 years of age and with newly diagnosed Graves' disease attending the endocrine outpatient clinics in a single institution were recruited between July 2012 and September 2014. All subjects were treated with thioamides to achieve euthyroidism. Clinical parameters (body weight, body composition via bioelectrical impedance analysis, resting energy expenditure and respiratory quotient via indirect calorimetry, and reported total energy intake via 24 h food diary), biochemical parameters (thyroid hormones, lipid profile, fasting insulin and glucose levels), serum leptin, adiponectin, and metabolomics profiles were measured during hyperthyroidism and repeated in early euthyroidism. RESULTS Twenty four Chinese women with an average age of 36.3 ± 8.6 years were included in the study. The average duration of treatment that was required to reach euthyroidism for these subjects was 38 ± 16.3 weeks. There was a significant increase in body weight (52.6 ± 9.0 kg to 55.3 ± 9.4 kg; p < 0.001) and fat mass (14.3 ± 6.9 kg to 16.8 ± 6.5 kg; p = 0.005). There was a reduction in resting energy expenditure corrected for weight (28.7 ± 4.0 kcal/kg to 21.5 ± 4.1 kcal/kg; p < 0.001) and an increase in respiratory quotient (0.76 to 0.81; p = 0.037). Resting energy expenditure increased significantly with increasing free triiodothyronine levels (p = 0.007). Significant increases in total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were noted. There was no significant change in leptin levels, but adiponectin levels increased significantly (p = 0.018). Significant reductions in fasting C2, medium-chain, long-chain, and total acylcarnitines were observed, but no changes in the fat-free mass, branched chain amino acid levels, or insulin sensitivity during recovery from hyperthyroidism were noted. CONCLUSIONS Serum metabolomics profile changes complemented the physiological changes observed during the transition from hyperthyroidism to euthyroidism. This study provides a comprehensive and integrated view of the changes in fuel metabolism and energy balance that occur following the treatment of hyperthyroidism.
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Affiliation(s)
- Chiaw-Ling Chng
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | | | - Hong Chang Tan
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Jean-Paul Kovalik
- 2 Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School , Singapore
| | - Kwang Wei Tham
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Yong Mong Bee
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Weiying Lim
- 1 Department of Endocrinology, Singapore General Hospital , Singapore
| | - Sanchalika Acharyya
- 3 Centre for Quantitative Medicine, Duke-NUS Graduate Medical School , Singapore
| | - Oi Fah Lai
- 4 Department of Clinical Research, Singapore General Hospital , Singapore
| | - Mary Foong-Fong Chong
- 5 Singapore Institute for Clinical Sciences (SICS) , A*star, Brenner Centre for Molecular Medicine, Singapore
| | - Paul Michael Yen
- 2 Cardiovascular and Metabolic Disorders Program, Duke-NUS Graduate Medical School , Singapore
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49
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Alperet DJ, Lim WY, Mok-Kwee Heng D, Ma S, van Dam RM. Optimal anthropometric measures and thresholds to identify undiagnosed type 2 diabetes in three major Asian ethnic groups. Obesity (Silver Spring) 2016; 24:2185-93. [PMID: 27558457 DOI: 10.1002/oby.21609] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify optimal anthropometric measures and cutoffs to identify undiagnosed diabetes mellitus (UDM) in three major Asian ethnic groups (Chinese, Malays, and Asian-Indians). METHODS Cross-sectional data were analyzed from 14,815 ethnic Chinese, Malay, and Asian-Indian participants of the Singapore National Health Surveys, which included anthropometric measures and an oral glucose tolerance test. Receiver operating characteristic curve analyses were used with calculation of the area under the curve (AUC) to evaluate the performance of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) for the identification of UDM. RESULTS BMI performed significantly worse (AUCMEN = 0.70; AUCWOMEN = 0.75) than abdominal measures, whereas WHTR (AUCMEN = 0.76; AUCWOMEN = 0.79) was among the best performing measures in both sexes and all ethnic groups. Anthropometric measures performed better in Chinese than in Asian-Indian participants for the identification of UDM. A WHTR cutoff of 0.52 appeared optimal with a sensitivity of 76% in men and 73% in women and a specificity of 63% in men and 70% in women. CONCLUSIONS Although ethnic differences were observed in the performance of anthropometric measures for the identification of UDM, abdominal adiposity measures generally performed better than BMI, and WHTR performed best in all Asian ethnic groups.
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Affiliation(s)
- Derrick Johnston Alperet
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Derrick Mok-Kwee Heng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Stefan Ma
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
| | - Rob M van Dam
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore.
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50
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Zhang ZQ, Lu QG, Huang J, Jiao CY, Huang SM, Mao LM. Maternal and cord blood adiponectin levels in relation to post-natal body size in infants in the first year of life: a prospective study. BMC Pregnancy Childbirth 2016; 16:189. [PMID: 27459998 PMCID: PMC4962456 DOI: 10.1186/s12884-016-0978-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/18/2016] [Indexed: 11/18/2022] Open
Abstract
Background Adiponectin is an adipocyte hormone involved in energy homeostasis and metabolism. However, its role in early infancy is poorly understood. Methods We recruited a total of 443 pregnant women and their children in this prospective study. Cord blood samples were successfully obtained from 331 neonates. Maternal and umbilical blood serum adiponectin were measured. The weight-, height- and BMI-for-age Z scores of infants at birth and at 3, 6 and 12 months of age were assessed. Results Multiple linear regression analysis indicated that cord blood but not maternal serum adiponectin was positively associated with all of the anthropometric measures at birth (P < 0.01). Using Generalized Estimating Equation model after adjustment for sex, time, maternal age, gestational age, prepregnancy BMI, weight gain during pregnancy, maternal education, parity, history of miscarriage and mode of delivery, for every 1-μg/ml increment of maternal serum adiponectin, the height-for-age Z score during the first year of life increased by 0.026 (P =0.013) on average, and the height-for-age Z score of infants in the highest quartile of maternal serum adiponectin was 0.270 (95 % CI: 0.013–0.527) higher than those in the lowest quartile. The changes in weight-for-age Z score from birth decreased by 0.67 × 10−2 on average with every 1-μg/ml additional increase of cord blood adiponectin (P = 0.047). The infants in the highest quartile of cord blood adiponectin showed a −0.368 (95 % CI, −0.701–−0.035) decrease in weight-for-age Z score change from birth compared with those in the lowest quartile. Conclusions Cord blood adiponectin concentration is a determinant of infant birth size and weight gain in the first year of life. Circulating maternal adiponectin during pregnancy may predict postnatal height growth. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0978-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhe-Qing Zhang
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Qing-Gui Lu
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Jie Huang
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Chang-Ya Jiao
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Shao-Ming Huang
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Li-Mei Mao
- Department of Nutrition and Food Hygiene, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, People's Republic of China.
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