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Sign up to take part. A Nature Research Journal. Serum gamma-glutamyltransferase GGT , which is mainly derived from the liver, is a sensitive marker of liver cell damage and oxidative stress. More recently, it has been found that increased GGT plasma activity is also associated with cardiovascular disease CVD.

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However, data on the relationship between GGT and cardiovascular risk factors CRFs are lacking in nationally representative samples of the Chinese population. A cross-sectional survey was conducted in a representative sample of adults aged 18 years and older from to nationally, which included a plurality of ethnic minorities. The participants were then divided into quartiles of sex-specific serum GGT.

From the low to high GGT quartiles, the incidence of each CRF and clustered risk factors increased after adjusting for age, uric acid UA , ethnicity, drinking, and all other risk factors. In conclusion, our data highlight that there is an association between higher serum GGT levels and prevalence of CRFs, which tend to cluster with the increase in GGT activity in Chinese adults. Cardiovascular disease CVD is considered a major cause of death in most developed and developing countries 1 and represents a huge economic burden for humans 2. It is recognized that the more risk factors there are in the same individual, the more the incidence of future CVD will increase compared with individuals with only a single risk factor 4.

Gamma-glutamyltransferase GGT is a liver enzyme that is traditionally used in clinical practice as a marker for liver function and alcohol abuse 5.

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However, the predictive utility of GGT applies well beyond liver disease. Serum GGT is not only a correlate of increased risk for cardiovascular death, but is also associated with higher risk of premature coronary artery disease CAD in young patients with typical chest pain or positive non-invasive tests 6. Several longitudinal and cross-sectional investigations have associated GGT with an increase in all-cause mortality and chronic heart diseases such as congestive heart failure 7 , 8.

Recent studies have also shown that elevated serum GGT levels are a risk factor for cardiovascular deaths in both healthy and type 2 diabetic patients 9. In addition, elevated serum levels of GGT are associated with metabolic syndrome 10 , and metabolic syndrome itself can promote the development of atherosclerosis and CVD. Baseline circulating GGT levels and an increase in GGT over time are associated with an increased risk of hypertension 11 , This association is stronger in obese men and women than in their lean counterparts Therefore, a number of studies have confirmed that elevated GGT levels are linked to an increased risk of a multitude of diseases and conditions, including CVD and CRFs, such as diabetes, metabolic syndrome MetS , hypertension, and all-cause mortality 14 , Previous studies on the Chinese population focused more on the correlation between GGT and a single CRF, and such studies were limited to certain geographical regions, so the population was not representative 16 , China, as a large developing country, has marked regional and ethnic differences.

In addition, the levels of GGT differ between districts and counties.

We conducted a population-based, cross-sectional survey from to This research used a multistage, random, stratified sampling method to obtain a nationally representative sample of the general Chinese population 18 , A 3-stage cluster sampling method was used to select eligible subjects in each province. Written informed consent forms were obtained from each participant prior to data collection, and participants reported to the physical examination centers voluntarily to take part in the survey.

There were eligible subjects, among which people were selected randomly to complete blood biochemical testing. Finally, subjects Of the , 2. Actually, the final sample size in this study included people men and women. The protocol was in accordance with the Helsinki Declaration and was approved by the institutional review board of the Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences.


A schematic used for screening and inclusion of study samples. The final sample size was , which consisted of men and women. All of the participants were asked to complete a standard questionnaire. Measure body weight to the nearest 0. Body mass index BMI, an index for overall obesity was calculated as body weight divided by height in square meters.

Waist circumference WC was measured midway between the lower rib margin and the iliac crest. We took the measurements three times and used the averages. All personnel who took part in data collection and anthropometry were trained medical personnel, and all devices were calibrated. The Peking Union Medical College Hospital took charge of the common internal quality control program which was followed by the biochemical laboratories participating in the survey. In this study, we evaluated five risk factors including hypertension, diabetes, dyslipidemia, overweight, smoking in the study population and analyzed the relationship between serum GGT and these risk factors in the Chinese population.

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Variables with a skewed distribution age, TG, and GGT are presented as the median interquartile range and were compared by the Kruskal-Wallis test. Categorical data age group, regions, ethnic group are presented as percentages and were compared by the x2 test. The tests were performed to compare the variables with the relevant groups. Multivariate logistic regression analyses were performed to calculate the odds ratios ORs for CRFs according to the GGT quartile, adjusting for age, UA, regions, and all other risk factors.

All statistical analyses were performed with SPSS Men had a higher serum level of GGT than women did in each quartile. Except for Cr, Urea, and eGFR, whose values fluctuated, the rest of the indictors showed linear rising or falling trends from low to high serum GGT quartiles.

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Compared with women, men drank and smoked more on average. For men, however, the proportion could be more than half. For men, The proportion of people with higher GGT levels was different in divided age groups; for men, the biggest percentage existed in the age range of 45—54 years, but for women, this occurred at the age range of 55—64 years. People in northern and rural areas tended to have upper quartiles of GGT, and for ethnic groups, Mongolians had the highest serum levels of GGT.

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The major CRFs that tended to cluster included diabetes, dyslipidemia, hypertension, current smoking, and being overweight. From low to high GGT quartiles, the incidence of each CRF increased except for smoking in women, which was only significant in upper quartiles.


Dyslipidemia, overweight, and diabetes were statistically significant CRFs and correlated with upper quartiles 75th percentiles positively in both genders. Hypertension is also positively associated with upper quartiles 75th percentiles especially with the new standard. In Fig. CRF clustering was associated with the higher ORs of upper quartiles in men than in women. To our knowledge, our research is the first multicenter study to analyze the association between serum GGT and CRFs, as well as CRF clustering, in diverse Chinese provinces with a large and representative study population covering all adult age groups and including a plurality of ethnic minorities.

Our previous study revealed that serum GGT and uric acid levels were associated with impaired fasting glucose Kong, AP. In another previous study, we explored the relationship between hyperuricemia and clustering of CRFs in the Chinese adult population The correlation between GGT and CRFs was further analyzed after adjusting several risk factors such as age, ethnicity, and drinking. UA was also included as a confounding factor and the results showed that GGT and CRF clustering was still significantly related after excluding the effect of these confounding factors.

In our study, people in the northern and rural areas tended to belong in the upper quartiles of GGT, which may be related to a different lifestyle, such as drinking more. In particular, Mongolians who live in the northwest of China had a higher prevalence of alcohol drinking Our data also indicated that Mongolians accounted for a bigger proportion in the upper serum levels of GGT compared with other ethnic groups.

People who consume more alcohol tend to have higher serum GGT levels, a conclusion that is consistent with that of Tynjala J. Men are more likely to drink than women. Several reports support the notion of a detrimental interaction between cigarette smoking and alcohol consumption leading to elevated serum GGT levels, especially in men 29 , This may partly explain why these CRFs were more closely linked to men.

Our data suggests that the proportion of each risk factor increases as the quartiles of GGT increase. GSH is a major antioxidant of cells; thus, GGT can antagonize the anti-oxidative effects of GSH, causing damage to vascular endothelial cells and leading to the hardening of arteries. Oxidative stress increases the level of GGT, resulting in reactive oxygen species that play a role in diabetes Furthermore, there are findings showing that serum GGT levels could be a predictor of the development of insulin resistance in Korean men Established seller since Seller Inventory FM Book Description Condition: New.

This is Brand New. Seller Inventory Manohar Book Description Cambridge University Press , Marta Tienda. Publisher: Cambridge University Press , This specific ISBN edition is currently not available. View all copies of this ISBN edition:. Synopsis About this title Research clearly indicates that ethnic groups differ significantly on levels of mental and physical health, antisocial behavior, and educational attainment.

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