Objective. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and easily measurable laboratory index indicating systemic inflammation, while the application of many other inflammatory markers has been limited in daily clinical practice. However, large population studies about investigating the associations of the NLR level with diabetic complications including cardiovascular and cerebrovascular diseases (CVD), diabetic kidney disease (DKD), and diabetic retinopathy (DR) in the same population were limited. The aim of our study is to evaluate the associations between the NLR level and the prevalence of CVD, DKD, and DR in adults with diabetes simultaneously. Methods. A cross-sectional survey of 4,813 diabetic adults was conducted in seven communities in China. Persons underwent several medical examinations, including the measurement of anthropometric factors, blood pressure, routinely analyzed leukocyte characteristics, glucose, lipid profiles, urine albumin/creatinine ratio, and fundus photographs. Results. Compared with the first quartile of the NLR level, the odds of having CVD was significantly increased by 21% for participants in the highest quartile (OR 1.21; 95% CI 1.00, 1.47) (P for trend<0.05). Similarly, the prevalence of DKD among participants in the highest quartile of the NLR level was significantly increased by 150% (OR 2.50; 95% CI 1.95, 3.19) (P for trend<0.05). However, no association was found between the NLR level and the prevalence of DR (P for trend>0.05). These associations were all fully adjusted. Conclusions. A higher NLR level was associated with an increased prevalence of CVD and DKD, other than DR, in diabetic adults.

To date, no study has explored the association between androgen levels and 25-hydroxyvitamin D (25(OH)D) levels in Chinese men. We aimed to investigate the relationship between 25(OH)D levels and total and free testosterone (T), sex hormone binding globulin (SHBG), estradiol, and hypogonadism in Chinese men. Our data, which were based on the population, were collected from 16 sites in East China. There were 2,854 men enrolled in the study, with a mean (SD) age of 53.0 (13.5) years. Hypogonadism was defined as total T <11.3 nmol/L or free T <22.56 pmol/L. The 25(OH)D, follicle-stimulating hormone, luteinizing hormone, total T, estradiol and SHBG were measured using chemiluminescence and free T by enzyme-linked immune-sorbent assay. The associations between 25(OH)D and reproductive hormones and hypogonadism were analyzed using linear regression and binary logistic regression analyses, respectively. A total of 713 (25.0 %) men had hypogonadism with significantly lower 25(OH)D levels but greater BMI and HOMA-IR. Using linear regression, after fully adjusting for age, residence area, economic status, smoking, BMI, HOMA-IR, diabetes and systolic pressure, 25(OH)D was associated with total T and estradiol (P < 0.05). In the logistic regression analyses, increased quartiles of 25(OH)D were associated with significantly decreased odds ratios of hypogonadism (P for trend <0.01). This association, which was considerably attenuated by BMI and HOMA-IR, persisted in the fully adjusted model (P for trend <0.01) in which for the lowest compared with the highest quartile of 25(OH)D, the odds ratio of hypogonadism was 1.50 (95 % CI, 1.14, 1.97). A lower vitamin D level was associated with a higher prevalence of hypogonadism in Chinese men. This association might, in part, be explained by adiposity and insulin resistance and warrants additional investigation.

The alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ratio is reportedly associated with insulin resistance (IR). However, few studies have explored the relationship between the ALT/AST ratio and IR in the Chinese population. Here, we aimed to explore whether the ALT/AST ratio is associated and, if so, to what extent, with IR in the Chinese population as categorized by waist circumference (WC). Our data were obtained from the SPECT-China study, a cross-sectional survey on the prevalence of metabolic diseases and risk factors in East China from 2014 to 2015. A total of 8398 participants aged 52.16 ± 13.16 (mean ± standard deviation) years were included in this study. Anthropometric indices, biochemical parameters and clinical characteristics were measured. IR was defined as the top quartile of the homeostasis model assessment of insulin resistance (HOMA-IR > 1.6), and central obesity was defined as a WC ≥90 cm in males or ≥80 cm in females. Linear regression and receiver operating characteristic curve analyses were conducted. The ALT/AST ratio was significantly correlated and associated with HOMA-IR in both non-centrally obese (r = 0.284, B = 0.509, 95% confidence interval (CI): 0.459–0.559, P < 0.001) and centrally obese subjects (r = 0.372, B = 0.607, 95%CI: 0.532–0.683, P < 0.001) after adjusting for potential confounders. The ALT/AST ratio was one of the best markers of IR, with areas under the curve (AUC) values of 0.66 (0.64–0.68) in non-centrally and 0.68 (0.66–0.70) in centrally obese subjects. In the prediction model for IR, the AUCs were significantly augmented after adding the ALT/AST ratio in both non-centrally obese [AUC 95%CI 0.69(0.67–0.71) vs 0.72(0.70–0.74), P<0.001] and central obese [AUC 95%CI 0.69(0.67–0.71) vs 0.73(0.72–0.75), P<0.001] subjects. The optimal cut-off points of the ALT/AST ratio for identifying IR were 0.80 in non-centrally obese people and 0.78 in centrally obese people, respectively. The ALT/AST ratio may be one of the best markers for IR in the Chinese population. Whether the ALT/AST ratio should be regarded as an additional metabolic syndrome component in the Chinese population warrants further investigation.

Used the EuroQoL-5 dimension (EQ-5D) to evaluate the health status of 5310 residents who live in East China, and compared the health-related quality of life (HRQoL) with 311 patients with type 2 diabetes as well as to explore the main influence factors to HRQoL in East China. The cohort includes 5310 participants aged 18-89 years old lived in East China. EuroQoL-5 dimension (EQ-5D) scale was used for the assessment of health-related quality of life. The mean age of the cohort was 52.2 ± 13.4 years of which 43.7% were male. A moderate level of health-related quality of life was measured of that EQ-5D index and EQ-VAS scores were 0.939 ± 0.111 and 80.06 ± 11.58, respectively. There was a significant difference between diabetes patients and non-diabetes (p = 0.029, p < 0.001, respectively). The age had an inverse correlation with the EQ-5D scores both in general population and diabetes patients. The EQ-5D Vas was weakly adversely associated with the FPG, HbA1c and HOMA-IR. The overall health-related quality of life of population in East-China was moderate. Diabetes patients had lower score of health-related quality. The healthy-related quality was associated with the age, gender, economic development of region, level of education and marital status.

Objective. Diabetic kidney disease is one of the most common microvascular complications of diabetes mellitus. We aimed to analyze the association of thyroid parameters with kidney disorders, especially in euthyroid participants. Methods. The data were obtained from a cross-sectional study, the METAL study. Thyroid parameters, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT₃), free thyroxine (FT₄), triiodothyronine (T₃), thyroxin (T₄), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb), of 4136 participants with type 2 diabetes were measured. Two structure parameters of thyroid homeostasis, including the sum activity of step-up deiodinases (SPINA-G_D) and thyroid secretory capacity (SPINA-G_T), and two pituitary thyrotropic function indices, including Jostel’s TSH index (TSHI) and the thyrotroph thyroid hormone resistance index (TTSI), were also calculated. Kidney disorders were described according to the presence of reduced estimated glomerular filtration rate (eGFR) and/or higher urinary albumin to creatinine ratio (UACR). Results. The prevalence of kidney disorders increased with decreasing FT₃ or T₃ and increasing FT₄ or T₄ quartile levels (all P<0.05). After full adjustment, linear regression showed that UACR levels were negatively associated with FT₃ and T₃ (P<0.001). In addition, eGFR was positively associated with FT₃ and T₃ and was negatively associated with TSH and FT₄ levels and TgAb positivity (all P<0.05). By using binary logistic regression, higher TSH and FT₄ and lower FT₃ and T₃ were associated with kidney disorders (all P<0.05). Similar results were seen in sensitivity analyses, which were performed in 3035 euthyroid diabetic participants; however, TSH was no longer related to them. The area under the receiver operating characteristic curve (AUROC) of lower FT₃ for existing kidney disorder was greater than that for any other thyroid hormones (all P<0.001). The cutoff value of FT₃ for reduced eGFR was 4.39 pmol/L. Regarding thyroid homeostasis parameters, SPINA-G_D was negatively associated with three statuses of kidney disorders, and TSHI and TTSI were positively associated with reduced eGFR (all P<0.05). Conclusions. Among patients with type 2 diabetes, elevated TSH and FT₄ (or T₄), lower FT₃ (or T₃), TgAb positivity, lower SPINA-G_D, and higher TSHI and TTSI were associated with kidney disorders. The lower FT₃, even within the normal range (<4.38 pmol/L), may be the factor most related to reduced eGFR compared with other thyroid hormones in diabetic patients.

Chinese population are experiencing remarkably changes of economic and cultural environments. The present study was to examine the prevalence of metabolic syndrome (MetS) by age between genders and to investigate the current characteristics of MetS and its components in China. SPECT-China is a population-based cross-sectional survey on Chinese adults aged ≥18 years in East China. A total of 10,441 Chinese residents participated in anthropometric and laboratory measurements. Of these, 9969 subjects (females, 5868) were eligible for the data analysis reported here. Estimates of the prevalence of MetS and its components were calculated. Presence of MetS was defined based on the IDF/AHA harmonized criteria. MetS z-score was calculated to evaluate the degree of total metabolic disorder. The age-standardized prevalence of the metabolic syndrome was 22.0% (21.9% in men and 22.0% in women). Unlike the continuous MetS rise with age in females, the MetS prevalence in males remained stable among 46–55, 56–65 and > 65 yrs. age groups (31.2%, 31.4%, 32.5%, p = 0.538). In the five components of MetS, contrary to the elevated BP and BG disorders, the frequency of TG disorders decreased with age in males (46.6%(46–55 yrs), 37.2% (56–65 yrs), 27.7%(> 65 yrs), p < 0.001). Multivariable logistic regression showed that in males, more TG disorders were associated with higher BMI, higher educational level and current nonsmoker. In the MetS subjects, the 3-factor combinations which included TG disorders decreased with age in both genders. The whole metabolic profile became better in older male MetS subjects, which was opposite to the female. Our results showed a distinct age-related prevalence of MetS between genders in dramatically changed China, in which the TG disorders played an important role. More targeted measures need to be taken to meet the serious challenges of metabolic diseases. ChiCTR-ECS- 14005052 , Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China).