Association between age at menarche and risk of diabetes in adults: results from the EPIC-Norfolk cohort study

Aims/hypothesis Earlier age at menarche is associated with increased BMI and obesity risk from early childhood through to adulthood. We hypothesised that earlier age at menarche would also predict subsequent diabetes risk. Methods This was a population-based prospective cohort study of 13,308 women, who were aged 40 to 75 years between 1993 and 1997 and participating in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk). We used data on age at menarche and ascertained diabetes incidence to 2005. Results There were 734 cases of diabetes (363 incident and 371 prevalent cases). Mean age at menarche was lower in women with diabetes than in non-diabetic women (12.8 vs 13.0 years, p = 0.008). Compared with the earliest quintile (menarche at 8–11 years), women in the oldest quintile (menarche at 15–18 years) had lower BMI (25.5 vs 27.4 kg/m², p < 0.0001) and a reduced risk of diabetes (OR 0.66 [95% CI 0.51–0.86] adjusted for age, family history, physical activity, smoking, occupational social class, parity and use of hormonal preparations). The association between age at menarche and diabetes was linear (adjusted OR 0.91 [95% CI 0.87–0.96] per 1 year later menarche) and appeared to be completely mediated by adult BMI or waist circumference (OR 0.98 [95% CI 0.93–1.03], further adjusted for BMI at age 40–75 years). Conclusions/interpretation Earlier age at menarche increases the risk of diabetes in women and this association appears to be mediated by increased adiposity. History of earlier menarche may help to identify women with increased subsequent risk of diabetes.     

Comparison of anthropometric indices (body mass index,waist circumference,waist to hip ratio and waist to height ratio) in predicting risk of type II diabetes in the population of Yazd,Iran

Background and objectives

The purpose of this study was to determine the best anthropometric index and calculate the cut-off point for each anthropometric index in predicting the risk of type II diabetes in the population of Yazd city in Iran.

Physical activity is associated with decreased incidence of chronic kidney disease in type 2 diabetes patients: A retrospective cohort study in Taiwan

AimsTo assess the effect of physical activity in patients with type 2 diabetes mellitus on prevention of diabetes with chronic kidney disease.MethodsThis is a cohort study on stratified selected subjects in Taiwan from 2004/01/01 to 2005/12/31. Demographic data, lifestyle factors and clinical characteristics were analyzed for an association with the occurrence of chronic kidney disease. Applicable analysis weights, Stata 11.0, were applied to adjust the design variables for clustering and stratification.ResultsDuring the two year study period, the univariate Cox proportional hazards model showed significant associations of age, physical activity, and the Charlson comorbidity index (CCI) with chronic kidney disease. Physical activity had a beneficial effect in diabetic subjects with chronic kidney disease (HR: 0.31, p < 0.01). Older age and a CCI greater than 2 were both harmful in diabetic subjects with chronic kidney disease (1.06 and 3.44, respectively). The results of a multivariate Cox proportional hazards evaluation model were similar to those of a univariate evaluation model, except that CCI was not significantly different. Moreover, medications for hypertension of diabetic subjects created an increased risk of chronic kidney disease (HR: 5.85 and 3.74, respectively), indicating that the presence of hypertension is a strong risk factor for the progression of chronic kidney disease.ConclusionIn this study, physical activity was not only a healthful lifestyle factor but also a treatment to decrease incidence of chronic kidney disease in diabetic patients.     

Waist circumference, body mass index and waist to hip ratio for prediction of the metabolic syndrome in Chinese

Background and aimsTo explore the ability of waist circumference (WC), body mass index (BMI) and waist to hip ratio (WHR) to predict two or more non-adipose components of the metabolic syndrome (MetS) among individuals aged 18–85 in North China.Methods and resultsThis study is a cluster sample survey of 101,510 individuals, complete data are 75,788 subjects, 59,874 males and 15,914 females. Their ages were 51.9 ± 12.7 years (males) and 48.7 ± 11.5 years (females). Receiver operating characteristic (ROC) analysis was used to examine discrimination and find optimal cut off values of WC, BMI and WHR to predict two or more non-adipose components of MetS. The area under the ROC curve (AURC) for WC (0.694) and BMI (0.692) in females showed no difference. In males BMI (0.657) had a better discrimination than WC (0.634). WHR was weaker in both sexes. The optimal cut off value of WC in males (86.5 cm) was higher than in females (82.1 cm); and that of BMI was about 24 kg/m² in both genders. The optimal cut off values of WC, BMI, and WHR, increased with age in both sexes.ConclusionsBMI and WC are more useful than WHR for predicting two or more non-adipose components of MetS. Cut off values for WC in males, and those of BMI and WHR in both sexes are lower than that in present MetS criteria; WC in females is slightly higher. Cut off values of WC, BMI and WHR were increased with age in the Chinese.     

2型糖尿病患者发生慢性肾脏病的危险因素及与肥胖的相关性研究

目的研究2型糖尿病(T2DM)患者发生慢性肾脏病(CKD)的危险因素,并着重分析肥胖与CKD发生的关系。方法纳入2009年1月至2019年6月在南京鼓楼医院就诊的18至75岁诊断为T2DM的患者,收集一般资料包括性别、年龄、体重指数(BMI)、收缩压、舒张压、糖尿病病程以及实验室指标包括血红蛋白(Hb)、白蛋白、丙氨酸转氨酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、尿酸、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿白蛋白/肌酐比值和估算的肾小球滤过率。肥胖定义为BMI≥28 kg/m²,超重定义为24 kg/m²≤BMI<28 kg/m²。根据是否合并CKD,将研究对象分为合并CKD组和不合并CKD组。在不合并CKD的T2DM患者中,选取至少随访一次,随访时间超过12个月且随访数据完整的患者,按是否发生CKD分为发生CKD组和未发生CKD组。两组间各指标的比较采用t检验、非参数检验以及χ²检验。采用单因素及多因素logistic回归分析法分析T2DM患者发生CKD的危险因素,采用Cox比例风险模型分析随访的T2DM患者CKD发生的危险因素。采用限制性立方样条(RCS)拟合Cox回归模型来评估不同的BMI截点与CKD的关系。结果共纳入3194例T2DM患者,其中合并CKD组620例,不合并CKD组2574例。与不合并CKD组相比,合并CKD组T2DM患者BMI明显增高(P=0.005)。单因素logistic回归分析结果显示,性别、肥胖、收缩压、舒张压、Hb、白蛋白、TG、TC、FPG及HbA1c为T2DM患者发生CKD的影响因素(均P<0.05),将上述指标作为自变量,进行多因素logistic回归分析,结果显示,肥胖(OR=1.058,95%CI 1.079~2.018),收缩压增高(OR=1.027,95%CI 1.018~1.035),TG增加(OR=1.087,95%CI 1.008~1.171),FPG增高(OR=1.042,95%CI 1.003~1.083)是T2DM患者发生CKD的影响因素(均P<0.05)。不合并CKD组中随访时间超过12个月且随访数据完整的T2DM患者共753例,其中,发生CKD组182例,未发生CKD组571例。Cox比例风险模型分析结果显示,在校正年龄、糖尿病病程、收缩压、AST、TG及FPG后,超重为发生CKD的危险因素(OR=1.95,95%CI 1.05~3.61)。RCS拟合Cox回归模型结果显示,T2DM患者BMI与CKD发生风险呈非线性关系,BMI在28~31 kg/m²的T2DM患者CKD的发生风险增加(均P<0.05)。结论T2DM患者肥胖与CKD密切相关,肥胖的T2DM患者,特别是BMI在28~31 kg/m²,容易发展为CKD。     

2型糖尿病患者发生慢性肾脏病的危险因素及与肥胖的相关性研究

目的研究2型糖尿病(T2DM)患者发生慢性肾脏病(CKD)的危险因素,并着重分析肥胖与CKD发生的关系。方法纳入2009年1月至2019年6月在南京鼓楼医院就诊的18至75岁诊断为T2DM的患者,收集一般资料包括性别、年龄、体重指数(BMI)、收缩压、舒张压、糖尿病病程以及实验室指标包括血红蛋白(Hb)、白蛋白、丙氨酸转氨酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、尿酸、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿白蛋白/肌酐比值和估算的肾小球滤过率。肥胖定义为BMI≥28 kg/m²,超重定义为24 kg/m²≤BMI<28 kg/m²。根据是否合并CKD,将研究对象分为合并CKD组和不合并CKD组。在不合并CKD的T2DM患者中,选取至少随访一次,随访时间超过12个月且随访数据完整的患者,按是否发生CKD分为发生CKD组和未发生CKD组。两组间各指标的比较采用t检验、非参数检验以及χ²检验。采用单因素及多因素logistic回归分析法分析T2DM患者发生CKD的危险因素,采用Cox比例风险模型分析随访的T2DM患者CKD发生的危险因素。采用限制性立方样条(RCS)拟合Cox回归模型来评估不同的BMI截点与CKD的关系。结果共纳入3194例T2DM患者,其中合并CKD组620例,不合并CKD组2574例。与不合并CKD组相比,合并CKD组T2DM患者BMI明显增高(P=0.005)。单因素logistic回归分析结果显示,性别、肥胖、收缩压、舒张压、Hb、白蛋白、TG、TC、FPG及HbA1c为T2DM患者发生CKD的影响因素(均P<0.05),将上述指标作为自变量,进行多因素logistic回归分析,结果显示,肥胖(OR=1.058,95%CI 1.079~2.018),收缩压增高(OR=1.027,95%CI 1.018~1.035),TG增加(OR=1.087,95%CI 1.008~1.171),FPG增高(OR=1.042,95%CI 1.003~1.083)是T2DM患者发生CKD的影响因素(均P<0.05)。不合并CKD组中随访时间超过12个月且随访数据完整的T2DM患者共753例,其中,发生CKD组182例,未发生CKD组571例。Cox比例风险模型分析结果显示,在校正年龄、糖尿病病程、收缩压、AST、TG及FPG后,超重为发生CKD的危险因素(OR=1.95,95%CI 1.05~3.61)。RCS拟合Cox回归模型结果显示,T2DM患者BMI与CKD发生风险呈非线性关系,BMI在28~31 kg/m²的T2DM患者CKD的发生风险增加(均P<0.05)。结论T2DM患者肥胖与CKD密切相关,肥胖的T2DM患者,特别是BMI在28~31 kg/m²,容易发展为CKD。     

Physical inactivity and chronic kidney disease in Australian adults: The AusDiab study

Background and Aims

Physical inactivity is associated with cardiovascular risk however its relationship to chronic kidney disease is largely unknown. We examined the association between leisure-time physical activity and risk of chronic kidney disease in a prospective, population-based cohort of Australians aged ≥25 years (AusDiab).

Methods and Results

The baseline sample included 10,966 adults (4951 males and 6015 females). From this sample, 6318 participants with complete baseline and 5-year follow-up urinalysis and serum creatinine measurements formed the study population for longitudinal analysis. Self-reported leisure-time physical activity was measured using a validated, interviewer-administered questionnaire. Compared with sufficiently active individuals (≥150 min physical activity per week), those who were inactive (0 min/week) were more likely to have albuminuria at baseline (multivariate-adjusted OR = 1.34, 95% CI 1.10-1.63). Inactivity (versus sufficient physical activity) was associated with increased age- and sex-adjusted odds of an estimated glomerular filtration rate <3rd percentile (OR = 1.30, 95% CI 1.02-1.65), although this was not significant after multivariate adjustment (OR = 1.17, 95% CI 0.91-1.50). Obese, inactive individuals were significantly more likely to have albuminuria at baseline (multivariate-adjusted OR = 1.74, 95% CI 1.35-2.25), compared with sufficiently active, non-obese individuals. Baseline physical activity status was not significantly associated with longitudinal outcomes.

Conclusions

Physical inactivity is cross-sectionally associated with albuminuria prevalence, particularly when combined with obesity. Future studies are needed to determine whether this association is causal and the importance of physical activity in CKD prevention.     

The effects of physical activity, body mass index (BMI) and waist circumference (WC) on glucose intolerance in older people: A nationwide study from Taiwan

We investigated the gender-specific effects of physical activity, BMI and WC on glucose intolerance in an elderly Taiwanese population (n = 1344) aged 65 and above, who participated in the Elderly Nutrition and Health Survey in Taiwan in 1999-2000. In this cross-sectional study, physical activity was assessed using the Modified Baecke Questionnaire for Older Adults (MBQOA). Categories of physical activity level were defined by tertiles of MBQOA scores. Glucose intolerance in subjects not previously diagnosed with diabetes was categorized according to 2003 American Diabetes Association criteria. After adjustment for potential confounders, physical activity was significantly inversely associated with the presence of undiagnosed type 2 diabetes and impaired fasting glucose (IFG) in older women. In older men, the association was less clear. BMI and WC were significantly positively associated with the presence of undiagnosed diabetes in men and were significantly associated with IFG in both sexes. In older women, undiagnosed diabetes was strongly associated with increased WC, but not with BMI. Our findings highlight that older women with low physical activity or high WC, and older men with high BMI or WC are important target populations for interventions to prevent glucose intolerance.     

体质指数与冠心病、脑卒中发病的前瞻性研究

目的　探讨体质指数水平与冠心病事件和脑卒中发病的关系。方法　 1982～ 1985年在我国不同地区的 10组人群中 (年龄 35～ 5 9岁 )进行心血管病危险因素调查 ,对其中无脑卒中、无心肌梗死及无恶性肿瘤史的研究对象随访至 1999～ 2 0 0 0年 ,登记并核实冠心病事件、脑卒中事件的发生情况以及各种原因的死亡。结果　对共计 2 4 90 0人 ,平均 15 2年的随访中 ,共发生冠心病事件 2 5 3例 ,脑卒中事件 797例 ,其中缺血性脑卒中 4 5 3例 ,出血性脑卒中 311例。用Cox比例风险回归模型(调整年龄、性别、收缩压、血清总胆固醇水平、吸烟和饮酒情况 )估计低体重组 (BMI<18 5 )、正常体重组 (BMI为 18 5～ 2 3 9)、超重组 (BMI为 2 4～ 2 7 9)和肥胖组 (BMI≥ 2 8)发生冠心病事件的相对危险分别为 0 70、1 0、1 33和 1 74 ,缺血性脑卒中的相对危险分别为 0 5 6、1 0、2 0 3和 1 98。与非超重者相比 ,超重和肥胖者冠心病事件和缺血性脑卒中事件的归因危险度百分比分别为 32 0 %和 5 3 3% ,人群归因危险度百分比分别为 7 3%和 16 1%。结论　体质指数与冠心病事件、缺血性脑卒中的发病危险呈明显的正关联。控制体重、降低超重和肥胖率应是预防冠心病和缺血性脑卒中的重要措施。     

Body shape trajectories and the incidence of hypertension in a Mediterranean cohort: The sun study

Aims

Our aim was to assess the association between trajectories of body-shape across the first 40 years of life and subsequent development of hypertension in a Mediterranean cohort.

Clinical features and long-term outcomes of diabetic kidney disease – A prospective cohort study from China

Background

Information regarding the clinical phenotypes of diabetic kidney disease (DKD) might guide better practice for clinicians. We aim to compare the clinical features and long-term outcomes of proteinuric and non-proteinuric phenotypes of DKD, based on a prospective cohort of Chinese population.

The Association Between Obesity and GERD: A Review of the Epidemiological Evidence

The current epidemics of obesity and gastroesophageal reflux disease (GERD)-related disorders have generated much interest in studying the association between them. Results of multiple studies indicate that obesity satisfies several criteria for a causal association with GERD and some of its complications, including a generally consistent association with GERD symptoms, erosive esophagitis, and esophageal adenocarcinoma. An increase in GERD symptoms has been shown to occur in individuals who gain weight but continue to have a body mass index (BMI) in the normal range, contributing to the epidemiological evidence for a possible dose-response relationship between BMI and increasing GERD. Data are less clear on the relationship between Barrett's esophagus (BE) and obesity. However, when considered separately, abdominal obesity seems to explain a considerable part of the association with GERD, including BE. Overall, epidemiological data show that maintaining a normal BMI may reduce the likelihood of developing GERD and its potential complications.     

银川市老年人体质指数与常见慢性病的相关性

目的 探讨体质指数(BMI)与常见慢性病的相关性.方法 对银川市830例60～80岁常住社区的老年人采用分层整群随机抽样方法,计算体质指数,分析体质指数与慢性疾病的关系.结果 该人群慢性病的总患病率为74.9％,超重和肥胖的总检出率为59.03％,男、女性别间无显著差异;肥胖与超重组患慢性病人数占患慢性病总人数的61.4％,肥胖组患慢性病人数比例明显高于正常组(P=0.004).体质指数与慢性病总体患病情况呈显著相关(P=0.001),与糖尿病(P=0.0l5)、高血压(P=0.001)、高脂血症(P=0.045)三种疾病相关.超重和肥胖组冠心病、高脂血症、脑血管疾病三种疾病的患病率明显高于正常组与消瘦组(均P＜0.05).结论 应对超重与肥胖人群给予充分关注,以社区为依托进行综合干预,减少慢性病危险因素,提高老年人生命质量.     

体重指数与慢性阻塞性肺疾病及生活质量的关系

目的在2002至2004年中国7个地区（北京、上海、广东、辽宁、天津、重庆和陕西）慢性阻塞性肺疾病（COPD）现况调查的基础上，探讨体重指数（BMI）与COPD的关系。方法现况调查采用多阶段分层整群随机抽样方法，对40岁及以上的居民进行问卷调查、身高和体重的测量及肺功能检测。调查有效人数为20245名，男8705名，女11540名，以支气管扩张试验后第一秒用力呼气容积／用力肺活量（FEV1／FVC）〈70％作为COPD的诊断标准，并排除其他已知的气流受限的疾病，共筛查出1668例COPD和18577例非COPD进行BMI与COPD的关系分析。结果COPD患者的BMI[（22．7±3．5）kg／m^2]较非COPD患者[（24．1±3．4）kg／m^2]低，吸烟者BMI为[（23．6±3．4）kg／m^2]较不吸烟者[（24．2±3．5）ks／m^2]低，差异均有统计学意义（F分别为158．31、49．10，P均〈0．01），且COPD与吸烟存在对BMI的交互作用（F=6．03，P〈0．05）。COPD病情程度分级越高BMI越低（F=45．46，P〈0．01），COPD病情程度分级与BMl分级存在负相关（r=-0．08，P〈0．01）。BMI越低COPD的患病率越高（趋势x^2=102．68，P〈0．01），多因素logistic回归分析显示，与正常BMI（18．5～23．9kg／m^2）比较，1级BMI（〈18．5kg／m^2）、3级BMI（24．0～27．9kg／m^2）和4级BMI（≥28．0ks／m^2）患COPD的D尺值分别为[2．12（1．73～2．59）、0．67（0．59～0．76）、0．60（0．49～0．73），P均〈0．05]；且BMl分级与吸烟存在对COPD的交互作用（x^2=4．73，P〈O．05）。与2级BMI的COPD患者比较，1级BMI的COPD患者生活质量差（心理指数评分：55±8、57±6，F=2．96，P〈0．05；躯体指数评分：42±10、46±9，F=4．21，P〈0．01）；气促分数高（1．4±1．5、1．1±1．3，x^2=14．32，P〈0．01）。结论1级BMI与COPD关系密切，其可能是COPD患病的独立于吸烟的危险因素，而低BMI也可能是COPD病情严重程度的一个重要指标。     

广西城市社区居民高尿酸血症流行病学调查及其与慢性肾脏病的关系

目的 通过社区人群筛查了解广西城市原住民中高尿酸血症(HUA)的患病率及其与慢性肾脏病(CKD)的关系,并探讨影响HUA肾损害的风险因素.方法 选择桂林市城区原住居民集中的象山社区,对18～75岁居民(n=6 273)采取横断面进行筛查.收集空腹血及晨尿进行血糖、肾功能、血脂、胰岛素和尿蛋白等检测,同时进行问卷调查和体格检查.结果 社区居民中HUA总患病率为23.5%,其中男性HUA患病率显著高于女性(28.4%对19.7%,P＜0.01).社区居民中CKD患病率为21.6%,其中男性居民CKD患病率较女性显著增高(24.9%对19.0%,P＜0.01).在HUA人群中CKD检出率显著高于尿酸正常人群(30.4%对18.9%,P＜0.01).男性HUA人群CKD检出率显著高于同性别正常血尿酸人群(34.3%对21.2%,P＜0.01),也显著高于女性HUA人群(25.9%,P＜0.01).Logistic回归分析发现,CKD仅与收缩压、低密度脂蛋白胆固醇和血糖水平独立相关(P＜0.01).结论 广西城市社区居民中HUA患病率显著增加,与CKD患病率增高有关,且血尿酸轻度增高即增加CKD患病率.

Abstract：

Objective To detect the prevalence of hyperuricemia and its relationship to chronic kidney disease(CKD) in the residents of Guangxi, and to discuss the risk factors for the hyperuricemia associated renal damage. Methods The residents aged 18-75 years old(n=6 273) in Xiangshan community,Guilin, were screened by means of cross-sectional study. Blood pressure was measured at 8:00-9:00.Fasting blood and urine samples were collected to determine blood glucose, lipid, insulin, creatinine, and urine albumin. Results The prevalence of hyperuricemia in the community residents was 23.5% in all cohort, being significantly higher in male residents than in female(28.4% vs 19.7%,P＜0.01). The prevalence of CKD was 21.6% in all cohort, and was 24.9% in males and 19.0% in females(P＜0.01). The prevalence of CKD was 30.4% and 18.9% respectively in residents with and without hyperuricemia(P＜0.01).The prevalence of CKD in males with hyperuricemia(34.3%) was significantly higher than in males without hyperuricemia(21.2%) and females with hyperuricemia(25.9%, all P＜0.01). CKD was only positively related to low-density lipoprotein cholesterol, blood glucose, and systolic blood pressure shown by logistic regression analysis. Conclusions The prevalence of hyperuricemia markedly increases in the urban residents, which contribute to the raised prevalence of CKD. Slightly elevated blood uric acid level is associated with raised prevalence of CKD.     

Association of the triglycerides to high-density lipoprotein cholesterol ratio with the risk of chronic kidney disease: Analysis in a large Japanese population

Objectives

To investigate the relationship between triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) and chronic kidney disease (CKD).

Methods

We used data from 216,007 Japanese adults who participated in a nationwide health checkup program. Men (n = 88,516) and women (n = 127,491) were grouped into quartiles based on their TG/HDL-C levels (<1.26, 1.26–1.98, 1.99–3.18, and >3.18 in men; <0.96, 0.96–1.44, 1.45–2.22, and >2.22 in women). We cross-sectionally assessed the association of TG/HDL-C levels with CKD [defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m² (low eGFR) and/or proteinuria (defined as urinary protein ≥1+ on dipstick testing)], low eGFR, and proteinuria.

Results

The prevalence of CKD, low eGFR, and proteinuria increased significantly with elevating quartiles of TG/HDL-C in both genders (all P for trend <0.001). Participants in the highest quartile of TG/HDL-C had a significantly greater risk of CKD than those in the lowest quartile after adjustment for the relevant confounding factors (odds ratio: 1.57, 95% confidence interval: 1.49–1.65 in men; 1.41, 1.34–1.48 in women, respectively). Furthermore, there were significant associations with low eGFR and proteinuria. In stratified analysis, the risk of CKD increased linearly with greater TG/HDL-C levels in participants with and without hypertension, diabetes, and obesity. Moreover, higher TG/HDL-C levels were relevant for CKD, especially in participants with hypertension and diabetes (P for interaction <0.001, respectively).

Conclusions

An elevated TG/HDL-C is associated with the risk of CKD in the Japanese population.