Prevalence of overweight and obesity and its associated factors: findings from National Nutrition and Health Survey in Taiwan, 1993-1996

Plasma Dickkopf-1 Levels Are Associated with Chronic Kidney Disease

BACKGROUND

Wnt/β-catenin signaling is important in the development and repair of the kidney. Dickkopf-1 (DKK-1) is characterized as an inhibitor of the Wnt/β-catenin signaling pathway.

PURPOSE

We examined the relationship between plasma DKK-1 levels and the risk of chronic kidney disease (CKD).

METHODS

In this cross-sectional study, patients without known diabetes mellitus who were admitted for coronary angiography due to angina were enrolled. Fasting blood samples were collected at a predetermined outpatient visit.

RESULTS

Among 373 enrolled patients, 62 (16.6%) were in the CKD group, and 311 (83.4%) were in the nonCKD group. Plasma DKK-1 levels were significantly higher in the CKD group than in the nonCKD group (697.2 ± 174.7 vs. 589.0 ± 193.3 pg/mL; p < 0.001). Plasma DKK-1 levels were inversely correlated with the eGFR (Pearson's correlation coefficient = -0.265; p < 0.001). On the basis of multivariable logistic regression analyses, patients in the highest DKK-1 quartile had a significantly greater risk of CKD (OR = 4.188; 95% CI: 1.564, 11.212; p = 0.004) than did those in the lowest DKK-1 quartile.

CONCLUSIONS

Plasma DKK-1 levels are associated with the risk of CKD in patients with angina. Further studies investigating the underlying mechanisms involved in the relationship between DKK-1 and CKD are warranted.

Trends and Age-Period-Cohort Effect on Incidence of Male Breast Cancer from 1980 to 2019 in Taiwan and the USA

Although male breast cancer (MBC) is globally rare, its incidence significantly increased from 1990 to 2017. The aim of this study was to examine variations in the trends of MBC incidence between populations in Taiwan and the USA from 1980 to 2019. The Taiwan Cancer Registry database and the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute of the USA were used. The age-standardized incidence rate was calculated using the world standard population in 2000. The long-term trends of the age, time period, and birth cohort effect on MBC incidence rates were estimated using the SEER Age-Period-Cohort Web Tool. The results revealed that the incidence of MBC in both countries increased from 2010 to 2019 (Taiwan: average annual percentage change (AAPC) = 2.59%; USA: AAPC = 0.64%). The age and period effects on the incidence rates in both countries strengthened, but the cohort effect was only identified in Taiwan (Rate ratio: 4.03). The identified cohort effect in this study bears resemblance to that noted in a previous investigation on female breast cancer in Taiwan. This suggests the possible presence of common environmental factors influencing breast cancer incidence in both genders, such as a high fat diet and xenoestrogen.

Age-specific trend and birth cohort effect on different histologic types of uterine corpus cancers

To evaluate the uterine corpus cancer incidence rates, age-specific trends, and birth cohort patterns by different histologic types. We conducted a retrospective cohort study of uterine cancer patients (n = 28,769) of all ages from the National Cancer Registry of Taiwan between 1998 and 2017. We estimated the incidence trends, average annual percent changes (AAPCs), and cancer-specific survival (CSS) rate for the two main subtypes (endometrioid and nonendometrioid) of uterine cancer in Taiwan. During the study period, uterine corpus cancer incidence rates increased over time from 5.3 to 15.21 per 100,000 women. Incidence trends for endometrioid carcinoma increased in all age groups (positive AAPCs > 5% for each age group), and the rise was steeper among women aged 50 years and younger. For nonendometrioid carcinomas, incidence rates increased among women over 50 years. The CSS rate improved among women with stage I (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.49-0.81) and stage III (HR 0.72, 95% CI 0.58-0.90) endometrioid carcinomas after 2013 compared with those during 2009-2012. However, the CSS rate remained unchanged for nonendometrioid carcinomas. Age, diagnostic period, stage and histologic types were significant factors associated with the 5-year CSS rate. We found that the incidences of both endometrioid and nonendometrioid carcinomas continued to increase among contemporary birth cohorts. Etiologic research is needed to explain the causes of these trends.

Trends in the distribution of body mass index, waist circumference and prevalence of obesity among Taiwanese adults, 1993–2016

Background

Differences in the prevalence of general and abdominal obesity by subgroups such as age, sex, and education have been reported worldwide. Most studies in Taiwan regarding obesity prevalence were targeted at school-aged children or without further stratification by subgroups. Our aim was to examine the age-specific secular trend of body mass index (BMI), waist circumference (WC), and obesity prevalence stratified by sex, education and urbanization levels in Taiwanese adults.

Methods

We used three waves of nationally representative population from the Nutrition and Health Survey in Taiwan (NAHSIT) 1993–1996 (n = 2 989), 2005–2008 (n = 2 495), and 2013–2016 (n = 2 880). The data included standardized measurement of body weight, height, and WC. We conducted a serial cross-sectional analysis among adults aged 20 years or above to examine the age-specific trends of BMI, WC, and the prevalence of underweight, overweight, general obesity, and abdominal obesity with stratification by sex, education, and urbanization levels.

Results

The general obesity prevalence was 16%, 21%, and 20% and the abdominal obesity prevalence was 27%, 42%, and 47% in the 1993–1996, 2005–2008, and 2013–2016 surveys, respectively. The age-specific secular trend of BMI differed across subgroups; however, the trend of WC increased rapidly regardless of subgroups, except for women aged ≥60 years. The general obesity prevalence increased noticeably among men, younger- and middle-age adults with high school or higher education, middle- and older-age adults with lower than high school education, people <39 and ≥50 years of age residing in rural areas, and among those between 30 and 59 and ≥70 years of age residing in urban areas.

Conclusions

Although the increasing trend of general obesity prevalence was levelling off among several subgroups, the abdominal obesity prevalence increased significantly and rapidly in Taiwan. Future research in developing effective weight and WC control interventions tailored to different subgroups is urgently needed.

Obesity and its associated factors among older adults: MyHEBAT (alasian alth and Well-eing ssessmen) study

Background

Despite being a preventable disease, the prevalence of obesity is rising progressively worldwide. However, the prevalence of obesity and its associated factors among older adults remains unclear in Malaysia. The aim of this study was to determine the prevalence of obesity and its associated factors among older adults who voluntarily attended the health screening programs, which were part of the Malaysian HEalth and Well-Being AssessmenT (My-HEBAT) Study.

Methods

Cross-sectional study was conducted among Malaysian adults, aged ≥60 years. A standardized self-administered questionnaire was used to gather information regarding socio-demographic status, personal, family and medical history. Anthropometric indices, blood pressure and physical examinations were conducted on site. Venous blood samples were collected for lipid profile and blood glucose analysis. Participants with BMI of ≥30 kg/m2 or < 30kg/m2 were classified as obese or non-obese respectively. Age was categorized into three subgroups: 60-69, 70-79, and ≥80 years old. The factors associated with obesity among older adults were then identified using multiple logistic regression.

Results

A total of 716 older adults aged ≥60 years (mean ± SD: 66.6 ± 6.0 years) were recruited. The prevalence of obesity among older adults was 15.8%, while higher prevalence was found among females (42.9%) compared to males (38.3%). The prevalence of obesity decreased with increasing age (48.5% in 60-69 years, 20.8% in 70-79 years, and 11.8% in ≥80 years).

Conclusion

The prevalence of obesity among Malaysian population is higher than that of worldwide prevalence. Current national health promotion and educational programs should focus on identifying factors associated with obesity, and promotion of healthy lifestyle with obesity should be improved and modified, particularly for older adults in Malaysia.

Efficacy of corticosteroid in patients with COVID-19: A multi-center retrospective study and meta-analysis

To evaluate the efficacy of corticosteroids on coronavirus disease 2019 (COVID-19) patients with different levels of disease severity. In our multicenter study, 543 patients with confirmed COVID-19 were classified as non-severe group and severe group, and then were compared respectively for all-cause mortality and length of hospital stay between those who received corticosteroids and not. By searching in PubMed, Web of Science, Embase, and CNKI, we identified 13 retrospective studies and 6 random control trials eligible for criteria of inclusion, and conducted comprehensive meta-analyses assessing the impacts of corticosteroids on mortality, length of stay, duration of RNA clearance and duration of fever. Our multicenter study demonstrated that low-dose corticosteroids can reduce mortality in the multivariable Cox regression analysis for severe patients (p = .03), while presented no influence in univariable analysis for non-severe patients (p = .14). From multivariable analyses, patients with corticosteroids in non-severe group had longer duration of hospitalization (p = .003), but did not in severe group (p = .18). Moreover, for severe patients, corticosteroids can evidently shorten duration of fever. The same results were summarized in the meta-analyses supplemented with the result that corticosteroids delayed viral clearing in non-severe patients. Corticosteroids should be considered based on patient's condition. For patients with non-severe COVID-19, corticosteroid was not recommended as a routine therapeutic initiative as that presented prolonged duration of hospitalization and delayed viral clearing, as well as no positive impact on prognosis. While low-dose corticosteroids may benefit patients with severe COVID-19 for it can manifestly lower risk of death and improve the clinical status to some extent.

Pre-treatment high body mass index is associated with poor survival in Asian premenopausal women with localized breast cancer

Background: Obesity is associated with poor prognosis in breast cancer patients. This study aimed to evaluate the effect of obesity measured by body mass index (BMI) on survival of Taiwanese breast cancer patients in a single institution.

Methods: We observed 5000 patients who were diagnosed with stage I-III breast cancer between 1990 and 2005. Information on BMI at diagnosis, and clinical follow-up for disease recurrence and death, up to 20 years post-diagnosis were available. BMI (in kg/m²) categories included normal weight (BMI<24), overweight (24≤BMI<27), and obesity (BMI≥27), according to recommendations from the Bureau of Health Promotion of Taiwan. The role of BMI and other known prognostic factors for patient survival were evaluated in this patient cohort.

Results: Obesity was associated with advanced stage, higher nuclear grade, and higher percentages of estrogen receptor (ER) positive. The median age of patients with a higher BMI was greater than the median age of patients with a lower BMI. Obesity was an independent prognostic factor of overall survival (OS) (P<0.001), but not disease-free survival (DFS) (P=0.067). We subsequently analyzed the impact of age-stratified BMI (age<50 and age≥50 years) to ameliorate the impact of age bias. Following subset analyses, obesity correlated with shorter DFS (P=0.004) and OS (P=0.009) only in women<50 years of age. Multivariate analysis revealed that BMI was an independent prognostic factor for both DFS and OS in this group of patients. Subset analysis revealed that in women <50 years old, the impact of BMI on survival was associated with higher stage, ER negativity.

Conclusion: BMI is an independent prognostic factor of OS and DFS in breast cancer patients aged<50 years. Although the cause-effect relationship between obesity and survival is unclear, we recommend that weight control measures in young breast cancer survivors should be considered.

Aspirin associated with a decreased incidence of uterine cancer: A retrospective population-based cohort study

Aspirin (ASA) exerts an anti-tumor effect via the COX pathway. Clinical studies on the chemopreventive effects of ASA on uterine cancer (UC) remain inconsistent. We used population-based retrospective cohort study to evaluate the UC in ASA users in Taiwanese women. From insurance claims data, we identified 23,342 women received ASA treatment between 2000 and 2010 and a comparison group of same sample size randomly selected from the same database matched by the propensity score. The incidence of UC in the ASA cohort was 10% of that in the comparison group (0.28 vs 2.73 per 10,000 person-years). The Poisson regression analysis estimated adjusted incidence rate ratio (IRR) was 0.10 (95% confidence interval (CI) = 0.09-0.11) for ASA users relatives to comparisons after controlling for covariates. The UC incidence in ASA users decreased with age, from 0.61 per 10,000 person-years in the 20 to 39 years old (adjusted IRR = 0.21, 95% CI = 0.15-0.29) to 0.21 per 10,000 person-years in the 65 to 80 years old (adjusted IRR = 0.15, 95% CI = 0.12-0.16). The incidence was higher in longer term users. Hormone therapy of estradiol was associated with the increase of UC risk in both cohorts, but less in ASA users than comparisons (1.34 vs 4.75 per 10,000 person-years). This study suggests that ASA use was associated with a decreased risk of UC. Further prospective randomized clinical trials are warranted to confirm the association.

Hepatocellular adenoma in Taiwan: Distinct ensemble of male predominance, overweight/obesity, and inflammatory subtype

BACKGROUND AND AIM

The clinicopathologic features of hepatocellular adenoma in Asian populations have been poorly defined. The study aimed to characterize this rare entity in a single institution in Taiwan.

METHODS

In total, 45 hepatocellular adenomas from 1995 to 2018 were included and sent for pathologic review and molecular subtyping.

RESULTS

The numbers of patients with hepatocellular adenoma has doubled in the recent decade. Surprisingly, men outnumbered women in our cohort (n = 26, 58% vs N = 19, 42%). A collection of clinical information revealed that overweight/obesity accounts for most of the associated conditions of hepatocellular adenoma. Only three women took oral contraceptives. There were 34 inflammatory (75%), three LFABP-negative (7%), four β-catenin activated (9%), and four unclassified (9%) hepatocellular adenomas. Ten inflammatory hepatocellular adenomas demonstrated strong and homogeneous glutamine synthetase staining and were thus also β-catenin activated. Notably, overweight and obesity were significantly associated with inflammatory hepatocellular adenoma than other subtypes (P = .029 and .056, respectively) and were strongly correlated with steatosis in background liver (P = .028 and.007, respectively). Malignant transformation (four borderline tumors and two hepatocellular carcinomas) was identified in six adenomas (two women and four men). All six hepatocellular adenomas with malignancy were β-catenin activated; β-catenin activation could serve as a biomarker for malignant progression.

CONCLUSIONS

The clinicopathologic features of hepatocellular adenoma in Taiwan are distinct from those reported in Western countries. Rare oral contraceptive usage and an emerging epidemic of overweight/obesity in Taiwan provides new insights into the pathogenesis of hepatocellular adenoma.

Parity as a Prognostic Factor in Patients with Advanced-Stage Epithelial Ovarian Cancer

Aim

This study aimed to determine the prognostic factors influencing the overall survival (OS) of Iranian women with epithelial ovarian cancer (EOC).

Methods

Information about newly diagnosed patients with confirmed EOC at Motahari Clinic, Shiraz, Iran, from January 1, 2001, to December 31, 2016, was retrospectively reviewed and analyzed. Cox-adjusted proportional hazards (PH) and stratified Cox (SC) models were used to determine the potential prognostic factors.

Results

The mean (±SD) age at the diagnosis of 385 patients with EOC was 49.0 (±13.2) years old. Early-stage EOC (ESEOC) and advanced-stage EOC (ASEOC) were diagnosed in 34.3% and 65.7% of the total patients, respectively. The median (95% CI) OS was 35 (28-41) months. For ESEOC patients, a stage II-tumor led to a lower OS in the multivariable analysis compared to a lower stage tumor (P= 0.025). For ASEOC patients, age≥65 years at diagnosis (P=0.008) led to a lower OS. ASEOC patients with 2-5 parities (P=0.014) and >5 parity (P=0.001) demonstrated better OS than nulliparous women.

Conclusion

Patients with ESEOC, higher tumor stage was associated with a shorter OS. The age at diagnosis harmed the OS of patients with ASEOC. More than one parity improved OS in ASEOC patients.

Effect of preoperative computed tomography parameters and obesity on surgical outcomes of laparoendoscopic single-site adrenalectomy

BACKGROUND

The aims of the present study were to (1) analyse preoperative computed tomography (CT) parameters, (2) investigate whether obesity and CT parameters affect surgical outcomes in patients undergoing LESS lateral retroperitoneal adrenalectomy, and (3) further establish the optimal cutoff point of CT parameters for tolerable operating time.

METHODS

Between January 2010 and August 2016, patients who underwent LESS adrenalectomy through the retroperitoneal approach in our hospitals were included. Patients' demographic data, preoperatively measured CT parameters (the depth and horizontal width to the adrenal gland in the axial view of abdominal CT, the vertical height in the coronal view of CT, and the angle of the depth and horizontal width), and intraoperative (operative time and blood loss) and postoperative (hospital stay and complications) parameters were retrospectively reviewed. Linear regression was performed to determine factors that potentially affect surgical outcomes.

RESULTS

In 116 patients, depth was the only CT parameter associated with surgical outcomes. Large depth (P = 0.005; 95% CI 1.739-9.256) and high BMI (P = 0.012; 95% CI 0.357-2.851) were factors significantly associated with longer operative time. The area under the ROC curve for the depth was 0.69 (P = 0.002), and the cutoff point 10.48 cm may be the tolerable operating time.

CONCLUSIONS

Our results suggest a depth limit of 10.48 cm for the optimal prediction of operating time less than 90 min; although obese patients and deeper adrenal glands had longer operative time, LESS adrenalectomy could be performed in the obese patients without increased blood loss, prolonged hospital stay, or increased pain.

A Survey on Satisfaction of Type 2 Diabetes Patients with Different Demographic Variables to Medical Services

Taking Type 2 diabetes as the research object, and through questionnaire interviews, this study sought to determine the degree of satisfaction of patients with different attributes with medical services according to the distribution of demographic variables. Finally, the statistical results were taken as the reference basis for medical personnel to provide care to patients. Regarding the questionnaire survey, the questionnaire items were designed through face-to-face interviews aiming at their medical treatment process, thus, patients could truly reflect their feelings. This study used the SPSS statistical software (IBM, Armonk, New York, NY, USA) for analysis, and the results show that: (1) Patients of different genders had different degrees of satisfaction with medical services. (2) The difference in age, monthly disposable income, occupational category, and education level had no significant effect on service satisfaction. (3) The research subjects were all on the high side regarding their satisfaction with the service provided by medical facilities. This study is a pilot study, and it is hoped it will be used as a guideline for improving patient care quality in the future, thus, reducing the occurrence of diabetic complications through better medical care. The long-term goal is to continuously improve care and medical service quality, thus, reducing the waste of medical resources.

Association between life-course socio-economic status and prevalence of cardio-metabolic risk ractors in five middle-income countries

BACKGROUND

The burden of non-communicable diseases has increased rapidly in low- and middle-income countries. Past studies have reported an association between socioeconomic status (SES) and cardio-metabolic risk factors, but most have focused on upper income countries. The purpose of this study is to examine the association between SES over the life-course and the burden of cardio-metabolic risk factors in middle-income countries.

METHODS

A total of 38 297 adults from China, Mexico, India, South Africa and Russia were included in this cross-sectional study. Life-course SES was defined based on maternal and participant education, and data on blood pressure, body mass index (BMI), self-reported diabetes and hypertension were obtained by trained interviewers. Descriptive, age standardized and multivariable adjusted analyses were conducted using survey weighted statistical procedures in SAS 9.4 (SAS Institute, Cary, NC, USA).

RESULTS

Although 14% of men and 12% of women had current hypertension based on blood pressure measurements, only 2% of men and 4% of women were aware of their hypertensive status. Men with stable high life-course SES had higher odds of being overweight/obese (odds ratio OR = 2.01, 95% confidence interval (CI) = 1.30-3.10), diabetic (OR = 4.82, 95% CI = 2.07-11.2) and hypertensive based on self-report (OR = 3.42, 95% CI = 1.85-6.32) compared to men of low life-course SES. Among women, the odds of being overweight/obese were significantly higher among women with high life-course SES (OR = 1.50, 95% CI = 1.08-2.08).

CONCLUSIONS

Higher life-course SES for both men and women was associated with increased odds of overweight/ obesity, and additionally diabetes and hypertension for men in middle income countries.

Orexin-A Levels in Relation to the Risk of Metabolic Syndrome in Patients with Schizophrenia Taking Antipsychotics

BACKGROUND

The role of orexin-A in regulating metabolic homeostasis has been recognized, but its association with antipsychotic-induced metabolic abnormalities remains unclear. We investigated the association between orexin-A levels and metabolic syndrome in patients with schizophrenia treated with clozapine or less obesogenic antipsychotics compared with nonpsychiatric controls.

METHODS

Plasma orexin-A levels and metabolic parameters were determined in 159 patients with schizophrenia: 109 taking clozapine; 50 taking aripiprazole, amisulpride, ziprasidone, or haloperidol; and 60 nonpsychiatric controls.

RESULTS

Orexin-A levels were significantly higher in the group taking less obesogenic antipsychotics, followed by the clozapine group and the controls (F=104.6, P<.01). Higher orexin-A levels were correlated with better metabolic profiles in the patient groups but not in the controls. Regression analyses revealed that the patients with higher orexin-A levels had significantly lower risk of metabolic syndrome (adjusted odds ratio [OR]=0.04, 95% CI: 0.01-0.38 for the 2nd tertile; OR=0.04, 95% CI: 0.01-0.36 for the 3rd tertile, compared with the first tertile), after adjustment for age, sex, smoking history, types of antipsychotics (clozapine vs less obesogenic antipsychotics), duration of antipsychotic treatment, and disease severity.

CONCLUSIONS

Our results revealed that the orexin-A level was upregulated in patients with schizophrenia treated with antipsychotics, especially for the group taking less obesogenic antipsychotics. Furthermore, higher orexin-A levels were independently associated with better metabolic profiles. These observations suggest that an upregulation of orexin-A has a protective effect against the development of metabolic abnormalities in patients with schizophrenia receiving antipsychotic treatment.

The impact of occupational psychological hazards and metabolic syndrome on the 8-year risk of cardiovascular diseases-A longitudinal study

There was little information concerning the combined effect of occupational psychosocial hazards such as long working hours, high job stress, and high fatigue on the risk of cardiovascular and cerebrovascular diseases (CVD). The aim of this study was to investigate the interaction among occupational psychosocial hazards and the impact of metabolic syndrome (MetS) on the risk of CVD among bus drivers. The Taiwan Bus Driver Cohort Study involving 1014 professional drivers was established in 2005 and comprehensively studied. The interactions among occupational psychosocial hazards and the impact of MetS on the risk of CVD were measured. A working pattern questionnaire, job stress questionnaires, the Swedish occupational fatigue inventory, the stress satisfaction offset score, biochemical measurements, and physical examinations were used to assess psychosocial hazards and the presence of metabolic syndrome. There were 707 eligible bus drivers with a mean age of 43.5years old. During the 8-years of follow-up, 77 drivers were diagnosed with CVD. Long working hours, high job stress, and high fatigue were associated with an increased risk of cardiovascular disease incidence in the multivariate analysis. There were synergistic effects among long working hours, high job stress, and high fatigue only in drivers with MetS. A combination of long working hours, high job stress, and high fatigue increased the risk of developing CVD in bus drivers with MetS.

Impact of performance grading on annual numbers of acute myocardial infarction-associated emergency department visits in Taiwan: Results of segmented regression analysis

To reduce patient boarding time at the emergency department (ED) and to improve the overall quality of the emergent care system in Taiwan, the Minister of Health and Welfare of Taiwan (MOHW) piloted the Grading Responsible Hospitals for Acute Care (GRHAC) audit program in 2007-2009.The aim of the study was to evaluate the impact of the GRHAC audit program on the identification and management of acute myocardial infarction (AMI)-associated ED visits by describing and comparing the incidence of AMI-associated ED visits before (2003-2007), during (2007-2009), and after (2009-2012) the initial audit program implementation.Using aggregated data from the MOHW of Taiwan, we estimated the annual incidence of AMI-associated ED visits by Poisson regression models. We used segmented regression techniques to evaluate differences in the annual rates and in the year-to-year changes in AMI-associated ED visits between 2003 and 2012. Medical comorbidities such as diabetes mellitus, hyperlipidemia, and hypertensive disease were considered as potential confounders.Overall, the number of AMI-associated patient visits increased from 8130 visits in 2003 to 12,695 visits in 2012 (P-value for trend < 0.001), corresponding to an average annual growth rate of 5.3% (95%confidence interval [CI]: 0.5-10%). Although age was a major risk factor for AMI-associated ED visits, the statistical association was observed in middle-to-old (aged 40-64; P-value < 0.001) and older aged individuals (aged ≥65; P-value <0.001). As compared to 2003-2007, AMI-associated ED visits increased slightly during the intervention roll-in period (2007-2009, slope = 394.5, P-value = 0.117) followed by a dramatic uptake in the early post-intervention period (2010-2012, slope = 1037, P-value = 0.083).There was evidence suggesting for a significant intervention effect of the GRHAC program on identifying critically ill patients with AMI-associated diagnosis at the ED. As the program evaluation is still ongoing, we expect to observe a sustained program effect on hospitals' capacity for timely and correctly diagnosing and managing patients presenting with AMI-associated symptoms or signs at the ED.

Prevalence and Risk Factors Associated with Dyslipidemia in Chongqing, China

The increasing prevalence of dyslipidemia has become a worldwide public health problem, and the prevalence varies widely according to socioeconomic, cultural and ethnic characteristics. Chongqing has experienced rapid economic development and is now the economic center of Southwestern China. There are scant data on serum lipid profile of residents in Chongqing, the largest municipality directly under the Central Government in China. We conducted a cross-sectional study in a representative sample of 5375 residents of Chongqing, aged ≥18 years, and estimated the prevalence of dyslipidemia and its associated risk factors. According to the National Cholesterol Education Program-Adult Treatment Panel III criteria, the age-standardized prevalence of dyslipidemia was 35.5% (34.4% among men and 37.6% among women). Among the 2009 patients with dyslipidemia, 44.2% had isolated hypertriglyceridemia, 14.7% had isolated hypercholesterolemia, 13.2% had mixed hyperlipidemia, and 28.0% had isolated low high-density lipoprotein cholesterol. The peak prevalence of dyslipidemia in men was between 30 and 39 years (48.2%), and then declined gradually; in women, the prevalence of dyslipidemia increased with age, with the peak prevalence occurring after age 60 (46.3%). Multivariable logistic regression analysis revealed that dyslipidemia was associated with age, education level, physical activity, obesity and central obesity for both men and women. In conclusion, the results indicated dyslipidemia, particularly hypertriglyceridemia and low high-density lipoprotein cholesterol, are very common in Chongqing. To prevent dyslipidemia, it is essential to conduct appropriate intervention programs aimed at risk factor reduction and implement routine screening programs for blood lipid levels in Chongqing, China.

The Association between Obstructive Sleep Apnea and Metabolic Markers and Lipid Profiles

PURPOSE

The purpose of this study was to investigate the association between apnea-hypopnea index (AHI) and metabolic markers and whether the elevated risk of Metabolic Syndrome (MetS) is related to Obstructive Sleep Apnea (OSA).

METHODS

This cross-sectional study recruited 246 male bus drivers from one transportation company in Taiwan. Each participant was evaluated by a polysomnography (PSG) test and by blood lipids examination. Severity of OSA was categorized according to the apnea-hypopnea index (AHI).

RESULTS

The results showed that a 73.3% prevalence of MetS in OSA (AHI > 15) and a 80.0% prevalence of MetS in severe OSA (AHI > 30) were found. After adjusting for confounding variables, an increased level of Body-Mass Index (BMI) and two non-MetS cardiovascular risk factors, total cholesterol/HDL-C ratio and TG/HDL-C ratio was significantly associated with AHI in subjects with severe OSA. MetS was about three times to be present in subjects with severe OSA, even adjusted for BMI.

CONCLUSIONS

The findings showed a high prevalence of MetS in OSA among professional drivers, especially in the severe group category. BMI was the major contributing factor to OSA. However, the present study did not find a sensitive clinical marker of a detrimental metabolic profile in OSA patients.

The impact of obstructive sleep apnea on high-sensitivity C-reactive protein in subjects with or without metabolic syndrome

BACKGROUND

It is unclear whether obstructive sleep apnea (OSA) is independently associated with increased levels of the acute-phase reactant C-reactive protein (CRP). The purpose of this study was to evaluate the relationship between OSA and high-sensitivity CRP (hs-CRP) levels according to the presence or absence of metabolic syndrome (MetS).

METHODS

This study recruited 245 male bus drivers from one transportation company in Taiwan. Each participant was evaluated by a polysomnography (PSG) test, blood lipids examination, and hs-CRP. Severity of OSA was categorized according to the apnea-hypopnea index (AHI).

RESULTS

Subjects were categorized into severe OSA group (n = 44; 17.9 %), moderate and mild OSA group (n = 117; 47.8 %), and non-OSA group (n = 84; 34.3 %). AHI had a significant association with hs-CRP (β = 0.125, p = 0.009) adjusting for age, smoking, drinking, and MetS status. Hs-CRP was elevated with severe OSA (β = 0.533, p = 0.005) even adjusting for BMI and MetS. Moreover, there was an independent effect for adjusted odds ratios (AORs) between the stratification of the severity for OSA and MetS.

CONCLUSION

Elevated hs-CRP level is associated with severe OSA, independent of known confounders. The effect of OSA in CRP is independent of MetS was identified.

Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan

OBJECTIVE

To examine familial aggregation of gout and to estimate the heritability and environmental contributions to gout susceptibility in the general population.

METHODS

Using data from the National Health Insurance (NHI) Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from 22 643 748 beneficiaries of the NHI in 2004; among them 1 045 059 individuals had physician-diagnosed gout. We estimated relative risks (RR) of gout in individuals with affected first-degree and second-degree relatives and relative contributions of genes (heritability), common environment shared by family members and non-shared environment to gout susceptibility.

RESULTS

RRs for gout were significantly higher in individuals with affected first-degree relatives (men, 1.91 (95% CI 1.90 to 1.93); women, 1.97 (95% CI 1.94 to 1.99)) and also in those with affected second-degree relatives (men, 1.27 (95% CI 1.23 to 1.31); women, 1.40 (95% CI 1.35 to 1.46)). RRs (95% CIs) for individuals with an affected twin, sibling, offspring, parent, grandchild, nephew/niece, uncle/aunt and grandparent were 8.02 (6.95 to 9.26), 2.59 (2.54 to 2.63), 1.96 (1.95 to 1.97), 1.93 (1.91 to 1.94), 1.48 (1.43 to 1.53), 1.40 (1.32 to 1.47), 1.31 (1.24 to 1.39), and 1.26 (1.21 to 1.30), respectively. The relative contributions of heritability, common and non-shared environmental factors to phenotypic variance of gout were 35.1, 28.1 and 36.8% in men and 17.0, 18.5 and 64.5% in women, respectively.

CONCLUSIONS

This population-based study confirms that gout aggregates within families. The risk of gout is higher in people with a family history. Genetic and environmental factors contribute to gout aetiology, and the relative contributions are sexually dimorphic.

Circulating adipokines and insulin resistance in subjects with combined cardiac and metabolic syndrome X

BACKGROUND

Cardiac syndrome X (CSX) is characterized by angina pectoris but with patent coronary arteries. Our previous study showed that CSX subjects had decreased serum adiponectin but higher leptin and insulin resistance (IR). However, few studies have investigated circulating adipokines and IR in subjects with combined metabolic syndrome X (MetX) and CSX.

METHODS

Fifty-nine subjects with CSX were retrospectively enrolled from our cardiac catheterization patient databank. Fifty-four subjects with valvular heart disease or arrhythmia and with normal coronary angiograms were recruited as the non-CSX comparison group. The study subjects were reclassified according to the presence or absence of MetX. Circulating adipokines and degree of IR were measured.

RESULTS

Subjects with combined MetX and CSX had a significantly higher HOMA-IR, a higher circulating leptin level (median 8.7 vs. 3.3 ng/mL, p < 0.001), but a lower circulating adiponectin level (median 2.8 vs. 12.3 μg/mL, p < 0.001) than those without MetX and CSX. In pairwise comparisons, combined MetX and CSX subjects had a similar circulating adipokines and IR index as those who had only either one syndrome X. In a multivariate regression analysis, serum triglycerides (odds ratio 1.011, p = 0.024) and hypertension (odds ratio 14.453, p = 0.003) were independently associated with diagnosis of combined MetX and CSX.

CONCLUSIONS

Combined MetX and CSX had a significantly higher HOMA-IR, a higher circulating leptin but a lower circulating adiponectin level than those without MetX and CSX. Combined syndrome X did not confer more changes on adipokines or IR index comparing with those with only one syndrome X.

Vegetarian diet and cholesterol and TAG levels by gender

OBJECTIVE

The present study assessed the effects of vegetarian and omnivorous diets on HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), TAG and the ratio of HDL-C to total cholesterol (TC) by gender.

DESIGN

HDL-C, LDL-C, TAG and HDL-C:TC were compared among three diet groups (vegan, ovo-lacto vegetarian and omnivorous). Multivariate linear regression analysis was performed to examine factors significantly and independently associated with vegetarian status and to estimate the β value of lipid profiles for the diet groups. Settings A cross-sectional study. Data were obtained from the Taiwanese Survey on the Prevalence of Hyperglycemia, Hyperlipidemia and Hypertension (TwSHHH).

SUBJECTS

The study comprised included 3257 men and 3551 women.

RESULTS

After adjusting for confounders, vegan and ovo-lacto vegetarian diets lowered LDL-C levels (β=-10.98, P=0.005 and β=-7.12, P=0.025, respectively) in men compared with omnivorous diet. There was a significant association between HDL-C and vegan diet (β=-6.53, P=0.004). In females, the β values of HDL-C, TAG and HDL-C:TC were -5.72 (P<0.0001), 16.51 (P=0.011) and -0.02 (P=0.012) for vegan diet, and -4.86 (P=0.002), 15.09 (P=0.008) and -0.01 (P=0.026) for ovo-lacto vegetarian diet, when compared with omnivorous diet.

CONCLUSIONS

Vegan diet was associated with lower HDL-C concentrations in both males and females. Because the ovo-lacto vegetarian diet was effective in lowering LDL-C, it may be more appropriate for males.

Contextual factors influencing leisure physical activity of urbanized indigenous adolescents

BACKGROUND/PURPOSE

Indigenous populations suffer from disparities in socioeconomic resources and health status. One approach to addressing these disparities is by targeting modifiable risk factors such as leisure physical activity (LPA). This study investigated and compared factors related to LPA among urbanized indigenous and nonindigenous adolescent students.

METHODS

This cross-sectional survey comprised fifth to ninth grade indigenous and nonindigenous students (n = 733). The nonindigenous students were matched with indigenous students on sex and academic achievement and used as a reference group. Data were collected through telephone interviews using structured questionnaires. Major items included: demographic characteristics; average time spent watching television per bout; participation in LPA; and stress and depression experiences.

RESULTS

With the exception of the duration of television watching per bout, Chi-square and independent t tests demonstrated that there were no significant differences between indigenous and nonindigenous adolescents in the selected LPA-related factors. Multiple logistic regression analysis including terms investigating interaction between ethnicity and the contextual factors included in this study indicated that the following factors were correlated with LPA participation: age [odds ratio (OR) = 0.82, 95% confidence interval (CI) = 0.71-0.94], male sex (OR = 1.77, 95%CI = 1.19-2.61), total hours spent watching television in the past 2 weeks (OR = 0.79, 95%CI = 0.63-0.99), life satisfaction (OR = 2.25, 95%CI = 1.04-4.90), and exercise enjoyment (OR = 3.40, 95%CI = 1.71-6.74). However, neither indigenous status (OR = 1.03, 95%CI = 0.19-5.79) nor any of the interaction terms reached the significant level.

CONCLUSION

No significant ethnic differences were found in LPA participation. LPA was significantly correlated with age, male sex, total time spent watching television, life satisfaction, and enjoyment of exercise.

Prevalence and trend of dyslipidaemia from 1996 to 2006 among normal and overweight adolescents in Taiwan

OBJECTIVES

To evaluate the trend of dyslipidaemia from 1996 to 2006 and examine its relationship with weight status among adolescents in Taiwan.

DESIGN

2 cross-sectional surveys were conducted in 1996 and 2006.

SETTING

The junior high schools in Taipei.

PARTICIPANTS

After multistage sampling, total of 1500 and 1283 junior high school students were chosen in 1996 and 2006. After excluding missing data, a total of 1353 (676 boys and 677 girls) and 1203 (585 boys and 618 girls) children were included in the final analyses in 1996 and 2006.

OUTCOME MEASURES

Anthropometric measures as body height and weight were measured, and body mass index (BMI) was calculated. Blood lipid profiles as total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol were measured.

RESULTS

From 1996 to 2006, the prevalence of dyslipidaemia and hypercholesterolaemia significantly increased from 13% (95% CI 11.3% to 15.0%) to 22.3% (95% CI 20.0% to 24.7%) and 6.2% (95% CI 5.0% to 7.6%) to 13.8% (95% CI 11.9% to 15.9%), respectively. The prevalence of hypertriglyceridaemia and low HDL-C dyslipidaemia increased from 3% (95% CI 1.8% to 4.5%) to 4.3% (95% CI 2.8% to 6.2%) and 6.5% (95% CI 4.8% to 8.6%) to 11.6% (95% CI 9.1% to 14.5%), with significance seen only in boys. When compared with normal weight participants, overweight boys and girls faced a 2-fold and 1.6-fold increased risk of dyslipidaemia, respectively, in the 2006 study. The increased risk of low HDL-C dyslipidaemia for overweight participants was 2.6-fold and 7.2-fold in boys and girls, respectively. In 2006, each unit increment of BMI was associated with 28%, 13% and 13% risk of hypertriglyceridaemia, low HDL-C and dyslipidaemia for boys, and 25% risk of low HDL-C dyslipidaemia in girls.

CONCLUSIONS

The prevalence of dyslipidaemia had increased significantly for boys and girls in normal weight and overweight adolescents. Early screening of dyslipidaemia and weight intervention programmes in adolescents will be the key to prevent dyslipidaemia and cardiovascular-related comorbidities.

Hibiscus sabdariffa extract inhibits obesity and fat accumulation, and improves liver steatosis in humans

Obesity is associated with a great diversity of diseases including non-alcoholic fatty liver disease. Our previous report suggested that Hibiscus sabdariffa extracts (HSE) had a metabolic-regulating and liver-protecting potential. In this study, we performed a clinical trial to further confirm the effect of HSE. Subjects with a BMI ≧ 27 and aged 18-65, were randomly divided into control (n = 17) and HSE-treated (n = 19) groups, respectively, for 12 weeks. Our data showed that consumption of HSE reduced body weight, BMI, body fat and the waist-to-hip ratio. Serum free fatty acid (FFA) was lowered by HSE. Anatomic changes revealed that HSE improved the illness of liver steatosis. Ingestion of HSE was well tolerated and there was no adverse effect during the trial. No alteration was found for serum α-amylase and lipase. The clinical effect should mainly be attributed to the polyphenols of HSE, since composition analysis showed that branched chain-amino acids, which is associated with obesity, is not obviously high. In conclusion, consumption of HSE reduced obesity, abdominal fat, serum FFA and improved liver steatosis. HSE could act as an adjuvant for preventing obesity and non-alcoholic fatty liver.

Associations of subjective social status with physical activity and body mass index across four Asian countries

OBJECTIVE

The aims of this study were to (1) assess physical activity and weight status differences and (2) explore the direction and shape of subjective social status (SSS) association with physical activity and weight status within four Asian countries.

METHODS

Cross section data of adult respondents from the nationally representative East Asian Social Survey were used for analyses. Logistic regression stratified by gender was conducted for the first aim, and simple and quadratic logistic regression models were used for the second.

RESULTS

SSS was significantly associated with odds of weekly or daily physical activity across all countries and genders, except for South Korean and Japanese females. Quadratic models provided significantly better fit for Chinese males (LR (d.f. = 1) = 6.51, P value <.05) and females (LR (d.f. = 1) = 7.36, P value <.01), South Korean males (LR (d.f. = 1) = 4.40, P value <.05), and Taiwanese females (LR (d.f. = 1) = 4.87, P value <.05).

CONCLUSIONS

This study provides a comparable cross Asian country measure of moderate-to-vigorous physical activity and new findings that a connection exists between SSS and physical activity. Differences of class distinction help explain the different shaped SSS relationships.

The risky body mass index ranges for significant hepatitis B viral load: A campus-based study

SUMMARY

Significant hepatitis B viral load (≥10,000 copies/mL) was established to increase risk of advanced liver diseases. The aim of this study was to explore the metabolic risk factors for significant hepatitis B viral load. A campus-based cohort consisting of 146 participants of chronic hepatitis B virus (HBV) infection in Northern Taiwan was investigated in 2009. Clinical profiles including serum levels of deoxyribonucleic acid of hepatitis B virus (HBV DNA) were collected. Hepatitis B e antigen (HBeAg) serostatus, high alanine aminotransferase level, body mass index (BMI) ranges, and insulin resistance were related to significant HBV DNA levels in univariate analysis. Compared to individuals with BMI 23-24.9 kg/m(2) in multivariate analysis, those with BMI ≥25 kg/m(2) (OR = 3.86, 95% CI = 1.38-10.8, P = 0.010) and those with BMI <23 kg/m(2) (OR = 4.47, 95% CI = 1.32-15.2, P = 0.016) were at higher risk for significant HBV DNA levels. This phenomenon was also manifest in HBeAg seronegatives, who contributed to a majority of significant viral load in our study. Furthermore, insulin resistance and BMI ≥25 kg/m(2) had positive additive effects on significant HBV DNA levels (adjusted OR = 9.34, 95% CI = 1.74-50.3, P = 0.009). In conclusion, having certain BMI ranges (BMI ≥25 kg/m(2) or BMI <23 kg/m(2)) could be a risk factor of significant HBV DNA levels.:

Trends in incidence and survival outcome of epithelial ovarian cancer: 30-year national population-based registry in Taiwan

Objective

To investigate the changes of incidence and prognosis of epithelial ovarian cancer in thirty years in Taiwan.

Methods

The databases of women with epithelial ovarian cancer during the period from 1979 to 2008 were retrieved from the National Cancer Registration System of Taiwan. The incidence and prognosis of these patients were analyzed.

Results

Totally 9,491 patients were included in the study. The age-adjusted incidences of epithelial ovarian cancer were 1.01, 1.37, 2.37, 3.24, 4.18, and 6.33 per 100,000 person-years, respectively, in every 5-year period from 1979 to 2008. The age-specific incidence rates increased especially in serous, endometrioid and clear cell carcinoma, and the age of diagnosis decreased from sixty to fifty years old in the three decades. Patients with mucinous, endometrioid, or clear cell carcinoma had better long-term survival than patients with serous carcinoma (log rank test, p<0.001). Patients with undifferentiated carcinoma or carcinosarcoma had poorer survival than those with serous carcinoma (log rank test, p<0.001). The mortality risk of age at diagnosis of 30-39 was significantly higher than that of age of 70 years or more (test for trend, p<0.001). The mortality risk decreased from the period of 1996-1999 (hazard ratio [HR], 0.90; p=0.054) to the period after 2000 (HR, 0.74; p<0.001) as compared with that from the period of 1991-1995.

Conclusion

An increasing incidence and decreasing age of diagnosis in epithelial ovarian cancer patients were noted. Histological type, age of diagnosis, and treatment period were important prognostic factors for epithelial ovarian carcinoma.

Weight reduction effects of acupuncture for obese women with or without perimenopausal syndrome: a pilot observational study

This study was designed to compare the weight reduction effects of acupuncture for obese women with or without perimenopausal syndrome. We observed 60 women with either simple obesity or perimenopausal obesity (obesity complicated with perimenopausal syndrome) treated by five acupuncture treatments given in the first week of three successive four-week treatment courses, and obesity indexes including body weight, body mass index, obesity degree and waist/hip ratio were evaluated. Versus baseline, the obesity indexes decreased at the end of each treatment course in women with simple obesity (p < 0.05 or p < 0.01), while women with perimenopausal obesity showed no decrease at the end of the first course of treatment, and these indexes decreased at the end of the second and the third courses of treatment (p < 0.05). There was no difference when comparing obesity indexes recorded at the end of three courses of treatment and at the end of three-month follow-up between women with simple obesity and those with perimenopausal obesity. The results suggest that acupuncture reduced body weight in the obese women, and the weight loss occurred earlier in the treatment process for simple obesity than perimenopausal obesity.

The association between self-reported sleep quality and overweight in a Chinese population

OBJECTIVE

Sleep quality and obesity are associated with type 2 diabetes, hypertension, and metabolic syndrome. However, there is limited research on the association between sleep quality and obesity, and thus the aim of this study is to investigate this relationship in a Chinese population.

DESIGN AND METHODS

Subjects were recruited from the Prevention Health Center of National Cheng Kung University Hospital. Anthropometric data and metabolic parameters were measured. Being overweight or obese was defined according to the recommendations of the Department of Health in Taiwan. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Of the total 2,803 subjects, 1,059 were classified as normal weight, 1,127 were overweight, and 617 were obese. The global PSQI score were 6.30 ± 2.56, 6.61 ± 2.96, and 7.02 ± 2.95 in subjects who were normal weight, overweight, and obese, respectively (test for trend, P < 0.001). Of the variables tested in the multivariate linear regression model, female gender, being overweight, obesity, sleep duration, and alcohol drinking were significantly associated with global PSQI scores, and in the multivariate logistic regression model, female gender, being overweight, obesity, and sleep duration were independent predictors of poor sleepers after controlling for age, gender, BMI or different weight statuses, sleep duration, alcohol drinking, smoking, habitual exercise, hypertension, newly diagnosed diabetes, total cholesterol, high-density lipoprotein, triglyceride, estimated glomerular filtration rate, and alanine aminotransferase.

CONCLUSIONS

In conclusion, female gender, being overweight, obesity, and sleep duration were associated with poor sleep quality independent of cardiometabolic risk factors. In clinical practice, subjects who are obese, or even only overweight, should be evaluated for the presence of sleep disturbance.

Serum adiponectin levels are associated with hepatitis B viral load in overweight to obese hepatitis B virus carriers

OBJECTIVE

This study aimed to investigate the association between serum adiponectin and chronic hepatitis B virus (HBV) infection.

DESIGN AND METHODS

We conducted a campus-based cross-sectional study in Northern Taiwan, an HBV-endemic country. A total of 506 participants, including 147 chronic HBV-infected individuals and 359 healthy controls, were assessed for anthropometric indices, serum adiponectin levels, serum HBV viral load and markers, serum alanine aminotransferase levels and metabolic factors.

RESULTS

Older age, male gender, higher alanine aminotransferase, higher body mass index, greater waist circumference, lower fasting glucose, higher triglycerides, and higher adiponectin were associated with chronic HBV infection in univariate analyses. In multivariate analysis, the presence of chronic HBV infection was positively associated with serum adiponectin levels (P < 0.0001) and high adiponectin levels over the 75th percentile (odds ratio, 4.25; 95% confidence interval, 2.36-7.66; P < 0.0001) after adjusting for age, gender, body mass index, and insulin resistance index. Furthermore, serum adiponectin levels were positively associated with HBV viral load in overweight to obese HBV-infected subjects (P = 0.018).

CONCLUSION

Although chronic HBV-infected individuals were heavier than healthy controls, they had significantly higher serum adiponectin levels than healthy counterparts. Additionally, adiponectin levels were positively associated with HBV viral load in overweight to obese HBV-infected subjects. Future research should focus on elucidating adiponectin pathways, which may contribute to the development of adjuvant treatments for chronic HBV infection.

Nationwide surveillance in uterine cancer: survival analysis and the importance of birth cohort: 30-year population-based registry in Taiwan

Introduction

Uterine cancer was the most rapidly increasing malignancy and the second most common gynecologic malignancy in Taiwan.

Methods

We analyzed the secular trend of uterine cancer incidence and compare the survival of women with uterine carcinomas and uterine sarcomas in Taiwan. Data on women diagnosed with uterine cancer between 1979 and 2008 were obtained from the Taiwan cancer registry. Survival data were analyzed by using Kaplan-Meier and Cox proportional hazards regression methods.

Results

Records of 11,558 women with uterine carcinomas and 1,226 women with uterine sarcomas were analyzed. The age-adjusted incidence rate of endometrioid adenocarcinoma increased from 0.83 per 100,000 women per year between 1979 and 1983 to 7.50 per 100,000 women per year between 2004 and 2008. The 5-year survival rate of women with endometrioid adenocarcinoma (83.2%) was higher than that for women with clear cell carcinoma (58.3%), serous carcinoma (54.4%), and carcinosarcoma (35.2%) (p<0.0001, log-rank test). The 5-year survival rates of women with low grade endometrial stromal sarcoma, endometrial stromal sarcoma, leiomyosarcoma (LMS), and adenosarcoma were 97.5%, 73.5%, 60.1%, and 77.2%, respectively (p<0.0001, log rank test). The histologic type of endometrioid adenocarcinoma, young age, and treatment period after 2000 were independent, favorable prognostic factors in women with uterine carcinomas by multivariate analysis. The histologic type of LMS, old age, and treatment period after 2000 were independent, poor prognostic factors in women with uterine sarcomas by multivariate analysis.

Conclusions

An increase over time in the number of patients with endometrioid adenocarcinomas was noted in this 30-year, nationwide, population-based study. Histologic type, age and treatment period were survival factors for uterine cancers. A more comprehensive assessment of uterine cancers and patient care should be undertaken on this increasingly common type of cancer.

Obesity in Asia--is it different from rest of the world

An epidemic of obesity and obesity related diseases such as diabetes and cardio vascular disease (CVD) is prevalent in many Asian countries. Migration from rural to urban areas, and rapid socio-economic transition are associated with the lifestyle changes resulting in decreased levels of physical activity and increased intake of energy dense diet.

The epidemiology of urinary incontinence and it's influence on quality of life in Taiwanese middle-aged women

AIM

To evaluate the prevalence and risk factors of urinary incontinence (UI) and its effects on quality of life in women aged between 35 and 64 years.

METHODS

Data were obtained from the 2005 National Health Interview survey, in which 4,661 women aged between 35 and 64 years responded to questions concerning UI occurrence and health-related quality of life (HRQL), assessed using the Short Form 36, Taiwan version. Chi-square tests and multiple logistic regressions were applied to analyze comorbidity and risk factors of UI. Multivariable liner regression was used to evaluate the association between UI and HRQL.

RESULTS

The weighted UI prevalence in Taiwanese women aged 35-44, 45-54 years, and 55-64 years were 14.7%, 24.7%, and 32.4%, respectively. After adjustment, increased age, greater parity, higher BMI (body mass index), former HRT use, having a psychiatric disease, hyperlipidemia, and respiratory disease were identified as significant UI risk factors. Women with UI had significantly lower scores on all SF-36 dimensions. After adjusting for other factors, UI remained a significant predictor of all domains of SF-36 and was associated with reduced physical (by 2.31 points) and mental (by 2.76 points) component summary scores. From a mental health perspective, UI had a greater influence on HRQL than diabetes, hyperlipidemia, and chronic kidney disease.

CONCLUSION

The UI prevalence of Taiwanese women is high, and its negative effects on quality of life are greater than those of other major chronic conditions, but are often overlooked and seldom intervened.

Global gender disparities in obesity: a review

There is a global obesity pandemic. However, the prevalence of overweight and obesity among men and women varies greatly within and between countries, and overall, more women are obese than men. These gender disparities in overweight and obesity are exacerbated among women in developing countries, particularly in the Middle East and North Africa. Yet, in developed countries, more men are overweight than women. Current knowledge suggests that myriad sociocultural dynamics throughout the world exacerbate gender disparities in excess weight gain. Different contextual factors drive gender differences in food consumption, and women often report consuming healthier foods, yet may consume more sugar-laden foods, than men. Acculturation, through complex sociocultural pathways, affects weight gain among both men and women. The nutrition transition taking place in many developing countries has also affected excess weight gain among both genders, but has had an even greater impact on the physical activity levels of women. Furthermore, in some countries, cultural values favor larger body size among women or men as a sign of fertility, healthfulness, or prosperity. As the global obesity pandemic continues, more research on gender disparities in overweight and obesity will improve the understanding of this pandemic.

The relationship between obesity, insulin and arsenic methylation capability in Taiwan adolescents

PURPOSE

This study evaluated the arsenic methylation profile of adolescents and explored the influence of body mass index (BMI) on the arsenic methylation profile of adolescents in an area of Taiwan with no-obvious arsenic exposure.

METHODS

This study evaluated 202 normal weight students and 101 obese students from eight elementary schools, recruited from September 2009 to December 2009. Concentrations of urinary arsenic species, including inorganic arsenic, monomethylarsonic acid (MMA(5+)) and dimethylarsinic acid (DMA(5+)) were determined by a high-performance liquid chromatography-linked hydride generator and atomic absorption spectrometry.

RESULTS

Urinary total arsenic was significantly decreased with increasing BMI, indicating that obese children may retain higher levels of arsenic in the body, as compared to normal weight children. Participants with obesity accompanied by high insulin levels had higher inorganic arsenic, significantly higher MMA percentage and significantly lower DMA percentage than those with obesity and low insulin levels. It seems children with obesity and high insulin levels had lower arsenic methylation capacity than those with obesity and low insulin.

CONCLUSIONS

This is the first study to demonstrate that total urinary arsenic is negatively associated with the BMI in adolescents in Taiwan, adjusted for age and sex. Obese adolescents with high insulin levels had significantly higher MMA% and significantly lower DMA% than obese adolescents with low insulin.

Waist-to-height ratio, waist circumference, and body mass index as indices of cardiometabolic risk among 36,642 Taiwanese adults

PURPOSE

We aimed to investigate the association of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with cardiometabolic risk.

METHODS

In this cross-sectional study, 21,038 men and 15,604 women who participated in a health check-up were included.

RESULTS

In both men and women, the area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of diabetes, hypertension, high total cholesterol, high triglycerides, and low HDL-cholesterol (P < 0.05 for all). The AUC for WHtR in the prediction of metabolic syndrome (MS) was also highest in the women (P < 0.05). After adjustment for potential confounders, the odds ratios and 95% confidence intervals for MS for each standard deviation increase in BMI, WHtR, and WC were 1.47 (1.46-1.49), 1.32 (1.31-1.33), and 1.19 (1.18-1.19), respectively. Finally, patients of either sex with a normal BMI or WC level, but with an elevated WHtR, had higher levels of various cardiometabolic risk factors in comparison with their normal BMI or WC, but low WHtR, counterparts (P < 0.05 for all).

CONCLUSION

Among Taiwanese adults, a WHtR greater than 0.5 is a simple, yet effective indicator of centralized obesity and associated cardiometabolic risk, even among individuals deemed 'healthy' according to BMI and WC.

Prevalence of obesity and associated risk factors in Northeastern China

AIM

To investigate the prevalence of obesity and associated risk factors in the Northeastern Chinese city of Dehui.

METHODS

A cross-sectional study involving random sampling methods generated 3598 completed questionnaires by permanent residents of Dehui. Binary multivariate logistic regression analysis was used to identify factors that were significantly associated with obesity.

RESULTS

Based on the 2000 WHO diagnostic criterion regarding populations in the Asia-Pacific region, the prevalence of obesity was 37.71% (34.77% of females; 41.11% of males). Elevated body mass index (BMI) was significantly associated with cardiovascular disease (CVD)-associated conditions (P<0.05), and increased prevalence of abnormally high transaminase levels (P<0.05). Binary logistic regression analysis demonstrated the following variables were associated with obesity: increased age (odds ratio [OR]: 1.01, 95% confidence interval [CI]: 1.0-1.02), high total cholesterol (TC) (OR: 1.26, 95% CI: 1.03-1.54), high triglycerides (TG) (OR: 1.38, 95% CI: 1.16-1.64), hypertension (OR: 1.62, 95% CI: 1.39-1.90), fatty liver (OR: 2.91, 95% CI: 2.41-3.49), living in an urban setting (OR: 2.84, 95% CI: 2.39-3.38), and advanced education (OR: 1.22, 95% CI: 1.06-1.40).

CONCLUSIONS

Obesity is prevalent among the adult population in Northeastern China and is significantly associated with CVD risk factors such as hypertension, dyslipidemia, as well as transaminase abnormalities.

Transcutaneous electrical stimulation of acupoints changes body composition and heart rate variability in postmenopausal women with obesity

This study aimed to evaluate the effect of transcutaneous electric acupoint stimulations (TEAS) on body composition and heart rate variability (HRV) in postmenopausal women with obesity. In this prospective study, 49 postmenopausal women were recruited in Taiwan. Body composition was used as a screening test for obesity (percentage body fat > 30%, waist circumference > 80 cm). The experimental group (n = 24) received TEAS treatment 30 min twice per week for 12 weeks at the Zusanli (ST 36) and Sanyinjiao (SP 6) acupoints. The control group (n = 25) did not receive any intervention. The study of HRV was analyzed by time (standard deviation of the normal-to-normal (NN) intervals (SDNN) and square root of the mean squared differences of successive NN intervals (RMSSD) indices) and frequency domain methods. Power spectral components were obtained at low (LF) and high (HF) frequencies. Body composition and HRV values were measured at the 4th, 8th, and 12th weeks. A total of 40 subjects completed this study. Waist circumference and percentage body fat in the experimental group (n = 20) were significantly less than those of the control group (n = 20) at the 8th and 12th weeks (all P < .05). Additionally, at the same time points, percentage lean body mass in the experimental group was significantly greater than that in the control group (P < .05). SDNN values increased significantly at the 4th and 8th weeks when compared with the control group (all P < .05). At 12 weeks, SDNN value was not significantly different from that of the control group (P = .105). TEAS treatment improves body composition, and has a transient effect on the HRV in postmenopausal women with obesity.

A quantile regression approach to re-investigate the relationship between sleep duration and body mass index in Taiwan

OBJECTIVE

Previous studies on the relationship between sleep duration and body mass index (BMI) have shown inconsistent results by using estimation strategies within the framework of ordinary least squares (OLS). This study examined the relationship between sleep duration and BMI by using quantile regression to account for the potential heterogeneous effect of sleep duration on BMI in different BMI categories.

METHODS

The data of 2,392 adults were from the 2005 Panel Study of Family Dynamics in Taiwan. The dependent variable was BMI of the respondents. Both OLS and quantile regression models were used for comparison.

RESULTS

The OLS model does not show significant relationship, while the quantile regression model shows a U-shaped relationship between sleep duration and BMI beyond the 90th percentile in men (BMI = 28.69) and an inverse U-shaped relationship at the 30th percentile of BMI in women (BMI = 21.37).

CONCLUSIONS

Quantile regression can provide information that may be masked by OLS in analyzing the relationship between sleep duration and BMI. Sleep modification with the aim to obtain the optimal sleep duration may help to reduce BMI in obese men.

The effects and mechanism of xenogeneic adipocyte vaccine for the prevention of obesity in rats

The objectives of this study were to observe the effects of immunization with mouse mature adipocytes for the prevention of obesity in rats and to investigate their mechanism of action. Mouse mature adipocytes (3T3-L1) were injected as a vaccine into the abdominal cavity of rats. Control rats were injected with fibroblast cell lines (MRC-5 or NIH/3T3) or with 0.9% saline. Rats were fed a high calorie diet and body weight changes were used to evaluate obesity prevention. Immunohistochemical and immunofluorescence assays were used to investigate the mechanism of action. Results showed that obesity in rats can be prevented by immunization with xenogeneic mature mouse adipocytes. Body weight gain was inhibited in rats in the treatment group but not in the control groups and was statistically significant between the groups over the 19-week observation period. The assays demonstrated the presence of autoantibodies in rat adipocytes. It was concluded that vaccines of xenogeneic adipocytes can effectively prevent obesity in rats.

Waist-to-hip ratio is a better anthropometric index than body mass index for predicting the risk of type 2 diabetes in Taiwanese population

Body mass index (BMI) has been reported to be related to the risk of type 2 diabetes and hypertension. However, waist circumference or waist-to-hip ratio (WHR) can better reflect the accumulation of intra-abdominal fat and might be a better predictor than BMI of the risk of type 2 diabetes and hypertension. We hypothesized that other anthropometric indices rather than BMI could more accurately predict the risk of type 2 diabetes and hypertension. The purpose of this study was to determine which anthropometric index can be a better predictor for forecasting the risk of type 2 diabetes and hypertension in the Taiwanese population. We conducted a cross-sectional study and reviewed data derived from the Nutrition and Health Survey in Taiwan, 1993-1996. The subjects were 2545 men and 2562 women, aged 18 to 96 years. Receiver operating characteristic curve analysis was used to measure the predictive diabetic and hypertensive performance of each anthropometric measurement based on the area under the curve (AUC). Among 5 anthropometric indices, WHR had a significantly adjusted odds ratio (OR) and the highest AUC (0.72 for men and 0.80 for women) to predict the risk of type 2 diabetes. Although BMI had a significantly adjusted OR, the AUC was not the highest among the 5 anthropometric indices used to predict the risk of hypertension. Our findings suggested that WHR is a better anthropometric index for predicting the risk of type 2 diabetes, and the optimal cutoff values of WHR are considered as 0.89 for men and 0.82 for women in the Taiwanese population.

Serological surveillance and IL-10 genetic variants on anti-HBs titers: hepatitis B vaccination 20 years after neonatal immunization in Taiwan

BACKGROUND

The national hepatitis B (HB) vaccination program in Taiwan that began in 1984 has resulted in a significant reduction in the carrier rate among children. However, a significant proportion of Taiwanese neonatal HB immunization recipients have exhibited low anti-HBs titers that fall to non-protective or undetectable levels.

METHODS

We recruited 1677 entering freshman and graduate student participants at a Taiwanese university health center, grouped them into three age groups representing three stages of Taiwan's HB vaccination program, then conducted hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) serological surveillances for each individual. Univariate and multivariate regression analyses of clinical characteristics and Interleukin-10 (IL-10) genetic variations were also conducted.

RESULTS

A trend toward a decreasing HBsAg carrier rate was observed over the starting dates of the vaccination program (11.7%, 1.6% and 1.7% for age groups 1, 2 and 3, respectively), but we also observed an increasing rate of non-protective anti-HBs titers (15%, 26% and 50.3% for cohorts 1-3, respectively). The percentage of students with non-protective anti-HBs titers increased from 23.1% for students born in 1984, to 25.2% for those born in 1985, to 39.4% for birth-year 1986 students, to 45.7% for birth-year 1987 students, and to 56.5% for birth-year 1988 students. The risk for low anti-HBs titers increased concurrently with increases in systolic blood pressure (BP), the IL-10 ATA/ACC haplotype, and the IL-10 ATA present haplotype. Risk for low anti-HBs titers decreased with concurrent decreases in glucose ante cibum (AC, before meals) and the IL-10 ACC/ACC haplotype.

CONCLUSIONS

These results suggest that the genetic determinants may also contribute to variations in anti-HBs titers in immune responses to HB vaccination.

Rising burden of obesity in Asia

Overweight and obesity have reached epidemic proportions in many Asian countries. These countries also face a grave burden of obesity-related disorders such as diabetes, hypertension, and cardiovascular diseases, which develop at a younger age than in Western populations. These disorders are also manifested in childhood. The major causative factors are related to the lifestyle changes occurring due to rapid socioeconomic transition. Asian populations show several differences in genetic factors when compared with the white population, and they also have lower cut points for environmental risk factors. National programmes targeting public awareness, education and improved structural facilities to facilitate healthy lifestyle are the keys to alleviate the economic and health care burden of the obesity-related disorders.