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Background:Obesity, physical inactivity and reduced physical fitness may contribute to the rising burden of chronic diseases in China. We investigated these factors in China over a 14-year period using data from the randomized national surveys in 2000, 2005, 2010 and 2014. Methods:We conducted four national surveys among 151,656, 163,386, 154,931and 146,703 Chinese adults aged 20-59 in 2000, 2005, 2010 and 2014, respectively. Body mass index (BMI, kg/m 2 ) was used to evaluate underweight (BMI<18·5), overweight (BMI 23·0-27·5) and obesity (BMI≥27·5). Central obesity was defined as waist circumference >90 cm in men and >85 cm in women. Leisure-time physical activity (LTPA) was evaluated by whether or not the participants had completed the recommended minimum 150-min moderate or 75-min vigorous exercise per week. Indices for assessing physical fitness included forced vital capacity, resting heart rate, handgrip strength, sit and reach, and standing on one leg. Findings:The prevalence of obesity increased from 8·6% in 2000, 10·3% in 2005, and 12·2% in 2010 to 12·9% in 2014 (0·32% per year). Comparable estimates were 37·4%, 39·2%, 40·7% and 41·2% for overweight and 13·9%, 18·3%, 22·1% and 24·9% for central obesity. The corresponding upward trends per year were 0·27% and 0·78%, respectively. The prevalence of overweight, obesity and central obesity increased with age and was higher in men than women.. A simultaneous decrease was observed in the prevalence of underweight (5·4% in 2000 versus 4·6% in 2014, a downward trend of 0·06% per year). More participants met the minimum LTPA recommendation (17·2% in 2000 versus 22·8% in 2014), with the prevalence change per year being 0·33%, 0·50%, 0·37%, 0·06% for underweight, normal-weight, overweight, and obesity, respectively. Physical fitness deterioration was observed for all measures examined except resting heart rate. Interpretation:Despite increased participation in LTPA, we observed an upward trend in overweight/obesity and a decline in physical fitness in Chinese adults. Continued nationwide interventions are needed for promoting physical activity and other healthy lifestyles in China. Funding:National Physical Fitness Surveillance Center, Ministry of Science and Technology of the People's Republic of China. Introduction In recent decades, China has witnessed a rapid rise in the burden of noncommunicable diseases (NCDs). Despite differences in sampling methods and 3 diagnostic criteria, the estimated prevalence grew from 9.7% to 11.6% for type 2 diabetes, and from 15.5% to 50.1% for pre-diabetes between 2008 and 2010. 1 These diseases accounted for an estimated 80% of deaths and 70% of total disease burden in China. 2 While aging of the population is an important contributing factor, such health consequences are also likely attributed to the drastic changes in lifestyles following China's economic boom that result in obesity and physical inactivity. 3 These two factors, despite their strong correlation, have been independently linked to increased risk of ...

Background: Previous studies have shown that women have higher urinary concentrations of several phthalate metabolites than do men, possibly because of a higher use of personal care products. Few studies have evaluated the association between phthalate metabolites, diabetes, and diabetes-related risk factors among women.Objective: We explored the association between urinary phthalate metabolite concentrations and diabetes among women who participated in a cross-sectional study.Methods: We used urinary concentrations of phthalate metabolites, analyzed by the Centers for Disease Control and Prevention, and self-reported diabetes of 2,350 women between 20 and 79 years of age who participated in the NHANES (2001–2008). We used multiple logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) and adjusted for urinary creatinine, sociodemographic characteristics, dietary factors, and body size. A secondary analysis was conducted for women who did not have diabetes to evaluate the association between phthalate metabolite concentrations and fasting blood glucose (FBG), homeostasis model assessment–estimated insulin resistance, and glycosylated hemoglobin A1c.Results: After adjusting for potential confounders, women with higher levels of mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP), monobenzyl phthalate (MBzP), mono-(3-carboxypropyl) phthalate (MCPP), and three di-(2-ethylhexyl) phthalate metabolites (ΣDEHP) had an increased odds of diabetes compared with women with the lowest levels of these phthalates. Women in the highest quartile for MBzP and MiBP had almost twice the odds of diabetes [OR = 1.96 (95% CI: 1.11, 3.47) and OR = 1.95 (95% CI: 0.99, 3.85), respectively] compared with women in the lowest quartile. Nonmonotonic, positive associations were found for MnBP and ΣDEHP, whereas MCPP appeared to have a threshold effect. Certain phthalate metabolites were positively associated with FBG and insulin resistance.Discussion: Urinary levels of several phthalates were associated with prevalent diabetes. Future prospective studies are needed to further explore these associations to determine whether phthalate exposure can alter glucose metabolism and increase the risk of insulin resistance and diabetes.

BackgroundResults from observational and genetic epidemiological studies suggest that lower serum homocysteine levels are associated with lower incidence of cardiovascular disease (CVD). Numerous randomized controlled trials have investigated the efficacy of lowering homocysteine with folic acid supplementation for CVD risk, but conflicting results have been reported.Methods and ResultsThree bibliographic databases (Medline, Embase, and the Cochrane Database of Systematic Reviews) were searched from database inception until December 1, 2015. Of the 1933 references reviewed for eligibility, 30 randomized controlled trials involving 82 334 participants were included in the final analysis. The pooled relative risks of folic acid supplementation compared with controls were 0.90 (95% CI 0.84–0.96; P=0.002) for stroke, 1.04 (95% CI 0.99–1.09; P=0.16) for coronary heart disease, and 0.96 (95% CI 0.92–0.99; P=0.02) for overall CVD. The intervention effects for both stroke and combined CVD were more pronounced among participants with lower plasma folate levels at baseline (both P<0.02 for interaction). In stratified analyses, a greater beneficial effect for overall CVD was seen in trials among participants without preexisting CVD (P=0.006 for interaction) or in trials with larger reduction in homocysteine levels (P=0.009 for interaction).ConclusionsOur meta‐analysis indicated a 10% lower risk of stroke and a 4% lower risk of overall CVD with folic acid supplementation. A greater benefit for CVD was observed among participants with lower plasma folate levels and without preexisting CVD and in studies with larger decreases in homocysteine levels. Folic acid supplementation had no significant effect on risk of coronary heart disease.

To cross-sectionally and prospectively investigate the association between irregular sleep patterns, a potential marker for circadian disruption, and metabolic abnormalities. RESEARCH DESIGN AND METHODS In the Multi-Ethnic Study of Atherosclerosis, participants completed 7-day actigraphy at exam 5 (2010-2013) and were prospectively followed throughout exam 6 (2016 to 2017). Sleep regularity was quantified by the 7-day SD of actigraphyassessed sleep duration and sleep onset timing. Metabolic abnormalities were defined by 1) the National Cholesterol Education Program Adult Treatment Panel III criteria and 2) a data-driven clustering of metabolic factors. RESULTS In the exam 5 cross-sectional analysis adjusted for sociodemographic and lifestyle factors (n = 2,003), every 1-h increase in the sleep duration SD was associated with 27% (95% CI 1.10, 1.47) higher odds of metabolic syndrome, and every 1-h increase in the sleep timing SD was associated with 23% (95% CI 1.06, 1.42) higher odds. The associations remained significant with additional adjustment for sleep-related factors including sleep duration. In the prospective analysis (n = 970), the corresponding fully adjusted odds ratio (OR) was 1.27 (95% CI 0.97, 1.65) for sleep duration and 1.36 (1.03, 1.80) for sleep timing. Compared with the cluster of few metabolic changes, every 1-h increase in sleep variability was associated with almost doubled odds for the cluster characterized by incidence of multiple metabolic abnormalities (OR 1.97 [95% CI 1.18, 3.30] for sleep duration and OR 2.10 [95% CI 1.25, 3.53] for sleep timing). CONCLUSIONS Increased variability in sleep duration and timing was associated with higher prevalence and incidence of metabolic abnormalities even after consideration of sleep duration and other lifestyle factors.

BackgroundPhthalates are ubiquitous endocrine disrupting chemicals associated with diabetes. Although women and minorities are more likely to be exposed to phthalates, no prior studies have examined phthalate exposure and markers of diabetes risk evaluating effect modification by gender and race/ethnicity.MethodsWe analyzed CDC data for 8 urinary phthalate metabolites from 3,083 non-diabetic, non-pregnant participants aged 12- < 80 years in the National Health and Nutrition Examination Survey (NHANES) 2001–2008. We used median regression to assess the associations between urinary phthalate metabolites and fasting blood glucose (FBG), fasting insulin and Homeostatic Model Assessment of insulin resistance (HOMA-IR), controlling for urinary creatinine as well as several sociodemographic and behavioral factors. Stratified analyses were conducted to compare the gender- and race/ethnicity-specific patterns for the associations.ResultsUrinary levels of several phthalate metabolites, including MBzP, MnBP, MiBP, MCPP and ∑DEHP showed significant positive associations with FBG, fasting insulin and HOMA-IR. No clear difference was noted between men and women. Mexican-Americans and non-Hispanic blacks had stronger dose–response relationships for MnBP, MiBP, MCPP and ∑DEHP compared to non-Hispanic whites. For example, the highest quartile of MiBP relative to its lowest quartile showed a median FBG increase of 5.82 mg/dL (95% CI: 3.77, 7.87) in Mexican-Americans, 3.63 mg/dL (95% CI: 1.23, 6.03) in blacks and 1.79 mg/dL (95% CI: -0.29, 3.87) in whites.ConclusionsThe findings suggest that certain populations may be more vulnerable to phthalates with respect to disturbances in glucose homeostasis. Whether endocrine disrupting chemicals contribute to gender and racial/ethnic differences in diabetes risk will be an important area for further study.

OSA is independently associated with an increased risk of diabetes, whereas insulin-treated diabetes is independently associated with a higher risk of OSA, particularly in women. Clinical awareness of this bidirectional association may improve prevention and treatment of both diseases. Future research aimed at elucidating the mechanisms that underlie each association may identify novel intervention targets.

BackgroundHigher exposure to certain phthalates is associated with a diabetes and insulin resistance, with sex differences seen. Yet, little is known about the association between phthalates and metabolic syndrome (MetS), particularly with consideration for differences by sex and menopausal status.MethodsWe analyzed data from 2719 participants in the National Health and Nutrition Examination Survey (NHANES) 2001–2010 aged 20–80 years. Five urinary phthalate metabolites (MEP, MnBP, MiBP, MBzP, and MCPP) and DEHP metabolites were analyzed by the Centers for Disease Control and Prevention and were evaluated as population-specific quartiles. MetS was defined by National Cholesterol Education Program’s Adult Treatment Panel III report criteria. Prevalence odds ratios (POR) and 95 % confidence intervals (CI) were calculated using multivariable logistic regression, adjusting for potential confounders and stratifying by sex and menopausal status.ResultsParticipants with MetS (32 % of the study population) had higher concentrations for all urinary phthalate metabolites. After full adjustment, higher DEHP metabolite concentrations were associated with an increased odds of MetS in men, but not women (adj. POR for men Q4 versus Q1: 2.20; 95 % CI: 1.32, 3.68 and adj. POR for women Q4 versus Q1: 1.50; 95 % CI: 0.89, 2.52). When evaluating by menopausal status, pre-menopausal women with higher concentrations of MBzP had close to a 4-fold increased odds of MetS compared to pre-menopausal women with the lowest concentrations of MBzP (adj POR: Q4 versus Q1: 3.88; 95 % CI: 1.59, 9.49).ConclusionsHigher concentrations of certain phthalate metabolites were associated with an increased odds of MetS. Higher DEHP metabolite concentrations were associated with an increased odds of MetS for men. In women, the strongest association was between higher concentrations of MBzP and MetS, but only among pre-menopausal women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-016-0136-x) contains supplementary material, which is available to authorized users.