As one of the important environmental endocrine disruptors,the effects of bisphenol A (BPA)are recently focused on its association with endocrine and metabolic diseases.Experimental studies have shed light on the potential mechanisms that BPA affects the development of diabetes and obesity.Epidemiological studies that aimed to provide clinical evidence have contributed substantially to the debate on BPA.

In 2010,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Chinese Center for Disease Control and Prevention conducted collaboratively a 2010 China Noncommunicable Disease Surveillance,and reported the results of diabetes prevalence and control in Chinese adults,which was published in the Journal of American Medical Association (JAMA) in 2013.This article is the interpretation of that report by original authors.

[Summary] It has been believed that both environmental and genetic effects play roles in the pathogenesis of type 2 diabetes. Genetic factors may influence the effect of environmental factors on risk of developing type 2 diabetes. This review focused on the latest evidence of the interaction effect of genes and the environmental factors on type 2 diabetes.

Objective Measurement of ankle brachial index (ABI) is a simple method of assessing lower limb arterial blood supply,while measurement of toe brachial index (TBI)has only been advocated as an alternative.The aim of this study was to obtain information about whether TBI should be taken in type 2 diabetes,even when ABI is normal,and to evaluate the relationship between TBI and atherosclerosis.Methods In a crosssection study,ABI,TBI,and carotid intimal-medial thickness (IMT) were measured on 979 outpatients with type 2 diabetes in Ruijin Hospital.Those with normal ABI (0.9 ≤ABI ＜ 1.3,n = 945) were divided into two groupsnormal TBI group(TBI≥0.6,n=893) and low TBI group(TBI＜0.6,n=52),and then the clinical and laboratory data were compared between these two groups.Furthermore,the relationship between TBI and atherosclerosis was investigated.Atherosclerosis was defined as the maximum IMT ≥ 1.1 mm.Results Low ABI and low TBI were detected in 1.3% and 6.6% of the patients,respectively.Comparison of the clinical and laboratory data between the two groups showed that age and HbA1C values were significantly higher in the low TBI group.Furthermore,TBI was inversely associated with IMT(β=-0.217,P＜0.01),an indicator for atherosclerosis of the carotid artery.Multiple logistic regression analysis revealed that decline of TBI was an independent risk factor of atherosclerosis (OR=1.30,95% CI 1.01-1.69,P＜0.05).Conclusion In type 2 diabetes,the decline of TBI is associated with atherosclerosis,indicating the necessity for diabetic patients to detect TBI,even when ABI is within normal range,in order to detect peripheral artery disease in early stage,and reduce the risk for atherosclerosis.

patients. Maintenance of systolic BP<120 mm Hg(1 mm Hg=0.133 kPa) and diastolic BP<80 mm Hg may reduce the risk of atherosclerosis in type 2 diabetes.

Objective To investigate the association between levels of serum alanine aminotransferase (ALT) and the risks of metabolic syndrome in middle-aged and elderly Chinese. Methods After excluding subjects with known liver disease, excess alcohol consumption and serum ALT≥40 IU/L,1 664 subjects aged 40 years or older from Baoshan Community, Shanghai were recruited to undergo questionnaire interview, anthropometric measurements, and fasting blood sampling. Biochemical features were evaluated and the metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria with modification on waist circumference cutoff which is more appropriate for an Asian population. Results Increased ALT levels were associated with more unfavorable metabolic risk profiles. The prevalence rates of the metabolic syndrome in participants with increasing ALT quartiles were 29. 2% , 38. 0% , 44.9% , and 62. 9% , respectively (P for trend <0. 01 ). ALT concentrations were significantly elevated with increasing number of the metabolic syndrome components (P for trend<0.01). Serum ALT levels were significantly associated with the risks of metabolic syndrome and most of its components in a dose-response manner. As compared with participants in the first ALT quartile, the risks of metabolic syndrome were increased by 146% , central obesity by 204% , hypertension by 35% , high triglycerides by 133% , and hyperglycemia by 72% in participants of the fourth ALT quartile. Conclusions A high-normal serum ALT level was significantly associated with an increased risk of the metabolic syndrome in middle-aged and elderly Chinese.

Objective To investigate the association between peripheral white blood cell (WBC) count and the carotid intimal-medial thickness (cIMT) in middle-aged and elderly Chinese of suburban area of Shanghai.Methods A total of 2 519 subjects aged 40 years or older from Jiading District,Shanghai were recruited to undergo questionnaire interview,anthropometric measurements,fasting blood sampling,and carotid B-mode ultrasonography.After excluding subjects with biochemical index missing,WBC count ＞ 10× 109/L as well as those with known myocardial infarction,cerebral infarction,coronary heart disease,and those taking lipid-lowing agents,2 239subjects were included in this analysis.Results Increased WBC count was associated with more unfavorable metabolic risk profiles.With the increasing quartiles of WBC count,cIMT were 0.558,0.570,0.573,and 0.587mm respectively(P for trend ＜ 0.01).As compared with participants in the first WBC quartile,the risks of cIMT thickening were increased by 79％,109％ in males and 29％ in females (P＞ 0.05 in females).Multiple linear regression model showed that peripheral WBC count was an independent risk marker for cIMT thickening,especially for neutrophil and monocyte count.Conclusion A high-normal WBC count was significantly associated with cIMT thickening in middle-aged and elderly Chinese of suburban area of Shanghai,especially in males.

Objective To explore the molecular defects of CYP17A1 gene in a family with 17?-hydroxylase deficiency. Methods Clinical features and laboratory data were collected from the pedigree with 17?-hydroxylase derficiency and the proband was hospitalized in Shanghai Clinical Center for Endocrine and Metabolic Diseases. PCR and subclone sequencing were performed to screen the mutations of CYP17A1 gene. Results The patient was diagnosed as 17?-hydroxylase deficiency according to the clinical presentations, laboratory examination and blood level of steroid hormones. A new type of mutation was identified as a base deletion and a base transversion (TAC/AA) at codon 329 in the patient. It produced a missense mutation of Tyr→Lys at codon 329 and the open reading frame shift following this codon. The patient was homozygous mutation and her parents were heterozygote carrying TAC329AA mutation. Conclusion 17?-hydroxylase deficiency in this family was caused by CYP17A1 mutation (TAC329AA) which was first identified as a complex defects of missense mutation and the open reading frame shift at codon 329.

Recently, gut microbiota is found to be associated with human health and diseases. Environmental and genetic factors both play pivotal roles in the pathogenesis of type 2 diabetes, in which the gut microbiota is regarded as an important environmental factor. In addition, gut microbiota may become a novel therapeutic approach for type 2 diabetes. Present review focused on the association between the alterations of gut microbiome and type 2 diabetes, hyperglycemia, and insulin resistance;also summarized the molecular mechanisms underlying microbe-host interactions in the context of diabetes, potential contribution of the gut microbiota to the pharmacological or surgical treatment of type 2 diabetes, and the interaction of human genetics with gut microbiome. Based on the understanding of gut microbiota-host interactions, probiotic and fecal microbiota transplantation will be potential novel therapeutic approaches for type 2 diabetes.