The Effect of Blood Lipid Profiles on Chronic Kidney Disease in a Prospective Cohort:Based on a Regression Discontinuity Design

Objective Previous studies on the association between lipid profiles and chronic kidney disease(CKD)have yielded inconsistent results and no defined thresholds for blood lipids.Methods A prospective cohort study including 32,351 subjects who completed baseline and follow-up surveys over 5 years was conducted.Restricted cubic splines and Cox models were used to examine the association between the lipid profiles and CKD.A regression discontinuity design was used to determine the cutoff value of lipid profiles that was significantly associated with increased the risk of CKD.Results Over a median follow-up time of 2.2(0.5,4.2)years,648(2.00%)subjects developed CKD.The lipid profiles that were significantly and linearly related to CKD included total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),TC/HDL-C,and TG/HDL-C,whereas lowdensity lipoprotein cholesterol(LDL-C)and LDL-C/HDL-C were nonlinearly correlated with CKD.TC,TG,TC/HDL-C,and TG/HDL-C showed an upward jump at the cutoff value,increasing the risk of CKD by 0.90%,1.50%,2.30%,and 1.60%,respectively,whereas HDL-C showed a downward jump at the cutoff value,reducing this risk by 1.0%.Female and participants with dyslipidemia had a higher risk of CKD,while the cutoff values for the different characteristics of the population were different.Conclusion There was a significant association between lipid profiles and CKD in a prospective cohort from Northwest China,while TG,TC/HDL-C,and TG/HDL-C showed a stronger risk association.The specific cutoff values of lipid profiles may provide a clinical reference for screening or diagnosing CKD risk.

Medical expenditures for colorectal cancer diagnosis and treatment: A 10-year high-level-hospital-based multicenter retrospective survey in China, 2002-2011

Objective: Colorectal cancer(CRC) causes a substantial burden of disease in China and the evidence of economic burden triggered is fundamental for priority setting. The aim of this survey was to quantify medical expenditures and the time trends for CRC diagnosis and treatment in China.Methods: From 2012 to 2014, a hospital-based multicenter retrospective survey was conducted in 13 provinces across China. For each eligible CRC patient diagnosed from 2002 to 2011, clinical information and expenditure data were extracted using a uniform questionnaire. All expenditure data were reported in Chinese Yuan(CNY)using 2011 values.Results: Of the 14,536 CRC patients included, the average age at diagnosis was 58.2 years and 15.8% were stageI cases. The average medical expenditure per patient was estimated at 37,902 CNY [95 % confidence interval(95%CI): 37,282-38,522], and the annual average increase rate was 9.2% from 2002 to 2011(P for trend <0.001), with a cumulative increase of 2.4 times(from 23,275 CNY to 56,010 CNY). The expenditure per patient in stages Ⅰ, Ⅱ, Ⅲ and Ⅳ were 31,698 CNY, 37,067 CNY, 38,918 CNY and 42,614 CNY, respectively(P<0.001). Expenditure significantly differed within various subgroups. Expenses for drugs contributed the largest proportion(52.6%).Conclusions: These conservative estimates illustrated that medical expenditures for CRC diagnosis and treatment in tertiary hospitals in China were substantial and increased rapidly over the 10 years, with drugs continually being the main expense by 2011. Relatively, medical expenditures are lower for CRC in the earlier stages. These findings will facilitate the economic evaluation of CRC prevention and control in China.

Predictive value of total cholesterol to high-density lipoprotein cholesterol ratio for chronic kidney disease among adult male and female in Northwest China

Background: Studies have found that the ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) was associated with the development of chronic kidney disease (CKD). However, the relationship in different genders was rarely discussed. The aim of this study was to explore this relationship and assess its predictive power for both males and females.Methods: Based on a prospective cohort platform in northwest China, 32,351 participants without CKD were collected in the baseline and followed up for approximately 5 years. Cox proportional hazard model and restricted cubic spline regression analysis were performed to investigate the association between TC, HDL-C, TC/HDL-C and CKD in adult female and male. The clinical application value of the indicators in predicting CKD was evaluated by the receiver operator characteristic curve.Results: During a mean follow-up of 2.2 years, 484 males and 164 females developed CKD. After adjusted for relevant confounders, for every one standard deviation increase in TC, HDL-C and TC/HDL-C, the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for CKD were 1.17 (1.05-1.31), 0.84 (0.71-0.99), and 1.15 (1.06-1.25) for males, 0.94 (0.78-1.13), 0.58 (0.35-0.95), and 1.19 (1.01-1.40) for females, respectively. The results also showed that TC, HDL-C, and TC/HDL-C were associated with CKD in a linear dose-response relationship. The TC/HDL-C had the largest area under the curve (AUC) compared to TC and HDL-C, and the AUC among the females was larger than that among males.Conclusions: The TC/HDL-C was significantly associated with CKD in adult males and females and has better clinical value in predicting CKD than TC and HDL-C, especially in females.

Sex-specific and dose-response relationships of urinary cobalt and molybdenum levels with glucose levels and insulin resistance in U.S. adults

Growing studies have linked metal exposure to diabetes risk.However,these studies had inconsistent results.We used a multiple linear regression model to investigate the sexspecific and dose-response associations between urinary metals(cobalt(Co)and molybdenum(Mo))and diabetes-related indicators(fasting plasma glucose(FPG),hemoglobin A1c(HbA1c),homeostasis model assessment for insulin resistance(HOMA-IR),and insulin)in a cross-sectional study based on the United States National Health and Nutrition Examination Survey.The urinary metal concentrations of 1423 eligible individuals were stratified on the basis of the quartile distribution.Our results showed that the urinary Co level in males at the fourth quartile(Q4)was strongly correlated with increased FPG(β=0.61,95%CI:0.17–1.04),HbA1c(β=0.31,95%CI:0.09–0.54),insulin(β=8.18,95%CI:2.84–13.52),and HOMA–IR(β=3.42,95%CI:1.40–5.44)when compared with first quartile(Q1).High urinary Mo levels(Q4 vs.Q1)were associated with elevated FPG(β=0.46,95%CI:0.17–0.75)and HbA1c(β=0.27,95%CI:0.11–0.42)in the overall population.Positive linear dose-response associations were observed between urinary Co and insulin(Pnonlinear=0.513)and HOMA–IR(Pnonlinear=0.736)in males,as well as a positive linear dose-response relationship between urinary Mo and FPG(Pnonlinear=0.826)and HbA1c(Pnonlinear=0.376)in the overall population.Significant sex-specific and dose-response relationships were observed between urinary metals(Co and Mo)and diabetes-related indicators,and the potential mechanisms should be further investigated.

Comparing the Diagnostic Criteria of MAFLD and NAFLD in the Chinese Population:A Population-based Prospective Cohort Study

Background and Aims:Metabolic dysfunction-associ-ated fatty liver disease(MAFLD)is a new concept,pro-posed in 2020;however,its applicability in Asia populations has yet to be evaluated.Therefore,we aimed to compare the difference in epidemiological and clinical characteris-tics between MAFLD and non-alcoholic fatty liver disease(NAFLD)among Asian populations.Methods:Based on the Jinchang cohort,30,633 participants were collected.The prevalence and incidence of MAFLD and NAFLD were used to analyze the epidemic characteristics and its overlapping effects.In addition,the corresponding clinical character-istics of the two diagnostic criteria populations were com-pared.Results:The prevalence rates of MAFLD and NAFLD were 21.03%and 18.83%,respectively.After an average 2.28-year follow-up,the incidence densities of MAFLD and NAFLD were 41.58 per 1,000 person-years and 37.69 per 1,000 person-years,respectively.With the increase of baseline age,body mass index(BMI),and waist circumfer-ence(WC)levels,the prevalence and incidence of MAFLD and NAFLD were on the rise(all ptrend<0.05).Among the total patients diagnosed at baseline or follow-up,most pa-tients had both MAFLD and NAFLD,accounting for 78.84%and 82.88%,respectively.Compared with NAFLD,MAFLD patients had greater proportions of males and metabolic diseases(diabetes,dyslipidemia),and had higher BMI,WC,liver enzymes,blood glucose,and lipid levels in the base-line diagnosis patients(p<0.05).Additionally,lean MAFLD patients had higher metabolic disorders than lean NAFLD patients(p<0.05).Conclusions:Compared with NAFLD,the newly proposed definition of MAFLD is more practical and accurate,and it can help identify more fatty liver pa-tients with high-risk diseases.