revention and control of noncommunicable diseases is a public health priority worldwide. However, data have shown steady increases in noncommunicable diseases, especially obesity and diabetes, in many countries. [1][2][3][4] Diabetes prevalence in China increased from less than 1% in the 1980s to almost 11% in 2013. [5][6][7][8][9] In 2013, China reported having the largest number of patients with diabetes and spending the second highest amount on diabetes and its complications worldwide. 8,10,11 In addition, the population of patients with prediabetes represents a large reservoir of patients at risk of diabetes. Previous research showed low rates of awareness, treatment, and control of diabetes in China, 6-8 compared with the United States. 12 Previous national surveillance data described the prevalence and treatment of diabetes in China in 2013. 8 Another survey reported estimated diabetes prevalence of 11.2% and prediabetes prevalence of 35.2% in 2015. 13 The prevalence, awareness, and treatment of diabetes varies within populations. 3,7,8,14 Socioeconomic and behavioral factors (eg, diet, smoking) may account for this variation. Behavioral factors are important modifiable factors for diabetes prevention and management. China has launched public health campaigns to promote healthful behaviors, including tobacco control, healthful diet, and physical activity. To our knowledge, no nationally representative studies with consistent study design have comprehensively investigated trends in the prevalence, treatment, and risk factors of diabetes in China. IMPORTANCERecent data on prevalence, awareness, treatment, and risk factors of diabetes in China is necessary for interventional efforts. OBJECTIVE To estimate trends in prevalence, awareness, treatment, and risk factors of diabetes in China based on national data. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional nationally representative survey data collected in adults aged 18 years or older in mainland China from 170 287 participants in the 2013-2014 years and 173 642 participants in the 2018-2019 years.EXPOSURES Fasting plasma glucose and hemoglobin A 1c levels were measured for all participants. A 2-hour oral glucose tolerance test was conducted for all participants without diagnosed diabetes.MAIN OUTCOMES AND MEASURES Primary outcomes were diabetes and prediabetes defined accordingtoAmericanDiabetesAssociationcriteria.Secondaryoutcomeswereawareness,treatment, and control of diabetes and prevalence of risk factors. A hemoglobin A 1c level of less than 7.0% (53 mmol/mol) among treated patients with diabetes was considered adequate glycemic control.

BackgroundBile salt hydrolase plays an important role in bile acid-mediated signaling pathways, which regulate lipid absorption, glucose metabolism, and energy homeostasis. Several reports suggest that changes in the composition of bile acids are found in many diseases caused by dysbacteriosis.ResultsHere, we present the taxonomic identification of bile salt hydrolase (BSH) in human microbiota and elucidate the abundance and activity differences of various bacterial BSH among 11 different populations from six continents. For the first time, we revealed that bile salt hydrolase protein sequences (BSHs) are distributed in 591 intestinal bacterial strains within 117 genera in human microbiota, and 27.52% of these bacterial strains containing BSH paralogs. Significant variations are observed in BSH distribution patterns among different populations. Based on phylogenetic analysis, we reclassified these BSHs into eight phylotypes and investigated the abundance patterns of these phylotypes among different populations. From the inspection of enzyme activity among different BSH phylotypes, BSH-T3 showed the highest enzyme activity and is only found in Lactobaclillus. The phylotypes of BSH-T5 and BSH-T6 mainly from Bacteroides with high percentage of paralogs exhibit different enzyme activity and deconjugation activity. Furthermore, we found that there were significant differences between healthy individuals and patients with atherosclerosis and diabetes in some phylotypes of BSHs though the correlations were pleiotropic.ConclusionThis study revealed the taxonomic and abundance profiling of BSH in human gut microbiome and provided a phylogenetic-based system to assess BSHs activity by classifying the target sequence into specific phylotype. Furthermore, the present work disclosed the variation patterns of BSHs among different populations of geographical regions and health/disease cohorts, which is essential to understand the role of BSH in the development and progression of related diseases.Electronic supplementary materialThe online version of this article (10.1186/s40168-019-0628-3) contains supplementary material, which is available to authorized users.

SummaryBile salt hydrolase (BSH) in gut bacteria can hydrolyze conjugated bile salts to unconjugated bile acids and amino acids. Thereby play a crucially important role in host health by reducing serum cholesterol levels, preserving bile acids balance and regulating various metabolism as signaling molecules. Here we present the taxonomic identification of BSHs in human microbiota and elucidate the abundance and activity differences of various bacterial BSHs among 11 different populations. For the first time, we have revealed BSH are distributed in 154 intestinal bacterial strains within 33 genera in human microbiota. However, these BSHs present obviously differentiation for the sequence identity being from 28.6% to 100%, and the 32.7% bacteria strains having more than one paralogs of BSHs with dissimilarity. Therefore, we reclassified the BSHs from the different genera into 6 phylotypes basing on their phylogenetic tree, and demonstrate the significant abundance patterns of BSH phylotypes among different populations. From the enzyme activity comparison, the representative sequence of BSH-T3 was shown highest enzyme activity in 6 phylotypes. Meanwhile, BSH-T3 sequences which all distributed in Lactobacillus show highest abundance in Chinese and Austrian. The information illustrated by this study is useful for investigating the population differences of bile acid metabolism related diseases, and further giving a new suggestion on selection of probiotics or development of pharmaceutical proteins based upon the activity of BSH phylotypes to regulate host metabolism and maintain fitness.

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