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A significant shift in meal pattern with frequent eating out was closely associated with multiple chronic outcomes, but with limited evidence on hyperuricemia. We aimed to explore the associations between eating out and serum uric acid (SUA) as well as hyperuricemia. A total of 29,597 participants were recruited from the Henan Rural Cohort Study. A validated food frequency questionnaire (FFQ) was used to collect dietary data, including the frequency of eating out. Linear regression models were used to examine the association of eating-out frequency with SUA and BMI. Logistic regression and restricted cubic spline were performed to assess the association and dose–response relationship between eating-out frequency and hyperuricemia. The mediation effect of BMI between eating out and the risk of hyperuricemia was evaluated. Eating out was significantly associated with higher SUA levels in the total population and males (P

Although obesity reflected by BMI can enhance the association of air pollution with increase blood pressures (BP) and prevalent hypertension in susceptible population, there remains lack evidence on interactive effects of different obesity indices and air pollutants on BP and prevalent hypertension in rural adults. 39,259 individuals were recruited from the Henan Rural Cohort. Concentrations of air pollutants (PM1, PM2.5, PM10 and NO2) were evaluated by a spatio-temporal model based on satellites data. Independent associations of air pollutants and obesity reflected by BMI, WC, WHR, WHtR, BFP and VFI on BP indicators (SBP, DBP, MAP and PP) and prevalent hypertension were analyzed by linear regression and logistic regression models, respectively. Furthermore, their additive effects were quantified by RERI, AP and S. Six obesity indices enhanced the associations of four air pollutants and BP indicators. Individuals with high PM1 concentrations plus obesity classified by BMI, WC, WHR, WHtR, BFP and VFI had a 4.18-fold (95% CI: 3.86, 4.53), 3.58-fold (95% CI: 3.34, 3.84), 3.53-fold (95% CI: 3.28, 3.81), 4.02-fold (95% CI: 3.72, 4.35), 3.89-fold (95% CI: 3.59, 4.23), 3.87-fold (95% CI: 3.62, 4.14) increase in prevalent hypertension, respectively, compared to non-obese individuals with low PM1 concentrations; similar results were observed for combined effect of PM2.5, PM10 or NO2 and obesity indices on prevalent hypertension. The significant values of RERI, AP and S indicated additive effects of air pollutants and obesity indices on hypertension. Obesity amplified the effects of exposure to high levels of air pollutants on increased BP values and prevalent hypertension, implying that obese individuals may be susceptible to elevate BP and prevalent hypertension in relation to air pollution exposure. CLINICAL TRIAL REGISTRATION: The Henan Rural Cohort study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699, http://www.chictr.org.cn/showproj.aspx?proj=11375).

This study was conducted to investigate the association of eating away from home (EAFH) frequency with hypertension and to explore whether the association was mediated by BMI. A total of 29,611 participants were selected from the Henan Rural Cohort Study. Data on the frequency of EAFH were obtained by face-to-face questionnaires. The relationship between EAFH frequency and blood pressure was evaluated by linear regression. Logistic regression and restricted cubic spline were used to assess the association between EAFH frequency and hypertension, and the mediation effect of BMI on the relationship was performed. There were pronounced associations between the frequency of EAFH and blood pressure (P trend < 0.001) in the total population and men. Compared with the population with 0 times EAFH per week, the multivariate odds ratios (ORs) and 95% confidence intervals (95% CIs) for hypertension of the group with 7 times or more EAFH per week were 1.673 (1.482–1.889) for the total population and 1.634 (1.413–1.890) for men. A nonlinear dose-response relationship was detected between the frequency of EAFH and hypertension (p < 0.001), and the relationship was partially mediated by BMI. The proportion explained was 21.3% in the total population and 25.4% in men. The current study indicated that EAFH was associated with rising blood pressure and increased risk of hypertension and BMI partially mediated the relationship.

Residential greenness may be beneficial for cardiovascular health, but the evidence is still scarce, especially in developing countries. This study aimed to assess the associations between exposure to residential greenness and 10-year atherosclerotic cardiovascular disease (ASCVD) risk in a large rural Chinese adult population. This was a cross-sectional study based on 31,162 participants aged 35–74 years with complete data on predictors of the 10-year ASCVD risk from the Henan Rural Cohort Study. The satellite-derived Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) were used to quantify residential greenness in a buffer radius of 500 m, 1000 m, and 3000 m. The high 10-years ASCVD risk was defined as the estimated risk ≥10% based on prediction equations from the China-PAR Project for Chinese populations. Multivariable-adjusted logistic regression models were performed to estimate the associations of greenness exposures with high 10-year ASCVD risk, and mediation analyses were employed to the potential mediators. For per interquartile range (IQR) increase in NDVI500−m, NDVI1000−m, NDVI3000−m, EVI500−m, EVI1000−m, and EVI3000−m, the adjusted OR (95% CI) of high 10-years ASCVD risk was 0.828 (0.793–0.866), 0.850 (0.817–0.885), 0.823 (0.792–0.855), 0.848 (0.809–0.889), 0.863 (0.826–0.901), 0.843 (0.805–0.883), respectively. Strong associations of NDVI500−m and EVI500−m with high 10-years ASCVD risk were found among participants with lower education level and lower averaged monthly income. The associations of greenness exposures with high 10-year ASCVD risk were partially explained by particulate matter with an aerodynamic diameter ≤1 µm, BMI, and physical activity. Enhancing residential greenness exposure may be beneficial for reducing the high 10-year ASCVD risk in rural Chinese adults.

Background The study aimed to characterize the prevalence of alcohol consumption and further investigate the relationship between alcohol consumption and type 2 diabetes mellitus (T2DM). Methods We studied 39,259 participants aged 18 to 79 years of the Henan Rural Cohort study. The associations between alcohol consumption and T2DM were examined using the logistic regression models and restricted cubic spline. Results For men, alcohol abstinence was associated with an increased risk of T2DM (1.491(1.265, 1.758)), whereas current drinkers were not associated with T2DM (1.03(0.91, 1.15)). Further analysis of alcohol drinkers revealed that only high-risk drinkers of WHO drinking risk levels increased the risk of T2DM (1.289(1.061,1.566)) compared to never drinkers. The risk of T2DM increased as the age of starting to consume alcohol decreased and as the number of years of consuming alcohol and the alcohol intake increased only in men. We further found that the risk of T2DM decreased as the number of years of abstinence increases and no association between alcohol abstinence and T2DM was found after more than 10 years of abstinence among men. Conclusions Our results suggested that reducing the amount of alcohol consumed and adhering to abstinence from alcohol consumption are beneficial in reducing the risk of T2DM. Trial registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06. http://www.chictr.org.cn/showproj.aspx?proj=11375

The aim of the study was to determine if early menarche is associated with an increased risk of type 2 diabetes mellitus (T2DM) in rural Chinese women and to estimate the proportion that can be attributed to adiposity.A total of 15,346 postmenopausal women were enrolled in this study. Logistic regression and restricted cubic spline analysis were performed to estimate the relationship between age at menarche and T2DM. Mediation analysis was used to investigate whether the association was mediated by body mass index (BMI).After adjusting for multiple confounders, the early menarche group (≤14 y) had a higher risk of T2DM (odds ratio [OR] = 1.21; 95% CI = 1.06-1.38; P = 0.004) compared with the reference group (16-17 y), whereas the late onset group (≥19 y) had a lower risk of T2DM (OR = 0.78; 95% CI = 0.66-0.92; P = 0.003). BMI partially mediated the association between age at menarche and T2DM, and the proportion of the effect was 28%.Early menarche increases the risk of T2DM, whereas later menarche decreases the risk. The association seems to be partially mediated by BMI.

Background Familial hypercholesterolemia (FH) is a common monogenic disease, while studies about the epidemiology for the general population in China was scarce. Aim of the study was to estimate the prevalence of FH and explore related factors by the Chinese modified Dutch Lipid Clinic Network (DLCN) definition. Methods A total of 39,205 participants (15,463 males and 23,742 females) aged 18–79 years old were enrolled from the Henan Rural Cohort Study. FH was defined by the Chinese modified DLCN definition, and score > 5 was classified as FH. Logistic regression analysis was used to calculate the odds ratio and 95% confidence interval. Results Crude prevalence of probable/definite FH was 0.35% (0.29–0.41%), estimated by the Chinese modified DLCN definition. Prevalence in female was 0.38%, and in male, it was 0.32%. Age-standardized prevalence in female increased significantly around the age of 50 years. Moreover, there were no FH patients getting low-density lipoprotein cholesterol controlled to the recommended level. Multivariate logistic regression identified that older, overweight/obesity were positively associated with FH. Conclusions The current study indicated that FH was not rare in rural area of China (1 in 286). Effective early detection and timely control of FH must be strengthened to reduce disease burden. Electronic supplementary material The online version of this article (10.1186/s12889-019-7212-4) contains supplementary material, which is available to authorized users.

Objective To estimate the prevalence of poor sleep quality and identify related factors by gender in the Chinese rural population. Methods Overall, 27424 subjects (10881 males and 16543 females) aged 18–79 years were enrolled from the Henan Rural Cohort Study. Sleep quality was evaluated by the standard Pittsburgh Sleep Quality Index (PSQI) and global score>5 was classified as poor sleep quality. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). A meta-analysis including 14 studies was used to validate the result of the cross-sectional study. Results The average PSQI score was 3.78 ± 2.72 in total, and the score of females (4.10 ± 2.90) was significantly higher than males (3.29 ± 2.33). The crude and age-standardized prevalences of poor sleep quality were 21.62% and 15.80%, respectively. The crude prevalence in females (25.73%) was significantly higher than males (15.38%). The results of meta-analysis showed that the pooled prevalence of poor sleep quality was 25.0% (18.8%–31.2%) in total sample, 31.7% (24.9%–38.5%) in male, and 38.2% (29.7%–46.7%) in females. Multivariate logistic regression identified that older age, being female, unmarried/divorced/widowed, low education level, low income, drinking, depression and dyslipidemia could increase the odds of poor sleep quality. Conclusions More than one fifth of the participants in a rural area of China slept poorly and the prevalence in females was significantly higher than males. Effective interventions are urgently needed to improve the sleep quality in resource limited areas. Clinical trial registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). http://www.chictr.org.cn/showproj.aspx?proj=11375 .

Background The measures of socioeconomic status (SES) differed across divergent researches and rare of them focused on rural population. This research, thus, presented a novel measure of SES among rural population and then estimated its association with type 2 diabetes mellitus (T2DM). Methods All participants were farmer and enrolled from the Henan Rural Cohort study. SES of individual was assessed by SES-score, a composite index derived from three SES-related indicators (education level, average monthly income, and marital status). Binary logistic regression was employed to examine the independent association between SES-score and T2DM as well as the combined effects of SES and age on T2DM. To detect the gender differences, all analyses were stratified by gender. Results Among 39259 rural participants, the means (SDs) SES-score of total population, men, and women were 3.47 (1.54), 3.72 (1.49), and 3.31 (1.57), respectively. The SES-score decreased with age and men always had a higher score than women. The prevalence of T2DM decreased with increasing SES-score among women (14.87–4.47%, P trend P trend

Background The study aimed to investigate the independent and combined effects of midpoint of sleep and night sleep duration on type 2 diabetes mellitus (T2DM) in areas with limited resources. Methods A total of 37,276 participants (14,456 men and 22,820 women) were derived from the Henan Rural Cohort Study. Sleep information was assessed based on the Pittsburgh Sleep Quality Index. Logistic regression models and restricted cubic splines were used to estimate the relationship of the midpoint of sleep and night sleep duration with T2DM. Results Of the 37,276 included participants, 3580 subjects suffered from T2DM. The mean midpoint of sleep among the Early, Intermediate and Late groups were 1:05 AM ±23 min, 1:56 AM ±14 min, and 2:57 AM ±34 min, respectively. Compared to the Intermediate group, adjusted odds ratios (ORs) and 95% confidence interval (CI) of T2DM were 1.13 (1.04–1.22) and 1.14 (1.03–1.26) in the Early group and the Late group. Adjusted OR (95% CI) for T2DM compared with the reference (7- h) was 1.28 (1.08–1.51) for longer (≥ 10 h) night sleep duration. The combination of late midpoint of sleep and night sleep duration (≥ 9 h) increased 38% (95% CI 10–74%) prevalence of T2DM. These associations were more obvious in women than men. Conclusions Late and early midpoint of sleep and long night sleep duration were all associated with higher prevalence of T2DM. Meanwhile, midpoint of sleep and night sleep duration might have combined effects on the prevalence of T2DM, which provided potential health implications for T2DM prevention, especially in rural women. Trial registration The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06.

Objective:The purpose of the current study was to investigate associations between spicy food intake and serum lipids levels in Chinese rural population.Design:Information on spicy food flavour and intake frequency was obtained using a two-item questionnaire survey. Dietary data were collected using a validated thirteen-item FFQ. Fasting blood samples were collected and measured for total cholesterol (TC), TAG, HDL-cholesterol and LDL-cholesterol. Multivariate linear and logistic regression models were employed to examine the relationship between spicy food and serum lipids levels according to the spicy food flavour and intake frequency, respectively.Setting:A cross-sectional study in Henan Province.Participants:38 238 participants aged 18–79 years old.Results:Spicy flavour and intake frequency were consistently associated with decreased TC and non-HDL-cholesterol levels but mildly associated with elevated TAG levels. Each level increment in spicy flavour was inversely associated with high TC (OR: 0·91; 95 % CI 0·88, 0·93) and high non-HDL-cholesterol (OR: 0·88; 95 % CI 0·85, 0·91) but positively associated with high TAG (OR: 1·04; 95 % CI 1·01, 1·07). Similarly, 1-d increment in spicy food intake frequency was also inversely associated with high TC (OR: 0·92; 95 % CI 0·91, 0·94) and high non-HDL-cholesterol (OR: 0·91; 95 % CI 0·89, 0·93) but positively associated with high TAG (OR: 1·04; 95 % CI 1·02, 1·06).Conclusions:Spicy food intake was mildly associated with increased risk of abnormal TAG level, significantly associated with decreased risk of abnormal TC and non-HDL levels. Spicy food intake may be contribute to the management of lipid levels.

Obesity and ambient air pollution are independent risk factors of type 2 diabetes mellitus (T2DM), however, the evidence regarding their joint associations on T2DM was sparsely studied in low-middle income countries.A total of 38,841 participants were selected from Henan Rural Cohort study which was carried out during 2015-2017. Obesity was identified by body mass index (BMI), WC (waist circumstance), WHR (waist-to-hip ratio), WHtR (waist-to-height ratio), BFP (body fat percent), and VFI (visceral fat index). Three-year averaged-concentrations of NOPositive associations of six obesity measures and four air pollutants with FBG levels and prevalent T2DM were observed. Obese participants measured by BMI plus high exposure to NOThe synergistic associations of obesity and air pollutants on FBG levels and prevalent T2DM were observed, indicating that obese participants were at high risk for prevalent T2DM in highly polluted rural regions.

Background The relationship of spicy food intake with hyperuricemia remains unknown. The objective of this study was to examine the association between spicy food intake and hyperuricemia, and whether this association was mediated by body mass index (BMI) in Chinese rural population. Methods 38, 027 adults aged 18–79 years were recruited from the Henan Rural Cohort Study. Information on spicy food intake was obtained using a validated questionnaire survey. Multivariable logistic regression model was used to estimate the association between spicy food intake and hyperuricemia, multiple linear regression model was performed to estimate the relationships between spicy food intake, BMI and serum urate level. BMI was used as a mediator to evaluate the mediation effect. Results After adjusting for potential confounders, compared with no spicy food flavor, the odds ratio (OR) and 95% confidence interval (CI) of mild, middle, and heavy flavor for hyperuricemia were 1.09 (1.00–1.19), 1.10 (0.97–1.24), and 1.21 (1.10–1.46), respectively (Ptrend = 0.017). Similarly, compared with those without intake in spicy food, the multivariable adjusted OR (95% CI) of 1-2 days/week, 3–5 days/week, and 6–7 days/week were 1.15 (1.01–1.31), 1.14 (1.01–1.30) and 1.15 (1.05–1.26), respectively (Ptrend = 0.007). However, when we further controlling for BMI, the associations were substantially attenuated. Furthermore, mediation analysis showed that BMI play a full mediating role in the relationship of spicy food intake with hyperuricemia. Conclusion Spicy food flavor and intake frequency are positively related with hyperuricemia in Chinese rural population. BMI may play a full mediating role in the relationship. Trial registration The Henan Rural Cohort Study registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06.

ObjectiveThe aims of this study were to describe distributions of the prevalence of osteopenia and osteoporosis and identify the potential risk factors by gender in a Chinese rural population.DesignA cross-sectional survey.Setting and participantsA total of 8475 participants (18–79 years) were obtained from the Henan Rural Cohort Study. Bone mineral density (BMD) of the calcaneus for each individual was measured by ultrasonic bone density apparatus. Logistic regression models were used to evaluate associations of potential risk factors with prevalence of osteopenia and osteoporosis. Furthermore, a meta-analysis of prevalence of osteoporosis which included eight studies was conducted to confirm this study results.ResultsThe mean of BMD were 0.42 and 0.32 g/cm2for men with osteopenia and osteoporosis (p2(pConclusionsAbout one-sixth of the participants suffered osteoporosis in rural China, and the prevalence in women was higher than men. Although the results were lower than that of meta-analysis, osteoporosis still accounts for huge burden of disease in rural population due to limited medical service and lack of health risk awareness rather than urban area.Trial registration numberChinese Clinical Trial Registry (ChiCTR-OOC-15006699; Pre-results).

Background: Obesity is an important risk factor for hypertension. Previous studies have explored the association between body fat percentage (BFP) and hypertension, but evidence on the consistency of the association remains uncertain and limited. The aim of this study was to explore the relationship between BFP and hypertension in a Chinese rural population. Methods: The present cross-sectional study including 38,913 eligible individuals was conducted in rural areas of Henan province. BFP was measured by bioelectrical impedance methods using Omron body fat and weight measurement device. Logistic regression models and restricted cubic spline regression models were performed to investigate the relationship between BFP and hypertension. Receiver operating characteristic (ROC) analyses were used to compare the discriminating power of adiposity indices. Results: The age-standard prevalence of hypertension was 23.74 and 17.87% in males and females, respectively. Compared with the first quartile of BFP, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension in the highest BFP quartile were 3.30 (95% CI: 2.85, 3.83) in males and 2.66 (95% CI: 2.36, 2.99) in females, and the adjusted ORs increased along with increasing BFP levels. The areas under ROC and 95% CIs of BFP were 0.673 (0.665, 0.682) in males and 0.696 (0.689, 0.703) in females, respectively. Conclusions: BFP was significantly positively associated with the prevalence of hypertension in both males and females in the Chinese rural population. Controlling of body fat should be emphasized in rural areas of China. Clinical Trial Registration: Registration number: ChiCTR-OOC-15006699. http://www.chictr.org.cn/showproj.aspx?proj=11375.

Background This study aims to investigate the prevalence and associated factors of major depressive disorder (MDD) and generalized anxiety disorder (GAD) by gender in Chinese rural adults. Methods A total of 29,993 participants aged from 18 to 79 years from the Henan Rural Cohort Study were included in this study. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were used to assess MDD and GAD through a face-to-face interview. Multivariate logistic regression model was conducted to analyze the associated factors for MDD and GAD. Results The age-standardized prevalence of MDD and GAD (and 95%CI) in the total sample were 5.41% (5.17–5.66%) and 4.94% (4.71–5.18%), respectively. Besides, the crude prevalence in women were significantly higher than men for both MDD (6.81% vs. 4.77%) and GAD (6.63% vs. 3.93%) (both P r = 0.88, P = 0.01). Further analysis revealed that age, sex, marital status, educational level, per capita monthly income, drinking, physical activity, and body mass index were associated with MDD and GAD in the overall sample. Gender difference was found among age groups for MDD (Pinteraction Conclusions These findings showed that Chinese rural adults were at low risk for prevalence of MDD and GAD. Women had higher prevalence and risks for MDD and GAD compared with men, indicating that women deserved more attention. Gender-specific interventions on the modifiable associated factors are urgently needed to improve the mental conditions for Chinese rural population. Clinical trial registration The Henan Rural Cohort Study has been registered in the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 2015-07-06.

Background and aim The present study was conducted to explore the stratified and joint effects of age at menopause and body mass index (BMI) with the risk of type 2 diabetes mellitus (T2DM) in Chinese rural adults. Methods and results A total of 15,406 postmenopausal Chinese women were included in this study. Multivariable logistic regression analysis was used to quantify the stratified and joint effects of age at menopause and BMI on T2DM. Overall, the mean age at menopause and BMI was 48.8 ± 4.7 years and 25.1 ± 3.6 kg/m2, respectively. In general, data suggest that: 1) women with BMI ≥ 24 had a higher risk of T2DM, irrespective of age at menopause; 2) in women with BMI Conclusion Our findings suggest that: 1) women with BMI ≥ 24 had a higher risk of T2DM, irrespective of age at menopause; 2) in women with BMI The Chinese Clinical Trial Registration ChiCTR–OOC–1500669(URL: http://www.chictr.org.cn/showproj.aspx?proj=11375 )

Purpose The aims of this study were to evaluate the effect of age at menarche (AM) on type 2 diabetes mellitus (T2DM) and to assess whether the fasting plasma glucose (FPG) and homeostasis model assessment (HOMA) index responses to AM and menopause status interact in Chinese rural adults. Methods A cross-sectional, population-based study including 23 138 participants was performed. Logistic regression and multivariable linear regression were performed to investigate the relationship between AM and glucose status. Generalized linear model was used to calculate the interaction term of AM and menopause status on FPG and the HOMA index. Interaction plot was used to interpret the significant interaction effect. Results Women in the later menarche age group (≥18 years) had a 17.7% lower risk of T2DM (95% confidence interval [CI]: 0.712-0.951, P = .008), after adjusting for multiple variables. Further adjustment for body mass index (BMI) completely attenuated this association (odds ratio = 0.884, 95% CI: 0.764-1.024, P = .099). A significant interaction effect of AM and menopause status on T2DM (P = .004) was observed. The adverse effects of menopausal status on FPG and HOMA-2 of insulin resistance decreased with increasing menarche age, and the age ranges were limited to Conclusions Later menarche was associated with a lower risk of T2DM, and the association appears to be mediated by BMI. More importantly, the adverse effect of menopause status on T2DM was decreased along with increasing menarche age.

Background and aim Multiple studies support a complex relationship between testosterone and type 2 diabetes mellitus (T2DM) and the transformation of testosterone is affected by several reductases. Thus, we aimed to explore the associations of steroid-5α-reductase type 1 (SRD5A1) gene polymorphism with impaired fasting glucose (IFG) and T2DM and the interactive effects of testosterone and genotypes on glycometabolism. Methods and results A case–control study including 2365 participants was performed. Genomic DNA was extracted from the whole blood and genotyped for the SRD5A1 single nucleotide polymorphisms (SNP) rs1691053. Multivariable logistic regression and linear regression were performed to estimate the associations of SRD5A1 rs1691053 alleles and genotypes with glycometabolism. Generalized linear models were used to investigate the modulatory effects of serum testosterone on glycometabolism indexes in males. After multivariable adjustment, the odds ratio (OR) of homozygous CC genotypes in male carriers was 2.62 (95%CI: 1.11–6.18) for IFG. Furthermore, significant associations of SRD5A1 rs1691053 polymorphisms with adverse indices of glycometabolism were observed in males. Interestingly, the opposite associations in females were observed. The interactive associations of SNP and testosterone were found and mutations were more likely to lead unfavorable metabolic phenotypes. Conclusion These results showed that SRD5A1 rs1691053 gene polymorphism was independently associated with glycometabolism. The interaction between a genetic polymorphism from SRD5A1 and testosterone involved glycometabolism was identified in males. Although this preliminary data should be replicated with other rigorous researches, it highlighted the importance of the SNP-testosterone interaction over the present of glycometabolism.

ObjectiveThis study estimated the burden and characterised the risk factors associated with diabetes and impaired fasting glucose (IFG) in an undiagnosed rural population.DesignData for 36 960 participants from the Henan Rural Cohort baseline with undiagnosed diabetes were analysed. X2test and multivariate logistic regression analyses were performed to test for association between risk factors and diabetes and IFG.ResultsWomen constituted 60.30% of the study participants, mean age of participants was 55.32±12.18 years, risk factors for diabetes and IFG were prevalent (75% dyslipidaemia, 57% overweight/obese, 50% central obesity and 18% metabolic syndrome). The prevalence of diabetes and IFG was 4.19% and 7.22%, respectively. Having a metabolic syndrome (adjusted OR (aOR) 4.7, 95% CI 4.27 to 5.33), dyslipidaemia (aOR 2.76, 95% CI 2.31 to 3.21), centrally obese (aOR 2.38, 95% CI 2.11 to 2.70), being overweight/obese (aOR 1.66, 95% CI 1.45 to 1.79) and a family history of diabetes (aOR 1.50, 95% CI 1.15 to 1.92) were associated with diabetes. These factors were also associated with IFG. Intake of high salt diet (aOR 1.16, 95% CI 1.02 to 1.32) and smoking (aOR 1.22, 95% CI 1.02 to 1.47; significant in men) were also associated with diabetes. Engaging in moderate physical activity (aOR 0.94, 95% CI 0.89 to 0.98) was noted to be negatively associated with diabetes.ConclusionDiabetes and IFG remain prevalent in Chinese population with obesity and dyslipidaemia being some of the most significant predictors. Regular physical activity and consumption of fruits and vegetables may be beneficial in keeping blood glucose level low.Trial registration numberChiCTR-OOC-15006699

Background Excessive daytime sleepiness is associated with many adverse consequences, including cardiovascular diseases and mortality. Although exposure to air pollution has been suggested in connection with excessive daytime sleepiness, evidence in China is scarce. The study aimed to explore the association between long-term exposure to air pollution and excessive daytime sleepiness in rural China. Methods A lot of 27935 participants (60% females) from the Henan Rural Cohort Study were included in this analysis. A satellite-based spatiotemporal model estimated a 3-year average air pollution exposure to NO2 (nitrogen dioxide), PM1 (particulate matter with aerodynamic diameters not more than 1 μm) and PM2.5 (particulate matter with aerodynamic diameters not more than 2.5 μm) at the home address of participants before the baseline survey. Logistic regression was used to evaluate the odds ratio and 95% confidence interval between long-term air pollution and excessive daytime sleepiness. Results The average concentrations of NO2, PM1 and PM2.5 during three years preceding baseline survey were 38.22 μg/m³, 56.29 μg/m³ and 72.30 μg/m³. Exposure to NO2, PM1 and PM2.5 were all associated with excessive daytime sleepiness. Each 1 μg/m³ increment of NO2, PM1 and PM2.5 were related to a 20% (OR: 1.20, 95% CI: 1.13–1.27), 10% (OR: 1.10, 95% CI: 1.05–1.16) and 17% (OR: 1.17, 95% CI: 1.10–1.23) increase of the prevalence of excessive daytime sleepiness. Conclusion The study demonstrated that long-term exposure to NO2, PM1 and PM2.5 were all associated with excessive daytime sleepiness. The impact of air pollution should be considered when treating individuals with excessive daytime sleepiness.

Type 2 diabetes is a complex disease determined by variable genes and environmental factors. The study was designed to investigate the effect of interactions of four polymorphisms of suppressor of cytokine signaling 3 (SOCS3) with fruit and vegetable (F&V) intake on type 2 diabetes in a rural population of China. A total of 4411 participants from the rural areas of Henan, China were included in the study. Multivariate logistic regression and restricted cubic splines were used to estimate the associations between polymorphisms and risk allele score of SOCS3 and type 2 diabetes in different groups. Haplotype analysis was conducted to examine the effects of linkage inheritance at these four loci on type 2 diabetes. Three of the four polymorphisms showed significant associations with type 2 diabetes in the less F&V intake group after adjusting the covariates, the odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were 1.24 (1.08–1.41) for rs4969168, 1.16 (1.02–1.32) for rs9892622, and 1.21 (1.06–1.39) for rs9914220. No significant association was detected in the more F&V intake group. The obvious dose–response relationship between the risk allele score and type 2 diabetes was also noted only in the less F&V intake group. Variants of SOCS3 gene were associated with type 2 diabetes and the associations could be modified by the F&V intake.

Objective. The aim of the study was to investigate the independent and combined effects of the cortisol-to-cortisone ratio (F/E) and 11-deoxycortisol on prediabetes and type 2 diabetes mellitus (T2DM) among different genders. Methods. A case-control study was performed including 2676 participants from the Henan Rural Cohort Study. Liquid chromatography-tandem mass spectrometry was used to assess serum cortisol, cortisone, and 11-deoxycortisol. Conditional logistic regression was performed to estimate the associations between hormones and outcomes. Results. After adjusting for multiple variables, the negative associations of F/E and 11-dexyocortisol with T2DM were observed in females (T3 vs. T1: OR=0.56, 95% CI: 0.39-0.80 for F/E; T3 vs. T1: OR=0.44, 95% CI: 0.27-0.73 for 11-dexyocortisol). However, only 11-dexyocortisol showed a negative association with prediabetes both in males and females. Compared with the combination of low F/E and 11-dexyocortisol, the combination of middle F/E and high 11-dexyocortisol was significantly associated with prediabetes (OR=0.29, 95% CI: 0.12-0.71) in males. Furthermore, the combination of high F/E and 11-dexyocortisol was associated with the lowest odds of prediabetes (OR=0.39, 95% CI: 0.21-0.73) and T2DM (OR=0.25, 95% CI: 0.12-0.52) in females. Conclusions. Serum F/E level was negatively associated with T2DM only in females whereas serum 11-deoxycortisol level was negatively associated with prediabetes in males and with prediabetes and T2DM in females. Additionally, their combination has a synergistic effect on T2DM.

Objective: The aim of this study was to explore the latest prevalence of hyperuricemia and influencing factors in Chinese rural population. Methods: A survey was conducted from July 2015 to September 2017. A total of 38,855 (15,371 men and 23,484 women) subjects were recruited from the Henan Rural Cohort Study. Hyperuricemia was defined as a serum urate level of >7.0 mg/dL for men and >6.0 mg/dL for women. A meta-analysis of 19 studies that focused on hyperuricemia prevalence was performed to validate the result of the cross-sectional survey. Results: The crude and age-standardized prevalence of hyperuricemia was 10.24% and 12.60%, respectively. The prevalence of hyperuricemia decreased in men with increasing age, but the opposite trend was observed in women. The results of meta-analysis demonstrated that hyperuricemia prevalence in Chinese rural areas was 11.7%, consistent with the result of current survey. Multivariate logistic regression revealed that overweight or obesity, hypercholesterolemia, hypertriglyceridemia, hypoalphalipoproteinemia and high serum creatinine level could increase the risk of hyperuricemia, while high physical activity and fasting plasma glucose were associated with a lower risk of hyperuricemia in all participants. Conclusion: The latest prevalence of hyperuricemia is high in rural China and is associated with multiple factors, indicating that prevention and control strategies for hyperuricemia are needed urgently.

Aims We aimed to investigate the association of serum testosterone with impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM) and calculate the proportion explained by obesity status on the relationship. Materials and methods A case-control study including 2775 participants was performed. Serum testosterone was quantified by liquid chromatography-tandem mass spectrometry. Conditional logistic regression and multivariable linear regression were performed to estimate the relationships between testosterone and different glucose status. Waist circumference (WC) was used as a mediator to estimate the mediation effect. Results After adjusting for multiple variables, serum testosterone levels were negatively associated with T2DM in males (per 1 unit natural log-transformed, odd ratio (OR) = 0.73, 95% confidence interval (CI): 0.56, 0.96; Tertile 3 vs Tertile 1, OR = 0.46, 95% CI:0.29, 0.72) while were positively in females (per 1 unit natural log-transformed, OR = 1.56, 95% CI:1.32, 1.84; Tertile 3 vs Tertile 1, OR = 3.55, 95% CI: 2.22, 5.66). In males, a higher testosterone tended to be associated with a lower fasting plasma glucose level and a weaker HOMA2-IR but a stronger HOMA2-β. Opposite findings were observed in females. Furthermore, WC played a full and partial mediating role in the relationship between testosterone and IFG and T2DM both in males and females. Conclusion Serum testosterone levels had opposite effects on IFG and T2DM in males and females. With higher serum testosterone levels, the dysglycemia progression was decreased among males while increased among females. In addition, WC played a full and partial mediating role in the relationship between testosterone and IFG and T2DM.

Background The association between residential greenness and hyperuricemia remains unclear, especially in developing countries. The current study aimed to explore the associations between residential greenness and both serum uric acid (SUA) levels and hyperuricemia in a Chinese rural population and to examine potential pathways of these associations. Methods In this cross-sectional study, 38,721 rural residents were recruited from the baseline survey of the Henan Rural Cohort study in 2015–2017. Two satellite-derived vegetation indices, i.e., the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI), were used to estimate residential greenness. Air pollution was determined by two proxies: particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) and nitrogen dioxide (NO2). Hyperuricemia was defined as SUA levels of >417 μmol/L and > 357 μmol/L for men and women, respectively. Multivariable-adjusted linear regression and logistic regression models were applied to investigate the associations of greenness with SUA and hyperuricemia, and mediation analyses were used to explore possible mechanisms underlying the associations. Results An interquartile range (IQR) increase in both EVI and NDVI in the 500 m buffer was significantly associated with reductions in SUA levels of −7.23 μmol/L (95% confidence interval (CI): −8.96, −5.50) and -4.38 μmol/L (95% CI: −5.93, −2.83), respectively. The same increases in EVI500-m and NDVI500-m were associated with 13.8% (95% CI: 5.8%, 21.2%) and 13.0% (95% CI: 5.6%, 19.8%) lower hyperuricemia prevalence, respectively. These associations were stronger in older people (age ≥ 65), men or participants with higher averaged monthly income. The associations were partly mediated by physical activity and BMI, while no mediation effect was observed for air pollution. Conclusions Higher levels of residential greenness were significantly associated with lower SUA levels and hyperuricemia prevalence in the Chinese rural population. BMI and physical activity may play important mediating roles in the associations.

Socio-economic status (SES) and air pollutants are thought to play an important role in human obesity. The evidence of interactive effect between SES and long-term exposure to mixture of air pollutants on obesity is limited, thus, this study is aimed to investigate their interactive effects on obesity among a rural Chinese population.A total of 38,817 individuals were selected from the Henan Rural Cohort Study. Structural equation modeling (SEM) was applied to construct the latent variables of low SES (educational level, marital status, family yearly income, and number of family members), air pollution (particulate matter with aerodynamics diameters ≤ 1.0 μm, ≤ 2.5 μm or ≤ 10 μm, and nitrogen dioxide) and obesity (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, body fat percentage and visceral fat index). Generalized linear regression models were used to assess associations between the constructed latent variables. Interaction plots were applied to describe interactive effect of air pollution and low SES on obesity and biological interaction indicators (the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S)) were also calculated.Increased latent variables of low SES and mixture of air pollution were associated with a higher odds of latent variable of obesity (odds ratios (OR) (95% confidence interval (CI)) were 1.055 (1.049, 1.060) and 1.050 (1.045, 1.055)). The association of the mixture of air pollutants on obesity was aggravated by increased values of the latent variable of low SES (P 0.001). Furthermore, the values of RERI, AP and S were 0.073 (0.051, 0.094), 0.057 (0.040, 0.073) and 1.340 (1.214, 1.479), respectively, indicating an additive effect of estimated latent variable of low SES and air pollution on obesity.These findings suggested that low SES aggravated the negative effect of mixture of air pollutants on obesity, implying that individuals with low SES may be more susceptible to exposure to high levels of mixture of air pollutants related to increased risk of prevalent obesity.

Background Prolonged sleep latency is associated with far-reaching public health consequences. Although evidence about the effect of air pollution on sleep problem has been shown, the effect on sleep latency remained unknown. The study aimed to analyze the association between long-term exposure to air pollution and prolonged sleep latency in rural China. Methods In all, 27935 participants were included in the study from Henan Rural Cohort Study. A satellite-based spatiotemporal model was used to evaluate the 3-year average concentration of air pollutants at the home address of participants before the baseline survey. Air pollutants included NO2 (nitrogen dioxide), PM1 (particulate matter with aerodynamic diameters ≤1 μm), PM2.5 (particulate matter with aerodynamic diameters ≤ 2.5 μm), and PM10 (particulate matter with aerodynamic diametes ≤ 10 μm). A logistic regression model was conducted to assess the odds ratio (OR) and 95% confidence interval (95% CI) between air pollutants and prolonged sleep latency. Results There were 5825 (20.85%) participants with prolonged sleep latency. The average concentration of NO2, PM1, PM2.5, and PM10 were 38.22 (2.54) μg/m3, 56.29 (1.75) μg/m3, 72.30 (1.87) μg/m3, and 130.01 (4.58) μg/m3. The odds ratio (95%CI) of prolonged sleep latency with an IQR increase of NO2, PM1, PM2.5, and PM10 were 1.59 (1.33–1.90), 1.23 (1.13–1.33), 1.28 (1.13–1.45) and 1.43 (1.22–1.67). The stratified analysis showed the effect of air pollutants was stronger among those with stroke. Conclusion Long-term exposure to NO2, PM1, PM2.5 and PM10 were associated with prolonged sleep latency. The adverse impact of air pollution should be considered when treating sleep problems.

Background The association between ambient air pollutants exposure and suicidal ideation (SI) has rarely been explored, especially in Chinese population. Therefore, we aimed to investigate the long-term effects of ambient air pollutants on SI among a Chinese rural population. Method We recruited 29997 participants from the Henan Rural Cohort study in 2016–2017. SI was evaluated by using the ninth item of the Patient Health Questionnaire-9 (PHQ-9) in the baseline survey. We adopted a satellite-based spatiotemporal model to estimate participants’ exposure to particulate matters (PMs) (PM with an aerodynamic diameter ≤1 μm (PM1), ≤2.5 μm (PM2.5) or ≤10 μm (PM10), respectively) and nitrogen dioxide (NO2), and then calculated the 3-year average concentrations of the four pollutants. We used logistic regression models to explore the association between long-term exposure to ambient air pollutants and SI. In addition, we conducted several stratified analyses to examine effect modification of selected factors. Results The odds ratios (95% confidence intervals [CI]) of SI in response to each 1 μg/m3 increase in PM1, PM2.5, PM10 and NO2 concentrations were 1.08 (1.01, 1.15), 1.10 (1.02, 1.19), 1.05 (1.01, 1.09) and 1.12 (1.04, 1.21), respectively. Individuals exposed to PM1, PM2.5, PM10 or NO2 concentrations in the fourth quartile had a 1.36-fold (95%CI: 1.08, 1.72), 1.69-fold (95%CI: 1.05, 2.72), 1.49-fold (95%CI: 1.09, 2.05) or 1.71-fold (95%CI: 1.15, 2.85) risks of SI, compared to the ones with corresponding air pollutants in the first quartile. Besides, the risks of SI increased with the quartiles of air pollutants (PM1: Ptrend = 0.002, PM2.5: Ptrend = 0.003, PM10: Ptrend = 0.010, NO2: Ptrend = 0.010). Stratified analyses suggested that males, highly educated participants, ever-drinkers and people aged range 36–64 years were more vulnerable to the adverse effects of air pollutants. Conclusions This study provided evidence for the long-term effects of ambient PMs and NO2 on SI in rural Chinese adults, particularly for males, highly educated participants, ever-drinkers and people aged range 36–64 years.

Objectives The associations of long-term exposure to air pollution with osteoporosis are rarely reported, especially in rural China. This study aimed to explore the association among rural Chinese population. Methods A total of 8033 participants (18–79 years) derived from the Henan Rural Cohort Study (n = 39,259) were included in this cross-sectional study. Exposure to air pollutants was estimated using machine learning algorithms with satellite remote sensing, land use information, and meteorological data [including particulate matter with aerodynamic diameters ≤1.0 μm (PM1), ≤2.5 μm (PM2.5), and ≤10 μm (PM10), and nitrogen dioxide (NO2)]. The bone mineral density of each individual was measured by using ultrasonic bone density apparatus and osteoporosis was defined based on the T-score ≤ −2.5. Multiple logistic regression models were used to examine the association of air pollution and osteoporosis prevalence. Results We observed that per 1 μg/m3 increase in PM1, PM2.5, PM10 and NO2 were associated with a 14.9%, 14.6%, 7.3%, and 16.5% elevated risk of osteoporosis. Compared with individuals in the first quartile, individuals in the fourth quartile had higher odds ratio (OR) of osteoporosis (P-trend Conclusions Long-term exposure to air pollutants were positively associated with high-risk of osteoporosis, indicated that improving air quality may be beneficial to improve rural residents health.

This study investigated the association between poor sleep quality and hypertension, and evaluated how the Pittsburgh Sleep Quality Index (PSQI) score correlates with blood pressure and prevalent hypertension.A total of 27, 912 participants aged 18-79 years from the Henan Rural Cohort Study were included into the current study. PSQI score was classified as3, 3-, 6-, ≥9. Multivariate logistic regression models and restricted cubic spline with hypertension as a dependent variable were conducted. A meta-analysis was conducted to validate the result of the cross-sectional study.Altogether, 6,085 (21.80%) were poor sleepers and 9,056 (32.44%) suffered from hypertension. The odds ratios (ORs) (95% confidence intervals (CIs)) of participants with sleep quality of 3-, 6-, ≥9 were 1.16(1.07-1.26), 1.35(1.21-1.50) and 1.62 (1.39-1.88) compared to the participants with a score of less than 3 among participants excluding undiagnosed hypertension. ORs and 95% CIs per 3 increment score were higher for hypertension (1.16, 1.11-1.21) among total population, (1.18, 1.10-1.27) among men and (1.13, 1.08-1.19) among women. Compared to reference, poor sleep quality was associated with a higher odd of hypertension (OR 1.09, 95% CI 1.01-1.17) for total population, (1.14, 1.00-1.30) for men and (1.04, 0.95-1.13) for women. Moreover, the odds of hypertension were increased with increment of PSQI score after fitting restricted cubic splines (PHigher PSQI score was associated with increased odds of prevalent hypertension in both genders. In addition, poorer sleepers might suffer from hypertension.