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Context: In 2020, the terminology of metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to replace nonalcoholic fatty liver disease (NAFLD). Objectives: This work aimed to investigate the prevalence and incidence of MAFLD and evaluate its effects on incident extrahepatic diseases. Methods: A total of 6873 individuals, with a 4.6-year follow-up, were included in this study. Associations of MAFLD and NAFLD with diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD) were examined using logistic regression and Cox proportional hazards models. Results: The prevalence of NAFLD and MAFLD was 40.3% (95% CI, 39.2%-41.5%) and 46.7% (95% CI, 45.6%-47.9%), respectively. Additionally, 321 (4.7%) and 156 (2.3%) participants had MAFLD with excessive alcohol consumption and hepatitis B virus (HBV) infection. During the follow-up period, the incidence of NAFLD and MAFLD was 22.7% (95% CI, 21.3%-24.0%) and 27.0% (95% CI, 25.5%-28.4%). MAFLD was associated with higher risks of incident diabetes (risk ratio [RR] 2.08; 95% CI, 1.72-2.52), CKD (RR 1.64; 95% CI, 1.39-1.94), and CVD (hazard ratio 1.44; 95% CI, 1.15-1.81). Similar associations for NAFLD were observed. Furthermore, the MAFLD subgroups with excessive alcohol consumption (RR 2.49; 95% CI, 1.64-3.78) and HBV infection (RR 1.98; 95% CI, 1.11-3.52) were associated with higher risks of incident diabetes. Conclusion: The change from NAFLD to MAFLD did not greatly affect the associations with diabetes, CKD, and CVD. MAFLD further identified those patients of metabolically fatty liver combined with excessive alcohol consumption and HBV infection, who had increased risks of incident diabetes compared with those of non-fatty liver. [ABSTRACT FROM AUTHOR]

The incidence of type 2 diabetes (T2D) has rapidly increased over recent decades, and T2D has become a leading public health challenge in China. Compared with European descents, Chinese patients with T2D are diagnosed at a relatively young age and low BMI. A better understanding of the factors contributing to the diabetes epidemic is crucial for determining future prevention and intervention programs. In addition to environmental factors, genetic factors contribute substantially to the development of T2D. To date, more than 100 susceptibility loci for T2D have been identified. Individually, most T2D genetic variants have a small effect size (10-20% increased risk for T2D per risk allele); however, a genetic risk score that combines multiple T2D loci could be used to predict the risk of T2D and to identify individuals who are at a high risk. Furthermore, individualized antidiabetes treatment should be a top priority to prevent complications and mortality. In this article, we review the epidemiological trends and recent progress in the understanding of T2D genetic etiology and further discuss personalized medicine involved in the treatment of T2D. [ABSTRACT FROM AUTHOR]

Background: Diabetic retinopathy (DR) is an important microvascular complication of diabetes with a high concordance rate in patients with diabetes. Inflammation is supposed to participate in the development of DR. This study aimed to investigate whether genetic variants of CRP are associated with DR. Methods: A total of 1,018 patients with type 2 diabetes were recruited in this study. Of these patients, 618 were diagnosed with DR, 400 were patients with diabetes for over 10 years but without DR, considered as cases and controls for DR, respectively. Four tagging SNPs (rs2808629, rs3093077, rs1130864 and rs2808634) within CRP region were genotyped for all the participants. Fundus photography was performed for diagnosis and classification for DR. Results: rs2808629 was significantly associated with increased susceptibility to DR (odds ratio 1.296, 95% CI 1.076-1.561, P = 0.006, empirical P = 0.029, for G allele). This association remained significant after adjustment for confounding factors (odds ratio 1.261, 95% CI 1.022-1.555, P = 0.030). Conclusions: In this study, we found CRP rs2808629 was associated with DR in the Chinese patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background In China, obesity is expected to increase rapidly in both urban and rural areas. However, there have been no comprehensive reports on secular trends in obesity prevalence among Chinese adults in urban Shanghai, which is the largest city in southern China. Methods In 1998-2001 and again in 2007-2008, two independent population-based cross-sectional surveys were conducted in Shanghai to investigate the prevalence of metabolic disorders. These surveys obtained height, waist circumference (WC), and weight measurements for Chinese adults aged between 20 and 74 years who lived in urban communities. From the 1998-2001 survey, 4,894 participants (2,081 men and 2,813 women, mean age: 48.9 years) were recruited, and 4,395 participants (1,599 men and 2,796 women, mean age: 49.8 years) were recruited from the 2007-2008 survey. Using the World Health Organization criteria, overweight was defined as 25 kg/m² ≤ BMI < 30 kg/m² and obesity as BMI ≥ 30 kg/m². Central obesity was defined as WC ≥ 90 cm in men or ≥85 cm in women. The differences in prevalence of obesity, central obesity and overweight between the two surveys were tested using multivariable logistic regression analyses. Results Compared to the 1998-2001 survey, in the 2007-2008 survey the BMI distribution for men and the WC distribution for both genders is shifted significantly to the right along the x-axis (all p < 0.001). Over the ten years, the prevalence of combined overweight and obesity increased 24% (from 31.5% to 39.1%, p < 0.001) in men, but decreased 8% (from 27.3% to 25.0%; p < 0.01) in women. The prevalence of central obesity increased 40% in men (from 19.5% to 27.3%; p < 0.01), but the increase was not significant in women (15.0% to 17.1%; p = 0.051). In the total population, only central obesity showed a significant change between the populations in the two surveys, increasing 29% (from 17.3% to 22.4%; p < 0.001). Conclusions Over this 10 year period, central obesity increased significantly in the Shanghai adult population. However, the prevalence of combined overweight and obesity was significantly increased in men but not in women. [ABSTRACT FROM AUTHOR]

Aim. To investigate the effects of weight loss during an 8-week very low carbohydrate diet (VLCD) on improvement of metabolic parameters, adipose distribution and body composition, and insulin resistance and sensitivity in Chinese obese subjects. Methods. Fifty-three healthy obese volunteers were given an 8-week VLCD. The outcomes were changes in anthropometry, body composition, metabolic profile, abdominal fat distribution, liver fat percent (LFP), and insulin resistance and sensitivity. Results. A total of 46 (86.8%) obese subjects completed the study. The VLCD caused a weight loss of -8.7 ± 0.6 kg (mean ± standard error (SE), P < 0.0001) combined with a significant improvement of metabolic profile. In both male and female, nonesterified fatty acid (NEFA) significantly decreased (-166.2 ± 47.6 μmol/L, P = 0.001) and β-hydroxybutyric acid (BHA) increased (0.15 ± 0.06 mmol/L, P = 0.004) after eight weeks of VLCD intervention. The significant reductions in subcutaneous fat area (SFA), visceral fat area (VFA), and LFP were -66.5 ± 7.9 cm², -35.3 ± 3.9 cm², and -16.4 ± 2.4%, respectively (all P values P < 0.0001). HOMA IR and HOMA β significantly decreased while whole body insulin sensitivity index (WBISI) increased (all P values P < 0.001). Conclusion. Eight weeks of VLCD was an effective intervention in obese subjects. These beneficial effects may be associated with enhanced hepatic and whole-body lipolysis and oxidation. [ABSTRACT FROM AUTHOR]

Background: The Diabetes Impact Study followed up a large national population-based screening study to estimate the use of and expenditures for medical care caused by diabetes in China and to ascertain the use and cost of essential basic medicines and care. Methods: In 2009-10, the study team interviewed 1482 adults with diabetes and 1553 adults with glucose tolerance in the normal range from population-based random samples at 12 sites in China. The response rate was 67%. Findings: After adjusting for age, sex, and urban/rural location, people with diabetes received 1.93 times more days of inpatient treatment, 2.40 times more outpatient visits, and 3.35 times more medications than people with normal glucose tolerance (all p<0.05). Adjusted expenditures for medical care were 3.38 times higher among people with diabetes than among people with normal glucose tolerance (p<0.01, unadjusted 3.97). Persons who were diagnosed with ≥10 years prior to the survey paid 3.75 times as much for medical care as those with ≤5 years of diagnosed diabetes. Among persons with diabetes, 45.2% took medication to control blood sugar, 21.1% took an antihypertensive medicine, 22.4% took daily aspirin, and 1.8% took a statin. Over the three months before the interview, 46.1% of persons with diabetes recalled seeing a doctor, 48.9% recalled a blood pressure measurement, and 54.5% recalled a blood sugar test. Over the year preceding the interview, 32.1% recalled a retinal screening and 17.9% recalled a foot examination. Conclusions: In China, health care use and costs were dramatically higher for people with diabetes than for people with normal glucose tolerance and, in relative terms, much higher than in industrialized countries. Low-cost generic medicines that would reduce diabetes expenditures were not fully used. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that a microalbuminuria (MA) threshold can help predict the risk for the development of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM)_ patients. Design: We conducted a cross-sectional study of 4739 subjects with T2DM and a prospective study of 297 subjects with T2DM in China respectively. Methods: Clinical and laboratory data were collected and biologic risk factors associated with any DR were analysed. Results: In the cross-sectional study, we found that MA was an independent risk factor for DR development; further, when the patients were divided into MA deciles, odds ratio (ORs) of DR for the patients in the sixth MA decile (10.7 mg/24 h) was 1.579-fold (1.161-2.147) compared to that for patients in the first MA decile. Furthermore, the OR of DR increased with a gradual increase in MA levels. Similarly, in the prospective study, during a mean follow-up of 4.5 years, we found that 51 patients (29.0%) of the 176 subjects with high MA level (10.7-30 mg/24 h) developed DR, while 17 patients (14.1%) of the 121 subjects with lower MA (<10.7 mg/24 h) developed DR, and the relative risk ratio of the development of DR is 2.13(95% CI, 1.58-3.62, P<0.001). Conclusion: These data suggest that an MA threshold can predict the risk for the development of DR in type 2 diabetes mellitus, although it is still within the traditionally established normal range. [ABSTRACT FROM AUTHOR]

Background: Recent meta-analysis of genome-wide association studies in European descent samples identified novel loci influencing glucose and insulin related traits. In the current study, we aimed to evaluate the association between these loci and traits related to glucose metabolism in the Chinese. Methods/Principal Findings: We genotyped seventeen single nucleotide polymorphisms (SNPs) from fifteen loci including GIPR, ADCY5, TCF7L2, VPS13C, DGKB, MADD, ADRA2A, FADS1, CRY2, SLC2A2, GLIS3, PROX1, C2CD4B, SLC30A8 and IGF1 in 6,822 Shanghai Chinese Hans comprising 3,410 type 2 diabetic patients and 3,412 normal glucose regulation subjects. MADD rs7944584 showed strong association to type 2 diabetes (p = 3.5×10-6, empirical p = 0.0002) which was not observed in the European descent populations. SNPs from GIPR, TCF7L2, CRY2, GLIS3 and SLC30A8 were also associated with type 2 diabetes (p = 0.0487∼2.0×10-8). Further adjusting age, gender and BMI as confounders found PROX1 rs340874 was associated with type 2 diabetes (p = 0.0391). SNPs from DGKB, MADD and SLC30A8 were associated with fasting glucose while PROX1 rs340874 was significantly associated with OGTT 2-h glucose (p = 0.0392∼0.0014, adjusted for age, gender and BMI), the glucose-raising allele also showed association to lower insulin secretion. IGF1 rs35767 showed significant association to both fasting and 2-h insulin levels as well as insulin secretion and sensitivity indices (p = 0.0160∼0.0035, adjusted for age, gender and BMI). Conclusions/Significance: Our results indicated that SNPs from GIPR, TCF7L2, DGKB, MADD, CRY2, GLIS3, PROX1, SLC30A8 and IGF1 were associated with traits related to glucose metabolism in the Chinese population. [ABSTRACT FROM AUTHOR]

OBJECTIVE-- The widespread clinical application of continuous glucose monitoring (CGM) is limited by the lack of generally accepted reference values. This multicenter study aims to establish preliminary normal reference values for CGM parameters in a sample of healthy Chinese subjects. RESEARCH DESIGN AND METHODS-- A total of 434 healthy individuals with normal glucose regulation completed a 3-day period of glucose monitoring using a CGM system. The 24-h mean blood glucose (24-h MBG) and the percentage of time that subjects' blood glucose levels were ≥140 mg/dl (PT140) and ≤70 mg/dl (PT70) within 24 h were analyzed. RESULTS -- There was excellent compliance of finger stick blood glucose values with CGM measurements for subjects. Among the 434 subjects, the daily blood glucose varied from 76.9 ± 11.3 to 144.2 ± 23.2 mg/dl. The 24-h MBG, PT140, and PT70 were 104 ± 10 mg/dl, 4.1 ± 5.8%, and 2.4 ± 5.3%, respectively. As for these parameters, no significant differences were found between men and women. The 95th percentile values were adopted as the upper limits of CGM parameters, which revealed 119 mg/dl (6.6 mmol/l) for 24-h MBG, 17.1% for PT 140, and 11.7% for PT70. CONCLUSIONS-- We recommend a 24-h MBG value <119 mg/dl, PT140 <17% (4 h), and PT70 <12% (3 h) as normal ranges for the Chinese population. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, the prevalence of overweight or obesity has increased in China. The aims of this study were to firstly assess the baseline prevelences and the risk factors for overweight and obesity, and secondly to detect the changes of body mass index (BMI) over a follow-up period in Chinese adults in Shanghai. Methods: The data set of a population-based longitudinal study was analyzed. Anthropometric and biochemical data were collected for 5364 subjects (aged 25-95 years) during a period of 1998-2001. Among those individuals, 3032 subjects were interviewed and reexamined at the second survey from 2003 to 2004. Then the standardized prevalences for overweight and obesity were calculated using baseline data; the possible contributing factors of overweight and obesity were detected using binary logistic regression analysis; and the changes of BMI were evaluated after an average of 3.6-year follow-up period. Results: (1) According to the WHO standard and the Chinese standard, the sex- and age-standardized prevalences were 27.5% and 32.4% for overweight, and 3.7% and 9.1% for obesity, respectively. (2) The risks of overweight and obesity differed among different age groups. Family history of obesity increased the risk of overweight and obesity by about 1.2-fold for both genders. Current male smokers had a lower risk of overweight and obesity (OR = 0.76, p < 0.05) than nonsmokers. In contrast, current male drinkers had a higher risk of overweight and obesity (OR = 1.42, p < 0.05) than nondrinkers. Compared with low-educated women, medium- and high-educated women were at lower risk of overweight and obesity, and the corresponding ORs (95% CIs) were 0.64 (0.52-0.79) and 0.50(0.36-0.68), respectively. (3) The annual changes of BMI means ranged from an increase of 0.1 kg/m² to a decrease of 0.2 kg/m² (by genders and age groups). Meanwhile, the BMI increase was statistically significant in the 35-44 years age group, and the BMI decrease was significant above 65 years for both genders. Conclusion: This study showed high prevalence of overweight and obesity in Shanghai metropolis populations. The risk factors of overweight and obesity were multifactorial and gender specific. After 3.6 years, BMI means changed slightly, BMI increased mainly in middle-aged individuals and decreased in old individuals. [ABSTRACT FROM AUTHOR]

Background: The HapMap project aimed to catalog millions of common single nucleotide polymorphisms (SNPs) in the human genome in four major populations, in order to facilitate association studies of complex diseases. To examine the transferability of Han Chinese in Beijing HapMap data to the Southern Han Chinese in Shanghai, we performed comparative analyses between genotypes from over 4,500 SNPs in a 21 Mb region on chromosome 1q21-q25 in 80 unrelated Shanghai Chinese and 45 HapMap Chinese data. Results: Three thousand and forty-two SNPs were analyzed after removal of SNPs that failed quality control and those not in the HapMap panel. We compared the allele frequency distributions, linkage disequilibrium patterns, haplotype frequency distributions and tagging SNP sets transferability between the HapMap population and Shanghai Chinese population. Among the four HapMap populations, Beijing Chinese showed the best correlation with Shanghai population on allele frequencies, linkage disequilibrium and haplotype frequencies. Tagging SNP sets selected from four HapMap populations at different thresholds were evaluated in the Shanghai sample. Under the threshold of r2 equal to 0.8 or 0.5, both HapMap Chinese and Japanese data showed better coverage and tagging efficiency than Caucasian and African data. Conclusion: Our study supported the applicability of HapMap Beijing Chinese SNP data to the study of complex diseases among southern Chinese population. [ABSTRACT FROM AUTHOR]

The article offers information on a study which determined whether glycated haemoglobin A1c (HbA1c) may be used as a diagnostic marker for diabetes in the Chinese population. The study subjects of 4886 Chinese people between the ages of 20 years old and older and without a history of diabetes in Shanghai, China were recruited during 2007 to 2008. Presented in details are the findings of the study.

Background--Because of rapid change in lifestyle risk factors, cardiovascular disease has become the leading cause of death in China. We sought to estimate the national levels of serum lipids and lipoproteins among the Chinese adult population. Methods and Results--We conducted a cross-sectional study in a nationally representative sample of 46 239 adults aged >20 years. Fasting serum total, high-density lipoprotein, and low-density lipoprotein cholesterol and triglycerides were measured by standard methods. The age-standardized estimates of total, high-density lipoprotein, and low-density lipoprotein cholesterol and triglycerides were 4.72 (95% confidence interval, 4.70-4.73), 1.30 (1.29-1.30), 2.68 (2.67-2.70), and 1.57 (1.55-1.58) mmol/L, respectively, in the Chinese adult population. In addition, 22.5% (21.8-23.3%) or 220.4 million (212.1-228.8) Chinese adults had borderline high total cholesterol (5.18-6.21 mmol/L), and 9.0% (8.5-9.5%) or 88.1 million (83.4-92.8) had high total cholesterol (>6.22 mmol/L). The population estimates for borderline high (3.37-4.13 mmol/L), high (4.14-4.91 mmol/L), and very high (>4.92 mmol/L) low-density lipoprotein cholesterol were 13.9% (13.3-14.5%) or 133.5 million (127.0-140.1), 3.5% (3.3-3.8%) or 33.8 million (31.2-36.5), and 3.0% (2.8-3.3%) or 29.0 million (26.3-31.8) persons, respectively. In addition, 22.3% (21.6-23.1%) or 214.9 million (207.0-222.8) persons had low high-density lipoprotein cholesterol (<1.04 mmol/L). The awareness, treatment, and control of borderline high or high total cholesterol were 11.0%, 5.1%, and 2.8%, respectively, in the Chinese adult population. Conclusions--Serum total and low-density lipoprotein cholesterol levels were high and increasing in the Chinese population. Without effective intervention, atherosclerotic cardiovascular diseases may soar in the near future in China. [ABSTRACT FROM AUTHOR]

Background: Because of the rapid change in lifestyle in China, there is concern that diabetes may become epidemic. We conducted a national study from June 2007 through May 2008 to estimate the prevalence of diabetes among Chinese adults. Methods: A nationally representative sample of 46,239 adults, 20 years of age or older, from 14 provinces and municipalities participated in the study. After an overnight fast, participants underwent an oral glucose-tolerance test, and fasting and 2-hour glucose levels were measured to identify undiagnosed diabetes and prediabetes (i.e., impaired fasting glucose or impaired glucose tolerance). Previously diagnosed diabetes was determined on the basis of self-report. Results: The age-standardized prevalences of total diabetes (which included both previously diagnosed diabetes and previously undiagnosed diabetes) and prediabetes were 9.7% (10.6% among men and 8.8% among women) and 15.5% (16.1% among men and 14.9% among women), respectively, accounting for 92.4 million adults with diabetes (50.2 million men and 42.2 million women) and 148.2 million adults with prediabetes (76.1 million men and 72.1 million women). The prevalence of diabetes increased with increasing age (3.2%, 11.5%, and 20.4% among persons who were 20 to 39, 40 to 59, and ≥60 years of age, respectively) and with increasing weight (4.5%, 7.6%, 12.8%, and 18.5% among persons with a body-mass index [the weight in kilograms divided by the square of the height in meters] of <18.5, 18.5 to 24.9, 25.0 to 29.9, and ≥30.0, respectively). The prevalence of diabetes was higher among urban residents than among rural residents (11.4% vs. 8.2%). The prevalence of isolated impaired glucose tolerance was higher than that of isolated impaired fasting glucose (11.0% vs. 3.2% among men and 10.9% vs. 2.2% among women). Conclusions: These results indicate that diabetes has become a major public health problem in China and that strategies aimed at the prevention and treatment of diabetes are needed. N Engl J Med 2010;362:1090-101. [ABSTRACT FROM AUTHOR]

Previous studies have showed that hypertriglyceridemia may be a stronger risk factor for coronary heart disease in diabetic patients than non-diabetic individuals. Multiple genomic loci have been identified to be associated with lipid levels among general populations by genome-wide association studies. It is unclear about their effects on lipid levels among type 2 diabetes (T2D) patients. The present study aimed to investigate the associations of lipid related genomic loci and hypertriglyceridemia (defined as triglycerides ≥ 1.70mmol/L or taking lipidlowering medications) among 5,338 T2D patients from China. We genotyped 9 single nucleotide polymorphisms (SNPs) within or near ABCA1, DOCK7, TOMM40, GCKR, HNF1A, HNF4A, LDLR, BAZ1B and BUD13 genes. Under an additive genetic model, logistic and linear regression models were used to examine the associations of these genomic loci with hypertriglyceridemia and the triglycerides level (among 4,908 individuals without taking any lipid-lowering medications) with adjustment for age, sex, and body mass index, respectively. Five SNPs near ABCA1 (rs3890182), TOMM40 (rs157580), GCKR (rs780094), BAZ1B (rs2240466) and BUD13 (rs28927680) genes were significantly associated with hypertriglyceridemia among T2D patients (OR [95% CI] = 0.79 [0.67, 0.93] for per A allele of rs3890182, P = 4.03х10-3; 1.13 [1.04, 1.22] for per A allele of rs157580, P = 2.81х10-3; 0.87 [0.80, 0.94] for per G allele of rs780094, P = 4.26х10-4; 0.77 [0.68, 0.87] for per T allele of rs2240466, P = 1.28х10-5; 3.83 [1.39, 10.50] for per C allele of rs28927680, P = 9.27х10-3). Six SNPs within or near ABCA1, GCKR, BAZ1B, TOMM40, HNF1A and LDLR were significantly associated with the triglycerides level. For example, minor alleles of GCKR and BAZ1B were associated with lower triglycerides level (β [SE] = -0.025 [0.005] for per G allele of rs780094, P = 7.88х10-7; -0.035 [0.007] for per T allele of rs2240466, P = 2.03х10-6). To test the robustness of these findings, we conducted a sensitivity analysis to only include newly diagnosed T2D patients (2,646 out of 4,908 patients without taking any lipid-lowering medications). The associations between ABCA1, TOMM40, GCKR and BAZ1B with hypertriglyceridemia maintained significant (P value ranged from 7.79х10-4 to 1.29х10-2), as well as their associations with the triglycerides level (P value ranged from 2.76х10-5 to 2.89х10-2). In conclusion, our study provides the first data for the effects of lipid-related genomic loci on hypertriglyceridemia and the triglycerides level among T2D patients of the Chinese population. Further studies were warranted to replicate these findings. [ABSTRACT FROM AUTHOR]