Chinese Diabetes Society Criteria Research Articles

Association of Metabolic Syndrome with Macular Thickness and Volume in Older Adults: A Population-Based Optical Coherence Tomography Study.

Background: To explore the associations of the metabolic syndrome (MetS) and individual components with macular thickness and volume among rural-dwelling Chinese older adults. Methods: This population-based cross-sectional study included 705 participants (age ≥60 years) derived from the MIND-China study. In 2018-2019, we collected data through face-to-face interview, clinical examination, optical coherence tomography (OCT) examination, and blood test. We measured macular thickness and volume using spectral-domain OCT. MetS was defined following the International Diabetes Federation (IDF) criteria, the IDF/American Heart Association (AHA) criteria, the National Cholesterol Education Program-Adult Treatment Panel III criteria, and the Chinese Diabetes Society (CDS) criteria. Data were analyzed with multivariable general linear models. Results: MetS was significantly associated with thinner macula in central (multivariable-adjusted β = -5.29; 95% confidence interval: -9.31 to -1.26), parafoveal (-2.85; -5.73 to 0.04) and perifoveal regions (-4.37; -6.79 to -1.95) when using the IDF criteria, in the perifoveal regions (-3.82; -6.18 to -1.47) when using the IDF/AHA criteria, and in the central region (-5.63; -10.25 to -1.02) when using the CDS criteria, and with reduced macular volume when using the IDF (-0.16; -0.26 to -0.07) and IDF/AHA (-0.13; -0.22 to -0.04) criteria. In the parafoveal region, the IDF-defined MetS was significantly associated with thinner retina in men (β = -6.25; -10.94 to -1.56) but not in women. Abdominal obesity (-2.83; -5.41 to -0.25) and elevated fasting blood glucose (-2.65; -5.08 to -0.21) were associated with thinner macular thickness in the perifoveal region. Conclusion: MetS is associated with macular thinning and reduced macular volume among rural-dwelling older adults, and the associations vary by the defining criteria of MetS.

Metabolic Syndrome and Clinical Outcomes of Patients with Gastric Cancer: A Meta-Analysis.

Metabolic syndrome (MetS) is suggested to participate in the pathogenesis and progress of some cancers via inducing low-grade systemic inflammation. However, the influence of MetS on patients with gastric cancer (GC) remains not fully determined. A systematic review and meta-analysis was therefore performed to evaluate the influence of MetS on clinical outcomes of patients with GC. A search of PubMed, Embase, Web of Science, Wanfang, and CNKI retrieved relevant cohort studies from the inception of the databases to October 11, 2022. We pooled the results using a random-effects model that incorporates heterogeneity. In the meta-analysis, 6649 patients with GC were included, and all of them received gastrectomy. A total of 1248 (18.8%) patients had MetS at baseline. Pooled results showed that MetS was associated with higher risks of postoperative complications [risk ratio (RR): 2.41, 95% confidence interval (CI): 1.85 to 3.14, p<0.001; I2=55%], overall mortality (RR: 1.73, 95% CI: 1.85 to 3.14, p<0.001; I2=77%), and recurrence of GC (RR: 2.00, 95% CI: 1.10 to 3.63, p=0.02; I2=39%). Subgroup analyses showed similar results in prospective and retrospective cohort studies and in studies with MetS diagnosed with the Chinese Diabetes Society criteria and the National Cholesterol Education Program Adult Treatment Panel III criteria (p for subgroup difference all>0.05). In patients with GC after gastrectomy, MetS may be a predictor of high incidence of postoperative complications, cancer recurrence, and overall mortality.

Association of walkability and NO2 with metabolic syndrome: A cohort study in China

BackgroundEpidemiological studies have reported an association between traffic-related pollution with risk of metabolic syndrome (MetS). However, evidence from prospective studies on the association of walkability and nitrogen dioxide (NO2) with MetS is still scarce. We, therefore, aimed to evaluate the association of long-term exposure to NO2 and walkability with hazards of incident MetS. MethodsA total of 17,965 participants without MetS diagnosed within one year at baseline were included in our study from a population-based prospective cohort in Yinzhou District, Ningbo, Zhejiang Province, China. Participants were followed up by the regional Health Information System (HIS) until December 15, 2021. MetS was defined based on the criteria of Chinese Diabetes Society (CDS2004). We used walkscore tools, calculating with amenity categories and decay functions, and spatial–temporal land-use regression (LUR) models to estimate walkability and NO2 concentrations. We used Cox proportional hazards regression models to examine the association of walkability and NO2 with hazards of MetS incidence reporting with hazard ratios (HRs) and 95% confidence intervals (CIs). ResultsOverall, we followed up 77,303 person-years and identified 4040 incident cases of MetS in the entire cohort. Higher walkability was inversely associated with incident MetS (HR = 0.94, 95 % CI: 0.91–0.99), whereas NO2 was positively associated with MetS incidence (HR = 1.07, 95 %CI: 1.00–1.15) per interquartile range increment in two-exposure models. Furthermore, we found a significant multiplicative interaction between walkability and NO2. Stronger associations were observed for NO2 and incident MetS among men, smokers, drinkers and participants who aged < 60 years and had higher levels of income. ConclusionIn summary, we found living in areas with lower walkability and higher concentrations of NO2 were associated with increased incidence of MetS. The beneficial effect of higher walkability may be attenuated by exposure to NO2.

Metabolic syndrome in patients with first-ever ischemic stroke: prevalence and association with coronary heart disease

The metabolic syndrome (MetS) has been well linked with coronary heart disease (CHD) in the general population, but studies have rarely explored their association among patients with stroke. We examine prevalence of MetS and its association with CHD in patients with first-ever ischemic stroke. This hospital-based study included 1851 patients with first-ever ischemic stroke (mean age 61.2 years, 36.5% women) who were hospitalized into two university hospitals in Shandong, China (January 2016–February 2017). Data were collected through interviews, physical examinations, and laboratory tests. MetS was defined following the National Cholesterol Education Program (NCEP) criteria, the International Diabetes Federation (IDF) criteria, and the Chinese Diabetes Society (CDS) criteria. CHD was defined following clinical criteria. Data were analyzed using binary logistic regression models. The overall prevalence of MetS was 33.4% by NECP criteria, 47.2% by IDF criteria, and 32.5% by CDS criteria, with the prevalence being decreased with age and higher in women than in men (p < 0.05). High blood pressure, high triglycerides, and low HDL-C were significantly associated with CHD (multi-adjusted odds ratio [OR] range 1.27–1.38, p < 0.05). The multi-adjusted OR of CHD associated with MetS defined by the NECP criteria, IDF criteria, and CDS criteria (vs. no MetS) was 1.27 (95% confidence interval 1.03–1.57), 1.44 (1.18–1.76), and 1.27 (1.03–1.57), respectively. In addition, having 1–2 abnormal components (vs. none) of MetS was associated with CHD (multi-adjusted OR range 1.66–1.72, p < 0.05). MetS affects over one-third of patients with first-ever ischemic stroke. MetS is associated with an increased likelihood of CHD in stroke patients.

Could Metabolic Syndrome Be a Predictor of Survival Outcomes in Upper Tract Urothelial Carcinoma? A Propensity Score Matching Study in a Large Chinese Center.

PurposeTo evaluate the prognostic value of metabolic syndrome (MetS) in upper tract urothelial carcinoma (UTUC) patients based on propensity score matching (PSM) analysis.Patients and MethodsA total of 573 patients with UTUC after radical nephroureterectomy were included at Peking University People’s Hospital from January 2007 to April 2021. MetS was diagnosed according to the criteria of Chinese Diabetes Society and was defined as the presence of 3 or more of the following 4 conditions (obesity, hyperglycemia, hypertension, high triglycerides and/or low high-density lipoprotein-cholesterol). Patients were divided into two groups based on whether they had MetS, whose variables were adjusted using 1:1 PSM analysis with a caliber of 0.02 to minimize selection bias. Univariate and multivariate Cox regression analysis were used to evaluate the association of MetS and its components with pathological outcomes after adjusting preoperative confounders by propensity score matching. The Kaplan-Meier method was used to estimate overall survival (OS), cancer-specific survival (CSS), and intravesical recurrence-free survival (IVRFS) after surgery.ResultsMetS was significantly correlated with older age, a history of coronary heart disease, high Charlson Comorbidity Index, low estimated Glomerular filtration rate, and low aspartate/alanine aminotransferase ratio (all P<0.05). Multivariate Cox regression analysis and Kaplan-Meier curves demonstrated that MetS showed no statistical correlation with lower OS or IVRFS and approaching significance with lower CSS (P=0.063) before PSM. After PSM, the 5-year OS, CSS, and IVRFS were 64.1%, 74.7%, and 77.2%, respectively, in the MetS group, compared with 67.4%, 78.8%, and 77.2%, respectively, in non-MetS group. Univariate Cox regression analyses showed that MetS and its components were not associated with decreased OS, CSS, or IVRFS (all P>0.05).ConclusionIn our study, no statistical difference was found between MetS and survival outcomes in UTUC, except a marginal association with lower CSS. Further studies are needed to evaluate the role of MetS and its each single component on UTUC.

Nighttime sleep duration, daytime napping, and metabolic syndrome: findings from the China Health and Retirement Longitudinal Study.

This study aimed to assess the association between nighttime sleep, daytime napping, and metabolic syndrome (MetS) in an elderly Chinese population. A cross-sectional study was conducted using data from the 2011 China Health and Retirement Longitudinal Study (CHARLS) to examine the association between nighttime sleep, daytime napping, and MetS (defined according to the Chinese Diabetes Society criteria). Sleep duration was assessed by a self-reported questionnaire. Binary logistic regression models were used to estimate odds ratios and 95% confidence intervals of the associations adjusting for covariates. Among 4785 elderly Chinese aged over 65years old, there was no association between short-time sleep duration (< 7h/day) and MetS. However, long-time sleep duration (> 8h/day) decreased the odds of MetS by 53% (aOR= 0.47; 95% CI0.23-0.96)compared to normal sleep duration (7-8h/day). Compared to no daytime napping, short-time napping (≤ 30min/day) was associated with increased odds of MetS (aOR = 1.55, 95% CI 1.02-2.36) and long-time napping (> 30min/day) was associated with even higher odds of MetS (aOR = 1.77, 95%CI 1.24-2.53). Individuals who were over 75years old, with elementary school education, and good health status had lower odds of MetS, while women, individuals living in rural areas, and those who reported poor health status had higher odds of MetS. Long-time sleep duration decreased and daytime napping increased the risk of MetS among the elderly Chinese population. We speculate that increasing nighttime sleep duration and decreasing daytime napping may help reduce the risk of MetS.

Temporal trends in the prevalence of metabolic syndrome among middle-aged and elderly adults from 2011 to 2015 in China: the China health and retirement longitudinal study (CHARLS)

BackgroundMetabolic syndrome (MetS) is a major risk factor for cardiovascular diseases. The objective of the study was to evaluate the updated prevalence of MetS and provide a comprehensive illustration of the possible temporal changes in MetS prevalence in China from 2011 to 2015.MethodsThe data for this study are from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). CHARLS is a nationally representative survey targeting populations aged 45 and above from 28 provinces in mainland China. A total of 11,847 and 13,013 participants were eligible for data analysis at the two time points.ResultsThe estimated prevalence of MetS in 2015 was 20.41% (95% CI: 19.02–21.8%) by the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) criteria, 34.77% (95% CI: 33.12–36.42%) by the International Diabetes Federation (IDF) criteria, 39.68% (95% CI: 37.88–41.47%) by the revised ATP III criteria, and 25.55% (95% CI: 24.19–26.91%) by the Chinese Diabetes Society (CDS) criteria. The prevalence was higher among women and elderly adults and in urban and northern populations. Furthermore, the trends in the prevalence decreased significantly between 2011 and 2015 by the ATP III, revised ATP III and CDS criteria. However, trends increased significantly from 2011 to 2015 by the IDF criteria.ConclusionsA higher prevalence of MetS is found in those who reported being middle aged and elderly, women, residing in northern China or living in urban areas. Additionally, temporal changes in the prevalence of MetS varied according to different criteria. Increased attention to the causes associated with populations who have higher levels of MetS is warranted.

Comparison of the triglyceride glucose index and blood leukocyte indices as predictors of metabolic syndrome in healthy Chinese population

Triglyceride glucose (TyG) index and inflammatory markers are reported to have a positive association with metabolic syndrome (MetS). However, no previous study has assessed the value of TyG index and inflammatory markers as predictors of metabolic syndrome in the same study. This study looks at the comparison of the triglyceride index and blood leukocyte indices as predictors of metabolic syndrome in the Chinese population. The study cohort involved 1542 Chinese population without metabolic syndrome. The subjects underwent comprehensive routine health examination in 2011 and returned for a follow-up examination in 2016. Metabolic syndrome was defined according to Chinese Diabetes Society criteria, using body mass index for the replacement of waist circumference. TyG index, total leukocytes, neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio (NLR) were measured. Adjust d logistic models were used to assess the relationship between TyG index, blood leukocyte indices, and incident MetS. Receiver operating characteristic (ROC) curves were performed to determine the predictive value of TyG index and blood leukocyte indices for MetS. Results from multivariate logistic regression analysis showed that, in the adjusted model, the subjects with the highest quartile of TyG index and neutrophils had a 3.894- and 1.663-fold increased incidence of MetS (P < 0.0001 and P = 0.027), respectively. No significant association was observed between total leukocytes, lymphocytes, NLR with incident MetS. ROC analysis showed that the AUC of TyG index and neutrophils were 0.674 and 0.568 for incident MetS, respectively. TyG index rather than blood leukocyte indices may have the strongest predictive value in MetS development over a 5-year period.

2135-PUB: Identifying the Anthropometric Measurement and Lipid and Glucose Indexes That Best Correlate with Metabolic Syndrome in a Chinese Population

In this investigation, we compared the performance of various parameters including Waist-to-Height Ratio (WHtR), Waist-Hip Ratio (WHR), Waist Circumference (WC), Body Mass Index (BMI), and triglycerides glucose related Index including TyG index, TyG-BMI, TyG-WC in detecting Metabolic Syndrome (MS). (TyG index: TG× FPG, TyG-BMI: TyG index × BMI, TyG-WC: TyG index × WC) In 2013, 2972 registered permanent residents in a rural satellite town of Beijing, aged ≥ 20 years, were invited to participate in the study. MS patients were identified with the criteria of Chinese Diabetes Society (CDS). The receiver-operating characteristics (ROC) curve analyses and the respective area under the ROC curves (AUC) were used to compare the association of the different index with MS.In men, the AUC was 0.81 (0.78-0.84) for BMI, 0.77 (0.74-0.81) for WHtR, 0.68 (0.63-0.72) for WHR, 0.77 (0.74-0.80) for WC in detecting MS, respectively. In women, the AUC was 0.78 (0.76-0.81), 0.76 (0.73-0.78), 0.66 (0.64-0.68), 0.76(0.74-0.78), respectively. The correlation between BMI and MS was higher than other indicators by comparing AUCs (P&amp;lt;0.05). In men, the AUC was 0.88 (0.86-0.90) for TyG index, 0.89 (0.87-0.92) for TyG-BMI, 0.88 (0.86-0.90) for TyG-WC, respectively. In women, the AUC was 0.88 (0.86-0.90), 0.88 (0.86-0.92), 0.87 (0.85-0.89), respectively. There were no significant differences for these three indexes. However, the correlation between TyG index and MS was higher than BMI (P&amp;lt;0.05).The cut-off points for BMI evaluating MS were 25.0 Kg/m2 in men and 25.3 Kg/m2 in women, and for TyG index were 8.87 in men and 8.80 in women. BMI is an efficient surrogate marker in the evaluation of MS in Chinese people. It can be used to screen MS patients and self-assess the risk in common people easily. TyG index is better than BMI in the evaluation of MS. This will help general practitioners to assess the risks of their patients quickly. Disclosure Z. Xin: None. Funding Expert Promotion Program of Beijing Health Systems (2015-3-017)

Prevalence and associated factors of metabolic syndrome in adults: a population-based epidemiological survey in Jiangxi province, China

BackgroundMetabolic syndrome (MS) has abruptly increased in China in the past two decades, gradually representing an important public health threat over the years. Here, we firstly reported the prevalence and associated factors of metabolic syndrome in Jiangxi province, China.MethodsA population-based cross-sectional survey was performed in Jiangxi province, China, from April to August 2015. MS was diagnosed by International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS) criteria, respectively. Factors associated with MS were investigated by multivariate logistic regression.ResultsA total of 2665 residents aged over 18 years were enrolled, and 2580 effectively participated. According to IDF and CDS criteria, age-standardized prevalence of MS were 21.1 and 15.2% in all participants, respectively; prevalence were 19.6% or 17.1% in men, and 22.7% or 13.0% in women, based on these respective criteria. Rural participants had a significantly higher prevalence than urban individuals, so did rural females. Prevalence in males did not differ between rural and urban participants. Factors independently associated with MS were low education level and menopausal state.ConclusionsTo the best of our knowledge, this was the latest study on MS prevalence in Jiangxi province. In conclusion, MS prevalence is high in Jiangxi province. Considering the unhealthy lifestyle, education is urgently needed to prevent the rapid increase of MS prevalence.

Prevalence of Metabolic Syndrome and Its Determinants in Newly-Diagnosed Adult-Onset Diabetes in China: A Multi-Center, Cross-Sectional Survey.

Aim: The study aimed to investigate the prevalence of metabolic syndrome (MetS) and its determinants in newly-diagnosed adult-onset diabetes in China.Methods: From April 2015 to October 2017, 15,492 consecutive patients with diabetes diagnosed within 1 year and aged ≥30 years were recruited from 46 tertiary care hospitals in 24 cities across China. Glutamic acid decarboxylase autoantibody was assayed centrally and clinical data were collected locally. Classic type 1 diabetes mellitus (T1DM), latent autoimmune diabetes in adults (LADA) and type 2 diabetes mellitus (T2DM) were defined using the criteria of American Diabetes Association, Immunology of Diabetes Society and World Health Organization. MetS was defined using Chinese Diabetes Society's criteria. Logistic regression analysis was used to obtain odds ratios (OR) of determinants of MetS.Results: The overall prevalence of MetS was 66.5%, with the highest prevalence in T2DM (68.1%), followed by those in LADA (44.3%) and T1DM (34.2%) (P < 0.05 for all comparisons). After adjustment for traditional risk factors, T2DM had a 2.8-fold [95% confidence interval (CI): 2.36–3.37] MetS risk compared with LADA, whereas T1DM had significantly lower OR than LADA (OR: 0.68, 95% CI: 0.50–0.92). After further adjustment for insulin resistance, the OR of T2DM vs. LADA was slightly reduced but the OR of T1DM vs. LADA was greatly attenuated to non-significance (OR: 0.96, 95% CI: 0.70–1.33). In addition to types of diabetes, age, gender, geographical residence, education attainment, alcohol consumption and HOMA2-IR were independent determinants of MetS.Conclusions: MetS was highly prevalent, not only in T2DM but also in T1DM and LADA in Chinese newly diagnosed patients; higher risk of MetS in LADA than in T1DM was partially attributable to higher insulin resistance in LADA.

Metabolic syndrome and risks of carotid atherosclerosis and cardiovascular events in community-based older adults in China.

Previous studies on the importance of metabolic syndrome (MS) as a cardiovascular risk factor had not focused on older Chinese adults. The present study analyzed the association of MS with carotid atherosclerosis and the risk of cardiovascular events in Chinese adults. Data of a representative cohort study with 5-year follow-up were used. Community-dwelling people (n=1257) aged ≥55 years without cardiovascular disease (CVD) at baseline were followed up from 2009 to 2014. MS was defined based on the Chinese Diabetes Society criteria under the Chinese Medical Association. Multiple regression analyses were performed to examine the associations of MS with atherosclerosis and CVD events, with adjustment for confounding factors. In a multivariate logistic regression model with adjustment, MS was closely related to common carotid artery intima-media thickness (CCA-IMT) (1.62; 95% CI: 1.19-2.21) and carotid plaque presence (1.38; 95% CI: 1.01-1.89), but not with carotid artery stenosis. At the end of the 5-year follow- up, compared with subjects without MS, hazard ratios and 95% confidence intervals for the different risks in subjects with MS were 1.86 (1.02-3.29) for myocardial infarction (MI), 1.39 (1.01-2.05) for stroke, 1.52 (1.02- 2.37) for CVD death, and 1.13 (0.62-2.58) for total death, after adjusting for age, gender, smoking, drinking, physical activity, uric acid, high-sensitivity C-reactive protein, dietary factors and carotid atherosclerosis status. MS was significantly associated with IMT and the presence of carotid plaque and with positively increased risks of MI, stroke, and CVD mortality independent of CVD risk factors in older Chinese adults.

A9038 The prevalence of metabolically healthy and unhealthy obesity using different criteria

Objectives: To assess the prevalence of metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) using different definitions. Methods: The data were taken from a nation-wide survey on hypertension in China conducted in 2013–2015. Population-based sample of 4757 adults (male 51.1%) aged 35 years and older in Beijing provided data on BMI and metabolic status. Obesity was defined as BMI ≥28 kg/m2, and definitions of metabolic abnormalities were from 5 sets of metabolic syndrome or cardiometabolic abnormalities including the Adult Treatment Panel III (ATP-III), Karelis, Wildman, Chinese Diabetes Society (CDS) and homeostasis model assessment (HOMA) index. Results: The prevalence of obese was 24.3% (1155/4757). The highest prevalence of MHO (13.6%, 95% CI 11.0–16.2) was obtained from the HOMA criteria, followed by CDS, ATP-III, and Wildman. The lowest were from Karelis criteria (4.2%, 95% CI 1.4–7.0). The prevalence of MUO from the highest to the lowest were ranged on the contrary to MHO, the highest was Karelis (20.1%, 95% CI 17.6–22.6) and the lowest was HOMA (10.6%, 95% CI 7.9–13.3). The prevalence of MHO in criteria of ATP-III, Wildman, CDS and HOMA increased with age and reached the peak at age 45 years, then declined and slightly rose after age 80 except for Wildman criteria. The age-specific prevalence of MUO increased with age before 60–64 years and then declined after age 65 regardless of which criteria used. After age 84, the prevalence defined by the criteria of ATP-III and CDS kept on declining continuously, while an increment was observed in the prevalence defined by Karelis, Wildman and HOMA. Conclusion: The variations in the prevalence of both MHO and MUO were magnitude, and this may due to the heterogeneity of the definitions of metabolic disorder. Large cohort studies are needed in the future.

Comparison of coronary heart disease risk assessments among individuals with metabolic syndrome using three diagnostic definitions: a cross-sectional study from China

ObjectiveMetabolic syndrome (MetS) is a notable risk factor of coronary heart disease (CHD). However, there are differences in the methods used to define MetS. The purpose of this study was...

Self-reported snoring is associated with chronic kidney disease independent of metabolic syndrome in middle-aged and elderly Chinese.

Aims/IntroductionTo investigate the correlation between snoring and chronic kidney disease (CKD), and explore whether metabolic syndrome (MetS) plays an important role in this relationship among middle‐aged and elderly Chinese.Materials and MethodsThe participants included in the present study were categorized into three subgroups based on self‐reported snoring frequency (regularly [≥3 times per week], occasionally [between ‘regularly’ and ‘never’] or never [<1 time per month]). An estimated glomerular filtration rate <60 mL/min/1.73 m2 was considered as CKD. We diagnosed MetS based on the 2004 Chinese Diabetes Society criteria. We explored the relationship between snoring and CKD by using multiple logistic regressions.ResultsThe frequency of MetS, MetS components and CKD was dramatically higher in regular snorers than in non‐snorers and occasional snorers. The odds ratios for MetS and all the MetS elements, except for hyperglycemia, increased progressively with the snoring frequency (P < 0.001). Upon additional adjustment for other MetS components, snoring was not significantly related with hypertension; however, the associations between snoring frequency and overweight/obesity and dyslipidemia became attenuated, but still remained statistically significant (P < 0.01). Interestingly, odds ratios for CKD also increasingly augmented with snoring frequency (P < 0.001). Upon further adjustment for individual MetS components or MetS, regular snoring also resulted in a significantly increased odds ratio for CKD (odds ratio 1.72; P = 0.034) relative to non‐snoring.ConclusionsSelf‐reported snoring is closely associated with CKD independent of MetS among middle‐aged and elderly Chinese.

Dynamic development of metabolic syndrome and its risk prediction in Chinese population: a longitudinal study using Markov model

BackgroundWith the increasing prevalence of metabolic syndrome (MS), there is a need to track and predict the development of MS. In this study, we established a Markov model to explore the natural history and predict the risk of MS.MethodsA total of 21,777 Chinese individuals who had at least two consecutive health check-ups between 2010 and 2015 were studied. MS was defined using the Chinese Diabetes Society criteria. Twelve metabolic abnormal states (the no component state, four isolated component states, six 2-component states, and the MS state) were contained in each Markov chain. The transition probability was the mean of five probabilities for the transition between any two states in 2 consecutive years.ResultsThe dyslipidemia or overweight/obesity components were most likely to initiate the progress of MS in individuals aged 18–49. However, for individuals over 50 years old, the most likely initiating component of MS was dyslipidemia or hypertension. People who initially had dyslipidemia were most likely to develop the combined state of dyslipidemia with overweight/obesity before the age of 50, but after 50 years of age, the state of dyslipidemia merged with hypertension was the most common. Subjects (with the exception of males over 50 years of age who initially had an isolated state of hyperglycemia) who initially had an isolated state of overweight/obesity, hypertension, or hyperglycemia were most likely to develop a combination of one of these initial states with dyslipidemia. Males who initially had isolated hyperglycemia tended to develop hypertension after age 50. There was a greater chance for subjects who initially had an isolated hyperglycemia state or 2-component state that contained hyperglycemia to develop MS within 10 years compared to those who initially had other abnormal metabolic states.ConclusionsThe occurrence of MS primarily began with overweight/obesity or dyslipidemia in people aged 18–49. However, for those over 50 years old, MS primarily initiated under the conditions of dyslipidemia or hypertension. When MS started under the conditions of overweight/obesity, hypertension or hyperglycemia, dyslipidemia tended to occur next. People who initially had isolated hyperglycemia or a 2-component state that contained hyperglycemia had a higher risk of developing MS than those with other initiating states.

Abstract WP179: Recurrent Stroke in Minor Ischemic Stroke or TIA With Metabolic Syndrome and/or Diabetes Mellitus

Background: We aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack (TIA) from the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. Methods and Results: A total number of 3044 patients were included. Patients were stratified into four groups: neither, METS only, DM only, or both. METS was defined using Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definition. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. Multivariable Cox regression model was used to assess the relationship of METS/DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8% and 9.8% of patients were diagnosed as neither, METS only, DM only and both conditions, respectively. After 90 days of follow up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% vs 6.8%; adjusted Hazard Ratio = 2.50, 95% confidence interval 1.89-3.39) and both (17.1% vs 6.8%; adjusted HR = 2.76, 95% CI 1.98-3.86) had significantly increased rate of recurrent stroke. No interaction effect of antiplatelet therapy by different METS/DM status for the risk of recurrent stroke (p for interaction =0.82 in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results. Conclusions: Concurrent METS and DM was associated with an increased risk of recurrent stroke in minor stroke and TIA patients.

Utility of hemoglobin A1c for diagnosing metabolic syndrome in Chinese subjects over 50 years old

Objective: To evaluate glycated hemoglobing A1c (HbA1c) in diagnosing metabolic syndrome (MS) in Chinese subjects aged over 50 years. Methods: A community-based cross-sectional survey was conducted between October 2010 and January 2011 in Shipai community, Guangzhou. A total of 1 494 subjects aged over 50 years were investigated. Questionnaire survey and physical examination were performed among all participants. Fasting blood samples were obtained to measure plasma glucose (FPG), blood lipids and HbA1c. MS was defined by the criteria of International Diabetes Federation (IDF), National Cholesterol Education Program-Adult Treatment Panel Ⅲ (ATP Ⅲ)(2005) and Chinese Diabetes Society (CDS), respectively. Receiver operating characteristic (ROC) curves were plotted to explore the accuracy of HbA1c for diagnosing MS. Results: After excluding subjects with missing data, the remaining 1 473 subjects had a median age of 61 years (55-68 years). An HbA1c threshold of 6.1% yielded the highest combination of sensitivity (52.1%) and specificity (84.3%) for diagnosing MS. Using HbA1c≥5.7% as definition of dysglycemia, the prevalence of MS (IDF), MS (ATP Ⅲ) and MS (CDS) were 48.7%, 57.1% and 50.8%, respectively. The κ coefficients were 0.853, 0.768 and 0.730, respectively. Using HbA1c≥6.1% as definition of dysglycemia, the prevalences of MS (IDF), MS (ATP Ⅲ) and MS (CDS) were 41.2%, 45.8% and 39.1%, respectively. The κ coefficients were 0.923, 0.880 and 0.881, respectively. The optimal HbA1c threshold with the highest level of agreement according to IDF, ATP Ⅲ and CDS criteria were 6.1%, 6.3% and 6.3%, respectively. Conclusions: An HbA1c threshold of 6.1% showed a high specificity for diagnosing MS in Chinese subjects aged over 50 years in community-based setting. The optimal HbA1c threshold may vary according to different criteria and populations.

Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus.

BackgroundWe aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial.Methods and ResultsIn total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke (P=0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results.ConclusionsConcurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.

Positive association between the metabolic syndrome and white blood cell counts in Chinese.

The aim was to investigate the association between peripheral circulating white blood cell count (WBC) and the metabolic syndrome among populations in central China. In the present study, 5,278 subjects (2,412 women, 2,866 men) aged 18-75 years were recruited through a health check program in Wuhan, China. Biochemical and haematological parameters were measured by standard methods and the metabolic syndrome diagnosed as defined by the Chinese Diabetes Society criteria for Chinese. Both WBC counts and prevalence of metabolic syndrome were significantly higher in men than in women (p<0.01). Participants in the highest quartile of white blood cell count had significantly higher odds ratio of metabolic syndrome (3.79, 95% CI: 2.64, 5.44), compared with subjects in the lowest quartile. The trend remained significant after adjustment for confounding factors and in further subgroup-analyses. Metabolic syndrome prevalence was significantly and positively correlated with the total white blood cell count in this Chinese population.