Influencing Factors Of MetS Prevalence In Typical Rural Communities And Effects Of Short-term Air Pollution Exposure On MetS

Part 1 Prevalence of Met S and influencing factors of quality of life in typical rural communitiesObjective: To obtain the prevalence and quality of life of Met S in rural residents and analyze its influencing factors.Methods: 10894 permanent residents were recruited by random stratified sampling.Face to face questionnaire was used for investigation.Physical examination and blood samples were collected for biochemical analysis.In accordance with JIS,NCEP-ATPⅢ,IDF,CDS and C-ATP standard,Mets diagnostic criteria was defined.The health related quality of life,depression,sleep quality,physical activity,dietary condition and severity of chronic diseases other than basic diseases were assessed using EQ-5D scale,PHQ-2 scale,PSQI scale,IPAQ scale,simplified FFQ scale and Charlson comorbidity index,respectively.The influencing factors of Met S prevalence were analyzed by binary logistic regression analysis,Tobit regression model and generalized linear model(GLM).Results: 10114(92.84%)residents completed the questionnaire survey and provided blood samples.The prevalence of Met S age standardization was 30.02%(JIS),26.90%(NCEP-ATP Ⅲ),15.78%(IDF),16.34%(CDS)and 18.66%(C-ATP),which was higher than the average level in China.The most common aggregation characteristics of Met S components were central obesity + high blood pressure + high blood glucose(24.41%),and obesity was the most common component.The lower prevalence rate was found among participants with higher social and economic development level,higher personal income,tea intake,daily recommended daily intake(200-350g),and 75 grams of red meat and moderate physical activity.whereas the prevalence rate was higher among those of drinking Baijiu over 100 ml,depression,family history of hypertension and diabetes,and the higher incidence of comorbidity index and higher uric acid were higher.The utility value of quality of life in Met S patients was 0.945±0.129,and the VAS score was 77.18±14.21.The main protective factors affecting the quality of life of Met S patients were higher level of social and economic development,higher personal income,daily average recommended fruit intake(200-350g),use of red meat less than 75 g,abstinence,smoking cessation,better sleep quality and physical activity.The main risk factors affecting Mets patients’ quality of life were housework or unemployment,depression,family history of hypertension and high comorbidity index.There was no significant difference in the quality of life of smokers and drinkers,compared with non-smokers and non-drinkers.Subjectively,the respondents did not realize the adverse health effect of smoking and excessive drinking,so targeted health intervention should be strengthened.Conclusion: The prevalence of Met S is high,obesity is the most common component,physical activity and depression are important factors affecting the prevalence and quality of life of Met S.Excessive drinking and unsuitable fruit are the important risk factors for Met S.Part2 The value of obesity index in Met S screening of rural residentsObjective: To understand the level of obesity measurement indexes commonly used by research subjects,evaluate the screening effect of obesity measurement indexes on Mets,and evaluate the effect of combined screening test.Methods: Waist circumference(WL),body mass index(BMI),waist to hip ratio(WHR),waist to height ratio(WHt R),body fat index(BAI),visceral fat index(VFI),lipid accumulation index(LAP)and visceral obesity index(VAI)were used to evaluate the obesity of the subjects.Taking JIS standard as the gold standard,sensitivity,specificity and Youden index were used to evaluate the authenticity of eight obesity measurement indexes,coincidence rate and kappa value were used to evaluate the reliability of screening indexes,and positive predictive value and negative predictive value were used to evaluate the benefits of screening indexes.The area under the ROC curve(AUC)was used to evaluate the value of Met S screening,and the shortest distance method of ROC curve was used to determine the best cut-off value of Met S screening.Binary logistic regression was used to determine the Mets prediction probability of combined screening indicators,and AUC was used to evaluate the value of different combined screening indicators.Results: The risk of Met S increased with the increase of obesity measurement indexes(P < 0.001),and the risk of lap and VAI increased in the first two places.The top three indicators with the largest area under ROC curve were lap,VAI and WL in male,and lap,VAI and WHt R in female.The largest index of Youden index in both men and women was lap,with the best cut-off value of 33.22 and 33.99 respectively;the second was VAI,with the best cut-off value of 1.78 and 2.18 respectively;the third was WL,with the best cut-off value of 85.0cm in men,and WHt R,with the best cut-off value of 0.523 in women.WL,BMI and WHR were the top three sensitivity indicators in men,while WL,WHt R and lap were the top three sensitivity indicators in women.The top three of specificity indicators were VAI,lap and WHt R in male,and VAI,lap and WHt R in female.The highest consistent rate of male and female was lap,kappa was 0.59 and 0.61 respectively.The top three positive predictive values of male were VAI,lap and WHt R,and female were lap,VAI and WL;the top three negative predictive values of male were WL,lap and WHt R,and female were lap,WHt R and VAI / VFI.The top three combinations of area under ROC curve were VAI + WHt R(0.906),VAI + VFI(0.903)and VAI + WHR(0.897).Conclusion: The risk of Met S increases with the increase of obesity measurement index.The area under the ROC curve,Youden and the highest consistent rate were the lipid accumulation index(LAP).The highest positive predictive value was visceral obesity index(VAI)in male,and the highest negative predictive value was waist circumference(WL);the highest positive predictive value and negative predictive value were lap in female.Lap is the best screening index,and the combined application of multiple indexes improves the effect of screening test.Part3 Association of short-term outdoor air pollution exposure with related indicators and quality of life of Met S patientsObjective: To evaluate the effect of short-term air pollution exposure on Mets related components and quality of life.Methods: Roche Cobas C501 automatic biochemical analyzer was used to analyze the related biochemical indexes of Met S patients,and EQ-5D scale was used to evaluate their quality of life.The hourly pollutant concentration data were obtained from the website of Xinxiang Ecological Environment Bureau,and the daily average pollutant concentration was calculated.The daily average temperature and daily relative moderate were obtained from China Meteorological data network.Generalized linear model(GLM)was used to analyze the effects of related components and quality of life of Met S patients exposed to air pollution.Tobit regression model was used to analyze the effects of six air pollutants on quality of life(U).Results: SBP increased by 8.7%(95% CI: 4.9%,22.1%)and HDL-C decreased by0.285%(95%CI: 0.105%,0.266%)when PM2.5 increased by one standard deviation(15.6μg/m3).SBP increased by 2.7%(95%CI: 1.1%,4.4%),TG increased by0.39%(95% CI: 0,0.75%),HDL-C decreased by 0.037%(95%CI: 0.015%,0.058%)when PM10 increased by one standard deviation(55.9μg/m3).One standard deviation increase in SO2 was associated with increased SBP(2.5%,95%CI: 3.7%,22.1%),TG(0.24%,95%CI: 0.02%,0.47%)and HDL-C(0.302%,95%CI: 0.210%,0.404%).SBP increased by 28.7%(95%CI: 6.4%,55.8%),TG decreased(95%CI: 0.08%,1.71%),HDL-C increased by 0.563%(95%CI: 0.342%,0.785%)for each standard deviation of NO2(7.6μg/m3).The SBP decreased by 7.5%(95%CI: 4.2%,8.7%),TG increased by 0.08%(95%CI: 0.01%,0.16%),HDL-C decreased by 0.107%(95%CI:0.070%,0.143%)and FBG decreased by 0.536%(95%CI: 0.285%,0.786%)when O3 increased by one standard deviation(32.9μg/m3).For each standard deviation(191μg/m3)of CO,SBP,HDL-C and FBG increased by 0.25%(95%CI: 0.03%,0.47%),0.007%(95%CI: 0.003%,0.012%)and 0.081%(95%CI: 0.029%,0.142%)(lag06),respectively.There was a negative correlation between air pollutant concentration and quality of life(U).The quality of life(U)of Met S patients decreased significantly with the increase of SO2 concentration.When the concentration of NO2 and CO increased by one standard deviation,the quality of life(U)of female Mets patients decreased significantly.There was no significant change in the quality of life(U)of Met S patients.PM2.5 and PM10 exposure alone or combined with SO2,NO2,O3 and CO decreased the quality of life of Met S patients.Air pollutants increased the effect of depression and sleep quality on the quality of life,and reduced the effect of physical activity on the quality of life.Smokers had higher quality of life in air pollution.Sensitivity analysis showed that the conclusion was stable.Conclusion: PM2.5,PM10,SO2,NO2 and CO were related to the increase of SBP.O3 was related to the decrease of SBP.PM10,SO2 and O3 were related to the increase of TG.NO2 and O3 were related to TG reduction.SO2,NO2,O3 and CO were related to the increase of HDL-C.PM2.5 and PM10 were related to the decrease of HDL-C.CO was related to the increase of FBG,and O3 was related to the decrease of FBP.Short-term air pollution exposure reduced the quality of life of Met S patients,weakened the positive effect of physical activity,and enhanced the negative effect of depression and poor sleep quality.Smokers did not realize the health hazards caused by the combined effect of air pollution and tobacco.Part4 Prevention and treatment of metabolic syndrome in rural residentsObjective: To evaluate the modifiable degree and cost of influencing factors of Met S,and to formulate the priority level of change.Methods: Through literature review and previous analysis,the author summarized many factors affecting Mets disease and quality of life of the subjects,formed a pool of factors,and then used the thematic group discussion method to discuss the degree of changes,cost changes and priority change levels of Met S influencing factors,and finally put forward prevention and control measures.The change level included five levels: easy,easy,general,difficult and difficult to change.The change cost includes three levels: low,medium and high,and the priority change level includes four levels a,B,C and D.Results: Priority changes to A included moderate and above physical activity,smoking cessation and regular drinking of green tea.The priority change level of B included not daily consumption of 100 ml Baijiu,poor sleep quality,fruit and vegetable consumption,red meat consumption below 75 g,avoiding depression and inhaling particulate matter.Prevention and control measures mainly included policy intervention,environmental intervention,information intervention,interpersonal intervention and service intervention.Conclusion: Mets prevention and control need to be combined with individual prevention and group prevention.Lifestyle intervention is still the most priority intervention,but it needs the coordination of service intervention.