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McElwain CJ, Manna S, Musumeci A, Sylvester I, Rouchon C, O'Callaghan AM, Ebad MAB, McCarthy FP, McCarthy CM. Defective Visceral Adipose Tissue Adaptation in Gestational Diabetes Mellitus. J Clin Endocrinol Metab 2024; 109:1275-1284. [PMID: 38035802 PMCID: PMC11031241 DOI: 10.1210/clinem/dgad699] [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: 08/25/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023]
Abstract
CONTEXT Gestational diabetes mellitus (GDM) is a complex obstetric condition affecting localized glucose metabolism, resulting in systemic metabolic dysfunction. OBJECTIVE This cross-sectional study aimed to explore visceral adipose tissue (VAT) as an integral contributor to GDM, focusing on elucidating the specific contribution of obesity and GDM pathology to maternal outcomes. METHODS Fifty-six nulliparous pregnant women were recruited, including normal glucose tolerant (NGT) (n = 30) and GDM (n = 26) participants. Participants were subgrouped as nonobese (BMI <30 kg/m2) or obese (BMI ≥30 kg/m2). Metabolic markers in circulation, VAT, and placenta were determined. Morphological analysis of VAT and immunoblotting of the insulin signaling cascade were performed. RESULTS GDM participants demonstrated hyperinsulinemia and elevated homeostatic model assessment for insulin resistance (HOMA-IR) scores relative to NGT participants. The GDM-obese subgroup had significant VAT adipocyte hypoplasia relative to NGT-nonobese tissue. GDM-obese VAT had significantly lower insulin receptor substrate (IRS)-2 expression, with elevated ser312 phosphorylation of IRS-1, relative to NGT-nonobese. GDM-obese participants had significantly elevated circulating leptin levels and placental adipsin secretion, while GDM-nonobese participants had elevated circulating adipsin levels with reduced placental adiponectin secretion. CONCLUSION These findings suggest that GDM-obese pregnancy is specifically characterized by inadequate VAT remodeling and dysfunctional molecular signaling, which contribute to insulin resistance and hinder metabolic health.
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Affiliation(s)
- Colm J McElwain
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork T12XF62, Ireland
| | - Samprikta Manna
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork T12DC4A, Ireland
| | - Andrea Musumeci
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork T12XF62, Ireland
| | - Isaac Sylvester
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork T12XF62, Ireland
| | - Chloé Rouchon
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork T12XF62, Ireland
| | - Anne Marie O'Callaghan
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork T12XF62, Ireland
| | - Mustafa Abdalla Bakhit Ebad
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork T12XF62, Ireland
| | - Fergus P McCarthy
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork T12DC4A, Ireland
| | - Cathal M McCarthy
- Department of Pharmacology and Therapeutics, Western Gateway Building, University College Cork, Cork T12XF62, Ireland
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Hamdan Alshganbee MF, Nabatchian F, Farrokhi V, Fadaei R, Moradi N, Afrisham R. A positive association of serum CCN5/WISP2 levels with the risk of developing gestational diabetes mellitus: a case-control study. J Physiol Sci 2023; 73:22. [PMID: 37794318 DOI: 10.1186/s12576-023-00879-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/24/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION CCN5/WISP2 is prominently manifest in adipose tissue and has been linked to the pathogenesis of obesity, diabetes, and insulin resistance. However, discrepancies exist in previous studies, and little is known about its association with gestational diabetes mellitus (GDM). The current investigation is designed to examine the correlation of WISP2 with risk factors in GDM patients in comparison to healthy pregnant women for the first time. METHODS This case-control study measured serum levels of CCN5, TNF-α, IL-6, adiponectin, and fasting insulin using ELISA kits in 88 GDM patients and 88 pregnant women. RESULTS The GDM group had remarkably higher serum levels of CCN5 (379.41 ± 83.078 ng/ml) compared to controls (212.02 ± 77.935 ng/ml). In a similar vein, it was observed that patients diagnosed with GDM exhibited elevated levels of pro-inflammatory cytokines such as IL-6 and TNF-α; while conversely, adiponectin levels were found to be significantly lower than those observed in the control group (P < 0.0001). In women with GDM, a positive and significant correlation was observed between CCN5 and BMI, FBG, insulin, HOMA-IR, as well as IL-6 and TNF-α levels. In the adjusted model, the risk of GDM was significantly increased with elevated serum CCN5 level. CONCLUSION Our research indicates a noteworthy and affirmative correlation between the levels of CCN5 in the serum and the risk of developing GDM, along with its associated risk factors such as BMI, insulin resistance index, FBG, and inflammatory cytokines (TNF-α and IL-6). These findings suggest that CCN5 could potentially play a role in the etiology of GDM.
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Affiliation(s)
| | - Fariba Nabatchian
- Department of Clinical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Vida Farrokhi
- Department of Hematology, Faculty of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Fadaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nariman Moradi
- Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Afrisham
- Department of Clinical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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Zhu J, Jiang S, Jiang X, Luo K, Huang X, Hua F. Association Of Blood Lipocalin-2 Levels with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. Horm Metab Res 2022; 54:677-685. [PMID: 36206761 PMCID: PMC9546583 DOI: 10.1055/a-1909-1922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Lipocalin-2 (LCN2) is becoming recognized as a pleiotropic mediator of metabolic disorders. However, the relationship between LCN2 and gestational diabetes mellitus (GDM) is not well understood. We performed a systematic review and meta-analysis to explore it. A systematic search of Cochrane Library, PubMed, Embase, Scopus, Web of Science, Chinese National Knowledge Infrastructure, and Wan-fang Database was done for relevant articles published up to September 29, 2021. Standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated to explore the association of LCN2 levels with GDM using Revman 5.3 and Stata 15.1. Fifteen case-control studies were included in this meta-analysis. The patients with GDM had significantly higher levels of blood LCN2 than parturients with normal glucose tolerance (SMD=3.41, 95% CI=2.24 to 4.58). Meta-regression and subgroup analysis were conducted to investigate the source of heterogeneity. Likely sources of heterogeneity were age and testing methods. This study found that GDM showed higher blood LCN2 levels than controls. However, caution is warranted on the interpretation of these findings. Standardized LCN2 measurement methods and longitudinal studies are required to disentangle and better understand the relationships observed.
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Affiliation(s)
- Jing Zhu
- Department of Endocrinology, Third Affiliated Hospital of Soochow
University, Changzhou, China
| | - Shuai Jiang
- Department of Emergency Medicine, Zhejiang University School of
Medicine First Affiliated Hospital, Hangzhou, China
- Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical
Injury Diseases of Zhejiang Province, Hangzhou, China
| | - Xiaohong Jiang
- Department of Endocrinology, Third Affiliated Hospital of Soochow
University, Changzhou, China
| | - Kaiming Luo
- Department of Endocrinology, Third Affiliated Hospital of Soochow
University, Changzhou, China
| | - Xiaolin Huang
- Department of Endocrinology, Third Affiliated Hospital of Soochow
University, Changzhou, China
| | - Fei Hua
- Department of Endocrinology, Third Affiliated Hospital of Soochow
University, Changzhou, China
- Correspondence Dr. Fei Hua Third Affiliated Hospital of Soochow UniversityDepartment of EndocrinologyChangzhouChina+86 051968870000
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New Insights into Adipokines in Gestational Diabetes Mellitus. Int J Mol Sci 2022; 23:ijms23116279. [PMID: 35682958 PMCID: PMC9181219 DOI: 10.3390/ijms23116279] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 12/12/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is the most common metabolic disorder of pregnancy and has considerable short- and long-term consequences for the health of both the mother and the newborn. Within its pathophysiology, genetic, nutritional, epigenetic, immunological, and hormonal components have been described. Within the last two items, it is known that different hormones and cytokines secreted by adipose tissue, known collectively as adipokines, are involved in the metabolic alterations underlying GDM. Although the maternal circulating profile of adipokines in GDM has been extensively studied, and there are excellent reviews on the subject, it is in recent years that more progress has been made in the study of their expression in visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), placenta, and their concentrations in the umbilical circulation. Thus, this review compiles and organizes the most recent findings on the maternal and umbilical circulating profile and the levels of expression of adipokines in VAT, SAT, and placenta in GDM.
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Liu H, Liu A, Kaminga AC, McDonald J, Wen SW, Pan X. Chemokines in Gestational Diabetes Mellitus. Front Immunol 2022; 13:705852. [PMID: 35211112 PMCID: PMC8860907 DOI: 10.3389/fimmu.2022.705852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Studies investigating chemokines in gestational diabetes mellitus (GDM) have yielded mixed results. The purpose of this meta-analysis was to explore whether concentrations of chemokines in patients with GDM differed from that of the controls. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched Web of Science, Embase, Cochrane Library, and PubMed databases for articles, published in any language, on chemokines and GDM through August 1st, 2021. The difference in concentrations of chemokines between patients with GDM and controls was determined by a standardized mean difference (SMD) with a 95% confidence interval (CI), calculated in the meta-analysis of the eligible studies using a random-effects model with restricted maximum-likelihood estimator. Results Seventeen studies met the inclusion criteria for the meta-analysis. Altogether, they included nine different chemokines comparisons involving 5,158 participants (1,934 GDM patients and 3,224 controls). Results showed a significant increase of these chemokines (CCL2, CXCL1, CXCL8, CXCL9, and CXCL12) in the GDM patients compared with the controls. However, there was a significant decrease of the chemokines, CCL4, CCL11 and CXCL10, in the GDM patients compared with the controls. Moreover, subgroup analysis revealed a potential role of chemokines as biomarkers in relation to laboratory detection (different sample type and assay methods) and clinical characteristics of GDM patients (ethnicity and body mass index). Conclusion GDM is associated with several chemokines (CCL2, CCL4, CCL11, CXCL1, CXCL8, CXCL9, CXCL10 and CXCL12). Therefore, consideration of these chemokines as potential targets or biomarkers in the pathophysiology of GDM development is necessary. Notably, the information of subgroup analysis underscores the importance of exploring putative mechanisms underlying this association, in order to develop new individualized clinical and therapeutic strategies.
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Affiliation(s)
- Hongying Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Atipatsa C Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi
| | - Judy McDonald
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shi Wu Wen
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Obstetrics and Gynaecology and School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - Xiongfeng Pan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Peña-Cano MI, Valencia-Ortega J, Morales-Ávila E, Díaz-Velázquez MF, Gómez-Díaz R, Saucedo R. Omentin-1 and its relationship with inflammatory factors in maternal plasma and visceral adipose tissue of women with gestational diabetes mellitus. J Endocrinol Invest 2022; 45:453-462. [PMID: 34480740 DOI: 10.1007/s40618-021-01671-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/30/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the association of omentin-1 and inflammatory factors in serum and visceral adipose tissue (VAT) of women with gestational diabetes mellitus (GDM) compared to normal pregnant (NP) subjects. Furthermore, to examine their correlation with maternal clinical characteristics. METHODS We compared 116 GDM women to 115 NP women, at the time of cesarean section. Circulating omentin-1 and pro-inflammatory (IL-1β, IL-6, TNF-α), and anti-inflammatory cytokines (IL-1RA, IL-10) were examined. Moreover, their mRNA expression in VAT, along with inflammatory factors involved in the NF-κB pathway (TLR2, TLR4, NF-κB, IKκB), were examined. RESULTS Circulating omentin-1 (p = 0.022) was lower and circulating IL-1-β, IL-1RA, as well as IL-10 (p = 0.005, p = 0.007, and p = 0.015, respectively), were higher in GDM compared to NP women. Omentin-1 correlated negatively with pre-pregnancy and gestational BMI, and HOMA-IR in all women, but was not associated with cytokines. TLR2, TLR4, IL-1β, IL-1RA, IL-6, IL-10 mRNA expression in VAT was lower in GDM compared with controls (p < 0.05 all). In multivariate analysis, BMI at delivery was significantly correlated to omentin-1 concentrations in all and NP subjects. In addition, omentin-1 expression was correlated to inflammatory gene expression in all, GDM and NP, women (p < 0.05 all). CONCLUSION Serum levels and VAT gene expression of omentin-1 are not independently linked to GDM; notwithstanding, GDM women have a VAT-altered inflammatory status. In addition, no systemic association between omentin-1 and inflammatory factors was found, whereas associations between their expression in all women were observed, indicating that expression of these adipokines is linked between them regardless of GDM.
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Affiliation(s)
- M I Peña-Cano
- Hospital of Gynecology and Obstetrics 221, Instituto Mexicano del Seguro Social, Toluca, State of Mexico, México
| | - J Valencia-Ortega
- Endocrine Research Unit, National Medical Center, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Mexico City, 06720, México
| | - E Morales-Ávila
- Faculty of Chemistry, Universidad Autonoma del Estado de Mexico, Toluca, State of Mexico, México
| | - M F Díaz-Velázquez
- Hospital of Gynecology and Obstetrics 3, Medical Center La Raza, Instituto Mexicano del Seguro Social, Mexico City, México
| | - R Gómez-Díaz
- Unit of Research in Clinical Epidemiology, National Medical Center, Instituto Mexicano del Seguro Social, Mexico City, México
| | - R Saucedo
- Endocrine Research Unit, National Medical Center, Instituto Mexicano del Seguro Social, Cuauhtémoc 330, Mexico City, 06720, México.
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Fiore M, Petrella C, Coriale G, Rosso P, Fico E, Ralli M, Greco A, De Vincentiis M, Minni A, Polimeni A, Vitali M, Messina MP, Ferraguti G, Tarani F, de Persis S, Ceccanti M, Tarani L. Markers of Neuroinflammation in the Serum of Prepubertal Children with Fetal Alcohol Spectrum Disorders. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 21:854-868. [PMID: 34852752 DOI: 10.2174/1871527320666211201154839] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/27/2021] [Accepted: 10/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorders (FASD) are the manifestation of the damage caused by alcohol consumption during pregnancy. Children with Fetal Alcohol Syndrome (FAS), the extreme FASD manifestation, show both facial dysmorphology and mental retardation. Alcohol consumed during gestational age prejudices brain development by reducing, among others, the synthesis and release of neurotrophic factors and neuroinflammatory markers. Alcohol drinking also induces oxidative stress. HYPOTHESIS/OBJECTIVE The present study aimed to investigate the potential association between neurotrophins, neuroinflammation, and oxidative stress in 12 prepubertal male and female FASD children diagnosed as FAS or partial FAS (pFAS). METHODS Accordingly, we analyzed, in the serum, the level of BDNF and NGF and the oxidative stress, as Free Oxygen Radicals Test (FORT) and Free Oxygen Radicals Defense (FORD). Moreover, serum levels of inflammatory mediators (IL-1α, IL-2, IL-6, IL-10, IL-12, MCP-1, TGF-β, and TNF-α) involved in neuroinflammatory and oxidative processes have been investigated. RESULTS We demonstrated low serum levels of NGF and BDNF in pre-pubertal FASD children with respect to healthy controls. These changes were associated with higher serum presence of TNF- α and IL-1α. Quite interestingly, an elevation in the FORD was also found despite normal FORT levels. Moreover, we found a potentiation of IL-1α, IL-2, IL-10, and IL-1α1 in the analyzed female compared to male children. CONCLUSION The present investigation shows an imbalance in the peripheral neuroimmune pathways that could be used in children as early biomarkers of the deficits observed in FASD.
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Affiliation(s)
- Marco Fiore
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy
| | - Giovanna Coriale
- Centro Riferimento Alcologico Regione Lazio, ASL Roma 1, Rome, Italy
| | - Pamela Rosso
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy
| | - Elena Fico
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
| | | | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonella Polimeni
- Department of Odontostomatological and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | | | | | | | - Francesca Tarani
- Department of Pediatrics, Sapienza University Hospital of Rome, Italy
| | | | - Mauro Ceccanti
- SITAC, Societa' Italiana per il Trattamento dell'Alcolismo, Roma Italy SIFASD, Società Italiana Sindrome Feto-Alcolica, Roma, Italy
| | - Luigi Tarani
- Department of Pediatrics, Sapienza University Hospital of Rome, Italy
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Wang Y, Liu H, Wang J, Hu X, Wang A, Nie Z, Xu H, Li J, Xin H, Zhang J, Zhang H, Wang Y, Lyu Z. Development and validation of a new predictive model for macrosomia at late-term pregnancy: A prospective study. Front Endocrinol (Lausanne) 2022; 13:1019234. [PMID: 36465629 PMCID: PMC9713232 DOI: 10.3389/fendo.2022.1019234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Fetal macrosomia is defined as a birth weight more than 4,000 g and is associated with maternal and fetal complications. This early metabolic disease may influence the entire life of the infant. Currently, macrosomia is predicted by using the estimated fetal weight (EFW). However, the EFW is inaccurate when the gestational week is gradually increasing. To assess precisely the risk of macrosomia, we developed a new predictive model to estimate the risk of macrosomia. METHODS We continuously collected data on 655 subjects who attended regular antenatal visits and delivered at the Second Hospital of Hebei Medical University (Shijiazhuang, China) from November 2020 to September 2021. A total of 17 maternal features and 2 fetal ultrasonographic features were included at late-term pregnancy. The 655 subjects were divided into a model training set and an internal validation set. Then, 450 pregnant women were recruited from Handan Central Hospital (Handan, China) from November 2021 to March 2022 as the external validation set. The least absolute shrinkage and selection operator method was used to select the most appropriate predictive features and optimize them via 10-fold cross-validation. The multivariate logistical regressions were used to build the predictive model. Receiver operating characteristic (ROC) curves, C-indices, and calibration plots were obtained to assess model discrimination and accuracy. The model's clinical utility was evaluated via decision curve analysis (DCA). RESULTS Four predictors were finally included to develop this new model: prepregnancy obesity (prepregnancy body mass index ≥ 30 kg/m2), hypertriglyceridemia, gestational diabetes mellitus, and fetal abdominal circumference. This model afforded moderate predictive power [area under the ROC curve 0.788 (95% confidence interval [CI] 0.736, 0.840) for the training set, 0.819 (95% CI 0.744,0.894) for the internal validation set, and 0.773 (95% CI 0.713,0.833) for the external validation set]. On DCA, the model evidenced a good fit with, and positive net benefits for, both the internal and external validation sets. CONCLUSIONS We developed a predictive model for macrosomia and performed external validation in other regions to further prove the discrimination and accuracy of this predictive model. This novel model will aid clinicians in easily identifying those at high risk of macrosomia and assist obstetricians to plan accordingly.
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Affiliation(s)
- Yuhan Wang
- Department of Endocrinology, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Hongzhou Liu
- Department of Endocrinology, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Department of Endocrinology, First Hospital of Handan City, Handan, Hebei, China
| | - Jincheng Wang
- Department of Epidemiology, The George Washington University, Washington, DC, United States
| | - Xiaodong Hu
- Department of Endocrinology, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Anning Wang
- Department of Endocrinology, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhimei Nie
- Department of Endocrinology, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Huaijin Xu
- Department of Endocrinology, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Jiefei Li
- Department of Endocrinology, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Hong Xin
- Department of Obstetrics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiamei Zhang
- Department of Ultrasound Diagnosis, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Han Zhang
- Department of Ultrasound Diagnosis, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yueheng Wang
- Department of Ultrasound Diagnosis, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhaohui Lyu
- Department of Endocrinology, The First Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Zhaohui Lyu,
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