Objective:To investigate the association between fibroblast growth factor 21(FGF21)and chronic kidney disease(CKD)in a prediabetic population by conducting a 4-year prospective cohort study among community-dwelling residents aged≥40 years in Guangzhou,China.Methods:A total of 1505 subjects who met the criteria for prediabetes and had complete baseline data were col-lected from the 2012 REACTION cohort,and they were followed up for 4 years to observe newly-onset CKD and the changes in urinary albumin-to-creatinine ratio(UACR)and estimated glomerular filtration rate(eGFR).Results:Among the 1 505 subjects with predia-betes,142 reached the diagnostic criteria for CKD during follow-up,yielding an overall incidence rate of 9.43%(95%CI=7.895%-10.902%).According to baseline serum FGF21 level,the subjects were divided into Q1-Q4 groups,with the lowest level of FGF21 in the Q1 group,and the Q4 group had a significantly higher eGFR than the other groups(P<0.05).After a mean follow-up time of 4 years,UACR was increased by 0.87 mg/g(P<0.001)and eGFR was reduced by 4.8 mL/(min·1.73 m2)(P<0.001).After stratification by FGF21 quartiles,there were differences in the declines of eGFR across groups,with the lowest degree of reduction in the Q2 group.In the multivariate regression model,the serum level of FGF21 was significantly negatively associated with the onset of CKD.When FGF21 was analyzed as a continuous variable in the multivariate lo-gistic regression analysis,FGF21 was still significantly negatively associated with the risk of CKD,which was consistent with the re-sults of the quartile-based analysis.However,restricted cubic spline curves showed an L-shaped non-linear relationship between FGF21 level and the risk of CKD,i.e.,the incidence rate of CKD de-creased with the increase in FGF21 level,but when FGF21 level reached a certain threshold,the risk of CKD no longer changed with FGF21.The linear regression analysis showed that FGF21 was positively associated with UACR and eGFR.Conclusion:In this pro-spective cohort study,FGF21 level might be potentially associated with the future risk of CKD among adults with prediabetes,while fur-ther studies are needed to clarify related mechanisms and clinical value.

Objective:To explore the association between weight change from age 20 to middle age and diabetes risk.Methods:A total of 10 104 residents over 40 years old were recruited in Guangzhou. The final analysis data set is a cohort of 6 272 patients from the REACTION study. Quartile of weight changes from age 20 to middle-age was used as an independent variable to explore its association with newly diagnosed diabetes. Simple and multivariable logistic regression analysis were used to calculate OR and 95% CI. Results:The prevalence of newly diagnosed diabetes in study cohort was 15.7%. Weight changes from age 20 to middle-age was significantly higher in diabetes group( P<0.001). Logistic regression analysis found in general population and overweight people [24.0≤body mass index(BMI)<28.0 kg/m 2], after adjusting for gender, age, educational level, family history of diabetes, drinking, SBP, waist circumference, cholesterol, high-density lipoprotein-cholesterol(HDL-C), TG, ALT, AST, the risk of diabetes increased in line with the magnitude of weight change( P=0.081). While in group of lean, normal and obese adult, no significant association has been found. Conclusion:The risk of diabetes increased with weight change in general population and overweight people, indicating that weight change in adults after age of 20 was positively associated with diabetes. It is suggested the importance of weight management in the prevention of dialetes.

Objective To investigate the status of dietary fiber ( DF ) and dietary glycemic load ( GL ) in middle-aged and elderly population, and to analyze the correlation of DF and GL with abnormal glucose metabolism. Methods Subjects aged 40-79 years came from Guangzhou community. Dietary nutrients intakes were assessed by continuous 24 hours review for 3 days. Correlation of abnormal glucose metabolism with GL and DF and their interaction were analyzed as quintiles of the distribution. Results Of 1 832 subjects, there were 990 subjects (54. 0%) with normal glucose tolerance, 640 (34. 9%) with IGR, and 202 (11. 0%) newly-diagnosed diabetes mellitus(DM). AverageDFintakeofsubjectswas(11.5±4.5)g/dandaverageGLintakewas(181.0±7.5)/d. Compared with the highest quintile group of total DF intake, the risk of abnormal glucose metabolism in the lowest quintile group was increased[OR=1. 99, 95% CI (1. 48,2. 67)], with increased IGR risk[OR=1. 85, 95% CI (1.34,2.57)]andDMrisk[OR=2.36,95% CI(1.50,3.73)]. ComparedwiththelowestquintilegroupofGL intake, the risk of abnormal glucose metabolism in the highest quintile group was increased [ OR=1. 58, 95% CI (1. 18, 2. 13)], and with increased IGR risk[OR=1. 75, 95%CI(1. 26, 2. 42)] and DM risk[OR=1. 22, 95%CI(0. 77, 1. 94)]. The lowest quintile of DF and the highest quintile of GL was associated with the risk of increased abnormal glucose metabolism[OR=3. 43, 95%CI(1. 41, 8. 36)]. Conclusion Abnormal glucose metabolism was negatively related with DF and positively related with GL.

Objective To investigate the effect of dietary glycemic load (GL) on the blood glucose level in women with impaired glucose regulation. Methods A total of 120 women with impaired glucose regulation aged from 40 to 79 were enrolled from Guangzhou community to participate in the epidemiological survey on dia-betes mellitus, and were followed up for 12 months. Continues 24 -hour dietary review of 3 days were completed before and after intervention. The dietary GI, GL and the changes of blood glucose level during the 12-month follow-up were analyzed. Results Ninety-nine subjects completed the 12-month follow-up. According to the GL change percentage (ΔGL), all of the subjects were divided into three groups, including group Ⅰ(ΔGL < -30%)、group Ⅱ(ΔGL -30% ~ -10%) and group Ⅲ (ΔGL≥-10%). The reductions of HbA1c in group Ⅰ and groupⅡ were greater than that in group Ⅲ (P < 0.05). Conclusion To lowering dietary GL at 10% or more should be conductive to reduce HbA1C of women with inpaired glucose regulation.

To discuss the relationship between dietary glycemic load (GL) and blood glucose and lipid,201 patients with newly-diagnosed type 2 diabetes and 126 subjects with normal glucose tolerance were enrolled,who were all above 40 years old and permanently lived in communities of Guangzhou.GL,blood glucose and lipid were assessed based on 3-d dietary records.The results showed that the level of dietary glycemic load in diabetic patients was significantly higher than control group (169.61 ± 44.83 vs 157.50 ± 38.47,P＜0.05).Correlation analysis showed that dietary GL was positively correlated with body mass index and HbA1C,and negatively correlated with HDL-C in diabetic patients (all P＜0.05).Adjusted for age and sex by multiple regression,the result was the same.Therefore,dietary with high level of GL may be associated with the occurrence of type 2 diabetes,and is closely related to glucose control and blood lipid metabolism suggesting the necessity to control the level of dietary GL in the nutritional therapy for diabetic patients.

Objective To study the effects of high matrix metalloproteinase 9 (MMP 9 ) on the biological behaviors of fibroblasts,in order to clarify the possible mechanisms in the wound healing of diabetic foot.Methods Establish the cell model of skin fibroblast with high expression of MMP 9 by high glucose (22.0 mmol/L) and high homocysteine (100 μmol/L) co-culture.Control group was incubated with normal glucose (5.5 mmol/L).Realtime PCR,ELISA and gelatin zymography were used to detect the MMP 9 mRNA,protein expression and activity of MMP 9.Flow cytometry,CCK-8,ELISA assay,scratch test and transwell were used to detect cell proliferation,viability,collagen (hydroxyproline) secretion,horizontal migration and vertical migration of cells.Results Data were expressed as (x- ± s).Differences were considered significant if their P value was ＜ 0.05.Results The expression of MMP 9 mRNA,protein levels and the activity of MMP 9 in high MMP 9 group were 6.05 folds,4.12 folds and 1.58 folds higher than those in control group (P ＜ 0.01,respectively).The proportion of S phase cells,proliferation index,cell viability,collagen (hydroxyproline) secretion,6 h horizontal migration rate and the number of vertical migration cells in high MMP9 group decreased by 29.8 ％,18.1％,23.3 ％,68.7 ％,45.0 ％ and 21.4 ％ than those in control group (P ＜ 0.01,respectively ). Conclusions Fibroblast with high expression of MMP 9 have decreased proliferation,activity,collagen secretion and reduced migration,which suggests that MMP 9 may inhibit the biological behaviors of fibroblasts.