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      Blood lead level is associated with non-alcoholic fatty liver disease in the Yangtze River Delta region of China in the context of rapid urbanization

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          Abstract

          Background

          China has undergone rapid urbanization in the past three decades. We aimed to report blood lead level (B-Pb) in the most rapidly urbanized Yangtze River Delta Region of China, and explore the association B-Pb and non-alcoholic fatty liver disease (NAFLD).

          Methods

          Our data source was the SPECT-China study. We enrolled 2011 subjects from 6 villages in the Yangtze River Delta Region. Lead was measured by atomic absorption spectrometry. According to abdominal ultrasound, residents were divided into normal and NAFLD groups.

          Results

          In total, 824 (41.0%) were diagnosed with NAFLD. Medians (interquartile range) of B-Pb were 5.29 μg/dL (3.60–7.28) [0.25 μmol/L (0.17–0.35)] for men and 4.49 μg/dL (2.97–6.59) [0.22 μmol/L (0.14–0.32)] for women. In both genders, the NAFLD group had significantly greater B-Pb than normal group (both P < 0.001). The prevalence of NAFLD significantly increased with increasing B-Pb quartiles in men ( P for trend = 0.032) and women ( P for trend = 0.001). Residents in Shanghai had significantly greater B-Pb ( P < 0.001) and a higher prevalence of NAFLD ( P < 0.001). Compared with women in the lowest quartile of BLL, OR of NAFLD in women in the highest quartile was 1.613 (95%CI 1.082–2.405) ( P for trend = 0.019) after multivariable adjustment. In men, this association showed marginal significance (OR 2.168, 95%CI 0.989–4.750, P for trend = 0.063).

          Conclusion

          B-Pb in Chinese residents in the Yangtze River Delta Region were much higher than in developed countries. Elevated B-Pb was associated with an increased risk of NAFLD, especially in women.

          Electronic supplementary material

          The online version of this article (10.1186/s12940-017-0304-7) contains supplementary material, which is available to authorized users.

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          Most cited references34

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          Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease.

          To clarify whether nonalcoholic fatty liver disease (NAFLD) increases the risk of cardiovascular disease. We carried out a prospective observational study with a total of 1637 apparently healthy Japanese men and women who were recruited from a health check-up program. NAFLD was diagnosed by abdominal ultrasonography. The metabolic syndrome (MS) was defined according to the modified National Cholesterol Education Program (NCEP) ATP III criteria. Five years after the baseline evaluations, the incidence of cardiovascular disease was assessed by a self-administered questionnaire. Among 1221 participants available for outcome analyses, the incidence of cardiovascular disease was higher in 231 subjects with NAFLD at baseline (5 coronary heart disease, 6 ischemic stroke, and 1 cerebral hemorrhage) than 990 subjects without NAFLD (3 coronary heart disease, 6 ischemic stroke, and 1 cerebral hemorrhage). Multivariate analyses indicated that NAFLD was a predictor of cardiovascular disease independent of conventional risk factors (odds ratio 4.12, 95% CI, 1.58 to 10.75, P = 0.004). MS was also independently associated with cardiovascular events. But simultaneous inclusion of NAFLD and MS in a multivariate model revealed that NAFLD but not MS retained a statistically significant correlation with cardiovascular disease. Although both of them were predictors of cardiovascular disease, NAFLD but not MS retained a statistically significant correlation with cardiovascular disease in a multivariate model. NAFLD is a strong predictor of cardiovascular disease and may play a central role in the cardiovascular risk of MS.
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            Prevalence of non-alcoholic fatty liver disease and its association with impaired glucose metabolism in Japanese adults.

            To assess the prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with impaired glucose metabolism in Japanese subjects. One thousand, nine hundred and fifty subjects enrolled in a general health examination programme from September 2002 to February 2003 were recruited. NAFLD was diagnosed if a person showed 'fatty liver' on ultrasonography, and his/her alcohol consumption, estimated by questionnaire, was < 40 gram/week. A general linear model was used for the comparison of estimated means of metabolic variables adjusted for age and body mass index (BMI) between subjects with NAFLD and those without fatty liver. Multivariate regression with fasting plasma glucose (FPG) as the dependent variable was performed in 1547 non-diabetic individuals after adjusting for age, gender, BMI and NAFLD. NAFLD was found in 566 of the 1950 health-check examinees (29%). Its prevalence increased with increasing FPG levels: 27% in the subgroup with normal fasting glucose, 43% in impaired fasting glucose and 62% in newly diagnosed diabetes. Adjusted means of FPG, HbA1c, triglyceride, total protein, albumin, AST and ALT were all significantly higher, while adjusted means of HDL cholesterol and AST/ALT ratio were significantly lower in subjects with NAFLD than those without fatty liver. Multivariate regression analysis showed that NAFLD was independently associated with increasing FPG in non-diabetic individuals. The prevalence of NAFLD was 29% in apparently healthy middle-aged Japanese adults and NAFLD was independently associated with impaired glucose metabolism.
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              Optimal cut-off values of BMI, waist circumference and waist:height ratio for defining obesity in Chinese adults.

              It has not been established which specific measures of obesity might be most appropriate for predicting CVD risk in Asians. The objectives of the present study were to determine the associations of BMI, waist circumference (WC) and waist:height ratio (WHtR) with CVD risk factors and to evaluate the optimal cut-off values to define overweight or obesity in Chinese adults. Data collected from seven nationwide health examination centres during 2008 and 2009 were analysed. The BMI, WC and WHtR of 244 266 Chinese adults aged ≥ 20 years included in the study were measured. Logistic regression models were fit to evaluate the OR of each CVD risk factor according to various anthropometric indices. Receiver operating characteristic (ROC) analyses were conducted to assess the optimal cut-off values to predict the risk of diabetes, hypertension, dyslipidaemia and the metabolic syndrome. WHtR had the largest areas under the ROC curve for all CVD risk factors in both sexes, followed by WC and BMI. The optimal cut-off values were approximately 24·0 and 23·0 kg/m2 for BMI, 85·0 and 75·0 cm for WC, and 0·50 and 0·48 for WHtR for men and women, respectively. According to well-established cut-off values, BMI was found to be a more sensitive indicator of hypertension in both men and women, while WC and WHtR were found to be better indicators of diabetes and dyslipidaemia. A combination of BMI and central obesity measures was found to be associated with greater OR of CVD risk factors than either of them alone in both sexes. The present study demonstrated that WHtR and WC may be better indicators of CVD risk factors for Chinese people than BMI.
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                Author and article information

                Contributors
                86-13585816216 , wnj486@126.com
                86-13636352507 , luyingli2008@126.com
                Journal
                Environ Health
                Environ Health
                Environmental Health
                BioMed Central (London )
                1476-069X
                31 August 2017
                31 August 2017
                2017
                : 16
                : 93
                Affiliations
                GRID grid.412523.3, Institute and Department of Endocrinology and Metabolism, , Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, ; Shanghai, 200011 China
                Article
                304
                10.1186/s12940-017-0304-7
                5580229
                28859656
                59e97481-64b1-4f8a-abfb-4b33715adb18
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 March 2017
                : 27 August 2017
                Funding
                Funded by: National Natural Science Foundation of China
                Award ID: 81270885
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81070677
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81300653
                Award Recipient :
                Funded by: Clinical Potential Subject Construction of Shanghai Jiaotong University School of Medicine
                Award ID: 2014
                Award Recipient :
                Funded by: Science and Technology Commission of Shanghai Municipality (CN)
                Award ID: 14495810700
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81600609
                Award Recipient :
                Funded by: The Fourth Round of Three-year Public Health Action Plan of Shanghai
                Award ID: 15GWZK0202
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Public health
                lead,non-alcoholic fatty liver disease,urbanization,chinese
                Public health
                lead, non-alcoholic fatty liver disease, urbanization, chinese

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