Flow chart for inclusion of study participants.

<p>Flow chart for inclusion of study participants.</p

Unadjusted and adjusted association analyses of child and adult adiposity predictors of LTL.

<p>AR is adiposity rebound; LTL is leukocyte telomere length. WHR is waist-to-hip ratio, BMI is body mass index, calculated as weight (kg)/height (m)². BAI is body adiposity index, calculated as (hip circumference (cm))/((height(m)^1.5)−18). BMI <i>z-score</i> change was calculated separately in males and females as the difference between the <i>z-scores</i> of BMI at AR, and BMI at 31 years. The number of individuals in each analysis is given (N); those in adjusted analyses are slightly lower than corresponding unadjusted analyses due to missing data for one or more covariates.</p>a<p>Linear regression model adjusted for maternal parity, SES at birth, Smoking at 31 years, SES at 31 years, children at 31 years and qPCR plate. In addition to these potential confounders, the model was also adjusted for age at menarche in women.</p>b<p>% change in LTL per unit change in predictor variable.</p>c<p>Statistically significant <i>P_corrected</i> values are shown in <b>bold</b>. FDR <i>P_corrected</i> values were calculated after adjustment using the Benjamini-Hochberg procedure <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0099133#pone.0099133-Aviv2" target="_blank">[34]</a>, which provides a correction for multiple testing.</p

Unadjusted means±SD of adiposity measures by gender and smoking groups.

<p>WC: waist circumference</p><p>WHtR: waist circumference/height ratio</p><p>^a: difference between nonsmokers and regular smokers, adjusted for age and survey sites.</p><p>Gender differences in means were all significant (P<0.001), adjusted for age and survey sites.</p><p>Unadjusted means±SD of adiposity measures by gender and smoking groups.</p

Characteristics (mean±SD or %) of study variables by gender groups.

<p>^a: <i>P</i>-values for gender difference were adjusted for age and survey site;</p><p>^b: Central obesity was defined as WHtR≥0.5.</p><p>MET-hours/day: metabolic equivalent hours per day</p><p>WHtR: waist circumference/height ratio</p><p>Characteristics (mean±SD or %) of study variables by gender groups.</p

Prevalence of central obesity in the total sample (BMI = 18.5–45.0) (A) and normal-weight adults (BMI = 18.5–23.9) (B).

<p>Prevalence of central obesity in the total sample (BMI = 18.5–45.0) (A) and normal-weight adults (BMI = 18.5–23.9) (B).</p

Prevalence of central obesity by 18 BMI subgroups in males and females.

<p>Prevalence of central obesity by 18 BMI subgroups in males and females.</p

Standardized regression coefficients of regular smokers for WHtR (A) and WC (B) by 18 BMI groups in males and females: Standardized regression coefficients greater than 0.026 for male smokers and 0.015 for female smokers were significant (p<0.05).

<p>Standardized regression coefficients of regular smokers for WHtR (A) and WC (B) by 18 BMI groups in males and females: Standardized regression coefficients greater than 0.026 for male smokers and 0.015 for female smokers were significant (p<0.05).</p

Metabolic and lifestyle risk factors for acute pancreatitis in Chinese adults: A prospective cohort study of 0.5 million people

<div><p>Background</p><p>Little prospective evidence exists about risk factors and prognosis of acute pancreatitis in China. We examined the associations of certain metabolic and lifestyle factors with risk of acute pancreatitis in Chinese adults.</p><p>Methods and findings</p><p>The prospective China Kadoorie Biobank (CKB) recruited 512,891 adults aged 30 to 79 years from 5 urban and 5 rural areas between 25 June 2004 and 15 July 2008. During 9.2 years of follow-up (to 1 January 2015), 1,079 cases of acute pancreatitis were recorded. Cox regression was used to estimate adjusted hazard ratios (HRs) for acute pancreatitis associated with various metabolic and lifestyle factors among all or male (for smoking and alcohol drinking) participants. Overall, the mean waist circumference (WC) was 82.1 cm (SD 9.8) cm in men and 79.0 cm (SD 9.5) cm in women, 6% had diabetes, and 6% had gallbladder disease at baseline. WC was positively associated with risk of acute pancreatitis, with an adjusted HR of 1.35 (95% CI 1.27–1.43; <i>p</i> < 0.001) per 1-SD-higher WC. Individuals with diabetes or gallbladder disease had HRs of 1.34 (1.07–1.69; <i>p</i> = 0.01) and 2.42 (2.03–2.88; <i>p</i> < 0.001), respectively. Physical activity was inversely associated with risk of acute pancreatitis, with each 4 metabolic equivalent of task (MET) hours per day (MET-h/day) higher physical activity associated with an adjusted HR of 0.95 (0.91–0.99; <i>p</i> = 0.03). Compared with those without any metabolic risk factors (i.e., obesity, diabetes, gallbladder disease, and physical inactivity), the HRs of acute pancreatitis for those with 1, 2, or ≥3 risk factors were 1.61 (1.47–1.76), 2.36 (2.01–2.78), and 3.41 (2.46–4.72), respectively (<i>p</i> < 0.001). Among men, heavy alcohol drinkers (≥420 g/week) had an HR of 1.52 (1.11–2.09; <i>p</i> = 0.04, compared with abstainers), and current regular smokers had an HR of 1.45 (1.28–1.64; <i>p</i> = 0.02, compared with never smokers). Following a diagnosis of acute pancreatitis, there were higher risks of pancreatic cancer (HR = 8.26 [3.42–19.98]; <i>p</i> < 0.001; 13 pancreatic cancer cases) and death (1.53 [1.17–2.01]; <i>p</i> = 0.002; 89 deaths). Other diseases of the pancreas had similar risk factor profiles and prognosis to acute pancreatitis. The main study limitations are ascertainment of pancreatitis using hospital records and residual confounding.</p><p>Conclusions</p><p>In this relatively lean Chinese population, several modifiable metabolic and lifestyle factors were associated with higher risks of acute pancreatitis, and individuals with acute pancreatitis had higher risks of pancreatic cancer and death.</p></div

Adjusted HRs for deaths and major disease outcomes following acute pancreatitis¹.

<p>Adjusted HRs for deaths and major disease outcomes following acute pancreatitis<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002618#t004fn001" target="_blank">¹</a>.</p

Adjusted HRs for acute pancreatitis by total physical activity.

<p>Total physical activity was classified by quintiles (<8.7 [reference], 8.7 to <14.3, 14.3 to <21.9, 21.9 to <33.2, and ≥33.2 MET-h/day). Model was stratified by sex and region and adjusted for age at baseline, education, smoking, alcohol, and medication (aspirin, ACE-I, beta blockers, statins, diuretics, Ca⁺⁺ antagonists, metformin, and insulin). Time since birth was used as the underlying time scale with delayed entry at age at baseline. HRs were plotted against the mean level in each adiposity group. Log-scale was used for the y-axis. The squares represent HRs, and the vertical lines represent 95% CIs. The area of the squares is inversely proportional to the variance of the log HRs. The numbers above the vertical lines are point estimates for HRs, and the numbers below the lines are numbers of events. ACE-I, angiotensin-converting enzyme inhibitor; HR, hazard ratio; MET-h/day, metabolic equivalent of task hours per day.</p