Diabetes/metabolism research and reviews, Mar 26, 2016
Passive smoking increased type 2 diabetes mellitus risk but it is uncertain whether it also incre... more Passive smoking increased type 2 diabetes mellitus risk but it is uncertain whether it also increased gestational diabetes mellitus (GDM) risk. We aimed to examine the association of passive smoking during pregnancy and its interaction with maternal obesity for GDM. From 2010 to 2012, 12,786 Chinese women underwent a 50-gram 1-hour glucose challenge test (GCT) at 24-28 weeks of gestation and further underwent a 75-gram 2-hour oral glucose tolerance test if the GCT result was ≥7.8 mmol/L. GDM was defined by the International Association of Diabetes and Pregnancy Study Group's cut-points. Self-reported passive smoking during pregnancy was collected by questionnaire. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between maternal obesity and passive smoking was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). Significant RERI >...
Aims To compare risks of early postpartum diabetes and prediabetes in Chinese women with and with... more Aims To compare risks of early postpartum diabetes and prediabetes in Chinese women with and without gestational diabetes mellitus (GDM) during pregnancy Subjects and methods Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM who participated in the urban GDM universal screening survey by using World Health Organization's criteria. Postpartum diabetes and prediabetes were identified after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum diabetes and prediabetes between women with and without GDM. Results During a mean follow-up of 3.53 years postpartum, 90 incident cases of diabetes and 599 incident cases of prediabetes were identified. Multivariable-adjusted hazard ratios among women with prior GDM, compared with those without it, were 76.1 (95% CI 23.6-246) for diabetes, and 25.4 (95% CI 18.2-35.3) for prediabetes. When the mean follow-up extended to 4.40 years, 1...
To report the weight loss findings after the first year of a lifestyle intervention trial among w... more To report the weight loss findings after the first year of a lifestyle intervention trial among women with gestational diabetes mellitus (GDM). A total of 1180 women with GDM were randomly assigned (1:1) to receive a 4-year lifestyle intervention (intervention group, n = 586) or standard care (control group, n = 594) between August 2009 and July 2011. Major elements of the intervention included 6 face-to-face sessions with study dieticians and two telephone calls in the first year, and two individual sessions and two telephone calls in each subsequent year. Among 79% of participants who completed the year 1 trial, mean weight loss was 0.82 kg (1.12% of initial weight) in the intervention group and 0.09 kg (0.03% of initial weight) in the control group (P = .001). In a prespecified subgroup analysis of people who completed the trial, weight loss was more pronounced in women who were overweight (body mass index ≥24 kg/m) at baseline: mean weight loss 2.01 kg (2.87% of initial weight) ...
Diabetes research and clinical practice, Jan 6, 2017
To assess the association of uric acid (UA) with the risks of postpartum type 2 diabetes and pred... more To assess the association of uric acid (UA) with the risks of postpartum type 2 diabetes and prediabetes among women with prior gestational diabetes mellitus (GDM). We performed a cross-sectional study of 1262 GDM women at 1-5 years after delivery using the baseline data from the Tianjin Gestational Diabetes Mellitus Prevention Program. Logistic regression models were used to estimate the association of different levels of serum UA with the risks of type 2 diabetes and prediabetes. The multivariable-adjusted odds ratios (ORs) across quartiles of serum UA were 1.00, 1.23 (95% confidence interval [CI] 0.55-2.78), 2.05 (95% CI 0.96-4.39), and 3.17 (95% CI 1.54-6.55) (Ptrend<0.001) for type 2 diabetes, and 1.00, 1.50 (95% CI 1.03-2.19), 2.28 (95% CI 1.58-3.30), and 2.88 (95% CI 1.99-4.17) (Ptrend<0.001) for prediabetes, respectively. Restricted cubic splines models showed positive linear associations of serum UA as a continuous variable with the risks of type 2 diabetes and predia...
Journal of diabetes and its complications, Jan 17, 2017
To examine the association of connecting peptide (C-peptide) and the risks of postpartum diabetes... more To examine the association of connecting peptide (C-peptide) and the risks of postpartum diabetes and pre-diabetes among women with prior gestational diabetes. A cross-sectional study of 1263 women with prior gestational diabetes was carried out at 1-5years after delivery in Tianjin, China. Logistic regression was used to assess the associations of C-peptide and the risks of diabetes and pre-diabetes. The multivariable-adjusted odds ratios based on different levels of C-peptide (0-33%, 34-66%, 67-90%, and >90% as C-peptide cutpoints) were 1.00, 1.93 (95% confidence interval [CI] 0.85-4.39), 2.49 (95% CI 1.06-5.87), and 3.88 (95% CI 1.35-11.1) for diabetes (P for trend <0.0001), and 1.00, 1.66 (95% CI 1.18-2.36), 2.38 (95% CI 1.56-3.62) and 2.35 (95% CI 1.27-4.37) for pre-diabetes (P for trend <0.0001), respectively. Restricted cubic splines models showed a positive linear association of C-peptide as a continuous variable with the risks of type 2 diabetes and pre-diabetes. T...
To examine the joint association of birth weight and physical activity/sedentary time with childh... more To examine the joint association of birth weight and physical activity/sedentary time with childhood obesity in 12 countries. A cross-sectional study of 5,088 children aged 9 to 11 years was conducted. Birth weight was recalled by parents or guardians. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior were objectively measured using accelerometry. The association of birth weight with the odds of obesity, central obesity, and high body fat was significant among children with either low MVPA or high sedentary time but not among children with either high MVPA or low sedentary time. In comparison with children with normal birth weight and high MVPA, children with high birth weight and low MVPA showed 4.48- to 5.18-fold higher odds of obesity, central obesity, and high body fat; children with normal birth weight and low MVPA showed 3.00- to 3.30-fold higher odds of obesity, central obesity, and high body fat, and children with high birth weight and high MVPA showed 1.1...
We investigated the association of physical activity, TV watching time, sleeping time with the ri... more We investigated the association of physical activity, TV watching time, sleeping time with the risks of obesity and hyperglycemia among 1263 offspring aged 1-5 years of mothers with gestational diabetes (GDM) in a cross-sectional study. Logistic regression models were used to obtain the odd ratios (ORs) (95% confidence intervals [CI]) of childhood obesity and hyperglycemia associated with different levels of indoor activity, outdoor activity, TV watching, and sleeping time. The multivariable-adjusted ORs of obesity based on different levels of TV watching time (0, <1.0, and ≥1.0 hour/day) were 1.00, 1.21 (95% CI 0.72-2.05), and 2.20 (95% CI 1.33-3.63) (Ptrend = 0.003), respectively. The multivariable-adjusted ORs of hyperglycemia based on different levels of indoor activity (<5.0, 5.0-6.9, and ≥7.0 hours/day) were 1.00, 0.74 (95% CI 0.45-1.21), and 0.49 (95% CI 0.28-0.84) (Ptrend = 0.034), respectively. The multivariable-adjusted ORs of hyperglycemia associated with different ...
The purpose of this study was to determine the association between regular (sugar containing) and... more The purpose of this study was to determine the association between regular (sugar containing) and diet (artificially sweetened) soft drink consumption and obesity in children from 12 countries ranging in levels of economic and human development. The sample included 6162 children aged 9-11 years. Information on soft drink consumption was obtained using a food frequency questionnaire. Percentage body fat (%BF) was estimated by bio-electrical impedance analysis, body mass index (BMI) z-scores were computed using World Health Organization reference data, and obesity was defined as a BMI > +2 standard deviations (SD). Multi-level models were used to investigate trends in BMI z-scores, %BF and obesity across categories of soft drink consumption. Age, sex, study site, parental education and physical activity were included as covariates. There was a significant linear trend in BMI z-scores across categories of consumption of regular soft drinks in boys (p = 0.049), but not in girls; there were no significant trends in %BF or obesity observed in either boys or girls. There was no significant linear trend across categories of diet soft drink consumption in boys, but there was a graded, positive association in girls for BMI z-score (p = 0.0002) and %BF (p = 0.0001). Further research is required to explore these associations using longitudinal research designs.
The association between estimated glomerular filtration rate (eGFR) and the risk of mortality amo... more The association between estimated glomerular filtration rate (eGFR) and the risk of mortality among patients with coronary heart disease (CHD) is complex and still unclear. The aim of this study was to evaluate the effect of eGFR on the risk prediction of all-cause and cardiovascular disease (CVD) mortality with a long follow-up period among patients with CHD in China. We conducted a prospective cohort study of 3276 Chinese patients with CHD. Cox proportional hazards regression models were used to estimate the association of different levels of eGFR with the risks of mortality. During a mean follow-up period of 4.9 years, 293 deaths were identified. The multivariable-adjusted hazard ratios associated with different levels of eGFR (≥90 [reference group], 60-89, 30-59, 15-29 ml/min per 1.73m2) at baseline were 1.00, 1.28 (95% confidence interval [CI], 0.87-1.88), 1.96 (95% CI, 1.31-2.94), and 3.91 (95% CI, 2.15-7.13) (P <0.001) for all-cause mortality, and 1.00, 1.26 (95% CI, 0.78-...
The aim was to assess associations between lifestyle behaviors and obesity in a multinational stu... more The aim was to assess associations between lifestyle behaviors and obesity in a multinational study of children from 12 countries representing a wide range of human development. The sample included 6,025 children 9-11 years of age. Behavioral risk factors included nocturnal sleep duration, moderate to vigorous physical activity (MVPA), television viewing (TV time), and healthy and unhealthy diet pattern scores. Multilevel analyses were used to obtain odds ratios for obesity expressed per standard deviation of each behavioral risk factor. The odds ratios (95% confidence intervals) for obesity from multilevel, multivariable models were 0.79 (0.71-0.90) for nocturnal sleep duration, 0.52 (0.45-0.60) for MVPA, 1.15 (1.05-1.27) for TV time, 1.08 (0.96-1.20) for healthy diet score, and 0.93 (0.83-1.04) for unhealthy diet score in boys and 0.71 (0.63-0.80) for nocturnal sleep duration, 0.43 (0.35-0.53) for MVPA, 1.07 (0.96-1.19) for TV time, 1.05 (0.93-1.19) for healthy diet score, and 0.9...
International journal of epidemiology, Jan 12, 2015
Congenital heart disease (CHD) represents one of the most prevalent congenital malformations. How... more Congenital heart disease (CHD) represents one of the most prevalent congenital malformations. However, few studies use whole-population screening by colour Doppler ultrasonic diagnostic system to identify CHD among live infants. We estimate the prevalence of CHD and its major risk indicators among infants aged less than 6 months in urban Tianjin, China. A colour Doppler ultrasonic diagnostic system was used as the screening tool for the diagnosis of CHD. A total of 90 796 infants aged less than 6 months, living in the nine urban districts of Tianjin, China, participated in the CHD screening programme between July 2009 and June 2011. A total of 1817 children were identified as having CHD. The overall prevalence of congenital heart disease was 16.4 per 1000 live births among 47 697 boys, 24.1 per 1000 live births among 43 099 girls, and 20.0 per 1,000 live births among 90 796 boys and girls combined. Atrial septal defect was the most common heart lesion of CHD, with the prevalence of ...
Chronic hyperglycemia in type 2 diabetes increases the risk of microvascular events. However, the... more Chronic hyperglycemia in type 2 diabetes increases the risk of microvascular events. However, there is continuing uncertainty about its effect on macrovascular outcomes and death. We conducted a meta-analysis of prospective studies to estimate the association of glycosylated hemoglobin level with the risk of all-cause mortality and cardiovascular outcomes among patients with type 2 diabetes. We systematically searched the MEDLINE database through April 2011 by using Medical Subject Heading search terms and a standardized protocol. We included prospective cohort studies that reported data of glycosylated hemoglobin level on the risk of incident cardiovascular events and all-cause mortality. Relative risk estimates (continuous and categorical variables) were derived or abstracted from each cohort study. Twenty six studies were included in this analysis with a mean follow-up rang of 2.2-16 years. The pooled relative risk associated with a 1% increase in glycosylated hemoglobin level am...
Objective. To examine the association of maternal glycemia during pregnancy and after delivery wi... more Objective. To examine the association of maternal glycemia during pregnancy and after delivery with anthropometry in the offspring of mothers with gestational diabetes mellitus (GDM).Methods. A total of 1,263 GDM mothers and their children finished the health survey at 1–5 years after delivery.Results. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy had higher prevalence of overweight, higher mean weight for heightZscores, and higher mean BMI for ageZscores at 1–5 years old than the offspring of GDM mothers who were diagnosed with impaired glucose tolerance (IGT) during pregnancy. Offspring of GDM mothers who developed diabetes 1–5 years after delivery had higher mean values ofZscores for weight for height and BMI for age at 1–5 years old than the offspring of GDM mothers who had normal glucose or prediabetes after delivery.Conclusions. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy or after delivery had an increased risk of chi...
The joint relationship between healthy lifestyle and antihypertensive treatment with stroke risk ... more The joint relationship between healthy lifestyle and antihypertensive treatment with stroke risk is unclear. We prospectively investigated the individual and joint effects of healthy lifestyle factors and antihypertensive treatment on stroke risk among 36 686 Finnish participants aged 25 to 74 years and free of coronary heart disease and stroke at baseline. During a mean follow-up of 13.7 years, 1478 people developed stroke event (1167 ischemic and 311 hemorrhagic). The stroke risk was significantly decreased in people who adhered to ≥3 healthy lifestyle factors (never smoking, normal weight, moderate/high level of exercise, vegetable consumption ≥3 times per week, and light/moderate alcohol drinking) compared with those who adhered to <3 healthy lifestyle factors. The stroke risk was significantly increased in unaware untreated, aware untreated, aware treated and controlled, and aware treated and uncontrolled hypertensive people than in normotensive people. The risks of stroke w...
Background: The primary aim of the International Study of Childhood Obesity, Lifestyle and the En... more Background: The primary aim of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was to determine the relationships between lifestyle behaviours and obesity in a multinational study of children, and to investigate the influence of higher-order characteristics such as behavioural settings, and the physical, social and policy environments, on the observed relationships within and between countries. Methods/design: The targeted sample included 6000 10-year old children from 12 countries in five major geographic regions of the world (Europe, Africa, the Americas, SouthEast Asia, and the Western Pacific). The protocol included procedures to collect data at the individual level (lifestyle, diet and physical activity questionnaires, accelerometry), family and neighborhood level (parental questionnaires), and the school environment (school administrator questionnaire and school audit tool). A standard study protocol was developed for implementation in all regions of the world. A rigorous system of training and certification of study personnel was developed and implemented, including web-based training modules and regional in-person training meetings. Discussion: The results of this study will provide a robust examination of the correlates of adiposity and obesity in children, focusing on both sides of the energy balance equation. The results will also provide important new information that will inform the development of lifestyle, environmental, and policy interventions to address and prevent childhood obesity that may be culturally adapted for implementation around the world. ISCOLE represents a multinational collaboration among all world regions, and represents a global effort to increase research understanding, capacity and infrastructure in childhood obesity.
Background: The joint effects of different lifestyle factors on stroke risk are still to some ext... more Background: The joint effects of different lifestyle factors on stroke risk are still to some extent unclear, especially regarding hemorrhagic stroke. Methods: We prospectively investigated the association of different indicators of lifestyle (smoking, body mass index, physical activity, and vegetable and alcohol consumption) with total and type-specific stroke incidence among 36 686 Finnish participants who were 25 to 74 years old and free of coronary heart disease and stroke at baseline. Results: During a mean follow-up period of 13.7 years, 1478 people developed an incident stroke event (1167 ischemic and 311 hemorrhagic). The multivariateadjusted (age, sex, education, family history of stroke, history of diabetes mellitus, systolic blood pressure, and serum total cholesterol level) hazard ratios associated with adherence to 0 to 1 (reference group), 2, 3, 4, and 5 healthy lifestyle indicators were 1, 0.66, 0.57, 0.51, and 0.33 (P Ͻ.001 for trend) for total stroke; 1, 0.67, 0.60, 0.50, and 0.30 (P Ͻ.001 for trend) for ischemic stroke; and 1, 0.63, 0.49, 0.49, and 0.40 (P Ͻ.001 for trend) for hemorrhagic stroke, respectively. These inverse associations were similar in both men and women. The partial population attributable risk percentages associated with adherence to 3, 4, and 5 healthy lifestyle indicators were 26.3%, 43.8%, and 54.6% for total stroke; 22.7%, 45.3%, and 59.7% for ischemic stroke; and 35.0%, 35.0%, and 36.1% for hemorrhagic stroke, respectively. Conclusion: Healthy lifestyle factors are associated with a lower risk of stroke, and there is a graded inverse association between the number of healthy lifestyle indicators and the risks of total, ischemic, and hemorrhagic stroke.
The associations of serum total and high density lipoprotein (HDL) cholesterol with coronary hear... more The associations of serum total and high density lipoprotein (HDL) cholesterol with coronary heart disease were investigated in men aged 64-84 years from the Dutch town of Zutphen during 5 years of follow-up. In 1985, 885 randomly selected men, 710 of whom did not have a history of clinical coronary heart disease, participated in the study. Associations were adjusted for age, body mass index, systolic blood pressure, cigarette smoking, and alcohol consumption. Total cholesterol was not significantly associated with the incidence of coronary heart disease, but for mortality the relative risk corresponding to a 1.00 mmol/liter increase was 1.40 (95 percent confidence interval (Cl) 1.07-1.83). HDL cholesterol was not associated with mortality from coronary heart disease. The relative risk for the incidence of the disease, corresponding to a 0.26 mmol/liter increase, was 0.80 (95 percent Cl 0.60-1.08). For the ratio of HDL cholesterol to total cholesterol, the relative risk for coronary heart disease incidence corresponding to a 0.05 increase amounted to 0.70 (95 percent Cl 0.51-0.95). These results show that in elderly men followed for 5 years, both total and HDL cholesterol are important in predicting coronary heart disease. Total cholesterol seems to be a stronger risk factor for mortality from the disease, whereas HDL cholesterol is more strongly associated with the incidence of a first coronary heart disease event.
Aims/hypothesis The aim of this study was to examine the association between maternal gestational... more Aims/hypothesis The aim of this study was to examine the association between maternal gestational diabetes mellitus (GDM) and childhood obesity at age 9-11 years in 12 countries around the world. Methods A multinational cross-sectional study of 4740 children aged 9-11 years was conducted. Maternal GDM was diagnosed according to the ADA or WHO criteria. Height and waist circumference were measured using standardised methods. Weight and body fat were measured using a portable Tanita SC-240 Body Composition Analyzer. Multilevel modelling was used to account for the nested nature of the data. Results The prevalence of reported maternal GDM was 4.3%. The overall prevalence of childhood obesity, central obesity and high body fat were 12.3%, 9.9% and 8.1%, respectively. The multivariable-adjusted (maternal age at delivery, education, infant feeding mode, gestational age, number of younger siblings, child unhealthy diet pattern scores, moderate-tovigorous physical activity, sleeping time, sedentary time, sex and birthweight) odds ratios among children of GDM mothers compared with children of non-GDM mothers were 1.53 A list of members of the ISCOLE Research Group is given in the electronic supplementary material (ESM).
Primary prevention of cardiovascular disease (CVD) is considered the most effective strategy for ... more Primary prevention of cardiovascular disease (CVD) is considered the most effective strategy for controlling CVD and its consequences. Modification of risk factors is an effective way to reduce CVD risk, and most risk factors can be altered with lifestyle changes and medications. Prospective studies have demonstrated that individually modified lifestyle factors (including physical activity, smoking, alcohol consumption, body mass index, and dietary factors) are associated with lower risks of coronary heart disease (CHD), heart failure (HF), and stroke, but the results are inconsistent. The association between diet and the risk of CVD is varying. Furthermore, there are not enough studies to demonstrate the joint effects of multiple modifiable lifestyle factors on the risks of CHD, HF, and stroke. This review focuses on the dietary pattern, other lifestyle factors, and the joint associations of multiple modifiable lifestyle factors with the risks of CHD, HF, and stroke and has found that healthy lifestyle factors, including healthy diet, were significantly associated with decreased risks of CHD, HF, and stroke in men and women, and the risks progressively decreased as the number of healthy lifestyle factors increased. These results also suggest that in the general population, most cases of CHD, HF, and stroke could be avoided by practicing a healthy lifestyle.
Previous studies have documented that visceral adipose tissue is positively associated with the r... more Previous studies have documented that visceral adipose tissue is positively associated with the risk of diabetes. However, the association of subcutaneous adipose tissue with diabetes risk is still in dispute. We aimed to assess the associations between different adipose distributions and the risk of newly diagnosed diabetes in Chinese adults. The Shanghai Nicheng Cohort Study was conducted among Chinese adults aged 45-70 years. The baseline data of 12,137 participants were analyzed. Subcutaneous and visceral fat area (SFA and VFA) were measured by magnetic resonance imaging. Diabetes was newly diagnosed using a 75 g oral glucose tolerance test. The multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI) of newly diagnosed diabetes per 1-standard deviation increase in SFA and VFA were 1.29 (1.19-1.39) and 1.61 (1.49-1.74) in men, and 1.10 (1.03-1.18) and 1.56 (1.45-1.67) in women, respectively. However, the association between SFA and newly diagnosed diabetes disap...
Diabetes/metabolism research and reviews, Mar 26, 2016
Passive smoking increased type 2 diabetes mellitus risk but it is uncertain whether it also incre... more Passive smoking increased type 2 diabetes mellitus risk but it is uncertain whether it also increased gestational diabetes mellitus (GDM) risk. We aimed to examine the association of passive smoking during pregnancy and its interaction with maternal obesity for GDM. From 2010 to 2012, 12,786 Chinese women underwent a 50-gram 1-hour glucose challenge test (GCT) at 24-28 weeks of gestation and further underwent a 75-gram 2-hour oral glucose tolerance test if the GCT result was ≥7.8 mmol/L. GDM was defined by the International Association of Diabetes and Pregnancy Study Group's cut-points. Self-reported passive smoking during pregnancy was collected by questionnaire. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction between maternal obesity and passive smoking was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S). Significant RERI >...
Aims To compare risks of early postpartum diabetes and prediabetes in Chinese women with and with... more Aims To compare risks of early postpartum diabetes and prediabetes in Chinese women with and without gestational diabetes mellitus (GDM) during pregnancy Subjects and methods Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM who participated in the urban GDM universal screening survey by using World Health Organization's criteria. Postpartum diabetes and prediabetes were identified after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum diabetes and prediabetes between women with and without GDM. Results During a mean follow-up of 3.53 years postpartum, 90 incident cases of diabetes and 599 incident cases of prediabetes were identified. Multivariable-adjusted hazard ratios among women with prior GDM, compared with those without it, were 76.1 (95% CI 23.6-246) for diabetes, and 25.4 (95% CI 18.2-35.3) for prediabetes. When the mean follow-up extended to 4.40 years, 1...
To report the weight loss findings after the first year of a lifestyle intervention trial among w... more To report the weight loss findings after the first year of a lifestyle intervention trial among women with gestational diabetes mellitus (GDM). A total of 1180 women with GDM were randomly assigned (1:1) to receive a 4-year lifestyle intervention (intervention group, n = 586) or standard care (control group, n = 594) between August 2009 and July 2011. Major elements of the intervention included 6 face-to-face sessions with study dieticians and two telephone calls in the first year, and two individual sessions and two telephone calls in each subsequent year. Among 79% of participants who completed the year 1 trial, mean weight loss was 0.82 kg (1.12% of initial weight) in the intervention group and 0.09 kg (0.03% of initial weight) in the control group (P = .001). In a prespecified subgroup analysis of people who completed the trial, weight loss was more pronounced in women who were overweight (body mass index ≥24 kg/m) at baseline: mean weight loss 2.01 kg (2.87% of initial weight) ...
Diabetes research and clinical practice, Jan 6, 2017
To assess the association of uric acid (UA) with the risks of postpartum type 2 diabetes and pred... more To assess the association of uric acid (UA) with the risks of postpartum type 2 diabetes and prediabetes among women with prior gestational diabetes mellitus (GDM). We performed a cross-sectional study of 1262 GDM women at 1-5 years after delivery using the baseline data from the Tianjin Gestational Diabetes Mellitus Prevention Program. Logistic regression models were used to estimate the association of different levels of serum UA with the risks of type 2 diabetes and prediabetes. The multivariable-adjusted odds ratios (ORs) across quartiles of serum UA were 1.00, 1.23 (95% confidence interval [CI] 0.55-2.78), 2.05 (95% CI 0.96-4.39), and 3.17 (95% CI 1.54-6.55) (Ptrend<0.001) for type 2 diabetes, and 1.00, 1.50 (95% CI 1.03-2.19), 2.28 (95% CI 1.58-3.30), and 2.88 (95% CI 1.99-4.17) (Ptrend<0.001) for prediabetes, respectively. Restricted cubic splines models showed positive linear associations of serum UA as a continuous variable with the risks of type 2 diabetes and predia...
Journal of diabetes and its complications, Jan 17, 2017
To examine the association of connecting peptide (C-peptide) and the risks of postpartum diabetes... more To examine the association of connecting peptide (C-peptide) and the risks of postpartum diabetes and pre-diabetes among women with prior gestational diabetes. A cross-sectional study of 1263 women with prior gestational diabetes was carried out at 1-5years after delivery in Tianjin, China. Logistic regression was used to assess the associations of C-peptide and the risks of diabetes and pre-diabetes. The multivariable-adjusted odds ratios based on different levels of C-peptide (0-33%, 34-66%, 67-90%, and >90% as C-peptide cutpoints) were 1.00, 1.93 (95% confidence interval [CI] 0.85-4.39), 2.49 (95% CI 1.06-5.87), and 3.88 (95% CI 1.35-11.1) for diabetes (P for trend <0.0001), and 1.00, 1.66 (95% CI 1.18-2.36), 2.38 (95% CI 1.56-3.62) and 2.35 (95% CI 1.27-4.37) for pre-diabetes (P for trend <0.0001), respectively. Restricted cubic splines models showed a positive linear association of C-peptide as a continuous variable with the risks of type 2 diabetes and pre-diabetes. T...
To examine the joint association of birth weight and physical activity/sedentary time with childh... more To examine the joint association of birth weight and physical activity/sedentary time with childhood obesity in 12 countries. A cross-sectional study of 5,088 children aged 9 to 11 years was conducted. Birth weight was recalled by parents or guardians. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior were objectively measured using accelerometry. The association of birth weight with the odds of obesity, central obesity, and high body fat was significant among children with either low MVPA or high sedentary time but not among children with either high MVPA or low sedentary time. In comparison with children with normal birth weight and high MVPA, children with high birth weight and low MVPA showed 4.48- to 5.18-fold higher odds of obesity, central obesity, and high body fat; children with normal birth weight and low MVPA showed 3.00- to 3.30-fold higher odds of obesity, central obesity, and high body fat, and children with high birth weight and high MVPA showed 1.1...
We investigated the association of physical activity, TV watching time, sleeping time with the ri... more We investigated the association of physical activity, TV watching time, sleeping time with the risks of obesity and hyperglycemia among 1263 offspring aged 1-5 years of mothers with gestational diabetes (GDM) in a cross-sectional study. Logistic regression models were used to obtain the odd ratios (ORs) (95% confidence intervals [CI]) of childhood obesity and hyperglycemia associated with different levels of indoor activity, outdoor activity, TV watching, and sleeping time. The multivariable-adjusted ORs of obesity based on different levels of TV watching time (0, <1.0, and ≥1.0 hour/day) were 1.00, 1.21 (95% CI 0.72-2.05), and 2.20 (95% CI 1.33-3.63) (Ptrend = 0.003), respectively. The multivariable-adjusted ORs of hyperglycemia based on different levels of indoor activity (<5.0, 5.0-6.9, and ≥7.0 hours/day) were 1.00, 0.74 (95% CI 0.45-1.21), and 0.49 (95% CI 0.28-0.84) (Ptrend = 0.034), respectively. The multivariable-adjusted ORs of hyperglycemia associated with different ...
The purpose of this study was to determine the association between regular (sugar containing) and... more The purpose of this study was to determine the association between regular (sugar containing) and diet (artificially sweetened) soft drink consumption and obesity in children from 12 countries ranging in levels of economic and human development. The sample included 6162 children aged 9-11 years. Information on soft drink consumption was obtained using a food frequency questionnaire. Percentage body fat (%BF) was estimated by bio-electrical impedance analysis, body mass index (BMI) z-scores were computed using World Health Organization reference data, and obesity was defined as a BMI > +2 standard deviations (SD). Multi-level models were used to investigate trends in BMI z-scores, %BF and obesity across categories of soft drink consumption. Age, sex, study site, parental education and physical activity were included as covariates. There was a significant linear trend in BMI z-scores across categories of consumption of regular soft drinks in boys (p = 0.049), but not in girls; there were no significant trends in %BF or obesity observed in either boys or girls. There was no significant linear trend across categories of diet soft drink consumption in boys, but there was a graded, positive association in girls for BMI z-score (p = 0.0002) and %BF (p = 0.0001). Further research is required to explore these associations using longitudinal research designs.
The association between estimated glomerular filtration rate (eGFR) and the risk of mortality amo... more The association between estimated glomerular filtration rate (eGFR) and the risk of mortality among patients with coronary heart disease (CHD) is complex and still unclear. The aim of this study was to evaluate the effect of eGFR on the risk prediction of all-cause and cardiovascular disease (CVD) mortality with a long follow-up period among patients with CHD in China. We conducted a prospective cohort study of 3276 Chinese patients with CHD. Cox proportional hazards regression models were used to estimate the association of different levels of eGFR with the risks of mortality. During a mean follow-up period of 4.9 years, 293 deaths were identified. The multivariable-adjusted hazard ratios associated with different levels of eGFR (≥90 [reference group], 60-89, 30-59, 15-29 ml/min per 1.73m2) at baseline were 1.00, 1.28 (95% confidence interval [CI], 0.87-1.88), 1.96 (95% CI, 1.31-2.94), and 3.91 (95% CI, 2.15-7.13) (P <0.001) for all-cause mortality, and 1.00, 1.26 (95% CI, 0.78-...
The aim was to assess associations between lifestyle behaviors and obesity in a multinational stu... more The aim was to assess associations between lifestyle behaviors and obesity in a multinational study of children from 12 countries representing a wide range of human development. The sample included 6,025 children 9-11 years of age. Behavioral risk factors included nocturnal sleep duration, moderate to vigorous physical activity (MVPA), television viewing (TV time), and healthy and unhealthy diet pattern scores. Multilevel analyses were used to obtain odds ratios for obesity expressed per standard deviation of each behavioral risk factor. The odds ratios (95% confidence intervals) for obesity from multilevel, multivariable models were 0.79 (0.71-0.90) for nocturnal sleep duration, 0.52 (0.45-0.60) for MVPA, 1.15 (1.05-1.27) for TV time, 1.08 (0.96-1.20) for healthy diet score, and 0.93 (0.83-1.04) for unhealthy diet score in boys and 0.71 (0.63-0.80) for nocturnal sleep duration, 0.43 (0.35-0.53) for MVPA, 1.07 (0.96-1.19) for TV time, 1.05 (0.93-1.19) for healthy diet score, and 0.9...
International journal of epidemiology, Jan 12, 2015
Congenital heart disease (CHD) represents one of the most prevalent congenital malformations. How... more Congenital heart disease (CHD) represents one of the most prevalent congenital malformations. However, few studies use whole-population screening by colour Doppler ultrasonic diagnostic system to identify CHD among live infants. We estimate the prevalence of CHD and its major risk indicators among infants aged less than 6 months in urban Tianjin, China. A colour Doppler ultrasonic diagnostic system was used as the screening tool for the diagnosis of CHD. A total of 90 796 infants aged less than 6 months, living in the nine urban districts of Tianjin, China, participated in the CHD screening programme between July 2009 and June 2011. A total of 1817 children were identified as having CHD. The overall prevalence of congenital heart disease was 16.4 per 1000 live births among 47 697 boys, 24.1 per 1000 live births among 43 099 girls, and 20.0 per 1,000 live births among 90 796 boys and girls combined. Atrial septal defect was the most common heart lesion of CHD, with the prevalence of ...
Chronic hyperglycemia in type 2 diabetes increases the risk of microvascular events. However, the... more Chronic hyperglycemia in type 2 diabetes increases the risk of microvascular events. However, there is continuing uncertainty about its effect on macrovascular outcomes and death. We conducted a meta-analysis of prospective studies to estimate the association of glycosylated hemoglobin level with the risk of all-cause mortality and cardiovascular outcomes among patients with type 2 diabetes. We systematically searched the MEDLINE database through April 2011 by using Medical Subject Heading search terms and a standardized protocol. We included prospective cohort studies that reported data of glycosylated hemoglobin level on the risk of incident cardiovascular events and all-cause mortality. Relative risk estimates (continuous and categorical variables) were derived or abstracted from each cohort study. Twenty six studies were included in this analysis with a mean follow-up rang of 2.2-16 years. The pooled relative risk associated with a 1% increase in glycosylated hemoglobin level am...
Objective. To examine the association of maternal glycemia during pregnancy and after delivery wi... more Objective. To examine the association of maternal glycemia during pregnancy and after delivery with anthropometry in the offspring of mothers with gestational diabetes mellitus (GDM).Methods. A total of 1,263 GDM mothers and their children finished the health survey at 1–5 years after delivery.Results. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy had higher prevalence of overweight, higher mean weight for heightZscores, and higher mean BMI for ageZscores at 1–5 years old than the offspring of GDM mothers who were diagnosed with impaired glucose tolerance (IGT) during pregnancy. Offspring of GDM mothers who developed diabetes 1–5 years after delivery had higher mean values ofZscores for weight for height and BMI for age at 1–5 years old than the offspring of GDM mothers who had normal glucose or prediabetes after delivery.Conclusions. Offspring of GDM mothers who were diagnosed with diabetes during pregnancy or after delivery had an increased risk of chi...
The joint relationship between healthy lifestyle and antihypertensive treatment with stroke risk ... more The joint relationship between healthy lifestyle and antihypertensive treatment with stroke risk is unclear. We prospectively investigated the individual and joint effects of healthy lifestyle factors and antihypertensive treatment on stroke risk among 36 686 Finnish participants aged 25 to 74 years and free of coronary heart disease and stroke at baseline. During a mean follow-up of 13.7 years, 1478 people developed stroke event (1167 ischemic and 311 hemorrhagic). The stroke risk was significantly decreased in people who adhered to ≥3 healthy lifestyle factors (never smoking, normal weight, moderate/high level of exercise, vegetable consumption ≥3 times per week, and light/moderate alcohol drinking) compared with those who adhered to <3 healthy lifestyle factors. The stroke risk was significantly increased in unaware untreated, aware untreated, aware treated and controlled, and aware treated and uncontrolled hypertensive people than in normotensive people. The risks of stroke w...
Background: The primary aim of the International Study of Childhood Obesity, Lifestyle and the En... more Background: The primary aim of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was to determine the relationships between lifestyle behaviours and obesity in a multinational study of children, and to investigate the influence of higher-order characteristics such as behavioural settings, and the physical, social and policy environments, on the observed relationships within and between countries. Methods/design: The targeted sample included 6000 10-year old children from 12 countries in five major geographic regions of the world (Europe, Africa, the Americas, SouthEast Asia, and the Western Pacific). The protocol included procedures to collect data at the individual level (lifestyle, diet and physical activity questionnaires, accelerometry), family and neighborhood level (parental questionnaires), and the school environment (school administrator questionnaire and school audit tool). A standard study protocol was developed for implementation in all regions of the world. A rigorous system of training and certification of study personnel was developed and implemented, including web-based training modules and regional in-person training meetings. Discussion: The results of this study will provide a robust examination of the correlates of adiposity and obesity in children, focusing on both sides of the energy balance equation. The results will also provide important new information that will inform the development of lifestyle, environmental, and policy interventions to address and prevent childhood obesity that may be culturally adapted for implementation around the world. ISCOLE represents a multinational collaboration among all world regions, and represents a global effort to increase research understanding, capacity and infrastructure in childhood obesity.
Background: The joint effects of different lifestyle factors on stroke risk are still to some ext... more Background: The joint effects of different lifestyle factors on stroke risk are still to some extent unclear, especially regarding hemorrhagic stroke. Methods: We prospectively investigated the association of different indicators of lifestyle (smoking, body mass index, physical activity, and vegetable and alcohol consumption) with total and type-specific stroke incidence among 36 686 Finnish participants who were 25 to 74 years old and free of coronary heart disease and stroke at baseline. Results: During a mean follow-up period of 13.7 years, 1478 people developed an incident stroke event (1167 ischemic and 311 hemorrhagic). The multivariateadjusted (age, sex, education, family history of stroke, history of diabetes mellitus, systolic blood pressure, and serum total cholesterol level) hazard ratios associated with adherence to 0 to 1 (reference group), 2, 3, 4, and 5 healthy lifestyle indicators were 1, 0.66, 0.57, 0.51, and 0.33 (P Ͻ.001 for trend) for total stroke; 1, 0.67, 0.60, 0.50, and 0.30 (P Ͻ.001 for trend) for ischemic stroke; and 1, 0.63, 0.49, 0.49, and 0.40 (P Ͻ.001 for trend) for hemorrhagic stroke, respectively. These inverse associations were similar in both men and women. The partial population attributable risk percentages associated with adherence to 3, 4, and 5 healthy lifestyle indicators were 26.3%, 43.8%, and 54.6% for total stroke; 22.7%, 45.3%, and 59.7% for ischemic stroke; and 35.0%, 35.0%, and 36.1% for hemorrhagic stroke, respectively. Conclusion: Healthy lifestyle factors are associated with a lower risk of stroke, and there is a graded inverse association between the number of healthy lifestyle indicators and the risks of total, ischemic, and hemorrhagic stroke.
The associations of serum total and high density lipoprotein (HDL) cholesterol with coronary hear... more The associations of serum total and high density lipoprotein (HDL) cholesterol with coronary heart disease were investigated in men aged 64-84 years from the Dutch town of Zutphen during 5 years of follow-up. In 1985, 885 randomly selected men, 710 of whom did not have a history of clinical coronary heart disease, participated in the study. Associations were adjusted for age, body mass index, systolic blood pressure, cigarette smoking, and alcohol consumption. Total cholesterol was not significantly associated with the incidence of coronary heart disease, but for mortality the relative risk corresponding to a 1.00 mmol/liter increase was 1.40 (95 percent confidence interval (Cl) 1.07-1.83). HDL cholesterol was not associated with mortality from coronary heart disease. The relative risk for the incidence of the disease, corresponding to a 0.26 mmol/liter increase, was 0.80 (95 percent Cl 0.60-1.08). For the ratio of HDL cholesterol to total cholesterol, the relative risk for coronary heart disease incidence corresponding to a 0.05 increase amounted to 0.70 (95 percent Cl 0.51-0.95). These results show that in elderly men followed for 5 years, both total and HDL cholesterol are important in predicting coronary heart disease. Total cholesterol seems to be a stronger risk factor for mortality from the disease, whereas HDL cholesterol is more strongly associated with the incidence of a first coronary heart disease event.
Aims/hypothesis The aim of this study was to examine the association between maternal gestational... more Aims/hypothesis The aim of this study was to examine the association between maternal gestational diabetes mellitus (GDM) and childhood obesity at age 9-11 years in 12 countries around the world. Methods A multinational cross-sectional study of 4740 children aged 9-11 years was conducted. Maternal GDM was diagnosed according to the ADA or WHO criteria. Height and waist circumference were measured using standardised methods. Weight and body fat were measured using a portable Tanita SC-240 Body Composition Analyzer. Multilevel modelling was used to account for the nested nature of the data. Results The prevalence of reported maternal GDM was 4.3%. The overall prevalence of childhood obesity, central obesity and high body fat were 12.3%, 9.9% and 8.1%, respectively. The multivariable-adjusted (maternal age at delivery, education, infant feeding mode, gestational age, number of younger siblings, child unhealthy diet pattern scores, moderate-tovigorous physical activity, sleeping time, sedentary time, sex and birthweight) odds ratios among children of GDM mothers compared with children of non-GDM mothers were 1.53 A list of members of the ISCOLE Research Group is given in the electronic supplementary material (ESM).
Primary prevention of cardiovascular disease (CVD) is considered the most effective strategy for ... more Primary prevention of cardiovascular disease (CVD) is considered the most effective strategy for controlling CVD and its consequences. Modification of risk factors is an effective way to reduce CVD risk, and most risk factors can be altered with lifestyle changes and medications. Prospective studies have demonstrated that individually modified lifestyle factors (including physical activity, smoking, alcohol consumption, body mass index, and dietary factors) are associated with lower risks of coronary heart disease (CHD), heart failure (HF), and stroke, but the results are inconsistent. The association between diet and the risk of CVD is varying. Furthermore, there are not enough studies to demonstrate the joint effects of multiple modifiable lifestyle factors on the risks of CHD, HF, and stroke. This review focuses on the dietary pattern, other lifestyle factors, and the joint associations of multiple modifiable lifestyle factors with the risks of CHD, HF, and stroke and has found that healthy lifestyle factors, including healthy diet, were significantly associated with decreased risks of CHD, HF, and stroke in men and women, and the risks progressively decreased as the number of healthy lifestyle factors increased. These results also suggest that in the general population, most cases of CHD, HF, and stroke could be avoided by practicing a healthy lifestyle.
Previous studies have documented that visceral adipose tissue is positively associated with the r... more Previous studies have documented that visceral adipose tissue is positively associated with the risk of diabetes. However, the association of subcutaneous adipose tissue with diabetes risk is still in dispute. We aimed to assess the associations between different adipose distributions and the risk of newly diagnosed diabetes in Chinese adults. The Shanghai Nicheng Cohort Study was conducted among Chinese adults aged 45-70 years. The baseline data of 12,137 participants were analyzed. Subcutaneous and visceral fat area (SFA and VFA) were measured by magnetic resonance imaging. Diabetes was newly diagnosed using a 75 g oral glucose tolerance test. The multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI) of newly diagnosed diabetes per 1-standard deviation increase in SFA and VFA were 1.29 (1.19-1.39) and 1.61 (1.49-1.74) in men, and 1.10 (1.03-1.18) and 1.56 (1.45-1.67) in women, respectively. However, the association between SFA and newly diagnosed diabetes disap...
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