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Bawua SA, Ichihara K, Keatley R, Arko-Mensah J, Ayeh-Kumi PF, Erasmus R, Fobil J. Derivation of sex and age-specific reference intervals for clinical chemistry analytes in healthy Ghanaian adults. Clin Chem Lab Med 2022; 60:1426-1439. [PMID: 35786502 DOI: 10.1515/cclm-2022-0293] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTVIES This study is aimed at establishing reference intervals (RIs) of 40 chemistry and immunochemistry analytes for Ghanaian adults based on internationally harmonized protocol by IFCC Committee on Reference Intervals and Decision Limits (C-RIDL). METHODS A total of 501 healthy volunteers aged ≥18 years were recruited from the northern and southern regions of Ghana. Blood samples were analyzed with Beckman-Coulter AU480 and Centaur-XP/Siemen auto-analyzers. Sources of variations of reference values (RVs) were evaluated by multiple regression analysis (MRA). The need for partitioning RVs by sex and age was guided by the SD ratio (SDR). The RI for each analyte was derived using parametric method with application of the latent abnormal values exclusion (LAVE) method. RESULTS Using SDR≥0.4 as threshold, RVs were partitioned by sex for most enzymes, creatinine, uric acid (UA), bilirubin, immunoglobulin-M. MRA revealed age and body mass index (BMI) as major source of variations of many analytes. LAVE lowered the upper limits of RIs for alanine/aspartate aminotransferase, γ-glutamyl transaminase and lipids. Exclusion of individuals with BMI≥30 further lowered the RIs for lipids and CRP. After standardization based on value-assigned serum panel provided by C-RIDL, Ghanaian RIs were found higher for creatine kinase, amylase, and lower for albumin and urea compared to other collaborating countries. CONCLUSIONS The LAVE effect on many clinical chemistry RIs supports the need for the secondary exclusion for reliable derivation of RIs. The differences in Ghanaian RIs compared to other countries underscore the importance of country specific-RIs for improved clinical decision making.
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Key Words
- AG, anion gap
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AMY, amylase
- AST, aspartate aminotransferase
- Alb, albumin
- BD, Becton Dickinson
- BMI, body mass index
- BR, bias ratio
- C-RIDL, Committee on Reference Intervals and Decision Limits
- C3, complement component 3
- C4, complement component 4
- CDL, clinical decision limit
- CI, confidence interval
- CK, creatine kinase
- CRP, C-reactive protein
- CV(b), CV of the regression slope b
- Ca, calcium
- Cl, chloride
- Cre, creatinine
- DBil, direct bilirubin
- F, female
- GGT, gamma-glutamyl transferase
- Glb, globulin
- Glu, glucose
- HDL-CHDL-C, high-density lipoprotein cholesterol
- HbA1c, hemoglobin A1c
- IFCC, International Federation of Clinical Chemistry and Laboratory Medicine
- IP, inorganic phosphate
- IgA, immunoglobulin A
- IgG, immunoglobulin G
- IgM, immunoglobulin M
- K, potassium
- LAVE, latent abnormal values exclusion
- LDH, lactate dehydrogenase
- LDL-C, low-density lipoprotein cholesterol
- LL, lower limit
- M, male
- MF, male + female
- MRA, multiple regression analysis
- Mg, magnesium
- NP, non-parametric
- Na, sodium
- P, parametric
- RI, reference interval
- RV, reference values
- SDR, standard deviation ratio
- SV, sources of variation
- TBil, total bilirubin
- TC, total cholesterol
- TCO2, total carbon dioxide
- TG, triglycerides
- TP, total protein
- UA, uric acid
- UL, upper limit
- between-country differences
- bias ratio
- eGFR, estimated glomerular filtration rate
- ethnicity
- latent abnormal values exclusion method
- multiple regression analysis
- nonparametric method
- parametric method
- rp, standardized partial correlation coefficient
- standard deviation ratio
- standardization
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Affiliation(s)
- Serwaa Akoto Bawua
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | | | - John Arko-Mensah
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Patrick F Ayeh-Kumi
- Department of Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Ghana
| | - Rajiv Erasmus
- University of Stellenbosch, Division of Chemical Pathology, Tygerberg, Cape Town, South Africa
| | - Julius Fobil
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Accra, Ghana
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Hussain A, Ali I, Kaleem WA, Yasmeen F. Correlation between Body Mass Index and Lipid Profile in patients with Type 2 Diabetes attending a tertiary care hospital in Peshawar. Pak J Med Sci 2019; 35:591-597. [PMID: 31258559 PMCID: PMC6572993 DOI: 10.12669/pjms.35.3.7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: To determine the correlation between body mass index (BMI) and lipid profile in patients with Type 2 Diabetes (T2DM) attending a tertiary care hospital in Peshawar. Methods: A total of 305 patients (men, 132; women, 173) with T2DM visiting an Outpatient department in Northwest General Hospital and Research Centre, Peshawar from January 2016 to July 2016 were included in this study. The whole blood and sera were analyzed for Glycated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TGs), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C). The correlation of BMI with lipid ratios and individual lipid indices were analysed. Results: Mean of BMI was 29.29±5.23. Dyslipidemia; increased TC, increased LDL-C, increased triglyceride and decreased HDL-C were noted in 40.7%, 54.1%, 69.5% and 41% respectively. The mean difference of LDL-C (p=0.006) was significant between male and female. BMI, TC, TGs, and LDL-C showed no significant correlation where as a significant negative correlation between BMI and HDL-C was observed (r=-0.125, p=0.029, R2=0.016). The mean values of TC, TG, LDL-C, TC/ HDL-C and LDL/HDL were greater in patients with normal BMI compared to overweight and obese; however, the differences were not significant. HDL-C differed significantly in BMI groups (p=0.040). Conclusion: A significant negative correlation between BMI and HDL-C was observed, while the correlation between BMI and LDL-C was observed to be insignificant. HDL-C was found significantly higher in patients with normal BMI. These results are important to indicate that there is modest impact of BMI on lipid profile. Therefore, assessment and management for altered blood lipids should not be based on a patient’s body weight or BMI.
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Affiliation(s)
- Arshad Hussain
- Dr. Arshad Hussain, MRCP. Department of Medicine & Allied, Northwest General Hospital & Research Centre, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Iftikhar Ali
- Iftikhar Ali, M.Phil. Department of Pharmacy, University of Swabi, Khyber Pakhtunkhwa, Pakistan., Paraplegic Center, Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Waqar Ahmad Kaleem
- Dr. Waqar Ahmad Kaleem, PhD, Department of Pharmacy, University of Swabi, Khyber Pakhtunkhwa, Pakistan
| | - Fatima Yasmeen
- Fatima Yasmeen, M.Sc.(Hon), Nutritionist, Paraplegic Center, Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Chang HC, Hsieh CF, Tantoh DM, Ko PC, Kung YY, Lin MC, Liaw YC, Liaw YP. HDL and associated factors stratified by sex and menopausal status: results from a community-based survey in Taiwan. Oncotarget 2018; 9:16354-16367. [PMID: 29662650 PMCID: PMC5893245 DOI: 10.18632/oncotarget.24677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/27/2018] [Indexed: 12/21/2022] Open
Abstract
Aim To investigate factors, especially modifiable factors associated with high-density lipoprotein (HDL) in Taiwanese based on sex and menopausal status. Materials and Methods Participants comprised 2022 men and 2392 women (1267 menopausal and 1125 non-menopausal) aged ≥30 years who resided in Pingzhen district, Taoyuan from 2006-2011. Their data, obtained through questionnaires and measurements were retrieved from the Li-Shin Hospital. Results Higher HDL was associated with total cholesterol, underweight, and alcohol drinking in both men and women. It was also associated with education, blood group B, and marital status in men as well as with age in women. Moreover, it was associated with total cholesterol, underweight, and age in both menopausal and non-menopausal women. Furthermore, it was associated with marital status in non-menopausal women and alcohol drinking in menopausal women. Lower HDL was associated with triglycerides, low-density lipoprotein (LDL), overweight, obesity, waist-hip ratio (WHR), uric acid, and smoking in both men and women and with coffee drinking in only women. It was also associated with uric acid, triglycerides, LDL, overweight, obesity, WHR, and body fat in both menopausal and non-menopausal women. Moreover, it was associated with coffee drinking in menopausal women. Conclusion Modifiable factors associated with HDL differ according to sex and menopausal status. Sex and menopausal status should be considered when implementing lifestyle changes to raise HDL. For example, both men and women should maintain a normal weight as well as quit smoking.
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Affiliation(s)
- Huan-Cheng Chang
- Division of Family Medicine, Department of Community Medicine, Landseed Hospital, Taoyuan, Taiwan.,Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan
| | - Chuan-Fa Hsieh
- Department of Medical Education and Research, Landseed Hospital, Taoyuan, Taiwan.,Center for General Education, Hsin Sheng College of Medical Care and Management, Taoyuan, Taiwan
| | - Disline Manli Tantoh
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Pei-Chieh Ko
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Ya-Yu Kung
- Division of Health Management, Landseed Hospital, Taoyuan, Taiwan
| | - Mei-Chi Lin
- Division of Health Management, Landseed Hospital, Taoyuan, Taiwan
| | - Yi-Ching Liaw
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan.,Department of Family and Community Medicine, Chung Shan Medical University, Taichung, Taiwan
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Cong L, Zhan JQ, Yang L, Zhang W, Li SG, Chen C, Zhang HY, Ma ZP, Hao XL, Simayi D, Tao L, Zhao J, Amanguli A, Mohemaiti M, Jing MX, Wang W, Saimaiti A, Zou XG, Gu Y, Li L, Wang YH, Li F, Zhang WJ. Overweight and obesity among low-income Muslim Uyghur women in far western China: correlations of body mass index with blood lipids and implications in preventive public health. PLoS One 2014; 9:e90262. [PMID: 24587304 PMCID: PMC3938656 DOI: 10.1371/journal.pone.0090262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The pandemic of obesity is a global public health concern. Most studies on obesity are skewed toward high-income and urban settings and few covers low-income populations. This study focused on the prevalence of overweight and obesity and their correlations with blood lipids/metabolites/enzymes (bio-indicators) in a rural community typical of low-income in remote western China. METHODS This study was performed in a Muslim ethnic Uyghur rural community in Kashi Prefecture of Xinjiang, about 4,407 km (2,739 miles) away from Beijing. Body mass index (BMI) and major blood bio-indicators (25 total items) were measured and demographic information was collected from 1,733 eligible healthy women aged 21 to 71 yrs, of whom 1,452 had complete data for analysis. More than 92% of the women lived on US$1.00/day or less. According to the Chinese criteria, overweight and obesity were defined as BMI at 24 to <28 kg/m(2) and at ≥ 28 kg/m(2), respectively. RESULTS The average BMI among these low-income women was 24.0 ± 4.0 (95% CI, 17.5-33.7) kg/m(2). The prevalence of obesity and overweight was high at 15.1% and 28.9%, respectively. Among 25 bio-indicators, BMI correlated positively with the levels of 11 bio-indicators including triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TCHOL), glucose (GLU), and uric acid (UA); but negatively with the levels of 5 bio-indicators including high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A/B (APO A/B). CONCLUSIONS This is the first investigation reporting overweight and obesity being common in low-income Muslim Uyghur women, whose BMI correlates with several important blood bio-indicators which are risk factors for diabetes and cardiovascular diseases. These findings may help make preventive public health policies in Uyghur communities. To prevent diabetes and cardiovascular diseases in low-income settings, we therefore propose a cost-effective, two-step strategy first to screen for obesity and then to screen persons with obesity for diabetes and cardiovascular diseases.
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Affiliation(s)
- Li Cong
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
- The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University, Shihezi, Xinjiang, China
- Department of Oncology, the First People's Hospital of Suqian, Suqian, Jiangsu, China
| | - Jin Qiong Zhan
- Department of Laboratory Medicine, JiangXi Mental Health Center, Nanchang, Jiangxi, China
| | - Lan Yang
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
- The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University, Shihezi, Xinjiang, China
| | - Wei Zhang
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
- The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University, Shihezi, Xinjiang, China
| | - Shu Gang Li
- Faculty of Preventive Medicine, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Cheng Chen
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
- The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University, Shihezi, Xinjiang, China
| | - Hong Yan Zhang
- Department of Immunization, Xi'an Center for Disease Control and Prevention, Xi'an, Shanxi, China
| | - Zhi Ping Ma
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Xiao Ling Hao
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Dilixia Simayi
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Lin Tao
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Jin Zhao
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - A. Amanguli
- Department of Obstetrics and Gynecology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Meiliguli Mohemaiti
- Department of Obstetrics and Gynecology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Ming Xia Jing
- Faculty of Preventive Medicine, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Wei Wang
- Institute of Humanities, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Abudukeyoumu Saimaiti
- Kashi Prefecture First People's Hospital, Kashi Prefecture Health Bureau, Kashi, Xinjiang, China
| | - Xiao Guang Zou
- Kashi Prefecture First People's Hospital, Kashi Prefecture Health Bureau, Kashi, Xinjiang, China
| | - Yan Gu
- Department of Obstetrics and Gynecology, Institute of Surgery Research, Daping Hospital, the Third Military Medical University, Chongqing, China
| | - Li Li
- Department of Obstetrics and Gynecology, Institute of Surgery Research, Daping Hospital, the Third Military Medical University, Chongqing, China
| | - Ying Hong Wang
- The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University, Shihezi, Xinjiang, China
- Department of Obstetrics and Gynecology, the First Affiliated University Hospital, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Feng Li
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
- The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University, Shihezi, Xinjiang, China
| | - Wen Jie Zhang
- Department of Pathology, Shihezi University School of Medicine, Shihezi, Xinjiang, China
- The Key Laboratories for Xinjiang Endemic and Ethnic Diseases, Shihezi University, Shihezi, Xinjiang, China
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Wang Y, Lammi-Keefe CJ, Hou L, Hu G. Impact of low-density lipoprotein cholesterol on cardiovascular outcomes in people with type 2 diabetes: a meta-analysis of prospective cohort studies. Diabetes Res Clin Pract 2013; 102:65-75. [PMID: 23932206 PMCID: PMC4141536 DOI: 10.1016/j.diabres.2013.07.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 03/23/2013] [Accepted: 07/18/2013] [Indexed: 01/07/2023]
Abstract
AIMS To estimate the prospective association of low-density lipoprotein (LDL) cholesterol on cardiovascular disease (CVD) risk among people with type 2 diabetes. METHODS We used extensive literature searching strategies to locate prospective cohort studies that reported LDL cholesterol levels as a risk factor for cardiovascular events. We conducted meta-analytic procedures for two outcomes: incident CVD and CVD mortality. RESULTS A total of 16 studies were included in this analysis with a mean follow-up range of 4.8-11 years. The pooled relative risk associated with a 1mmol/L increase in LDL cholesterol in people with type 2 diabetes was 1.30 (95% confidence interval [CI], 1.19-1.43) for incident CVD, and 1.50 (95% CI, 1.25-1.80) for CVD mortality, respectively. Subgroup analyses showed that for incident CVD, the pooled relative risk was 1.28 (95% CI, 1.17-1.41) for 7 studies adjusted for blood pressure and/or glucose concentration (or insulin concentration, glycated hemoglobin) and 1.40 (95% CI, 1.05-1.86) for 3 studies that did not adjust for these variables. CONCLUSIONS Our study demonstrates that LDL cholesterol was associated with an increased risk for cardiovascular outcomes in people with type 2 diabetes, independent of other conventional risk factor.
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Affiliation(s)
- Yujie Wang
- Pennington Biomedical Research Center, Baton Rouge, LA, United States; School of Human Ecology, Louisiana State University AgCenter, Baton Rouge, LA, United States; Department of Experimental Statistics, Louisiana State University, Baton Rouge, LA, United States
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