Development and Validation of a Model for Predicting Diabetic Nephropathy in Chinese People

Objective To develop a risk model for predicting later development of diabetic nephropathy （DN） in Chinese people with type 2 diabetes mellitus （T2DM） and evaluate its performance with independent validation. Methods We used data collected from the project ＇Comprehensive Research on the Prevention and Control of Diabetes＇, which was a community-based study conducted by the Jiangsu Center for Disease Control and Prevention in 2013. A total of 11,771 eligible participants were included in our study. The endpoint was a clear diagnosis of DN. Data was divided into two components： a training set for model development and a test set for validation. The Cox proportional hazard regression was used for survival analysis in men and women. The model＇s performance was evaluated by discrimination and calibration. Results The incidence （cases per 10,000 person-years） of DN was 9.95 （95% CI; 8.66-11.43） in women and 11.28 （95% CI; 9.77-13.03） in men. Factors including diagnosis age, location, body mass index, high-density-lipoprotein cholesterol, creatinine, hypertension, dyslipidemia, retinopathy, diet control, and physical activity were significant in the final model. The model showed high discrimination and good calibration. Conclusion The risk model for predicting DN in people with T2DM can be used in clinical practice for improving the quality of risk management and intervention.

Genome-wide association study reveals novel loci for adult type 1 diabetes in a 5-year nested case-control study

BACKGROUND Type 1 diabetes(T1D)is a severe and prevalent metabolic disease.Due to its high heredity,an increasing number of genome-wide association studies have been performed,most of which were from hospital-based case-control studies with a relatively small sample size.The association of single nucleotide polymorphisms(SNPs)and T1D has been less studied and is less understood in natural cohorts.AIM To investigate the significant variants of T1D,which could be potential biomarkers for T1D prediction or even therapy.METHODS A genome-wide association study(GWAS)of adult T1D was performed in a nested case-control study(785 cases vs 804 controls)from a larger 5-year cohort study in Suzhou,China.Potential harmful or protective SNPs were evaluated for T1D.Subsequent expression and splicing quantitative trait loci(eQTL and sQTL)analyses were carried out to identify target genes modulated by these SNPs.RESULTS A harmful SNP for T1D,rs3117017[odds ratio(OR)=3.202,95%confidence interval(CI):2.296-4.466,P=9.33×10-4]and three protective SNPs rs55846421(0.113,0.081-0.156,1.76×10-9),rs75836320(0.283,0.205-0.392,1.07×10-4),rs362071(0.568,0.495-0.651,1.66×10-4)were identified.Twenty-two genes were further identified as potential candidates for T1D onset.CONCLUSION We identified a potential genetic basis of T1D,both protective and harmful,using a GWAS in a larger nested case-control study of a Chinese population.

Incidence, mortality, and temporal patterns of oropharyngeal cancer in China: a population-based study

Background:Thus far,the incidence,mortality,and temporal trend data of oropharyngeal cancers(OPC)in China were few.We estimated the incidence,mortality,and temporal patterns of OPC in China during 2008-2012 according to the data from 135 population-based cancer registries to better understand the epidemiological pattern of OPC and to provide more precise information for OPC control in China.Methods:According to the data of diagnosed OPC reported to 135 cancer registries during 2008-2012,we calcu-lated age-standardized rate of incidence and mortality by 2000 Chinese standard population(ASRIC and ASRMC)and by 1985 Segi’s world standard population(ASRIW and ASRMW)by age,sex,and geographic regions;annual percent-age changes of OPC incidence and mortality were calculated using Joinpoint trend analysis.Results:ASRIW and ASRMW were 2.22/100,000 person-years and 0.94/100,000 person-years,respectively.The incidence and mortality in urban areas were higher than those in rural areas.ASRIC and ASRIW of males were higher than those of females.The overall ASRIC of OPC was significantly increased by 6.2%annually between 2003 and 2006(P=0.038),but remained stable between 2007 and 2012(P=0.392).ASRIC and ASRMC of males and in rural areas were significantly increased in the last decade(P<0.05),but the rates of females remained stable during the same period(P>0.05).Conclusions:Across multiple cancer registries in China,there was an obvious increase in OPC in the recent decade,especially for incidence and mortality of males and in rural areas,whereas the rates of females remained stable.A healthy lifestyle should be advocated and early diagnosis and early treatment of OPC should be enhanced.

Correction to:Incidence,mortality,and temporal patterns of oropharyngeal cancer in China:a population-based study

In the original publication of this article[1],the num-ber of death cases in‘Materials and methods’section is incorrect.The original sentence is‘We quantified 20,618 new diagnoses of OPC and 9635 death cases that were reported to the 135 population-based cancer registries between 1 January 2008 and 31 December 2012 in China’.The correct number of death cases is 9335.

A risk-prediction score for colorectal lesions on 12,628 participants at high risk of colorectal cancer

Background The uptake of colonoscopy is low in individuals at risk of colorectal cancer(CRC).We constructed a riskprediction score(RPS)in a large community-based sample at high risk of CRC to enable more accurate risk stratification and to motivate and increase the uptake rate of colonoscopy.Methods A total of 12,628 participants classified as high-risk according to positivity of immunochemical fecal occult blood tests or High-Risk Factor Questionnaire underwent colonoscopy.Logistic regression was used to derive a RPS and analysed the associations of the RPS with colorectal lesions,giving odds ratios(ORs)and 95%confidence intervals(CIs).Results Of the participants,men(OR=1.73,95%CI=1.58–1.90),older age(≥65 years;1.41,1.31–1.53),higher body mass index(≥28 kg/m^(2);1.22,1.07–1.39),ever smoking(1.47,1.31–1.65),and weekly alcohol use(1.28,1.09–1.52)were associated with a higher risk of colorectal lesions.We assigned 1 point to each of the above five risk factors and derived a RPS ranging from 0 to 5,with a higher score indicating a higher risk.Compared with a RPS of 0,a RPS of 1,2,3,and 4–5 showed a higher risk of colorectal lesions,with the OR(95%CI)being 1.50(1.37–1.63),2.34(2.12–2.59),3.58(3.13–4.10),and 3.91(3.00–5.10),respectively.The area under the receiver-operating characteristic curve of RPS in predicting colorectal lesions was 0.62.Conclusions Participants with an increase in the RPS of≥1 point had a significantly higher risk of colorectal lesions,suggesting the urgency for measuring colonoscopy in this very high-risk group.High-risk strategies incorporating RPS may be employed to achieve a higher colonoscopy-uptake rate.

Investigating the impact of air pollution on AMI and COPD hospital admissions in the coastal city of Qingdao,China

Air pollution has been widely associated with adverse effects on the respiratory and cardiovascular systems.We investigated the relationship between acute myocardial infarction(AMI),chronic obstructive pulmonary disease(COPD)and air pollution exposure in the coastal city of Qingdao,China.Air pollution in this region is characterized by inland and oceanic transportation sources in addition to local emission.We examined the influence of PM_(2.5),PM_(10),NO_(2),SO_(2),CO and O_(3) concentrations on hospital admissions for AMI and COPD from October 1,2014,to September 30,2018,in Qingdao using a Poisson generalized additive model(GAM).We found that PM_(2.5),PM_(10),NO_(2),SO_(2) and CO exhibited a significant short-term(lag 1 day)association with AMI in the singlepollutant model among older adults(>65 years old)and females,especially during the cold season(October to March).In contrast,only NO2 and SO2 had clear cumulative lag associations with COPD admission for females and those over 65 years old at lag 01 and lag 03,respectively.In the twopollutant model,the exposure-response relationship fitted by the two-pollutant model did not change significantly.Our findings indicated that there is an inflection point between the concentration of certain air pollutants and the hospital admissions of AMI and COPD even under the linear assumption,indicative of the benefits of reducing air pollution vary with pollution levels.This study has important implications for the development of policy for air pollution control in Qingdao and the public health benefits of reducing air pollution levels.

Interaction of Diet/Lifestyle Intervention and TCF7L2 Genotype on Glycemic Control and Adiposity among Overweight or Obese Adults:Big Data from Seven Randomized Controlled Trials Worldwide

Objective.The strongest locus which associated with type 2 diabetes(T2D)by the common variant rs7903146 is the transcription factor 7-like 2 gene(TCF7L2).We aimed to quantify the interaction of diet/lifestyle interventions and the genetic effect of TCF7L2 rs7903146 on glycemic traits,body weight,or waist circumference in overweight or obese adults in several randomized controlled trials(RCTs).Methods.From October 2016 to May 2018,a large collaborative analysis was performed by pooling individualparticipant data from 7 RCTs.These RCTs reported changes in glycemic control and adiposity of the variant rs7903146 after dietary/lifestyle-related interventions in overweight or obese adults.Gene treatment interaction models which used the genetic effect encoded by the allele dose and common covariates were applicable to individual participant data in all studies.Results.In the joint analysis,a total of 7 eligible RCTs were included(n=4,114).Importantly,we observed a significant effect modification of diet/lifestyle-related interventions on the TCF7L2 variant rs7903146 and changes in fasting glucose.Compared with the control group,diet/lifestyle interventions were related to lower fasting glucose by-3.06(95%CI,-5.77 to-0.36)mg/dL(test for heterogeneity and overall effect:I^(2)=45:1%,p<0:05;z=2:20,p=0:028)per one copy of the TCF7L2 T risk allele.Furthermore,regardless of genetic risk,diet/lifestyle interventions were associated with lower waist circumference.However,there was no significant change for diet/lifestyle interventions in other glycemic control and adiposity traits per one copy of TCF7L2 risk allele.Conclusions.Our findings suggest that carrying the TCF7L2 T risk allele may have a modestly greater benefit for specific diet/lifestyle interventions to improve the control of fasting glucose in overweight or obese adults.

Cancer incidence and mortality in Zhejiang Province,Southeast China,2016:a population-based study

Backgrounds:Cancer is one of the main causes of death worldwide,seriously threatening human health and life expectancy.We aimed to analyze the cancer incidence and mortality rates during 2016 in Zhejiang Province,Southeast China.Methods:Data were collected from 14 population-based cancer registries across Zhejiang Province of China.Cancer incidence and mortality rates stratified by sex and region were analyzed.The crude rate,age-standardized rate,age-specific and region-specific rate,and cumulative rate were calculated.The proportions of 10 common cancers in different groups and the incidence and mortality rates of the top five cancers in different age groups were also calculated.The Chinese national census of 2000 and the world Segi population was used for calculating the age-standardized incidence and mortality rates.Results:The 14 cancer registries covered a population of 14,250,844 individuals,accounting for 29.13%of the population of Zhejiang Province.The total reported cancer cases and deathswere 55,835 and 27,013,respectively.The proportion ofmorphological verification(MV%)was 78.95%of the population,and percentage of incident cases identified through death certificates only(DCO%)was 1.23%with a mortality-to-incidence ratio(M/I ratio)of 0.48.The crude incidence rate in Zhejiang cancer registration areas was 391.80/105;the age-standardized incidence rate of the Chinese standard population(ASIRC)and the age-standardized incidence rate of theworld standard population(ASIRW)were 229.76/105 and 220.96/105,respectively.The incidence rate in men was higher than that inwomen.The incidence rate increased rapidly after 45 years of age and peaked in individuals aged 80 to 84 years.The top 10 incidence rates of cancers were lung cancer,female breast cancer,thyroid cancer,colorectal cancer,stomach cancer,liver cancer,prostate cancer,cervical cancer,esophageal cancer,and pancreatic cancer(from highest to lowest).The crude mortality rate in Zhejiang cancer registration areas was 189.55/105;the age-standardized mortality rate of the Chinese standard population(ASMRC)and the agestandardized mortality rate of the world standard population(ASMRW)were 94.46/105 and 93.42/105,respectively.The mortality rate in men was higher than that in women,and the male population in rural areas was higher than that in urban areas.The cancer mortality rate increased rapidly after 50 years of age and peaked in individuals aged 85+years.The top 10 mortality rates of cancers were lung cancer,liver cancer,stomach cancer,colorectal cancer,pancreatic cancer,esophageal cancer,female breast cancer,prostate cancer,lymphoma,and leukemia(from highest to lowest).Conclusions:Lung cancer,female breast cancer,thyroid cancer,colorectal cancer,prostate cancer,liver cancer,and stomach cancer were the most common cancers in Zhejiang Province.Effective prevention and control measures should be established after considering the different characteristics of cancers in urban and rural areas.