Objective:To investigate an association between glycosylated hemoglobin(HbA1c)level and non-alcoholic fatty liver(NAFL)in the elderly.Methods:In this retrospective case-control study, 5 186 elderly individuals aged 65 years and over meeting the inclusion conditions via health physical examination were successively selected from January to December 2018.They were divided into NAFL group(n=1 731)and non-NAFL group(n=3 455). Waist circumference, body mass index, smoking history, diastolic blood pressure, glomerular filtration rate, serum levels of triglyceride, low density lipoprotein cholesterol, alanine aminotransferase, aspartic aminotransferase, fasting blood glucose and HbA1c were compared between the two groups, and their correlations with NAFL were analyzed.Results:The prevalence of NAFL was 33.4%(1, 731/5, 186). The values of waistline, body mass index, smoking history, diastolic blood pressure, triglyceride, total cholesterol, low density lipoprotein cholesterol, glomerular filtration rate, alanine aminotransferase, aspartate aminotransferase, fasting glucose and HbA1c were higher in the NAFL group than in non-NAFL group(all P<0.05). While levels of creatinine, urea nitrogen and age were lower in the NAFL group than in non-NAFL group( P<0.05). According to the quartile of HbA1c level, these subjects were divided into Q1 to Q4 groups(HbA1c<5.7%, 5.7≤HbA1c<6.0%, 6.0%≤HbA1c<6.5%, HbA1c≥6.5%), and the prevalence of NAFL in the Q1 to Q4 were 22.8%(225/1 120), 27.9%(398/1 429), 36.5%(514/1 409), 45.9%(564/1 228)respectively.The prevalence of NAFL was increased along with the increase in the level of HbA1c( P<0.01). Multivariate Logistic regression analysis showed that after adjusting for age, gender and metabolic components, the risk for developing NAFL was gradually increased in Q2 group, Q3 group, Q4 group versus Q1 group as the following OR value: OR=1.274, 95% CI: 1.004-1.616; OR=1.639, 95% CI: 1.294-2.077; OR=1.787, 95% CI: 1.337-2.389, respectively, all P<0.01. Conclusions:The prevalence of NAFL is positively associated with HbA1c levels in the elderly and HbA1c is an independent risk factor for NAFL disease.

The introduction of evidence-based medicine in general practice teaching can effectively improve the clinical decision-making ability of general practitioners, promote the transformation of general practice service mode, and enrich the connotation of general practice. The ways to implement the idea of evidence-based medicine into general practice education include strengthening the teaching staff of evidence-based medicine in general practice, innovating the teaching methods of evidence-based medicine in general practice, and introducing the evaluation and examination of evidence-based medicine skills into the assessment system of general practitioners. Evidence-based medicine education in general practice teaching still faces many problems. It is necessary to continuously strengthen the connotation construction of evidence-based medicine teaching for general practitioners, continuously improve the teaching methods of evidence-based medicine for general practitioners, and scientifically carry out assessment of evidence-based medicine teaching for general practitioners.

Total 732 subjects aged 30-60 years undergoing health check-up at Beijing Hospital Medical Examination Center in 2009,who had no history of non-alcoholic fatty liver disease (NAFLD) were recruited in the study.According to the quartile of hemoglobin (HGB) level,the subjects were divided into 4 groups:Q1:HGB ≤ 131 g/L (n =192),Q2:HGB ＞ 131 g/L and ≤ 140 g/L (n =178),Q3:HGB ＞ 140 g/L and ≤152 g/L (n =184),Q4:HGB ＞ 152 g/L (n =178).All participants were followed up for 4 years,the prevalence rates of NAFLD in groups Q1,Q2,Q3 and Q4 were 8.3％ (16/192),17.4％ (31/178),23.4％ (43/184) and 25.3％ (45/178),respectively (P ＜0.05).Logistic regression showed that the rates of NAFLD in groups Q2,Q3 and Q4 were 2.32 (1.22-4.41),3.36 (1.81-6.21) and 3.72(2.02-6.87) times higher as group Q1 (P ＜ 0.05).Multiple logistic regression analysis showed that the hemoglobin level,TG and BMI were the independent risk factors of NAFLD.

Objective To evaluate the prevalence and risk factors of progressive liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).Methods A total of 2 054 subjects who underwent health check up and were diagnosed as NAFLD in 9 institutions were included in the study.Blood routine and biochemical findings were collected to calculate aspartate aminotransferase-to-platelet ratio index (APRI).Subjects were divided into three groups according to diagnostic threshold of liver fibrosis:APRI ＜0.43 group,APRI 0.43-0.53 group and APRI ≥ 0.54 group.The correlation between APRI and biochemical variables was analyzed,and the risk factors of progressive fibrosis were also analyzed.Results Among 2 054 subjects (male/female 1 598/456) there were 61 cases with APRI ≥ 0.98 (2.97％,progressive fibrosis),318 with APRI ≥0.54 (15.48％),1 475 with APRI ＜ 0.43 (71.81％),261 with APRI 0.43-0.53 (12.71％).Logistic stepwise regression analysis showed that TG (P =0.002,OR =1.095,95％CI:1.033-1.161),2 hPG(P =0.000,OR =1.103,95％ CI:1.058-1.151,BUN(P =0.034,OR =1.215,95 ％ CI:1.014-1.454) were risk factors,and H DL-C (P =0.034,OR =0.353,95 ％ CI:O.135-0.924) was a protective factor for the progression of fibrosis.Conclusion The progressive fibrosis in patients with NAFLD is closely associated to blood glucose and lipid metabolism disorder.

Objective To analyze the effect of Chinese diabetes risk score in health checkup of elderly population and to explore the risk factors of abnormal glucose metabolism in the elderly patients.Methods Chinese diabetes risk score(C-DRs)screening,glucose tolerance test(OGTT),blood biochemical parameters and history collection were performed in 1 181 elderly people participating the health checkup.The area under the ROC curve(AUC)was used to evaluate the accuracy of the screening method.The effect of different cumulative C-DRs on screening target population was reflected by the Gordon index.Multivariate logistic regression analysis was used to analyze relevant risk factors for the glucose metabolic abnormalities.Results The AUC of screening for diabetes was 0.749(95%CI:0.715-0.782),and the best cut-point value was 32.5 points.The sensitivity was 86.50%,the specificity was 60.84%,and the Gordon index was 0.47(P=0.000).The AUC of screening for the pre-diabetes was 0.760(95%CI:0.733-0.787),and the best cut-point was 33.5 points.The sensitivity was 70.89%,the specificity was 68.72%,and the Gordon index was 0.40(P=0.000).The AUC of screening for MS was 0.797(95% CI:0.772-0.823),and the best cut-point value was 32.5 points.The sensitivity was 83.62%,the specificity was 64.90%,and the Gordon index was 0.49(P=0.000).The AUC of screening for insulin resistance was 0.609(95%CI:0.645-0.734),and the best cut-point value was 30.5 points.The sensitivity was 81.25%,the specificity was 44.81%,and the Gordon index was 0.26(P=0.000).Multiple logistic regression analysis showed that age over 80 years,abdominal obesity(waist circumference,male ≥ 90 cm,female ≥ 85 cm),hypertension,hypertriglyceridemia,family history of diabetes were risk factors for abnormality of glucose metabolism in the elderly.The odd ratio values of the above were 1.557,1.543,1.495,1.569,1.625,1.715(all P<0.05).Conclusions Chinese diabetes risk score may be used to screen for diabetes,metabolic syndrome and insulin resistance in the elderly population.Old age,abdominal obesity,hypertension,hypertriglyceridemia and family history of diabetes are independent risk factors for abnormal glucose metabolism in the elderly population.

Objective To investigate the relationship between serum uric acid and the risk of nonalcoholic fatty liver disease.Methods A cohort study was performed among individuals who had physical examination at Beijing Hospital medical examination center during 2009.A total of 732 subjects without nonalcoholic fatty liver disease,30-60 years old,were selected.Subjects were divided into 4 groups (Q1,Q2,Q3,Q4) according to serum uric acid level.Theincidence of NAFLD in each group in 2013 were observed.Serum alanine aminotransferase,aspartate aminotransferase,triglycerides,total cholesterol,high density lipoprotein-cholesterol,low density lipoprotein-cholesterol,fasting plasma glucose,and imaging examinations were determined.Cumulative incidence ofNAFLD was compared between each group and effect of baseline serum uric acid on new-onset NAFLI was assessed by logistic regression analysis.Results The cumulative incidence of NAFLD increased irconjunction with the increase of baseline serum uric acid in 4 groups (Q1 8.70％,Q2 13.04％,Q3 19.23％,Q4 32.97％,x2=37.865,P＜0.05).Logistic regression showed that the incidence of nonalcoholic fattyliver disease was increased along with elevated levels of serum uric acid.Subjects in the Q2,Q3,Q4 groups showed an increased risk of NAFLD,relative risks were 1.575 (0.807-3.074);2.580 (1.329-54.701);5.164 (2.838-9.397),compared to those in Q1 group.Moreover,after adjustment for baseline factors (e.g.Age,sex),risk of NAFLD remained higher,with odds ratio at 1.234,and the difference was statistically significant.Conclusions Serum uric acid was found to be correlated with the prevalence of nonalcoholic fatty liver disease.Serum uric acid appeared to be an independent risk factor for NAFLD.

Objective To select health individual and test serum total bilirubin and direct bilimbin in order to provide a reference range for the establishment of appropriate reference interval in this region.Methods From October to December in 2009,314 of physical examination population of Beijing Hospital were selected by questionnaire and laboratory test excluding liver and gallbladder diseases or metabolic diseases.Roche and Prodia reagents were used to test TBIL and DBIL,respectively.Reference interval was calculated by sex group and compared with the existing reference interval.Results The level of TBIL had a significant difference between different genders(P ＜ 0.01).The level of TBIL had a significant difference between two kinds of reagents(P ＜ 0.01).Using Roche reagent,the reference interval of TBIL was 7.1 ～ 27.2 μmol/L for man,and 4.8 ～ 20.9 μmol/L for woman,and the reference interval of DBIL was 1.4 ～6.8 μmol/L for man,and 0.9 ～5.7 μmol/L for woman.Using Prodia reagent,the reference interval of TBIL was 9.5 ～ 35.7 μmol/L for man,and 6.8 ～ 28.9 μmol/L for woman,and the reference interval of DBIL was 1.3 ～ 7.0 μmol/L for man,and 1.0 ～ 6.6 μmol/L for woman.Conclusions The level of TBIL and DBIL in physical examination population was higher than the existing reference interval.It is necessary to modify the existing reference interval and establish reasonable reference interval for different regions and gender,respectively.

The health check-up results of 11 514 subjects in 2011 at Beijing Hospital were retrospectively analyzed,including the results of 13C urea breath test for detection of Helicobacter pylori (Hp) and HbA1c test.The results showed that the prevalence rate of Hp infection was significantly higher in females (31.77％) than that of males (29.36％) (x2 =7.355,P ＜0.05) ; the highest prevalence was found in 35-60 y age group (31.17％).Hp positive rates in subjects with body mass index (BMI) ≥28kg/m2 and central obesity were 31.55％ and 30.44％,respectively; there were no significant differences from those with normal weight and non central obesity.Subjects with positive Hp infection had higher levels of HbA1 c,compared to those with negative Hp infection (t =-2.276,P =0.01).In subjects with BMI ≥24 kg/m2 and central obesity,HbA1c level was higher in Hp positive subjects than that in Hp negative ones (P ＜0.05).Diabetes mellitus was positively associated with Hp infection (OR 1.282; 95％ CI 0.941-1.799),particularly in obese patients (OR 1.459 ; 95 ％ CI 1.070-2.071).The results indicate that Hp may be involved in the impairment of glucose regulation,particularly in those with higher body mass index.

Objective To examine the sensitivity and specificity of glycated haemoglobin A1c (HbA1c) in predicting metabolic syndrome (MS) and its association with cardiovascular risk factors.MethodsIn 6292 adults (median age 45 years) who participated in a medical check-up program,analysis of distribution of HbA1c and its association with various cardiovascular risk factors was performed. The ability of HbA1 c to predict MS was evaluated.Anthropometric measurements were made and fasting plasma glucose,lipid profiles and HbA1c were tested. ResultsThe prevalence of MS was 11.24％.Cardiovascular risk factors were significantly increased as the serum level of HbA1c increased. HbA1c of 5.8％ predicted the presence of MS.Females showed the same cut-off of HbA1c for the prediction of MS with males ( the area under the curve of the females was higher than that of the males ). Conclusion HbA1c was increased as cardiovascular risk factors increased and HbA1c of 5.8％ may predict the presence of MS.HbA1c might be a predictive measure of MS and cardiovascular diseases in adults.

Objective To explore the exercise risk of urban residents aged18 to 65 years old.MethodsHealth screening and cardiovascular risk stratification were performed among adults18 to 65 years old in 2010by using exercise risk assessmentrecommendedbyAmerican College of Sports Medicine.Result A total of15 498 subjects were recruited 9293 males and 6205 females,mean age (44.8 ±11.1) years,8929(57.6％ ) in the lower risk group,5323(34.3％ ) in the moderate risk group,and 1246(8.1％ ) in the higher risk group.The proportion of those in the higher risk group was increased with age.Conclusion Risk assessment and Physical Activity Readiness Questionnaires should be used before physical activity programme is initiated,especially in middle aged or elderly people.