Investigation On The Characteristics Of Epidemic Trend Of Non-communicable Chronic Diseases In Southern Communities And The Correlation Between Novel Body Fat Evaluation Indices And Chronic Kidney Disease

BackgroundThe prevalence of chronic non-communicable diseases such as obesity,hypertension,diabetes,cardiovascular disease,metabolic syndrome,and chronic kidney disease(CKD)has been increasing gradually in many countries,and it has become a global public health problem.Additionally,the chronic non-communicable diseases which were mentioned-above are closed corelated,and hypertension,obesity,abnormal glucose and lipid metabolism,and hyperuricemia are all closely related to kidney damage.Among them,the metabolic syndrome has received more and more attention in recent years.Our research team had conducted an epidemiological survey of chronic non-communicable diseases in the Wan Chai town of Zhuhai City,Guangdong Province,China in 2012.And after 6 years,our team finished another epidemic investigation in this area.In addition to reassessing the local prevalence of chronic non-communicable diseases and the changes in the components and constituent ratios of the metabolic syndrome,this study further evaluated the significance of new fat evaluation indicators in predicting CKD.Our team also evaluated the relationship of high-density lipoprotein subfractions with insulin resistance,MS and its components in people with normal or high levels of high-density lipoprotein.Objective1.To compare the change of the prevalence of chronic non-communicable diseases(obesity,central obesity,metabolic syndrome,hypertension,diabetes,hyperuricemia,CKD,insulin resistance)in the two epidemiological surveys in 2012 and 2018.2.To study the correlation of different new fat evaluation indicators with CKD in different genders,and compare the predictive value of different novel fat evaluation indicators in different genders for predicting CKD.3.To study the correlation of high-density lipoprotein subcomponents with insulin resistance,metabolic syndrome and its components in populations with normal or high HDL-C level.MethodThe research subjects were from the Wanchai town of Zhujiang River in southern China.The first survey was conducted from June to October,2012.Data was collected from 2,142 community residents aged 18-75.The second survey was conducted from December,2017 to March,2018.The data of 2,303 community residents was completed.Both surveys adopted multi-stage stratified clusters to sample the research subjects.In the first step,there are a total of 6 communities in the Wan Chai town,and 3 communities were randomly selected for epidemiological investigation;in the second step,500 families are randomly selected as the research target in these selected communities;In the selected households,all residents between the ages of 18 and 75 were the research subjects.The research subjects recruited volunteers mainly through emails,community publicity,telephone calls,and door-to-door publicity.The epidemiological investigation was approved by the Ethics Committee of the Third Affiliated Hospital of Southern Medical University,and the research process complied with the relevant regulations of medical ethics laws.All medical staff involved in the screening received strict SOP training.All subjects signed an informed consent form.The subjects completed data screening,physical examination and laboratory examination at the designated research center.The information collected through the above methods includes:1.Social demographic characteristics include age,gender,occupation,education level,lifestyle(smoking history,drinking history,exercise,eating habits),medical history(personal medical history,medication history,family medical history);2.Physical examination information:height,weight,waist circumference,hip circumference,systolic and diastolic blood pressure measured using standard mercury blood pressure agents,the measurement was repeated twice,1-2 minutes apart between the measurements and the average value was calculated;3.Laboratory information:serum creatinine,uric acid nitrogen,uric acid,fasting blood glucose,total cholesterol,triglycerides,low-density lipoprotein,high-density lipoprotein,high-sensitivity C-reactive protein,etc.,urine microalbumin,urine creatinine.The diagnostic criteria are as follows:1.The diagnostic criteria for overweight:BMI? 24 and BMI<28 kg/m2;and the diagnostic criteria for obesity:BMI?28 kg/m2;The definition standard of central obesity:male waist circumference? 85cm,female waist circumference? 80cm.2.Metabolic syndrome(MS)diagnostic criteria adopt the global consensus on metabolic syndrome jointly developed by IDF,AHA and NHLBI in 2009.The metabolic syndrome was diagnosed when the following three items were met:a.abdominal obesity;b.elevated blood pressure;c.elevated blood sugar;d.hypertriglyceridemia;e.decreased HDL.This study used the above-mentioned epidemiological survey data to conduct research.Among them,2142 people were screened in 2012,and the number of people with valid data in the screened population was 1815,of which 675 were men(37.19%),and 1140 were women(62.81%).A total of 2303 people were screened in 2018,of which 2127 were valid,including 770 men(36.20%)and 1357 women(63.80%).Statistical software SPSS(20.0 version)was used to complete the relevant statistical analysis.Count data were expressed as mean ± standard deviation(normal distribution)or median(25%quantile,75%quantile),and categorical data are expressed as absolute value(percentage),The t-test was used for the comparison of means between groups for normally distributed data,and the rank sum test was used for comparison of means between groups for non-normally distributed data.The chi-square test was used for the comparison of categorical data,and the Fisher exact test was used for those who did not meet the chi-square test conditions.Based on two cross-sectional surveys of randomly sampled populations in the same community at different time periods,the trends in the prevalence of chronic non-communicable diseases in different genders in the above-mentioned groups were evaluated.Then the cross-sectional research data surveyed in 2018 were used to study the correlation between 5 new fat evaluation indicators(CMI,BAI,VAI,TyG,LAPI)and chronic kidney disease,and compare and evaluate the difference in efficacy and predictive value of the 5 new fat evaluation indicators.A total of 463 eligible people with non-low HDL levels were selected from the 2018 epidemiological survey data,and the levels of HDL subcomponents of the included population were measured,and the subcomponents HDL2b and HDL3 in different genders were analyzed and compared.We also studied the relationship between the changes in the distribution of sub-components and insulin resistance,metabolic syndrome and its components in people with non-low levels of overall HDL.Results1.Compared the prevalence of male subjects in 2012 and 2018,there were significant differences in the overweight/obesity ratio,central obesity,hypertension,diabetes,metabolic syndrome and CKD.The prevalence of insulin resistance in 2018 was significantly higher than that of male subjects in 2012.2.Female subjects also showed a similar trend.In 2018,the prevalence in female subjects of overweight/obesity,central obesity,hypertension,diabetes,metabolic syndrome,CKD,and insulin resistance were also significantly higher.Women in 2012.3.Compared with 2012,the detection rates of blood pressure,blood sugar,abdominal obesity,and HDL levels in the components of metabolic syndrome in the male subjects showed an upward trend in 2018,and there was no significant change in the detection rate of high triglyceride components.The single detection rate is highest in blood pressure.4.Compared with 2012,the detection rates of the five components of metabolic syndrome(increased blood pressure,increased blood sugar,abdominal obesity,increased blood triglycerides,and decreased HDL levels)in female subjects have all increased in 2018.The single detection rate was highest in abdominal obesity.5.In this study,the prevalence of MS in the Wanchai town of Zhuhai City in 2012/2018 was 29.68%(201 persons)/40.25%(310 persons),and the proportion of subjects with 3 abnormal metabolic factors was 22.90%/27.14%,6.65%/11.17%were subjects with abnormal 4 metabolic factors,and 0.15%/1.95%were subjects with abnormal 5 metabolic factors.6.The prevalence of MS in the female population in 2012/2018 was 23.15%(264 persons)/32.79%(445 persons),and the proportion of subjects with three metabolic abnormalities was 16.05%/18.57%.Subjects with four metabolic abnormalities were 5.33%/11.05%and 1.58%/3.17%subjects had abnormalities of 5 metabolic factors.7.In this study,there were 155/209 males(2012/2018)and 183/252 females(2012/2018)with 3 metabolic abnormalities.The above population has any 3 kinds of MS component abnormalities,and there are 10 combinations.Among them,the combination of hypertension+abdominal obesity+high triglycerides had the highest detection rate among men(62.6%/49.3%),followed by the combination of hypertension+abdominal obesity+high fasting blood glucose(21.3%/31.3%).8.In the female population in 2012,the incidence of combined hypertension+abdominal obesity+ high triglycerides were the highest(39.3%),but in the female population in 2018,the incidence of hypertension+abdominal obesity+high fasting blood glucose replaced the combination of hypertension+abdominal obesity+high triglycerides and became the highest incidence(36.9%).9.The male population were divided into four quartiles by the 5 new fat evaluation indicators.In the Logistic regression model,the first quartile(Q1)of the four groups of the 5 new fat evaluation indicators was used as the control group.After adjusting for confounding factors,the risk of CKD in the population with third quartile(Q3)of TyG was 2.214 times respectively of the lowest quartile(Q1),and the risk of CKD in the highest quartile of CMI and VAI was 1.947 and 2.832 times of the lowest quartile.The difference was of statistical significance.10.In the female population were divided into four quartiles by the 5 new fat evaluation indicators.In the Logistic regression model,the first group of the four groups of 5 new fat evaluation indicators was used as the control group.After adjusting for confounding factors,the CKD risk of in the population with the third quartile(Q3)and the fourth quartile(Q4)of TyG was 2.303 and 3.849 times that of TyG(Q1),and the difference is statistically significant.11.The five new fat evaluation indicators shown poor performances when predict CKD.A new combined index prediction model has been established between different genders.The combined index prediction model has good predictive performance in predicting chronic kidney disease.12.In people with non-lower high-density lipoprotein levels,it has been found that the distribution ratio of HDL lipoprotein subcomponents HDL2b and HDL3 is correlated to insulin resistance,hypertension,diabetes,chronic kidney disease,metabolic syndrome and its components.After with the proportion of HDL2b decreasing and the proportion of HDL3 increasing,the prevalence of the above diseases gradually increased.13.With the increasing of the number of metabolic syndrome components,the proportion of HDL sub-components in non-lower HDL populations of different genders showed a trend of decreasing the proportion of HDL2b and increasing the proportion of HDL3.14.High-density lipoprotein subfractions HDL2b and HDL3 had better correlation with BMI,waist circumference,blood pressure,fasting blood glucose,insulin resistance index and other risk factors of human cardiovascular and metabolic disorders compared to traditional indicators HDL-C.15.The high-density lipoprotein subcomponent HDL2b predicted insulin resistance in different genders.The ROC curve AUC was 0.754(male)and 0.752(female)respectively,which had a stronger predictive value compared to HDL3 and other traditional lipoprotein indicators.