Prevalence and clustering of cardiovascular risk factors among healthy adults in a Chinese population: the MJ Health Screening Center Study in Taiwan

Trends by age and sex and projections of disease prevalence from studying hypertensive heart disease in China over the past three decades

BACKGROUND

Hypertensive heart disease (HHD) is a common cause of cardiovascular disease and mortality worldwide, and its burden is increasing with aging populations.

OBJECTIVES

This study aimed to estimate the prevalence and mortality rates of HHD in mainland China and Taiwan Province using data from the Global Burden of Disease Study 2019 (GBD 2019), and forecast the development trend of HHD from 2020 to 2024.

METHODS

We obtained data on number of cases, deaths, crude prevalence rate, crude death rate, age-standardized prevalence rate (ASPR), and age-standardized death rate (ASDR) for mainland China and Taiwan Province from 1990 to 2019 from the GBD 2019. Joinpoint software was used to estimate average annual percentage change (AAPC) with 95% confidence intervals, and the number of HHD cases in China from 2022 to 2024 was predicted by the exponential smoothing method.

RESULTS

Between 1990 and 2019, HHD cases and deaths increased in mainland China, but the ASPR and ASDR decreased by 5.96% and 48.72%, respectively. In Taiwan Province, ASPR and ASDR decreased by 7.66% and 52.14%, respectively. The number of HHD cases and death rates varied by region, age, and sex, with a higher number of cases in mainland China than in Taiwan Province. By 2024, the number of HHD cases in mainland China was projected to be over 9.6 million cases, and in Taiwan Province, it was projected to surpass 120,000 cases.

CONCLUSION

The differences in HHD cases between mainland China and Taiwan Province in terms of age and sex indicated the need for effective prevention and control measures, especially targeting the elderly population. These findings can inform policymakers and health professionals in the development of targeted prevention and treatment strategies and resource allocation for HHD in China.

Association of sleep duration and sleeping pill use with mortality and life expectancy: A cohort study of 484,916 adults

OBJECTIVES

To compare mortality risk and life expectancy among individuals with different sleep durations and sleeping pill use.

METHODS

A cohort of 484,916 community-dwelling adults in Taiwan was recruited into a health screening program from 1994 to 2011. Subjects were categorized by daily sleep duration into 4 groups: extremely short (<4 hours), short (4-6 hours), medium (6-8 hours), and long (>8 hours). Cox proportional hazards models were used to investigate the associations of mortality risk with sleep duration and sleeping pill use. Models were adjusted for sociodemographic characteristics, lifestyle, and comorbidities. Life expectancy tables were calculated among sleeping pill users and nonusers with different sleep durations.

RESULTS

With 6- 8 hours of daily sleep, sleeping pill nonusers had the lowest mortality risk. Sleeping pill users, even with this optimal amount of sleep, had a 55% (p < .001, 95% CI, 1.38-1.73) higher mortality risk than nonusers. The life expectancy of 30-year-old male sleeping pill users with extremely short or long sleep durations was 12-13 years shorter than sleeping pill nonusers who had 6-8 hours of sleep. On average, life expectancy in individuals using sleeping pills (vs. nonusers) was shorter by 5.3 (95% CI, 4.10-6.32) years in men and 5.7 (95% CI, 5.28-7.98) years in women.

CONCLUSIONS

This study suggests that the use of sleeping pills is associated with an increased risk of mortality and shortened life expectancy, especially in extreme sleepers. Regular users should be aware of potential harms from sleeping pills.

[Temporal trends in inequalities of accumulated behavioral risk factors in Brazilian state capitals, 2008-2018]

The aim of this study was to assess trends in inequalities regarding sex and educational levels in accumulated behavioral risk factors in the Brazilian state capitals. Repeated surveys from a Vigitel surveillance initiative carried out from 2008 to 2018 including adults (≥ 18 years) living in the 26 Brazilian state capitals and in the Federal District were analyzed (n = 569246). Accumulation of at least two behavioral risk factors including physical inactivity, inadequate diet, tobacco use and abusive alcohol consumption. Simple and complex measures of inequality were calculated according to sex and educational level, in addition to assessing intersectionality between age groups and regions of the country. The accumulated risk factor prevalence between 2008 and 2018 decreased from 51.6% to 41.2% among males and from 45.3% to 30.8% among females. Despite the observed decreasing trends in the prevalence of accumulated risk factors over time, inequalities of sex and educational levels persisted. Adult males and people with lower levels of education persistently presented higher prevalence of accumulated risk factors, highlighting not only the need for monitoring strategies of such inequalities, but also for actions aiming at reducing this trend.

Cardiovascular risk factors in China: a nationwide population-based cohort study

BACKGROUND

It is estimated that 4 million deaths are due to cardiovascular diseases each year in China. Comprehensive understanding about modifiable risk factors and how the risk differs across regions is needed to inform public health policies. We aimed to examine the geographical profile of cardiovascular disease risk across China.

METHODS

In this study, we analysed data from a nationwide, population-based screening project, which covered 152 rural counties and 100 urban districts from 31 provinces in China. Between Sept 1, 2015, and Nov 30, 2019, standardised measurements were taken from participants aged 35-75 years who had lived in the region for at least 6 of the preceding 12 months to collect information on blood pressure, blood lipids, blood glucose, physical activity, tobacco smoking, alcohol use, overweight or obesity, and intake frequencies of fruits, vegetables, whole grains, legumes, and red meat. Individuals with a high risk of cardiovascular disease were identified according to medical history and WHO risk prediction charts.

FINDINGS

983 476 individuals were included in this study. Among the participants included, 10·3% (95% CI 10·2-10·3) had a high cardiovascular disease risk after standardising age and sex, with a range of 3·1-24·9% across counties or districts. Among the seven regions in mainland China, the prevalence of high risk of cardiovascular disease was relatively high in northeast China (12·6% [12·4-12·8]) and north China (11·4% [11·3-11·6]), whereas it was low in south China (8·0% [7·8-8·2]). The geographical profiles of the 12 major cardiovascular disease risk factors were different. We found that the regions with high cardiovascular disease risk were facing challenges such as obesity and high blood pressure (north China) and consumption of unhealthy non-staple food (low intake of fruits and vegetables or high intake of red meat; northeast China). By contrast, south China-the region with the lowest cardiovascular disease risk-had the highest prevalence of unhealthy staple food (low intake of whole grains and beans), abnormal metabolism (glucose and lipid), and low physical activity in the country.

INTERPRETATION

Risk for cardiovascular diseases varies geographically, and the major contributing risk factors are different across regions in China. Hence, geographically targeted interventions are needed to mitigate the risk and reduce the burden in such a vast country.

FUNDING

Ministry of Science and Technology, Ministry of Finance, and National Health Commission of China.

Association of obesity and pulse pressure with hypertension in an Iranian urban population

Objective:

Nowadays, obesity is an important health problem and pulse pressure (PP) is a good predictor of cardiovascular events. The aim of study was to determine the association of obesity and PP with hypertension (HTN) in individuals aged 30 years or older in the urban population of Jahrom, Iran.

Materials and Methods:

In this study, we used a multistage stratified sampling method to select participants among the urban population aged 30 years or older. Height, weight, and blood pressure were obtained by a trained physician. Obesity was defined according to the World Health Organization classification. Angina was assessed with reliable and validate Rose questionnaire. Data were record by SPSS-16. Categorical and continues variables analyzed by Chi-squared, independent t-test, and one-way ANOVA test. Binary logistic regression analysis method was used for the association of PP and obesity with HTN and Rose angina that adjusted for age, gender, education class, marital status, smoking, total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein. A P < 0.05 was considered as statistical significance.

Results:

The prevalence of obesity was 18.1% that was greater in women (24.8% vs. 9.9%, P < 0.001). The prevalence of Rose angina and HTN in obese individuals were more than in normal weight individuals (24.8% vs. 16.4%, P = 0.027) and (42.0% vs. 31.1%, P < 0.001), respectively. Furthermore, patients in higher PP groups were older, were more possible to had HTN and had greater diastolic blood pressure (DBP), systolic blood pressure (SBP), and mean arterial pressure (MAP) in compared to individuals in the lower PP group. The individuals with HTN had greater DBP, SBP, MAP, PP, and body mass index (BMI) than individuals without HTN. However, individuals who had Rose angina, only had higher PP and BMI in compared to ones without Rose angina. The obese individuals had 1.97 (1.22–3.17, P = 0.005) fold for HTN risk than individuals with normal weight. In addition, PP weakly increased the risk of HTN about 1.09 fold (1.07–1.10, P < 0.001). However, Rose angina was associated only to overweight status (odds ratio = 1.51, confidence interval 95%: 1.03–2.20), P = 0.035) than individuals in normal weight group.

Conclusion:

Obesity and PP were higher in hypertensive individuals and overweight in individuals with Rose angina. It is time to pay more attention to abnormal BMI.

Dietary patterns in relation to testosterone levels and severity of impaired kidney function among middle-aged and elderly men in Taiwan: a cross-sectional study

Background

Chronic Kidney Disease (CKD), characterized by an impaired kidney function, is associated with low testosterone levels. This study investigated the association between dietary patterns, testosterone levels, and severity of impaired kidney function among middle-aged and elderly men.

Methods

This cross-sectional study used the database from a private health-screening institute in Taiwan between 2008 and 2010. Men aged 40 years old and older (n = 21,376) with estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m² and proteinuria were selected. Among 21,376 men, 256 men had available measurements of testosterone levels. Dietary assessment was conducted using a food frequency questionnaire and three dietary patterns (fried-processed, vege-seafood, and dairy-grain dietary patterns) were identified using principal component analysis.

Results

Men in the lower tertiles (T1 and T2) of eGFR had significantly decreased testosterone levels by 0.8 (95% CI: − 1.40, − 0.20) and 0.9 nmol/L (95% CI: − 1.43, − 0.33). Furthermore, serum triglycerides (TG) levels were inversely associated with testosterone levels (β = − 0.51, 95% CI: − 0.77, − 0.24). Men in the higher tertile of fried-processed dietary pattern scores were associated with decreased testosterone levels by 0.8 nmol/L (95% CI: − 1.40, − 0.16), reduced testosterone-to-TG (T/TG) ratio by 1.8 units (95% CI: − 2.99, − 0.53), and increased risk of moderate/severe impaired kidney function (eGFR < 60 mL/min/1.73 m²) and proteinuria severity by 1.35 (95% CI: 1.15, 1.58) and 1.18 (95% CI: 1.02, 1.37) times respectively. In contrast, the vege-seafood dietary pattern was negatively associated with severity of impaired kidney function and proteinuria after multivariable adjustment, but had no association with testosterone levels and T/TG ratio.

Conclusions

The fried-processed dietary pattern is negatively associated with testosterone levels but positively associated with the severity of impaired kidney function. However, the vege-seafood and dairy-grain dietary patterns appear to have beneficial effects.

Electronic supplementary material

The online version of this article (10.1186/s12937-019-0467-x) contains supplementary material, which is available to authorized users.

High TSH Level within Normal Range Is Associated with Obesity, Dyslipidemia, Hypertension, Inflammation, Hypercoagulability, and the Metabolic Syndrome: A Novel Cardiometabolic Marker

(1) Background: Overt and subclinical hypothyroidism has been associated with increased cardiometabolic risks. Here we further explore whether thyroid function within normal range is associated with cardiometabolic risk factors in a large population-based study. (2) Methods: We screened 24,765 adults participating in health examinations in Taiwan. Participants were grouped according to high-sensitive thyroid-stimulating hormone (hsTSH) level as: <50th percentile (0.47–1.48 mIU/L, the reference group), 50–60th percentile (1.49–1.68 mIU/L), 60–70th percentile (1.69–1.94 mIU/L), 70–80th percentile (1.95–2.3 mIU/L), 80–90th percentile (2.31–2.93 mIU/L), and >90th percentile (>2.93 mIU/L). Cardiometabolic traits of each percentile were compared with the reference group. (3) Results: Elevated hsTSH levels within normal range were dose-dependently associated with increased body mass index, body fat percentage, waist circumferences, blood pressure, hemoglobin A1c (HbA1c), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), high homeostasis model of assessment of beta-cell (HOMA-β), triglycerides, total cholesterols, fibrinogen, and uric acids (p-for-trend <0.001), but not with fasting glucose levels. The association remained significant after adjustment of age, sex, and lifestyle. As compared to the reference group, subjects with the highest hsTSH percentile had significantly increased risk of being overweight (adjusted odds ratio (adjOR): 1.35), increased body fat (adjOR: 1.29), central obesity (adjOR: 1.36), elevated blood pressure (adjOR: 1.26), high HbA1c (adjOR: 1.20), hyperinsulinemia (adjOR: 1.75), increased HOMA-IR (adjOR: 1.45), increased HOMA-β (adjOR: 1.40), hypertriglyceridemia (adjOR: 1.60), hypercholesterolemia (adjOR: 1.25), elevated hsCRP (adjOR: 1.34), increased fibrinogen (adjOR: 1.45), hyperuricemia (adjOR: 1.47), and metabolic syndrome (adjOR: 1.42), but significant risk of low fasting glucose (adjOR: 0.89). Mediation analysis indicates that insulin resistance mediates the majority of the association between thyroid hormone status and the metabolic syndrome. (4) Conclusion: Elevated hsTSH within the normal range is a cardiometabolic risk marker associated with central obesity, insulin resistance, elevated blood pressure, dyslipidemia, hyperuricemia, inflammation, and hypercoagulability.

Cardiovascular risk assessment of dyslipidemic middle-aged adults without overt cardiovascular disease over the period of 2009-2016 in Lithuania

BACKGROUND

Cardiovascular mortality in Lithuania is extremely high and abnormal lipid levels are very common among Lithuanian adults. Dyslipidemia is one of the main independent risk factors for cardiovascular diseases (CVD) leading to high absolute CVD risk. The aim of this study was to assess CVD risk in dyslipidemic middle-aged subjects.

METHODS

During the period of 2009-2016 a total of 92,373 people (58.4% women and 41.6% men) were evaluated. This study included men aged 40-54 and women aged 50-64 without overt CVD.

RESULTS

Any type of dyslipidemia was present in 89.7% of all study population. 7.5% of dyslipidemic patients did not have any other conventional risk factors. Three and more risk factors were detected in 60.1% of dyslipidemic subjects. All analyzed risk factors, except smoking, were more common in dyslipidemic adults compared to subjects without dyslipidemia: arterial hypertension (55.8% vs. 43.3%, p < 0.001), diabetes (11.1% vs. 7.3%, p < 0.001), abdominal obesity (45.3% vs. 30.2%, p < 0.001), BMI ≥30 kg/m2 (35.8% vs. 23.7%, p < 0.001), metabolic syndrome (34.0% vs. 9.2%, p < 0.001), family history of coronary heart disease (26.3% vs. 23.1%, p < 0.001), unbalanced diet (62.5% vs. 52.9%, p < 0.001) and insufficient physical activity (52.0% vs. 44.2%, p < 0.001). The prevalence of all evaluated risk factors, except smoking, increased with age. Average SCORE index was 1.87 in all study population, while dyslipidemic subjects had higher SCORE compared to control group (1.95 vs 1.20, p < 0.001).

CONCLUSIONS

Almost two thirds of dyslipidemic middle-aged Lithuanian adults without overt cardiovascular disease had three or more other CVD risk factors, which synergistically increase absolute risk of CVD. The average 10-year risk of CVD death in patients with dyslipidemia was 1.95%. The importance of managing dyslipidemia as well as other risk factors in order to reduce burden of cardiovascular disease in Lithuania is evident.

Prevalence and clustering of cardiovascular risk factors: a cross-sectional survey among Nanjing adults in China

OBJECTIVES

To estimate prevalence and clustering of cardiovascular risk factors (CRFs), and investigate the association between relevant characteristics and CRF clustering among adults in eastern China.

DESIGN

Community-based cross-sectional study.

SETTING

Data were collected by interview survey, physical measurements and laboratory examinations from the 2011 Nanjing Chronic Disease and Risk Factor Surveillance.

PARTICIPANTS

A representative sample of 41 072 residents aged ≥18 years volunteered to participate in the survey, with a response rate of 91.3%. We excluded 1232 subjects due to missing data or having a history of cardiovascular diseases; a total of 39 840 participants were included in the analysis.

OUTCOME MEASURES

Prevalence and clustering of five major CRFs including hypertension, diabetes, dyslipidaemia, overweight or obesity and current smoking.

RESULTS

Of 39 840 participants (mean age 47.9±16.2 years), 17 964 (45.1%) were men and 21 876 (54.9%) were women. The weighted prevalence of CRFs ranged between 6.2% for diabetes and 35.6% for overweight or obesity. The proportion of CRFs tended to be higher in men, the elderly, participants who lost a life partner, or lived in rural areas, or had lower level of education and total annual income. Overall, 30.1% and 35.2% of participants had one and at least two CRFs, respectively. Multivariate logistic regression revealed that men, older age, loss of a life partner, lower level of socioeconomic status, rural areas, insufficient physical activity or unhealthy diets were positively associated with CVD risk factor clustering, compared with their counterparts.

CONCLUSIONS

High regional prevalence of hypertension, dyslipidaemia, overweight or obesity and their clustering are present in Nanjing. The Nanjing government should develop effective public health policies at the regional level especially for high-risk groups, such as enhancing the public's health awareness, organising health promotion programmes, implementing smoke-free law, producing healthy nutrient foods, providing free or low-cost public sports and fitness facilities.

The Prevalence and Awareness of Cardiovascular Diseases Risk Factors among the Lebanese Population: A Prospective Study Comparing Urban to Rural Populations

Introduction. CVDs are largely driven by modifiable risk factors. This study sought to determine the awareness and prevalence of the modifiable CVDs risk factors among the Lebanese population. Methods. In a cross-sectional survey, 1000 participants aged ≥ 45 years were randomly selected from pharmacies and interviewed. The data was analyzed with SPSS version 21.0 software. Results. Differences between urban and rural areas include alcohol consumption (2.8% versus 1.7%; p = 0.0001), cardioprotective vegetable servings (6.1% versus 2.3%; p = 0.016), sedentary hours per day (18.6% versus 15.1%; p = 0.002), and hypertension (38.5% versus 25.4%; p = 0.001). The prevalence of overweight and obesity (77.3% versus 75.2%; p = 0.468), smoking (39.3% versus 43.3%; p = 0.232), diabetes (25.4% versus 21.4%; p = 0.173), and dyslipidemia (25 versus 21.2%) was reported. Measurements revealed 19.3% of undiagnosed hypertension (12.4% versus 22.4%, p = 0.001), 61.7% of hypertension (59.8% versus 62.6%; p = 0.203), and 7.9% of undiagnosed diabetes (6.6% versus 8.6%; p = 0.323). The declared awareness of CVDs risk factors was highest for smoking (91.5% versus 89.7%; p = 0.339) and lowest for diabetes (54.4 versus 55.7%; p = 0.692). Conclusion. This study has shown a high prevalence of modifiable CVDs risk factors in the Lebanese population ≥ 45 years, among which hypertension is the most prominent.

Prediction of 4-year incident diabetes in older Chinese: recalibration of the Framingham diabetes score on Guangzhou Biobank Cohort Study

OBJECTIVE

To recalibrate and modify the Framingham diabetes mellitus (DM) function and establish a simple point score for predicting near-term incident diabetes in a large sample of Chinese.

METHODS

A total of 16,043 participants aged 50years or above without diabetes at baseline from the Guangzhou Biobank Cohort Study (GBCS) were recruited from 2003 to 2008 and followed up until 31 December 2012, with an average follow-up period of 4.1years. A randomly selected sub-sample of 8000 participants was used to calculate the predictive model and the remaining sample including 8043 participants was used for validating the prediction model.

RESULTS

During follow-up, 5.2% (95% confidence interval (CI) 4.6-5.9) of men and 5.2% (95% CI 4.8-5.6) of women developed diabetes. A GBCS point score prediction model was constructed based on the Framingham DM function risk factors using the randomly selected sub-sample. Compared with the Framingham DM risk score (AUC 0.740, 95% CI 0.715-0.766), the GBCS point score prediction model predicted the development of diabetes well, with an AUC of 0.779 (95% CI 0.756-0.801, P for comparison <0.001). Validation analysis showed that the new GBCS function had satisfactory predictive ability for actual DM incidence and improved the calibration substantially. The original Framingham DM score underestimated diabetes incidence in the GBCS sample.

CONCLUSIONS

The constructed GBCS point score prediction model based on GBCS coefficients could be more useful for identifying high risk individuals in Chinese populations than the original Framingham DM score.

The impact of socioeconomic status on the incidence of metabolic syndrome in a Taiwanese health screening population

OBJECTIVES

The purpose of this study was to estimate the incidence of metabolic syndrome (MS) in a 5-year follow-up adult population in Taiwan who were examined at the Major Health Screening Center, and to assess possible socioeconomic determinants of the syndrome in this sample.

METHODS

The longitudinal study included 9,389 adults, aged 35-74 years, who visited the Major Health Screening Center from 1998-2002, and were followed up for 5 years.

RESULTS

The 5-year cumulative incidence of MS in this sample was 11.37%, and the weighted incidence was 12.46%; 14.95% for men and 9.89% for women, respectively. After adjustment for behavioral and habits, family history, gender and age, education level was associated with the incidence of MS. With middle school and lower as a baseline, the incidence of MS for high school, junior college, and college and above was OR 0.80, 95% CI 0.64-1.00; OR 0.80, 95% CI 0.62-1.03 and OR 0.65, 95% CI 0.50-0.83, respectively.

CONCLUSIONS

The standardized cumulative incidence of MS was 12.46%. Lower education level was an important socioeconomic determinant of MS in women.

Unravelling the effects of age, period and cohort on metabolic syndrome components in a Taiwanese population using partial least squares regression

Background

We investigate whether the changing environment caused by rapid economic growth yielded differential effects for successive Taiwanese generations on 8 components of metabolic syndrome (MetS): body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), triglycerides (TG), high-density lipoprotein (HDL), Low-density lipoproteins (LDL) and uric acid (UA).

Methods

To assess the impact of age, birth year and year of examination on MetS components, we used partial least squares regression to analyze data collected by Mei-Jaw clinics in Taiwan in years 1996 and 2006. Confounders, such as the number of years in formal education, alcohol intake, smoking history status, and betel-nut chewing were adjusted for.

Results

As the age of individuals increased, the values of components generally increased except for UA. Men born after 1970 had lower FPG, lower BMI, lower DBP, lower TG, Lower LDL and greater HDL; women born after 1970 had lower BMI, lower DBP, lower TG, Lower LDL and greater HDL and UA. There is a similar pattern between the trend in levels of metabolic syndrome components against birth year of birth and economic growth in Taiwan.

Conclusions

We found cohort effects in some MetS components, suggesting associations between the changing environment and health outcomes in later life. This ecological association is worthy of further investigation.

Metabolic syndrome and the development of chronic kidney disease among 118 924 non-diabetic Taiwanese in a retrospective cohort

AIM

Metabolic syndrome (MetS) is a common risk factor for cardiovascular and chronic kidney disease (CKD) in Western populations; however, no prospective studies have examined MetS as a risk factor for CKD in Chinese adults.

METHODS

The incidence of CKD and the prospective link between MetS (defined by two criteria: modified Adult Treatment Panel III (ATP-III) and the International Diabetes Federation (IDF)) and CKD among 118,924 Taiwanese participants without baseline diabetes, aged 20-74 years with a mean 3.7 years follow up, was examined. CKD was measured by using estimated glomerular filtration rate or dipstick proteinuria (1+). The association between MetS or combination patterns of MetS abnormalities and CKD was evaluated using Cox models with adjustment for confounders.

RESULTS

The incidence of CKD was 288/10,000 person-years (95% confidence interval (CI), 283-293). The findings showed that central obesity (OB), high blood pressure (BP) and high triglyceride were considered to be the major metabolic events in the study cohort. Incidences and hazard ratios (HR) on CKD had evidently increasing trends with the number of MetS components. The multivariable-adjusted HR for CKD associated with ATP-III-MetS was 1.30 (95% CI, 1.24-1.36). Equivalent HR for IDF-MetS were 1.37 (95% CI, 1.30-1.44). The associations were still observed when analyzing by stratifying incident diabetes and adjusting hypertension status.

CONCLUSION

MetS induces an increased risk for CKD independent of baseline confounding factors and subsequent incident diabetes modified the associations lightly. The mechanism through which MetS may cause CKD in this population likely is the development of multiple metabolic pathogenic processes together.

A recombinant peroxisome proliferator response element-driven luciferase assay for evaluation of potential environmental obesogens

A recombinant Huh7-PPRE-Luc cell line for analyzing the peroxisome proliferator response element (PPRE)-driven luciferase activity was established. The cells exhibited a good dose-response induction in PPRE-driven luciferase activity by three subtypes of peroxisome proliferator-activated receptor (PPAR) agonists as well as by a retinoid X receptor agonist, 9-cis-retinoic acid. Among five environmental chemicals tested, benzyl butyl phthalate and bisphenol induced PPRE-driven luciferase activation in Huh7-PPRE-Luc cells and caused adipogenic differentiation of 3T3-L1 cells. This recombinant Huh7-PPRE-Luc cell line would be useful for screening potential environmental obesogens with PPAR activity.

Diabetes in Asia

Prevalence of type 2 diabetes has rapidly increased in native and migrant Asian populations. Diabetes develops at a younger age in Asian populations than in white populations, hence the morbidity and mortality associated with the disease and its complications are also common in young Asian people. The young age of these populations and the high rates of cardiovascular risk factors seen in Asian people substantially increase lifetime risk of cardiovascular disease. Several distinctive features are apparent in pathogenetic factors for diabetes and their thresholds in Asian populations. The economic burden due to diabetes at personal, societal, and national levels is huge. National strategies to raise public awareness about the disease and to improve standard of care and implementation of programmes for primary prevention are urgently needed.

NaCl plus chitosan as a dietary salt to prevent the development of hypertension in spontaneously hypertensive rats

The effect of NaCl plus 3% chitosan on the systolic blood pressure of spontaneously hypertensive rats (SHR) were evaluated and compared with NaCl plus KCl (NaCl, 49.36% + KCl 49.36%) and chitosan or NaCl treatment alone. In SHR, administration of NaCl plus chitosan (44 mM Na/day) for two months significantly decreased the systolic blood pressure greater than of NaCl plus KCl and NaCl alone. NaCl plus chitosan resulted, though not statistically significant, in decreased urinary Na⁺ excretion and decreased blood urea nitrogen levels. Urinary creatinine of NaCl plus chitosan was slightly decreased compared to 3 treated groups. Serum electrolytes levels, however, remained unchanged. The combination of NaCl and chitosan may be superior to the conventional use of NaCl plus KCl or NaCl alone in the prevention of hypertension. Even though these supplementary diets have demonstrated potential anti-hypertensive effects in the experimental animal model, further research is needed before any recommendations can be made.

An accurate risk score for estimation 5-year risk of type 2 diabetes based on a health screening population in Taiwan

This study aimed to provide the epidemiological model evaluating the risk of developing type 2 diabetes (T2DM) in Taiwan periodic health-check population. We derived risk functions using multivariate Cox regression in a random half of the sample. Rules based on these risk functions were evaluated in another half. Model coefficients were used to assign each variable a score. 73,961 subjects aged 35-74, were included and followed up with a median 3.15 years. Six predictive models (PMs) were developed. PM1 contained simple clinical information, while PM2 contained fasting plasma glucose (FPG) based on PM1, and PM3 further added variables indicating lipid level, liver and kidney. PM4 only included FPG. The capability of published ARIC score model was also evaluated. Eventually we considered score defined nine predictors by PM2. The area under the ROC curve (AUC) was 0.848 (95% CI, 0.829-0.868) predicting diabetes within 5 years, and also had adequate performance in validation subsample (AUC=0.833, 95% CI, 0.811-0.855). The 5-year T2DM probability can be calculated by: 1-0.9743960037 exp((score points -15.0281284)). We concluded that this diabetes risk score, derived from clinical information combined with FPG is a simple, effective tool to identify individuals at high risk for undiagnosed T2DM.

All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan

BACKGROUND

Both end-stage renal disease and chronic kidney disease are increasing worldwide; however, the full effect of chronic kidney disease is unknown because mortality risks for all five stages are unavailable. We assessed prevalence and mortality risks for all stages of chronic kidney disease and quantified its attributable mortality in Taiwan.

METHODS

The cohort consisted of 462 293 individuals aged older than 20 years who participated in a standard medical screening programme since 1994. As of Dec 31, 2006, we identified 14 436 deaths. Chronic kidney disease was determined by glomerular filtration rate and urinary protein. We estimated national prevalence in Taiwan from the cohort by adjusting age and educational levels. Hazard ratios (HRs) were calculated with Cox proportionate hazards model. We calculated mortality attributable to chronic kidney disease for national population and for low socioeconomic status.

FINDINGS

The national prevalence of chronic kidney disease was 11.93% (95% CI 11.66-12.28), but only 3.54% (3.37-3.68) of participants in the cohort were aware of their disorder. Prevalence was substantially higher in the group with low socioeconomic status than in the high status group (19.87% [19.84-19.91] vs 7.33% [7.31-7.35]). 56 977 (12%) of cohort participants had chronic kidney disease; those with disease had 83% higher mortality for all cause (HR 1.83 [1.73-1.93]) and 100% higher for cardiovascular diseases (2.00 [1.78-2.25]), in a cohort that was observed for 13 years with median follow-up of 7.5 years (IQR 4.0-10.1). 10.3% (95% CI 9.57-11.03) of deaths in the entire population were attributable to chronic kidney disease, but 17.5% (16.27-18.67) of deaths in the low socioeconomic status population. 2350 (39%) deaths occurred before 65 years of age in those with chronic kidney disease. Regular users of Chinese herbal medicines had a 20% (odds ratio 1.20 [1.16-1.24]) increased risk of developing chronic kidney disease.

INTERPRETATION

The high prevalence of chronic kidney disease and its associated all-cause mortality, especially in people with low socioeconomic status, make reduction of this disorder a public-health priority. Promotion of its recognition through the general public knowing their glomerular filtration rate and testing their urine is crucial to reduce premature deaths from all causes and to attenuate this global epidemic.

Application of classification tree and logistic regression for the management and health intervention plans in a community-based study

BACKGROUND

A community-based aboriginal study was conducted and analysed to explore the application of classification tree and logistic regression.

METHODS

A total of 1066 aboriginal residents in Yilan County were screened during 2003-2004. The independent variables include demographic characteristics, physical examinations, geographic location, health behaviours, dietary habits and family hereditary diseases history. Risk factors of cardiovascular diseases were selected as the dependent variables in further analysis.

RESULTS

The completion rate for heath interview is 88.9%. The classification tree results find that if body mass index is higher than 25.72 kg m(-2) and the age is above 51 years, the predicted probability for number of cardiovascular risk factors > or =3 is 73.6% and the population is 322. If body mass index is higher than 26.35 kg m(-2) and geographical latitude of the village is lower than 24 degrees 22.8', the predicted probability for number of cardiovascular risk factors > or =4 is 60.8% and the population is 74. As the logistic regression results indicate that body mass index, drinking habit and menopause are the top three significant independent variables.

CONCLUSIONS

The classification tree model specifically shows the discrimination paths and interactions between the risk groups. The logistic regression model presents and analyses the statistical independent factors of cardiovascular risks. Applying both models to specific situations will provide a different angle for the design and management of future health intervention plans after community-based study.

Association of obesity and chronic diseases in Taiwan

Two systems were used to classify weight status based on body mass index (BMI) of 3,178 Taiwanese adults who participated in the 1993-1996 Nutrition and Health Survey and to explore associations of BMI categories and disease. In the system proposed by the International Association for the Study of Obesity and the International Obesity Taskforce for Asian adults, overweight was associated with one disease (hypertension) and obesity was associated with four diseases: diabetes (OR = 2.66; 95% CI = 1.39-5.09; p < 0.01); gout (OR = 4.33; 95% CI = 1.92-9.75; p < 0.01); hypertension (OR = 4.92; 95% CI = 2.87-8.42; p < 0.01); thyroid disease (OR = 2.29; 95% CI = 1.12-4.67; p < 0.05). In the system devised by Taiwan Health Department for Taiwanese adults, overweight was associated with four diseases (arthritis, diabetes, gout, hypertension), and obesity was associated with three diseases: diabetes (OR = 2.11; 95% CI = 1.07-4.19; p < 0.05); gout (OR = 4.06; 95% CI = 1.77-9.28; p < 0.01); hypertension (OR = 5.28; 95% CI = 3.23-8.63; p < 0.01). The Obesity Taskforce may underestimate the association of excess weight and disease in Taiwan.

Prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong, and Taiwan

This article reviews and describes trends and differences in prevalence of type 2 diabetes mellitus of Chinese populations in Mainland China, Hong Kong and Taiwan based on literatures published in the MEDLINE Advanced database (January 1966-October 2005) in both Chinese and English languages. Chinese populations in Hong Kong and Taiwan have significant higher prevalence rates of diabetes than their Mainland counterparts, with odds ratios 1.5 (95% confidence intervals: 1.4, 1.7) and 2.0 (95% confidence intervals: 1.8, 2.2), respectively in 1995-2003 adjusted for age and diagnostic criteria. Using stratified diagnostic criteria; the odds ratios in Hong Kong and Taiwan were consistently higher than Mainland China for the periods of 1985-1994 and 1995-2003. A large proportion, i.e. 68.6% (95% confidence intervals: 67.4%, 69.7%) of diabetic patients remains undiagnosed in Mainland China as compared to 52.6% (95% confidence intervals: 49.8%, 55.5%) undiagnosed in Hong Kong and Taiwan. The prevalence rates of diabetes and impaired glucose tolerance of the Chinese populations rise in older age groups. In tandem with economic development and change toward lifestyle that is lack of physical activity and rich in high-fat diet, prevalence of diabetes of the Chinese populations are on the rise. If the undiagnosed individuals left uncontrolled, they are subject to higher risks of developing diabetes and its complications. These will increase the burdens of diabetes medically and financially.

Prevalence of obesity in Taiwan

In Taiwan, the prevalence and problem of obesity has increased significantly in recent decades and has became an important public health issue. In children (12-15 years), the prevalence of obesity (defined as body weight > 120% of mean body weight with age- and gender-specification) was 12.4%, 14.8% and 15.6% among boys and 10.1%, 11.1% and 12.9% among girls in 1980, 1986 and 1996 respectively. A survey of 1500 12-15-year-old children during 1995-1996 in Taipei city found that about 16.6% of boys and 11.1% of girls were obese, while an additional 11.6% of boys and 10.2% of girls were overweight. In adults, using the criteria defined by the Department of Health in Taiwan [overweight as (body mass index) BMI > or = 24 and obese as BMI > or = 27], the age-adjusted prevalence of obesity was 10.5% and 15.9% for men and 13.2% and 10.7% for women from 1993-1996 to 2000-2001. From these data, we found that the prevalence of obesity in Taiwan has increased steadily from 1980 to 2000 especially in children and in men.

Physical activity buffers the effects of chronic stress on adiposity in youth

BACKGROUND

The moderating effect of physical activity (PA) on relations between chronic stress and adiposity is unknown in youth.

PURPOSE

The objective is to assess the mediating effect of PA on relations between stress and adiposity in youth.

METHODS

Participants were 303 youths (47% Black, 53% White, 50% male, M age = 16.6 years). The Adolescent Resource Challenge Scale assessed personal stress, whereas median rent or mortgage in the neighborhood reflected community stress. Body mass index (BMI) and sum of skinfolds reflected general adiposity, and waist circumference measured central adiposity. Days per week performing PA sufficient to work up a sweat measured PA.

RESULTS

Hierarchical regressions predicted each adiposity measure adjusting for age, race, gender, family socioeconomic status, and parental smoking. Independent contributions of personal stress, but not community stress, were found on BMI and sum of skinfolds. A similar model showed that both personal and community stress predicted waist circumference. PA was independently, inversely associated with sum of skinfolds but not BMI or waist circumference. The interaction between PA and personal stress predicted all three adiposity measures. The interaction of PA with community stress predicted BMI.

CONCLUSIONS

PA appears to buffer the effects of chronic stress on adiposity, providing evidence that PA is a protective factor for health.

PREVALENCE OF OVERWEIGHT AND SMOKING PATIENTS WITH CORONARY HEART DISEASE IN RURAL CHINA

OBJECTIVE

To investigate the prevalence of overweight and/or smoking patients with coronary artery disease in rural China.

DESIGN

A prospective survey with qualitative, open-ended questionnaires.

SETTING

Tertiary referral centre.

SUBJECTS

158 hospitalised patients (71 men and 87 women) with established coronary heart disease.

MAIN OUTCOME MEASURES

To determine the prevalence of overweight and/or smoking hospitalised patients who had a definitive diagnosis of coronary artery disease and to determine participants understanding of these risk factors.

RESULTS

Being overweight and smoking cigarettes were found in 32.7% and 15.2% of the participants, respectively. More than 70% of the overweight participants had neither knowledge nor counselling on their weight before the study. Most smokers believed smoking was harmful to their health and cardiac condition, and had tried unsuccessfully to quit smoking.

CONCLUSIONS

There was a high prevalence of overweight and/or smoking patients with coronary heart disease. A systematic approach is urgently required to educate patients and primary care physicians, and to improve the management of being overweight and smoking cigarettes.

Epidemiology of hypertension and associated cardiovascular risk factors in a country in transition: a population based survey in Tirana City, Albania

STUDY OBJECTIVE

To describe the prevalence of hypertension and other cardiovascular risk factors on the adult population of Tirana City (Albania).

DESIGN

Cross sectional survey.

SETTING

Tirana City in mid-2001.

PARTICIPANTS

1120 adults aged 25 years and over (response rate=72.7%).

MAIN RESULTS

Overall, hypertension prevalence (blood pressure =140 and/or 90 mm Hg, or known hypertensive receiving anti-hypertensive treatment) was 31.8% (36.6% and 27.4% in men and women respectively). Age standardised prevalence of hypertension (adjusted to the adult population of Tirana) was 30.2% (99% confidence intervals 29.8% to 30.6%) in men and 22.7% (22.3% to 23.1%) in women. Men were significantly more likely to be hypertensive than women (p value=0.001). Of those who had been diagnosed with hypertension, 87% were receiving anti-hypertensive therapy and more than half of them (52%) were adequately controlled. The prevalence of hypertension increased with increasing age and was more common in the obese in both sexes. While the prevalence of hypertension matched that in other industrialised and transition countries, the combination of hypertension with other cardiovascular risk factors was rather less common.

CONCLUSION

These findings provide important new evidence on the prevalence of hypertension and its association with other cardiovascular risk factors in Albania. Albania is in a state of rapid transition, with evidence that risk factors for non-communicable diseases have already increased considerably over the past two decades. These finding provide a unique baseline against which future change can be compared.

Body composition as a risk factor for coronary artery disease in Chinese type 2 diabetic patients in Taiwan

This study aimed to clarify whether body mass index (BMI), waist/hip ratio (WHR) or percent body fat (%fat) is associated with coronary artery disease (CAD) in Chinese type 2 diabetic patients in Taiwan. A total of 463 patients were recruited. BMI and WHR were measured by standard methods and %fat by bioelectrical impedance. CAD was diagnosed as acute myocardial infarction, angina pectoris, or an electrocardiogram showing 'coronary probable or possible' according to the Minnesota codes. Age, sex, diabetes duration, hypertension, smoking, fasting plasma glucose, hemoglobin A(1c),and serum concentrations of total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol were treated as confounders. Results showed that 144 patients had CAD. Age, hypertension, HDL-C and %fat were independently associated with CAD. CAD prevalence was 25.5%, 26.8%, 31.9% and 43.0%, respectively, for the first to fourth quartile of %fat (p<0.05). Multivariate-adjusted odds ratio for CAD for every 1% increase in %fat was 1.02 (1.01-1.03); and 1.01 (0.73-1.88), 1.26 (0.69-2.32) and 2.11 (1.09-4.07) for the second to fourth quartile, respectively, compared with the first quartile. BMI and WHR were not associated with CAD in similar analyses. In conclusion, %fat was a better predictor for CAD than BMI and WHR in Chinese type 2 diabetic patients in Taiwan.