Background Effects of the micronutrient selenium have been proposed in obesity and type 2 diabetes mellitus (T2DM) that involve impairments in glucose metabolic pathways and the insulin signaling cascade, mediated through oxidative stress and inflammation. However, the evidence collected to date through animal and epidemiologic studies has been inconclusive. Therefore, in the present study, we aimed to evaluate the relationships of selenium status and inflammation with T2DM and obesity. Methods Participants in the re-survey of the Electricity Generating Authority of Thailand (EGAT)2 study conducted in 2013 (N=655, age 45–60 years) were allocated to three groups based on their body mass index (World Health Organization Asia-Pacific Classification), and their serum selenium and high-sensitivity C-reactive protein (hs-CRP) concentrations and other clinical parameters were compared. Results Significant differences in serum selenium and hs-CRP among the groups were associated with differences in fasting blood glucose and glycated hemoglobin, as well as differences in the prevalence of prediabetes or T2DM. The adjusted odds ratios (ORs) (95% confidence intervals) for prediabetes or diabetes were 1.991 (1.318–3.009) and 3.786 (2.087–6.896) for the lowest and highest tertiles of serum selenium concentration in the entire sample and obese participants, respectively. Furthermore, the rising extent of hs-CRP increased the significantly associated with prediabetes or diabetes (adjusted ORs; 2.268 for the entire sample, 4.043 for the overweight and 1.910 for the obesity). Conclusion Selenium status may be linked to both obesity and T2DM through its effects on signaling pathways. Further nutrigenomic studies are required to clarify the relationship between selenium and metabolic diseases.

Background: Arterial stiffness, as reflected in the cardio-ankle vascular index (CAVI), is a risk factor for major adverse cardiovascular events (MACEs).Hypothesis: Combining CAVI and metabolic syndrome (MetS) may enhance prediction of MACEs in a general adult population.Methods: A total of 3807 employees of the Electricity Generating Authority of Thailand were enrolled in a longitudinal health study during 2007-2008. Baseline characteristics were collected and CAVI determined. Subjects with previous coronary artery disease or stroke were excluded from analysis. MetS was defined using the modified NCEP-ATP III for Asians. The primary study endpoint was occurrence of a MACE (myocardial infarction, stroke, or cardiovascular death).Results: MetS was present in 39.2% at study baseline. The prevalence of CAVI > 9 was higher in subjects with MetS compared to those without (33.7% vs. 28.5%, P = 0.001). During the 12.4 ± 0.6 years follow-up, 227 participants developed MACEs and 350 died. MetS was more common in patients who developed a MACE (8.2% vs. 5.0%, p < 0.001) than was non-MetS, but it was not a significant risk after adjusting covariables. Participants with CAVI > 9 had greater risk for MACEs 1.34 (95% CI: 1.01, 1.79) relative to those with CAVI < 9. Participants with both MetS and CAVI > 9 had the worst outcomes, with the highest frequency of MACEs, among the four groups. Conclusion: Arterial stiffness assessed by CAVI may enhance prediction of futureMACEs, adding to the null predictive power of MetS. This index can be used to motivate MetS patients to modify their life-styles for prevention.

Excess body weight is associated with cardiovascular events (CVEs) and premature death. This study aimed to find the causal pathways between excess body weight and CVEs through risk factors in a general adult population. A total of 7921 employees of the Electricity Generating Authority of Thailand were enrolled during 1997–2009. Baseline characteristics and blood test results were collected. A body mass index (BMI) ≥ 23 kg/m2, using WHO criteria for Asians was defined as excess body weight. A mediation analysis was applied to assess potential causal pathways. BMI ≥ 23 kg/m2 was considered as an independent variable, whereas diabetes mellitus (DM), hypertension (HT), and chronic kidney disease (CKD) were considered as mediators, and CVEs (i.e., fatal and non-fatal coronary artery disease or stroke) were considered as the outcomes. The prevalence of BMI ≥ 23 kg/m2, DM, HT, and CKD were 62.7%, 7.8%, 28.1% and 11.8% respectively. During an average of 17.2 ± 5.5 years follow-up, subjects with BMI ≥ 23 kg/m2 compared with those with lower BMIs more frequently developed CVEs (9.4 vs 6.2%, P < 0.001). The effects of BMI ≥ 23 kg/m2 on CVEs were mediated indirectly through DM and HT with significant ORs of 1.61 (1.34, 2.09) and 1.57 (1.39, 1.80), respectively. The indirect effect of CKD on CVEs was significantly increased if mediated through DM → HT or HT [ORs of 1.17 (1.09, 1.32) and 1.20 (1.10, 1.32), respectively]. Subjects with excess body weight were prone to develop CVEs which were mediated indirectly through DM and HT. The effect of CKD on CVEs was small but enhanced if it occurred as a complication of DM or HT.

Purpose. Osteoporotic VF is frequently asymptomatic and affects not only women but also men. Identifying patients at risk is essential for early management and prevention. BMD and the TBS are measurements of bone strength and trabecular microarchitecture, respectively. Their role in VF prediction in men is less well-studied. We determined the BMD and TBS predictive ability for osteoporotic VF in men. Methods. A total of 115 male participants of the Electricity Generating Authority of Thailand (EGAT) cohorts without a history of VF who completed the baseline BMD and TBS measurements in 2012 and a thoracolumbar spine radiograph in 2017 were recruited. The VF was assessed using the Genant semiquantitative method. Logistic regression analysis was performed to identify factors associated with the fracture. The area under the receiving operator curve (AUC) was analyzed to define VF predictive ability. Results. Forty subjects (34.78%) had VFs. The unadjusted relative risks (95% confidence interval) for VF for one standard deviation decrease in the TBS and low TBS were 1.319 (1.157–1.506) and 2.347 (1.496–3.682), respectively, and remained significant after BMD and age adjustment. For VF prediction, combined models had a greater AUC than models predicted from a single variable. The use of low TBS, femoral neck BMD, and age provided the best AUC (0.693). Conclusion. BMD and the TBS could predict osteoporotic VF in male EGAT employees. The use of both BMD and the TBS in the VF prediction process improved predictive ability.

Background: Overweight/obesity is associated with cardiovascular events (CVEs) and premature death. This study aimed to find the causal pathways between overweight/obesity and CVEs through risk factors in a general adult population. Methods: A total of 7,921 employees of the Electricity Generating Authority of Thailand (EGAT) were enrolled during 2007-2009. Baseline characteristics and blood test results were collected. Body mass index (BMI) >23kg/m2 by WHO criteria for Asians was defined as overweight/obesity. A mediation analysis was applied to assess potential causal pathways. BMI >23kg/m2 was considered as an independent variable, whereas diabetes mellitus (DM), hypertension (HT), and chronic kidney disease (CKD) were considered as mediators, and CVEs (i.e., fatal and non-fatal CAD or stroke) were considered as the outcomes. Results: The prevalence of BMI >23kg/m2, DM and HT, and CKD were 62.7%, 7.8%, 28.1%, and 11.8% respectively. During an average of 17.2±5.5 years follow-up, BMI >23kg/m2 subjects compared with those with lower BMIs more frequently developed CVEs (9.4% vs 6.2%, p<0.001). The effects of BMI >23kg/m2 on CVEs was significantly mediated indirectly through DM and HT with significant ORs of 1.61 (1.34, 2.09) and 1.57 (1.39, 1.80), respectively. The indirect effect of CKD on CVEs was significantly increased if mediated through DM -->HT or HT [ORs of 1.17 (1.09, 1.32) and 1.20 (1.10, 1.32), respectively]. Conclusion: Subjects with overweight/obesity were prone to develop CVEs which was mediated indirectly through DM and HT. The effect of CKD on CVEs was small but enhanced if it occurred as a complication of DM or HT.