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Evidence regarding the impact of education on diabetes risk is scarce in developing countries. We aimed to explore the association between education and diabetes within a large population in China and to identify the possible mediators between them.Information on educational level and lifestyle factors was collected through questionnaires. Diabetes was diagnosed from self-report and biochemical measurements. A structural equation model was constructed to quantify the mediation effect of each mediator.Compared with their least educated counterparts, men with college education had a higher risk of diabetes (odds ratio [OR] 1.19; 95% confidence interval [CI], 1.12-1.27), while college-educated women were less likely to have diabetes (OR 0.77; 95% CI, 0.73-0.82). Obesity was the strongest mediator in both genders (proportion of mediation: 11.6% in men and 23.9% in women), and its association with education was positive in men (β[SE] 0.0387 [0.0037]) and negative in women (β[SE] -0.0824 [0.0030]). Taken together, all behavioral factors explained 12.4% of the excess risk of diabetes in men and 33.3% in women.In a general Chinese population, the association between education level and diabetes was positive in men but negative in women. Obesity was the major mediator underlying the education disparities of diabetes risk, with a stronger mediation effect among women.目的: 在发展中国家，关于教育对糖尿病风险的影响的证据很少。我们的目的是在中国的一个大人群样本中探索教育和糖尿病之间的联系，并确定可能的中介因素。 材料和方法: 通过问卷调查，收集有关文化程度和生活方式因素的信息。糖尿病的诊断是通过自我报告和生化测量进行的。我们构建了结构方程模型量化了各变量的中介效应。 结果: 与受教育程度最低的男性相比，受过大学教育的男性患糖尿病风险较高(优势比OR:1.19, 95%可信区间(95%CI):1.12~1.27)，而受过大学教育的女性患糖尿病风险较低(OR:0.77, 95%CI:0.73~0.82)。肥胖在两性中均是最强的中介因素(中介比例:男性11.6%，女性23.9%)，肥胖与教育呈正相关(β[SE]0.0387[0.0037])，与女性中负相关(β[SE]-0.0824[0.0030])。所有行为因素加在一起，可以解释12.4%的男性和33.3%的女性患糖尿病的额外风险。 结论: 在中国普通人群中，男性受教育程度与糖尿病之间存在正相关，而女性则为负相关。肥胖是糖尿病风险教育差异的主要中介因素，在女性中的中介作用更强。.

Urinary albumin-creatinine ratio (UACR) is a sensitive marker of kidney injury. This study analyzed the prevalence of different metabolic phenotypes and investigated their relationship with UACR in Chinese community adults.This study involved 33 303 participants over 40 years old from seven centers across China. They were stratified into six groups according to their body mass index (BMI) and metabolic status: metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW), and metabolically unhealthy obesity (MUO). Increased albuminuria was defined as a UACR ≥30 mg/g.The percentages of MHNW, MHOW, MHO, MUNW, MUOW, and MUO were 27.6%, 15.9%, 4.1%, 19.8%, 22.5%, and 9.6%, respectively. Multiple logistic regression analysis showed that the MHO group (odds ratio [OR] 1.205; 95% CI, 1.081-1.343), MUNW group (OR 1.232; 95% CI, 1.021-1.486), MUOW group (OR 1.447; 95% CI, 1.303-1.607), and MUO group (OR 1.912; 95% CI, 1.680-2.176) were at higher risk of increased albuminuria compared to the MHNW group. Subgroup analysis indicated that the risk of increased albuminuria was further elevated among regular smokers in men aged 40 to 55 years old with abdominal obesity.Among Chinese community adults, increased albuminuria was associated with increased BMI whether metabolism was normal or not, and those with abnormal metabolism were at greater risk of increased albuminuria than those with normal metabolism. These findings suggest that overweight or obesity or metabolic abnormalities are risk factors for chronic kidney disease.背景: 尿白蛋白/肌酐比值(UACR)是反映肾脏损伤的有效指标。本研究分析了不同代谢表型在中国社区成人中的患病率, 并探讨了它们与UACR的关系。 方法: 这项研究纳入来自中国7个中心的33303名40岁以上的参与者。根据体重指数(BMI)和代谢状态将受试者分为6组:代谢健康正常体重(MHNW), 代谢健康超重(MHOW), 代谢健康肥胖(MHO), 代谢不健康正常体重(MUNW), 代谢不健康超重(MUOW)和代谢不健康肥胖(MUO)。UACR≥ 30 mg/g被定义为蛋白尿增加。 结果: MHNW, MHOW, MHO, MUNW, MUOW和MUO所占比例分别为27.6%, 15.9%, 4.1%, 19.8%, 22.5%和9.6%。多因素Logistic回归分析显示, MHO组(OR=1.205[95%CI:1.081~1.343]), MUNW组(OR=1.232[95%CI:1.021~1.486]), MUOW组(OR=1.447[95%CI:1.303~1.607])和MUO组(OR=1.912[95%CI:1.680~2.176])发生蛋白尿增加的风险高于MHNW组。亚组分析表明, 在40至55岁腹部肥胖的男性中, 经常吸烟的人蛋白尿增加的风险进一步增加。 结论: 在中国社区成年人中, 无论代谢是否正常, 尿白蛋白增加都与BMI增加相关, 代谢异常的人比代谢正常的人更容易出现蛋白尿增加的危险。这些发现表明, 超重, 肥胖和代谢异常是慢性肾脏疾病的风险因素。.

Gestational hyperglycemia increases the risk of diabetes in later life. However, the risk of future cardiovascular diseases (CVD) related to gestational hyperglycemia remains inconclusive. The purpose of this study was to investigate the impact of gestational hyperglycemia on the subsequent risk of CVD and its modifying factors among elderly Chinese women.We conducted a case-control study of elderly women from the baseline survey of Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Women with gestational hyperglycemia (n = 82), and controls matched by age and study site (n = 410) were included. Information on CVD, including reported coronary heart disease, stroke, or myocardial infarction, was collected through an interviewer-assisted questionnaire.Women with gestational hyperglycemia were more likely to develop diabetes (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.50-4.18) and CVD (OR, 1.98; 95% CI, 1.05-3.74). Even without progressing to type 2 diabetes, gestational hyperglycemia was associated with an increased risk of CVD (OR, 2.88; 95% CI, 1.18-7.00). However, subgroup analysis indicated that compared with those without gestational hyperglycemia or hypertension, women with both gestational hyperglycemia and hypertension had higher risk of CVD (OR, 3.98; 95% CI, 1.65-9.58), whereas the risk estimate did not significantly change in women with gestational hyperglycemia alone (OR, 2.15; 95% CI, 0.71-6.57). Stratified analysis indicated that among those with overweight/obesity, inactive physical activity, or unhealthy dietary habits, gestational hyperglycemia increased the risk of CVD.In elderly Chinese women, gestational hyperglycemia was associated with an increased risk of CVD in later life. This association was independent of the progression to diabetes and might be modified by lifestyle factors and hypertension.背景: 妊娠高血糖会增加以后患糖尿病的风险。然而，与妊娠高血糖相关的未来心血管疾病(Cardiovascular diseases, CVD)的风险仍然不确定。本研究旨在探讨妊娠高血糖对中国老年女性后续心血管疾病风险的影响及其可能的影响因素。 方法: 我们在中国2型糖尿病患者恶性肿瘤发生风险的流行病学(REACTION)研究的老年妇女中开展了一项病例对照研究。研究纳入82名妊娠高血糖女性及410名按年龄和研究中心匹配的对照女性。心血管疾病信息(包括冠心病、中风和心肌梗死)通过调查员辅助的标准化问卷收集。 结果: 有妊娠高血糖的女性更容易发生糖尿病 [比值比(Odd ratio, OR)，2.51； 95%可信区间(Confidence interval, CI)，1.50-4.18] 和CVD(OR，1.98； 95%CI，1.05-3.74)。即使没有进展为 2 型糖尿病，妊娠高血糖也与 CVD 风险增加相关(OR，2.88；95%CI，1.18-7.00)。然而，亚组分析表明，与没有妊娠期高血糖或高血压的女性相比，同时有妊娠期高血糖和高血压的女性患心血管疾病的风险更高(OR，3.98；95%CI，1.65-9.58)，而CVD风险在单纯有妊娠高血糖的女性中没有显著变化(OR，2.15；95%CI，0.71-6.57)。分层分析表明，在超重/肥胖、缺乏体力活动或饮食不健康的人群中，妊娠高血糖会显著增加CVD风险。 结论: 在中国老年女性中，妊娠期高血糖与晚年 CVD 风险增加有关。这种关联与是否发展为糖尿病无关，而可能会受到生活方式和高血压的影响。.

AIMS The aims of this study were to evaluate the associations of metabolic abnormalities with incident diabetic kidney disease (DKD) and to explore whether dyslipidaemia, particularly high fasting triglyceride (TG), was associated with the development of DKD. METHODS In total, 11 142 patients with new-onset type 2 diabetes with baseline estimated glomerular filtration rates (eGFR) ≥60 mL/min/1.73 m2 were followed up during 2011-2016. Incident DKD was defined as eGFR

Data are limited with regard to the association between low-grade albuminuria (below the threshold of microalbuminuria) and high cardiovascular risk in normoalbuminuric Chinese adults free of cardiovascular disease (CVD).A total of 32 650 participants aged over 40 years from seven regional centers in China were included in this study. The single-void first morning urine sample was collected to measure the urinary albumin to creatinine ratio (UACR) and the data were divided into sex-specific quartiles. The Framingham Risk Score (FRS) was used to identify participants at high risk of developing coronary heart disease (CHD) over the next 10 years and the association between low-grade albuminuria and high 10-year Framingham risk for CHD (FRS ≥20%) was investigated.Among males and females, the prevalence of cardiometabolic risk factors (diabetes, hypertension, and dyslipidemia) increased markedly with the elevation of UACR quartiles. Logistic regression analysis showed that the odds ratios (ORs) for high 10-year risk of CHD increased significantly from the second quartile in males (UACR: 4.78 ~ 7.53 mg/g, OR = 1.21, 95% confidence interval [CI]: 1.05-1.40) and the third quartile in females (UACR: 9.13 ~ 15.04 mg/g, OR = 3.07, 95% CI: 1.75-5.40). Stratified analysis showed that in males, the association was especially pronounced in elderly, overweight/obese participants and those without diabetes and hypertension whereas in females, the association was especially pronounced in elderly, overweight/obese participants and those without diabetes and with hypertension.Low-grade albuminuria was significantly associated with high 10-year cardiovascular risk among CVD-free and normoalbuminuric Chinese adults.背景: 在无心血管疾病(CVD)且尿蛋白正常的中国成年人群中, 关于低度白蛋白尿(低于微量白蛋白尿阈值)与心血管高危风险的相关性研究数据有限。 方法: 本研究共纳入来自中国7个中心的32650名40岁以上社区人群。收集晨尿测尿微量白蛋白与肌酐的比值(UACR), 分别在男性和女性中进行数据分析, 并根据UACR水平将各性别人群分成四分位。采用Framingham风险评分(FRS)计算参与者未来10年罹患冠心病(CHD)的风险, FRS ≥ 20%者被定义为未来10年患冠心病的风险为高危。建立Logistic回归模型, 分析低度白蛋白尿与未来10年冠心病高危风险的相关性。 结果: 在男性和女性中, 冠心病高危因素如糖尿病、高血压和血脂异常的患病率随着UACR水平的升高而显著增加。Logistic回归分析显示, 从男性UACR第二分位(UACR: 4.78 ~ 7.53 mg/g, OR = 1.21, 95% [CI]: 1.05-1.40)、女性第三分位(UACR:9.13 ~ 15.04 mg/g, OR = 3.07, 95% CI: 1.75-5.40)开始, 随着UACR的升高, 未来10年冠心病高危风险的比值比(OR)明显增加。分层分析显示, 在老年、超重或肥胖、无糖尿病和无高血压的男性以及老年、超重或肥胖、无糖尿病和有高血压的女性中, 这种相关性最为显著。 结论: 在无心血管疾病病史且尿蛋白正常的中国成年人群中, 低度白蛋白尿与未来10年冠心病高危风险显著相关。.

The correlation between remnant cholesterol (RC) and urinary albumin to creatinine ratio (UACR) has not been illustrated. The present study aims to explore the correlation between RC levels and UACR in Chinese community adults.This study included 35 848 participants from a cohort study (REACTION). The UACR data were divided into three groups: UACR10 mg/g, 10 ≤UACR30 mg/g, and UACR ≥30 mg/g groups. RC was divided into two groups, according to the 75th percentile:75% group and ≥75% group. Multiple logistic regression analysis was used to evaluate the correlation between RC and UACR.The RC exhibited an adjusted odds ratio that was significant in models 1-5. Although all confounders were corrected in model 5, RC and UACR were still significantly correlated， and the correlation was more significant in females，when compared to males (odds ratio [OR]: 1.117, 95% CI: 1.063-1.176, P 0.001 for all subjects; OR: 1.092, 95% CI: 1.128-1.161, P = 0.004 for females; and OR: 1.085, 95% CI: 0.998-1.194, P = 0.088 for males). The RC was significantly correlated with UACR for subjects with 5.6 ≤ fasting blood glucose 7.0 or 7.8 ≤ post-load blood glucose 11.1 mmol/L, 24 ≤ body mass index (BMI) 28 kg/mIn the Chinese community, RC is highly correlated with UACR, and the correlation is more significant in females compared with males. At higher RC levels, patients with critical values of blood pressure, BMI and blood glucose have a more significant correlation between RC and UACR.背景: 残余胆固醇(RC)和尿白蛋白肌酐比值(UACR)之间的相关性尚未被阐明。本研究旨在探讨中国社区成年人群中RC水平与UACR的相关性。 方法: 本研究纳入来自一个队列研究(REACTION研究)的35848名参与者。UACR分为三组: UACR 10 mg/g、 10≤UACR30 mg/g和UACR≥30 mg/g组。根据第75百分位，RC被分为两组:75%组和≥75%组。采用多元逻辑回归分析评估RC与UACR的相关性。 结果: 在模型1-5中，RC显示出显著的校正后优势比(OR)。尽管模型5中校正了所有混杂因素，RC和UACR仍然显著相关，并且与男性相比，这种相关性在女性中更为显著(对于所有受试者:OR: 1.117, 95% CI: 1.063-1.176, P 0.001；对于女性受试者:OR: 1.092, 95% CI: 1.128-1.161, P = 0.004；对于男性受试者:OR: 1.085, 95% CI: 0.998-1.194, P = 0.088)。对于5.6≤空腹血糖 7.0 mmol/L或7.8≤餐后血糖 11.1 mmol/L，24≤体重指数(BMI) 28 kg/m

Background A number of primary studies suggested that active smoking could be independently associated with incident diabetes. However less is known about the impact of active smoking and smoking cessation on glycemic control in patients with diabetes. We aimed to evaluate the associations of active smoking and smoking cessation with glycemic control in diabetic patients. Methods This is a cross-sectional study of 10,551 man and 15,297 women with diabetes from the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Risk factors for glycemic control and the association of active smoking with glycemic control were evaluated using logistic regression models. Hemoglobin A1c (HbA1c) ≥7.0% was defined as poor glycemic control. Results Current smokers have increased risk for poor glycemic control, and the multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) of HbA1c≥7.0% with current smoking were 1.49 (1.35-1.66) in men and 1.56 (1.13-2.15) in women. Further analysis demonstrated a dose–response relationship between active smoking and the risk of poor glycemic control in men. Former smokers who quit smoking for

Background Diagnosed diabetes has been associated with chronic kidney disease (CKD). However, the association between non-diabetic hyperglycemia and CKD remained uncertain. The aim of the present study was to investigate the association between different glycemic status and CKD in Chinese adults and to assess the prevalence and control of diabetes among individuals with CKD. Methods In all, 250 752 adults aged ≥40 years were selected from the baseline cohort of the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal (REACTION) study. Plasma glucose concentrations and biochemical and other clinical data were collected; CKD was defined as an estimated glomerular filtration rate (eGFR)

Objective To clarify the quantitative relationship of body mass index (BMI) change from early adulthood to midlife with presence of type 2 diabetes mellitus (T2DM) after midlife. Methods This study included 120,666 middle-aged and elderly, whose retrospectively self-reported body weight at 20 and 40 years and measured height were available. BMI at 20 and 40 years and BMI change in between were defined as early-adulthood BMI, midlife BMI, and early-adulthood BMI change. Results The odds ratio (OR) for T2DM associated with an 1-unit increment of early-adulthood or midlife BMI was 1.08 (95% confidence interval (CI), 1.07-1.08) and 1.09 (95% CI, 1.09-1.10) respectively. In the cross-tabulation of both early-adulthood BMI and BMI change, the prevalence of T2DM increased across both variables. Compared with participants with normal early-adulthood weight and BMI increase/decrease ≤1, the OR (95% CI) for T2DM of participants with early-adulthood overweight/obesity and BMI increase ≥4 kg/m2 was 3.49 (3.05-4.00). For participants with early-adulthood underweight and BMI increase/decrease ≤ 1, the OR (95% CI) was 0.85 (0.75-0.97). Subgroup analysis according to sex and age showed similar trends. Conclusions Early-adulthood BMI may influence T2DM prevalence after midlife independent of current BMI. T2DM prevalence after midlife was positively associated with early-adulthood weight gain and inversely related to early-adulthood weight loss, while early-adulthood weight loss could not completely negate the adverse effect of early-adulthood overweight/obesity on diabetes.

Aim To examine the association between depression and impaired glucose regulation, newly diagnosed diabetes and previously diagnosed diabetes in middle-aged and elderly Chinese people, and whether depression was associated with different treatment regimens or durations of diabetes. Methods A cross-sectional study was performed among 229 047 adults living in the community aged 40 years from 25 centres in China. The self-reported depression rating scale Patient Health Questionnaire 9 (PHQ-9) was used to diagnose probable and sub-threshold depression. Glucose metabolism status was determined according to World Health Organization 1999 diagnostic criteria. Results The numbers of participants with normal glucose regulation, impaired glucose regulation, newly diagnosed diabetes and previously diagnosed diabetes were 120 458, 59 512, 24 826 and 24 251, respectively. The prevalence of subthreshold depression in the total sample of participants was 4.8% (4.8%, 4.8%, 4.4% and 5.6% from normal glucose regulation to previously diagnosed diabetes, respectively), and the prevalence of probable depression was 1.1% (1.1%, 1.0%, 0.9% and 1.8% from normal glucose regulation to previously diagnosed diabetes, respectively). Compared with participants with normal glucose regulation, those with previously diagnosed diabetes had increased odds of probable depression [odds ratio (OR) = 1.61, 95% confidence interval (CI) 1.39-1.87] and sub-threshold depression (OR = 1.14, 95% CI 1.06-1.24), after adjustment for multiple confounding factors. Newly diagnosed diabetes or impaired glucose regulation was not associated with depression. Among those with previously diagnosed diabetes, insulin treatment was associated with greater odds of depression compared with no treatment or oral anti-diabetic medicine. Conclusion Previously diagnosed diabetes, but not newly diagnosed diabetes or impaired glucose regulation, was associated with a higher prevalence of depression. Patients receiving insulin were more likely to have depression than those not receiving treatment or being treated with oral anti-diabetic medicine.

Objective To demonstrate whether abnormal glucose metabolism (diabetes and prediabetes) is associated with increased risk for cancer in the Chinese population and to identify factors that modify the risk of cancer among individuals with abnormal glucose metabolism. Methods Between 2011 and 2012, 259 657 community-dwelling adults, aged 40 years and older, were recruited from 25 centers across mainland China to participant in the baseline survey of the REACTION study, with follow-up investigations performed 3, 5, and 10 years later. Detailed questionnaires about lifestyles, physical and biochemical measurement, bio-samples including serum, urine, and whole blood for DNA extraction were collected for all the participants. Results The mean ± standard deviation (SD) age of this cohort was 57 ± 10 years. And the prevalence of pre-existing and newly diagnosed diabetes was 10.32% and 10.57%, respectively. A total of 4511 prevalent cancer cases (988 men and 3523 women) were identified, the prevalence was 1.79. Compared to those with normal glucose metabolism, men with diabetes had a significantly lower adjusted prevalence ratio (PR) of stomach cancer (PR: 0.38, 95% CI: 0.16–0.89), and women with diabetes had significantly higher adjusted PRs of cancer of all sites (PR: 1.36, 95% CI: 1.20–1.56), and cancer of the breast (PR: 1.56, 95% CI: 1.21–2.00), the endometrium (PR: 1.58, 95% CI: 1.16–2.15), and the thyroid (PR: 1.53, 95% CI: 1.03–2.27). Conclusion The multi-center REACTION study has captured a broad range of data on physical, psychological and metabolic function as well as health status, biochemical and lifestyle information in 259 657 adults from the general population across the China.