| Background1.Research progress in community prevalence of metabolic disorders related chronic non-communicable diseases(NCDs)73.4%of the total deaths in the world are due to chronic noncommunicable diseases(NCDs),of which hyperuricemia,metabolic syndrome(MetS),hypertension,diabetes and chronic kidney disease(CKD)account for five most common NCDs associated with metabolic disorders.They are often causal or comorbid with each other and the final outcome is mostly cardiovascular disease,so joint research is necessary.The prevalence of the above NCDs has continued to increase globally for many years,but recently many countries have reported the evolution of new epidemic trends-the prevalences of some NCDs has stabilized or even declined.However,there is a lack of relevant epidemiological data in China.The national multi-center cross-sectional studies of a single NCD in different periods have not been found in hyperuricemia and CKD.Although there are many reports in the fields of hypertension,diabetes,and MetS,large differences existed in various research protocols such as diagnostic criteria,age range,sampling area,etc.So,it is also difficult to compare with each other directly to reflect the subtle changes in epidemic trends accurately.There is no repeated cross-sectional investigation report on the epidemic trends of the above five major NCDs and their comorbidities at the same time in China.Repeated cross-sectional studies on the community epidemic trend of single NCD in China are also rare,and some studies lacked in the analysis of different genders and ages.The few repetitive cross-sectional research reports on the trend of a single NCD or comorbidity that can be found in the literature,and the contents that need further research are summarized as follows:1)Hyperuricemia:There are only two studies from Beijing and Shandong reported increasing prevalence of hyperuricemia.There is no research report on population in south China.2)MetS:There is only one study reported no change in the prevalence of the disease in population over 55 years old.No research report has been found on population under 55 years old.3)CKD:There is only one study reported that the prevalence of the dise ase in Uyghur people in a certain place in Xinjiang has increased.Th ere is no research report on Han population.4)Hypertension:Five studies reported an increasing trend in the prevalenc e of hypertension but other three studies showed an upward and then a downward trend.The only two studies of normal high blood pressur e also contradict.There is a lack of repeated cross-sectional studies o n the prevalence of hypertension in Zhuhai and high normal blood pr essure in the southern population.5)Diabetes:Three studies respectively reported different trends of rising,or rising first and then falling,or only men rising but women stable.In addition,only one study reported an increase in pre-diabetes preval ence.No report on population from south China has been reported.6)MetS+CKD comorbidity,hyperuricemia+CKD comorbidity,hyperuricem ia+hypertensive comorbidity,hyperuricemia+diabetic comorbidity,hyper uricemia+MetS comorbidity:no repeated Cross-sectional research report has been found in China.2.Risk prediction of MetS+CKD comorbidity and correlation of high-density lipoprotein cholesterol(HDL)subtypeThere is a lack of reports on the risk of MetS+CKD comorbidity at home and abroad,and none paper has been published on high-density lipoprotein cholesterol(HDL)subtype HDL2b,HDL2b/HDL,HDL3/HDL,HDL3/HDL2b related to MetS+CKD comorbidity and risk prediction.3.Correlation and predictive value of retinol binding protein 4 with hyperuricemiaThere are still few reports on biomarkers for predicting the risk of hyperuricemia at home and abroad,and their prediction value is poor too.There is no report on the value of retinol binding protein 4(RBP4)in predicting hyperuricemia.The correlation between RBP4 and hyperuricemia has not been reported in the adult community population.The existing literature is only found in specific populations such as patients with diabetes,CKD,and MetS.4.Correlation between various new human body fat evaluation indexes with hyperuricemia and new progress in their predicting valueFew studies involved new body fat evaluation indicators at home and abroad in the field of hyperuricemia(only 8 papers have been found,including 5 from the community population,and only 1 item covers adults of all ages).Each study involved only 1 to 2 new indicators,and the predictive value is limited.None research was focused on the predictive value of three or more new indicators for hyperuricemia at the same time,so the prediction ability of each new indicator cannot be compared with each other,and the best predicting indicator couldnot be identified.None literature at home and abroad has elaborated the correlation of abdominal volume index(AVI),conicity index(C-index)with hyperuricemia and their predicting value.None author published the paper related to Guangdong population and the only publication(the indicator of VAI)involving the southern population comes from a multi-center study.5.The time association and gender heterogeneity of inflammation and metabolic syndrome remain controversial and contradictoryThe time association and gender heterogeneity of inflammation and metabolic syndrome remain controversial and contradictory.Although cross-sectional studies have reported the correlation and racial differences between inflammation and MetS,the causal relationship between them cannot be confirmed.The only four follow-up studies abroad have reported the impact of CRP and MetS and gender differences,but the conclusions are contradictory and most of research designs were flawed.No follow-up study has been reported in the field so far in China.Research purpose and innovation1.Our present study aimed to explore the evolution of community epidemics of above metabolic disorders related NCDs,involving single NCD(including potential risk population)and comorbidities of NCDs in overall population,different gender and age groups.our purpose was to provide a basis for the macro adjustment of future prevention policies in overall population and precise strategies implementation in different gender and age groups.As far as the study on the community epidemic trends of each single NCD or comorbidity is concerned,this research also has certain significance and innovation as follows:1)Hyperuricemia:This is the first repeated cross-sectional study conducte d in the southern population of China,and the normal high value of serum uric acid was first studied in China.2)Metabolic syndrome:This is the first repeated cross-sectional study co vering all age of adults for the prevalence trends of various compone nts of metabolic syndrome by subdivided the population into different gender and age groups.3)Chronic kidney disease:This is the first repeated cross-sectional study for the disease in the Han population.4)Hypertension:This is the first repeated cross-sectional study in the fie 1d in the population in Zhuhai.5)Diabetes:This is the first repeated cross-sectional study for diabetes i n the southern population in China.6)MetS+CKD comorbidity,hyperuricemia+CKD comorbidity,hyperuricem ia+hypertensive comorbidity,hyperuricemia+diabetic comorbidity,hyper uricemia+MetS comorbidity:they all are the first repeated cross-sectio nal studies in China.2.For the first time at home and abroad,the correlation and predictive value of high-density lipoprotein subtypes HDL2b,HDL2b/HDL,HDL3/HDL,HD3/HDL2b and MetS+CKD comorbidity were studied to clarify the characteristics of them in MetS+CKD comorbidity and whether they could be used as risk prediction of the latter.3.For the first time at home and abroad,the value of RBP4 in predicting the risk of hyperuricemia in the community was studied to evaluate whether RBP4 can be used alone or in combination to predict the risk of hyperuricemia in the community.4.For the first time at home and in abroad,eight new types of human body fat evaluation indexes were studied at the same time for comparing their efficacy in predicting hyperuricemia,and the predictive value of AVI,C-index and CMI were studied for the first time.We compared their prediction efficacy horizontally and compares their efficacy with traditional indicators in the same community,in order to obtain the best prediction indicators.5.For the first time in China,we performed a follow-up study exploring the time association between inflammation and metabolic syndrome and the potential gender heterogeneity in Chinese adult community population.Methods1.For the study,we made a community NCDs survey protocol including a questionnaire form,physical examination and laboratory test items by the end of 2017.There after we performed the repeated cross-sectional study in Zhuhai city in 2018.The last time of cross-sectional survey in the same population was performed in 2012.Data from the two cross-sectional studies including 3,192 residents(2138 in 2012 and 1054 new in 2018)were analysed to assess the standardized growth rate of the prevalence in single and co-morbidities of the above NCDs and the characteristics of different gender and age groups.2.Based on the data from the second cross-sectional study of 2,303 people(1249 follow-up residents from those surveyed in year 2012 and 1054 residents surveyed in year 2018)surveyed in 2018,650 of them were selected for case-control studies to analyze the correlation between the high-density lipoprotein subtype HDL2b,HDL2b/HDL,HDL3/HDL,HD3/HDL2b and MetS+CKD comorbidity and to evaluate their performance in prediction of MetS+CKD comorbidity.The best joint prediction equations were also established.3.Based on the data of 2303 residents involved in the cross-sectional survey in 2018,totally 2075 residents were included for the study of the correlation between RBP4 and hyperuricemia,the efficacy of RBP4 in predicting hyperuricemia,and the establishment of the best co-predictive equation.4.Based on the data of 2303 residents included in the cross-sectional survey in 2018(finally involved 2183 residents),eight novel body fat indexes were analyzed for evaluating their efficacy in predicting hyperuricemia and comparing their efficacy with other traditional indexes.5.From the population of the first cross-sectional survey in 2012,1780 non-MetS residents who met the criteria were selected to establish a follow-up cohort to observe the difference in the incidence of new MetS events in 2018 among different quartiles of hypersensitive CRP.Results1.Changes in the prevalence of chronic non-communicable diseases(NCDs)related to metabolic disordersThe data of our repeated cross-sectional study with 5.5 years apart indicated that the single NCD and comorbidities of above five major NCDs were of significant epidemic changes not only in general population but also in different gender and age groups.The different components of metabolic syndrome,the normal high value of serum uric acid,the normal high value of blood pressure,and impaired fasting blood glucose showed different trends of epidemic evolution.1)The standardized prevalence of hyperuricemia in the general communit y and men and women in 2018 was 30.1%,38.0%,and 21.8%respec tively,still ranking first in the country,but down 1.5%and 4,9%incr eased by 1.8%compared with 2012 survey(P>0.05).The prevalence of hyperuricemia in either the total population(and each age group)o r different genders(and each age group)in 2018 was not statistically different from the prevalence in 2012.The proportion of high normal uric acid in women as a whole and middle-young-aged women increas ed by 9.0%and 31.5%,respectively(P<0.05).2)The standardized prevalence of MetS in the general,male and female p opulation in 2018 increased by 39.3%,35.6%,and 60.3%,respectively,compared to 2012(P<0.05).The growth rates of middle-elderly-aged an d elderly groups were relatively fast,but no statistical differences existe d in young and middle-aged groups.Different MetS components show ed their own characteristics:hypertension components increased signifi cantly in most ages,of which young women had the fastest growth r ate(relative growth rate was 159.7%,which is 3.8 times that of men);Low HDL as also a component of metabolic symdrome increased rel atively by 264.7%,234.3%and 394.8%respectively in the overall,m ale and female populations,compared to 2012(all P<0.001).The fast est growth rates were shown in male middle-age and elder population(relative growth of 697.8%)and female elder group(relative growth of 1911.5%).Hyperglycemia component remained stable in general,m en and women and all ages;the prevalence of high waist circumferen ce components remained stable overall,but the trend was higher in el derly men;the prevalence of high triglycerides remained generally sta ble,but significantly increased in female middle-aged and elderly peop le.3)The overall standardized prevalence of CKD in 2018 was 11.2%,9.9%and 12.5%for the overall,male and female populations respectively,and the relative growth rate in the overall and female populations was 55.6%and 71.2%respectively,compared to 2012(both P<0.05),Bu t there was no significant difference in growth rate of male(P>0.05).The growth rate of the elderly population was as high as 115.5%(P=0.018),but there was no statistical difference in young and middle-a ged population.The relative growth rates in female middle-age and eld er groups were 127.6%and 54.8%respectively(all P<0.05),and the growth of male middle-aged and elderly men alone was statistically si gnificant.4)The prevalence of hypertension in 2018 in the overall,male and fema le populations was 29.9%,34.3%and 25.4%respectively,with a relati ve increase rate of 47.3%,53.8%and 40.3%compared to 2012(all P<0.001).The elderly population showed the fastest growth rate(63.8%,41.9%,P<0.01).The proportion of high normal blood pressure remai ned stable in the general population,men and women(P>0.05),but t he higher proportion of high normal blood pressure increased in youn g women by 213.3%,while there was no significant change in the ov erall male population and all age groups(P>0.05)5)The overall prevalence of diabetes in 2018 in all genders and age gro ups had no statistically significant change compared to 2012(P>0.05),but the proportion of impaired fasting blood glucose in middle-elder-a ged women has increased by 178.8%.6)The epidemic change trends in the prevalence of metabolic disorders a nd major NCD co-morbidities were very different and of different cha racteristics for different genders and ages:The epidemic change trend o f the co-morbidity of hyperuricemia+CKD in males was stable,but in the total population and female population had increased by 47.3%a nd 81.9%,compared to 2012;The hyperuricemia+hypertension co-morbi dity tended to be stable in the overall female population and at all ag es.However,in overall and male population it increased by 51.0%an d 71.8%respectively;The prevalence of the hyperuricemia+diabetes co morbidity in males and females was not statistically different from tha t in 2012,but was significantly higher in elder women;The hyperurice mia+MetS co-morbidity only increased in the female population(relati ve increase rate of 26%,of which only the elder women had a statist ically significant increase).In overall and male populations the trends were stable;The comorbidity of MetS and CKD increased substantially in the overall,male and female populations,compared to 2012,with a relative growth of 114.1%,101.3%and 133.3%respectively(all P<0.05).Among them,the growth rate in the middle-elder-aged women was as high as 381.2%.2.Correlation and risk prediction of high-density lipoprotein subtypes with MetS+CKD comorbidityThe serum concentration of HDL2b and HDL2b/HDL decreased gradually in non-MetS and non-CKD control group,CKD group alone,MetS group alon e,MetS+CKD group,while HDL3/HDL,HDL3/HDL2b increased gradually in order(all P<0.001).After adjusting for related influencing factors,the odds rati os of MetS+CKD comorbidity in the highest quartile of 1/HDL2b and HDL3/HDL2b were 10.87(95%CI:2.60-45.47,P<0.001),44.04(95%CI:4.32-449.23,P<0.001).The area under the ROC(AUC)of 1/HDL2b,1/(HDL2b/HDL),HDL 3/HDL,HDL3/HDL2b to predict the risk of MetS+CKD comorbidity were 0.814(95%CI:0.772-0.857),0.826(95%CI:0.788-0.865),0.811(95%CI:0.772-0.849),0.868(95%CI:0.838-0.898),respectively,which were all higher than traditional 1/HDL,BMI,blood uric acid,blood creatinine,1/eGFR,etc.As the index,the prediction performance of HDL3/HDL2b was the best(sensitivity 83.5%,spec ificity 74.5%,Youden index 0.579,best Cut-off value 1.04).The optimal joint prediction equation related to HDL2b was composed of 1/HDL2b,history of diabetes,BMI,uric acid,Log ACR,Log TG.Its AUC was 0.930(95%CI:0.909-0.952)with sensitivity 89.3%,specificity 81.5%,Youden index 0.708(P<0.001).The best combined prediction equation related to HDL3/HDL2b was comp osed of HDL3/HDL2b,gender,history of diabetes,BMI,uric acid,Log ACR,Log TG,and its AUC was as high as 0.944(95%CI:0.925-0.962)with sensitiv ity 95.0%,specificity 81.7%,and Youden index 0.758(P<0.001).HDL3 alone exhibited poor correlation and predictive performance.3.RBP4 was strongly correlated with hyperuricemia and the prediction performance was higher than all traditional prediction indicatorsThe serum concentration of RBP4 increased along with the blood uric acid level.After adjusting related influencing factors,the logistics regression equation showed that the risk of hyperuricemia in the group with the highest quartile of RBP4 was the highest,ORs=7.87(95%CI:4.18-14.84),compared the lowest quartile.The AUC was 0.749(95%CI:0.725-0.774),P<0.001.The predictive value of RBP4 was higher than all the other indicators,and women were slightly better.The best joint predictive equation for hyperuricemia consisted of retinol binding protein 4,gender(male),drinking,BMI,serum creatinine,hs-CRP,fasting blood glucose,and insulin.Its AUC was 0.804(95%CI:0.782-0.826),P<0.001.We had also developed joint prediction equations for different genders.4.LAP,AVI,CMI 3 new body fat evaluation indexes had good performance in predicting hyperuricemiaLAP,AVI and CMI,as the three new body fat evaluation indicators reflected good performance in predicting hyperuricemia and their predictive values were higher than all the traditional indicators such as BMI.LAP showed the best predictive value(AUC 0.687,Youden index 0.276,Cut-off value 1.57).In addition,the prediction performance of LogCMI,AVI,and LogTyG was also better than BMI,but the predictive value of logVAI was slightly lower than BMI(AUC 0.647 VS 0.654).Other new indicators,ABSI,BAI,BRI,TyG and VAI were correlated to hyperuricemia,but the prediction ability were poor.The 8 indicators with the highest predictive value according to AUC from high to low were LAP>CMI=AVI>TG>TyG>VLDL>BMI>VAI.5.Hypersensitive CRP only increased the risk of femaleTotally 886 residents from the community population surveyed in 2012 were effectively followed up for an average of 5.4±0.6 years and included in the final analysis,of which 13.3%had de novo MetS.Regression models showed that increased hypersensitive CRP led to an increased risk of MetS in the overall population,but when stratified by sex,positive correlation was only observed in women(OR 4.82,95%CI:1.89-12.3),gender-related P-interactive=0.039.Conclusions1.It is indicated by the study that there were not less novel community epidemic trends of metabolic disorders related major NCDs in Zhuhai city of south China which had not been reported in the literatures.1)The prevalence of hyperuricemia,diabetes,hyperuricemia+diabetes comorbidity,hyperuricemia+MetS comorbidity tends to stabilize.2)The prevalence of CKD,hypertension,MetS,MetS+CKD comorbidity,hyperuricemia+CKD comorbidity,hyperuricemia+hypertension comorbidity continues to increase.3)The epidemic trends for each single NCD and their co-morbidities also show obvious evolution of different trends in different components,risk groups,different genders and age groups:For example,the waist circumference,triglyceride,and high blood sugar components in MetS tend to be stable,but high blood pressure increases faster,and the incidence of low HDL components increases rapidly;CKD tends to be stable in the male population;the prevalence of hypertension among women is increasing rapidly;the proportion of high normal uric acid and high normal blood pressure in young-middle-aged women continues to increase,while the proportion of impaired fasting blood glucose in middle-elderly-aged women maintains sustained growth rapidly.2.HDL2b,HDL2b/HDL as protective factors are strongly negatively correlated with MetS+CKD comorbidity,while HDL3/HDL,HDL3/HDL2b as risk factors are positively correlated with the risk of MetS+CKD comorbidity.The four indicators have good predictive performance for MetS+CKD comorbidity and are higher than traditional indicators such as HDL,BMI,blood uric acid,blood creatinine,1/eGFR,etc.HDL3/HDL2b has the highest predictive value.3.The performance of RBP4 in predicting hyperuricemia is better than the single markers reported previously,and it is more effective in combination with other indicators.4.It is also suggested that LAP,AVI and CMI,the three new body fat evaluation indexes,could predict of hyperuricemia with good efficacy higher than all of above traditional evaluation indexes and LAP is the best.5.It is indicated that hs-CRP does increase the risk of de nove metabolic syndrome in adults but only in women. |
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