Background Diabetes is a major threat to public health across the world. Studies have shown that exposure to p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) is closely related to the occurrence of type 2 diabetes mellitus. However, the relevant molecular mechanism is not clear. Objective To investigate the effects of p,p'-DDE on H19 differentially methylated region (DMR) methylation and insulin secretion of rat insulinoma cells (INS-1 cells). Methods INS-1 cells were cultured with different concentrations (0, 3.125, 6.25, 12.5, 25, 50, and 75 µmol·L⁻¹) of p,p'-DDE for 24 h, and the viability of INS-1 cells was detected by CCK-8 method. INS-1 cells were exposed to 0, 12.5, 25, and 50 µmol·L⁻¹ p,p'-DDE for 24 h in subsequent experiments. The methylation levels of 24 CpG sites in H19 DMR were analyzed by bisulfite genomic sequencing. The expression levels of insulin-like growth factor 2 (IGF2) mRNA were detected by real-time quantitative PCR. The expression levels of IGF2 and insulin-like growth factor-1 receptor (IGF1R) proteins were detected by Western blotting. The insulin secretion function of INS-1 cells was determined by glucose-stimulatedinsulin secretion test (5 and 25 mmol·L⁻¹ glucose, respectively). Results Compared with the control group, the viability of INS-1 cells increased significantly after treatment with 12.5 µmol·L⁻¹ p,p'-DDE; however, it was significantly inhibited after treatment with 50 or 75 µmol·L⁻¹ p,p'-DDE (P<0.01); therefore, 50 µmol·L⁻¹ was chosen as the maximum concentration of exposure for subsequent experiments. The 25 µmol·L⁻¹ p,p'-DDE treatment decreased the methylation levels of CpG18 and CpG22-CpG24 sites in H19 DMR, and the 50 µmol·L⁻¹ p,p'-DDE treatment decreased the methylation levels of CpG10-CpG24 sites (P<0.05 or P<0.05). Multiple concentrations (12.5, 25, and 50 µmol·L⁻¹) of p,p'-DDE down-regulated the mRNA and protein relative expression levels of IGF2 and the protein relative expression levels of IGF1R. The transcription level of IGF2 decreased to 67.8%, 68.6%, and 62.5% of the control group, the protein level of IGF2 decreased to 73.3%, 79.5%, and 80.9% of the control group, and the protein level of IGF1R decreased to 54.8%, 25.6%, and 12.9% of the control group, respectively (P<0.01). In the high glucose context, p,p'-DDE at selected concentrations inhibited the insulin secretion levels to 85.0%, 58.6%, and 49.5% of the control group, respectively (P<0.01). Conclusion p,p'-DDE could down-regulate methylation level of H19 DMR, interfere the IGF2/IGF1R signaling pathway, and inhibit insulin secretion of islet cells.

Objective:To investigate the relationship between calf circumference and appendicular skeletal muscle mass (ASM) index, handgrip strength and gait speed in the elderly in Shanghai, and to explore the optimal cut-off point of calf circumference as a simple proxy marker of skeletal muscle mass, strength and function.Methods:A total of 2 294 participants were recruited from physical examination centers in Huadong Hospital Affiliated to Fudan University and 4 communities (954 males and 1 340 females) with an average age of (71.6±8.7) years. Appendicular skeletal muscle mass (ASM), Upper (UMM) and lower (LMM) limbs skeletal muscle mass were measured by bioelectrical impedance analysis (BIA). The ASM index (ASM/height 2) were calculated.Gait speed was measured.Muscle strength was measured by handgrip strength using an electronic hand dynamometer.Height, weight, right calf circumference and waist circumference were measured. Results:The age, body mass index (BMI), waist circumference and gait speed were not statistically different (all P>0.05) between both genders. Height, weight, ASM, ASM/height 2, UMM, LMM, handgrip strength, calf circumference were significantly higher in men than in women (all P<0.05). The calf circumference of the elderly with age ≥ 80 was significantly lower than that of the 70-79 age group and 60-69 age group ( P<0.05). The calf circumference of older women (age≥80) was significantly lower than that of the elderly women in the 70-79 age group and 60-69 age group ( P<0.05). Calf circumference was correlated negatively with age( P<0.01) and positively with ASM/height 2, height, weight, BMI, handgrip strength, UMM and LMM( P<0.01). There was no correlation between calf circumference and gait speed ( P>0.05). In the receiver operating characteristic curve (ROC), the cut-off value of calf circumference for low muscle mass was 35.1 cm for male(specificity, 0.721; sensitivity, 0.803, ROC, 0.809) and 33.6 cm for female(specificity, 0.774; sensitivity, 0.778; ROC, 0.827). Conclusions:Calf circumference decreases with ageing in the elderly. The optimal cut-off value of calf circumference for low muscle mass is 35.1 cm for males and 33.6 cm for females. We should pay attention to the importance of calf circumference in evaluation and diagnosis of sarcopenia.

Objective:To explore the main influencing factors for physical performance assessed by the short physical performance battery(SPPB)in the elderly in communities in Shanghai.Methods:A total of 500 elderly subjects from four communities in Shanghai who met the inclusion criteria with 165 males and 335 females aged 60-95 years(70.5±7.8)years were enrolled.A questionnaire was used to assess the general situation.International Physical Activity Questionnaire-Short Form(IPAQ-SF)was used to assess physical activity(PA). The appendicular skeletal muscle mass(ASM)was measured by bioelectrical impedance analysis, and the relative skeletal muscle mass index(RSMI). The lower extremity muscle strength(quadriceps strength, QS)was measured by a hand-held dynamometer.Lower body muscle quality(LB-MQ) was ascertained by taking the ratio of strength to muscle mass for lower extremity.SPPB score was used to assess physical activity, including full tandem test, 4-meter walking speed test and five timed chair stands test.Results:The age, RSMI, ASM and quadriceps strength were higher, and the body fat content was lower in males than in females(all P<0.001). There were no significant differences in BMI, SPPB scores, LBMQ, and PA between males and females( P>0.05). Pearson correlation analysis showed that SPPB score was negatively correlated with age( r=-0.615, P<0.001)and body fat content( r=-0.103, P=0.022), but SPPB score was positively correlated with quadriceps strength( r=0.351, P<0.001), RSMI( r=0.134, P=0.003), LBMQ( r=0.268, P<0.001)and amount of PA( r=0.204, P<0.001), however, SPPB score had no relationship with gender( r=0.068, P=0.132). Conclusions:Aging and frailty are the main factors for the decline of physical performance in the elderly.Participating physical activity, reducing body fat, maintaining muscle mass, and especially increasing muscle quality, may be the main interventions to prevent the further deterioration of physical performance in the elderly.

To study the effects of conjee and cooked rice on postprandial glucose and plasma insulin levels in type 2 diatetes,and to help diabetic patients select reasonably food.41 diabetes were divided into cooked rice group ( group A),conjee with steamed bread group ( group B),and oatmeal group ( group C ).At 1 h after meal,the values of postprandial plasma glucose (PPG) was significantly lower in group C than those in group A and group B [ ( 11.17± 2.30 vs 12.88 ± 1.29,13.29 ± 1.97 ) mmol/L,P ＜ 0.05 ].At 2 h after meal,the value of PPG was significantly lower in group C than in group A [ ( 8.88 ± 2.66 vs 10.87 ± 1.63 ) mmol/L,P ＜0.05 ].At 1 h and 2 h after meal,there was no significant difference between the value of PPG in goup A and group B ( P＞0.05 ).At 1 h after meal,the value of plasma insulin was significantly lower in group C than those in group B [ (46.02 ± 26.32 vs 88.56 ± 68.75 )μU/ml,P ＜0.05 ],and there was a littler higher in group B than group A ( P＞0.05 ).At 2 h after meal,there was no statistical difference of plasma insulin among group A,B,C [ ( 57.10 ± 33.56,62.26 ± 24.42,54.16 ± 41.35 )μU/ml,P＞0.05 ) ].Isocaloric oat food is potentially beneficial in sustaining blood glucose status and decreasing insulin secretion.It is the ideal choice for type 2 diabetes.Meanwhile,there were no statistical differences in PPG and insulin levels between the individuals taking conjee with steam bread and cooked rice.

A total of 127 type 2 diabetic patients were divided into low glycemic index meal replacements (intervention) group and standard food-based diet (reference) group in an experiment for 12 weeks.The results showed that fasting plasma glucose,postprandial 2 h plasma glucose,fasting insulin,and homeostasis model assessment insulin resistance(HOMA-IR) in the intervention group decreased significantly after 12 weeks trial ( P＜0.05 or P＜0.01 ).However,there were no significant changes in lipid profile and HbA1C in intervention group.In addition,percentage of body fatty,visceral fatty area,and waist-hip ratio also decreased in intervention group( all P＜0.01 ).Superoxide dismutase and glutathione levels increased significantly in intervention group by the end of trial (both P＜0.01 ),while malondialdehyde was decreased (P＜0.01 ).There were no significant changes in the aforementioned indices in the reference group.Weight,body mass index,and waist circumferences were decreased in both groups,but without significant difference between the two groups.

The association of serum uric acid ( SUA ) and urine albumin-to-creatinine ratio ( ACR ) in patients with type 2 diabetes mellitus was explored. The ACR abnormal rate was higher in hyperuricemia group( P＜0.01 ). ACR level was positively correlated with SUA( P＜0.01 ). The general linear model showed that SUA was a risk factor in ACR. Patients with hyperuricemia and type 2 diabetes mellitus were apt to have abnormal ACR and develop early renal damage.

Objective To investigate the relationship between glycemic index (GI) of mixed foods and glucose and lipid metabolism index in elderly patients with diabetes mellitus, and to analyze the effects of CI response with regard to sex and obesity. Methods Forty-three patients with diabetes mellitus were divided into two groups with randomly crossover methods: high CI group and low GI group. Mixed meals were given for ten weeks (washing time:2 weeks). The biochemistry index and anthropometric index at baseline,before and after the first and second phase were measured. At the same time,fasting blood glucose(FBG)and postprandial 2 h blood glucose (2hBG) were supervised thrice a week and the daily energy, three macronutrients, and GI were calculated during trial. Results GI was positively correlated with FBG, 2hBG, homeostasis model assessment of insulin resistance ( HOMA-IR) ,body mass index ( BMI), and low-density lipoprotein cholesterol ( r = 0. 097-0. 423, P = 0. 000 1-0.01). GI value was a strong associated factor for FBG and 2hBG in overweight male patients. Conclusions The GI of mixed foods can better reflect the level of glucose response, especially in obese men. And it had good correlations with other metabolic indexes.

Objective To test the effectiveness of an integrated intervention to improve control and management of type 2 diabetic patients.Methods The study was designed as a randomized and multi-center clinic trial for 24 weeks.150 overweight patients from 2 companies and one hospital in Shanghai were recruited.The principal objective of the project was to compare the effectiveness of a structured diabetes management program consisting of 200 kcal breakfast as a meal replacement with low glycemic index (GI),scheduled blood glucose monitoring(6 times per week),low GI diet consulting,monitoring and medical check up and nutritional education (diet consulting,health education on nutrition and healthy lifestyle) in overweight individuals with type 2 diabetes.Results At 12th week,the level of fasting blood glucose(FBG) in both groups decreased by 16.5% and 10.6%,and at 24th week,the FBG also decreased by 25.0% in intervention group,but in control group FGB increased 2.8% (P＜0.01).Meanwhile,there were 8.2% and 11.1% reductions in HbA1C respectively at 12th week and at 24th week in intervention group,while the values were increased slightly in control group(P＜0.01).Compared with control group,waist circumference,hip circumference,and blood pressure were significantly reduced after treatment for 24 weeks in intervention group (P＜0.01).Conclusions Integrated intervention is an effective approach in managing FBG,HbA1C blood pressure,and weight control in overweight diabetic patients.

Objectives:To observe the relationship between 2 different ways of nasal tube nutrition supplement patterns and clinical patients'endurance and complication. Methods:Self contrast study was used in 8 cases of old patients supplied with nasal tube nutrition for 4 months(perfusion and dripping pattern 2 months each). Biochemical indices and enteric complications before and after nasal tube nutrition were observed. Results:Slowly dripping supplement pattern greatly decreased the incidence of inhalation pneumonia and other complications related with gastro enteric nutrition supplement,such as diarrhea,bloating,vomits and etc.The nutritional status was obviously improved when the continuous dripping supplement pattern was used. Conclusions:Continuous dripping supplement pattern is better than perfusion supplement pattern.

Objective: To try to find out the morbidity of elderly chronic pulmonary disease's malnutrition by means of MNA and analyze the consistency between traditionalindex and MNA score. Methods: According to the score of MNA,we divided the 143 elderly pulmonary disease patients into three groups: A group(malnutrition); B group(malnutrition risk);C group(well nourished).The records included anthropometry,biochemical markers,dietary intake as well as the occurrence rate of pneumonia and respiratory failure. Results: There were marked differences on anthropometry,biochemical markers,dietary intake and the occurrence rate of pneumonia and respiratory failure among three groups. And the dietary intake of all three groups did not reach the standard of normal people. Conclusion: MNA is a good method that can be used to evaluate the nutritional state in elderly pulmonary disease patients.