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A. Assaf E, Al Sabbah H, Al-Jawadleh A. Analysis of the nutritional status in the Palestinian territory: a review study. Front Nutr 2023; 10:1206090. [PMID: 37533576 PMCID: PMC10391640 DOI: 10.3389/fnut.2023.1206090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/19/2023] [Indexed: 08/04/2023] Open
Abstract
Background Food insecurity, occupation, and poverty contribute to the poor nutritional status of Palestine. This review study aimed to analyze the nutritional status in the Palestinian Territory by analyzing published data from 2011 to 2023. Method Searching for relevant publications yielded 67 studies. Based on reviewing these studies, five major themes were identified: low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Results Based on the review of these studies, five major themes were identified, namely, low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Based on the literature, the prevalence rate of exclusive breastfeeding was 24.4% in the Gaza Strip, compared to a national rate of 39.9% in 2020. Smoking, anemia in mothers, diet during pregnancy, and indoor pollution were associated with low birth weight. One-fifth of the boys and girls were stunted by 2 years of age in the Gaza Strip, and girls were more stunted than boys. The prevalence rates of underweight, overweight, and obesity among school children in the West Bank were 7.3%, 14.5%, and 15.7%, respectively. Age, gender, and living area were significant predictors of being overweight among school children. The prevalence rates of overweight and obesity among adults in Palestine were 57.8% and 26.8%, respectively. Obesity is associated with a family history, chronic diseases, and low physical activity among adults. Exclusive breastfeeding was below the WHO recommendations, while significant rates of obesity and overweight were found among children and adults. Iron-deficiency anemia (IDA) among pregnant women and children remains a challenging public health issue, while other micronutrient deficiencies are high among children. Conclusion This review emphasizes the need for multi-sectoral interventions to address malnutrition and nutritional shifts. It identifies gaps and addresses nutrition-related issues in the Palestinian Territory, which can serve as a basis for guiding United Nations agencies and governments in formulating evidence-based policies and strategies for prioritizing nutritional interventions to meet sustainable development goals.
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Affiliation(s)
- Enas A. Assaf
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Haleama Al Sabbah
- Department of Public Health, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Ayoub Al-Jawadleh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Capuno J, Kraft A, Calicdan KG, O’Donnell O. Associations between health-related quality of life and measures of adiposity among Filipino adults. PLoS One 2022; 17:e0275798. [PMID: 36288388 PMCID: PMC9605333 DOI: 10.1371/journal.pone.0275798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/23/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Estimate associations between the health-related quality of life (HRQoL) and adiposity in a low-income population. METHODS In a cluster random sample of 3796 Filipinos aged 40-70 years in Nueva Ecija province, we measured body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and six dimensions of HRQoL using the 20-item Short Form Health Survey. We stratified by sex and used nonparametric regression to graph mean HRQoL in each dimension by BMI, WC, and WHR. We used ordinary least squares regression to estimate differences in each HRQoL dimension by categories of BMI, WC, and WHR adjusted for sociodemographic characteristics and smoking. RESULTS Mean HRQoL was lowest for health perception (Males: 67.5 (SD = 15.9); Females: 66.7 (15.8)) and highest for role functioning (Males: 97.5 (12.9); Females: 97.4 (13.3)). Mean (SD) values of BMI, WC, and WHR were 22.1 (3.6), 84.8 cm (9.5), and 0.9 (0.1), respectively for males, and 23.7 (4.2), 86.5 cm (10.2), and 0.9 (0.1), respectively, for females. There was no evidence that higher BMI was associated with lower HRQoL. Adjusted mean social functioning was 4.92 (p = 0.076) higher for males with high BMI risk (8.6% prevalence) compared with acceptable BMI risk (50.3%). Mean social functioning was 3.61 (p = 0.012) and 5.48 (p = 0.017) lower for females with high WC (44.7%) and WHR (83.1%), respectively, compared with those with low WC (23.8%) and WHR (3.6%). Mean physical functioning was lower by 2.70 (p = 0.204) and 1.07 (p = 0.198) for males and females, respectively, with high compared with low WC. Mean physical functioning was 3.93 (p = 0.037) lower for males with high (7.6%) compared with low (38.8%) WHR. Mean role functioning was 1.09 (p = 0.124) and 2.46 (p = 0.158) lower for males with borderline and high WHR, respectively. CONCLUSIONS There is discordance between future adiposity-related health risk and current experience of HRQoL.
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Affiliation(s)
- Joseph Capuno
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines
| | - Aleli Kraft
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines
| | - Kayleen Gene Calicdan
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines
| | - Owen O’Donnell
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, Netherlands
- Tinbergen Institute, Amsterdam, Netherlands
- University of Lausanne, Lausanne, Switzerland
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Sardana O, Kumari P, Singh R, Chopra H, Emran TB. Health-related quality of life among acute pancreatitis patients correlates with metabolic variables and associated factors. Ann Med Surg (Lond) 2022; 82:104504. [PMID: 36268403 PMCID: PMC9577452 DOI: 10.1016/j.amsu.2022.104504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Acute pancreatitis (AP) and associated metabolic abnormalities constitute prevalent medical disorders that have disastrous implications and expensive cost of care. However, the connection with metabolic abnormalities and their influence on wellbeing i.e., health-related quality of life (HRQoL) remains unclear. As a result, we investigated the influence of MetS components on HRQoL in AP patients. Methods In a tertiary care hospital in North India, comprehensive observational research was undertaken with enrollment of subjects having AP along metabolic syndrome (MetS) or without was included. MetS was diagnosed for subjects using the National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) guidelines. Various socio-demographic variables were also taken into consideration for the calculation of statistical significance (P ≤ 0.05) in AP patients. Student's t-test and Short Form-36 (SF-36) along with the association between AP and MetS, as well as their impact on HRQoL, was investigated finally with, Pearson Correlation Analysis Factor. Results The study comprised 100 subjects or patients diseased of AP associated with MetS and 100 patients with AP associated without MetS. Gender, Age, Educational Status, Tobacco uses along with the metabolic variables were found to be statistically significant (P ≤ 0.05) and comparatively increased in patients with AP with MetSthan AP without MetS except HDL levels. Finally, a negative association between all metabolic variables with the exception of HDL, and AP was found to be producing deterioration in Health compartment scores. Conclusion AP with MetS patients had a worse aggregate HRQOL than AP without MetS patients. Acute pancreatitis (AP) and associated metabolic abnormalities constitute prevalent medical disorders. We investigated the influence of MetS components on HRQoL in AP patients. The focus of this study is to figure out the relationship between MetS with quality of life among AP patients. AP with MetS patients had a worse aggregate HRQOL than AP without MetS patients.
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Affiliation(s)
- Ojus Sardana
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Pratima Kumari
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Ravinder Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
- Corresponding author. Department of Pharmacy Practice, Chitkara College of Pharmacy, Chitkara University, Patiala, 140401, Punjab, India.
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, 1207, Bangladesh
- Corresponding author. Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh.
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Mannan A, Akter KM, Akter F, Chy NUHA, Alam N, Pinky SD, Chowdhury AFMN, Biswas P, Chowdhury AS, Hossain MA, Rana MM. Association between comorbidity and health-related quality of life in a hypertensive population: a hospital-based study in Bangladesh. BMC Public Health 2022; 22:181. [PMID: 35081905 PMCID: PMC8793199 DOI: 10.1186/s12889-022-12562-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/11/2022] [Indexed: 12/22/2022] Open
Abstract
Background Hypertension is a known risk factor for several chronic conditions including diabetes and cardiovascular diseases. However, little is known about its impact on Health-related quality of life (HRQoL) in the context of Bangladesh. This study aimed to evaluate the association of hypertension on HRQoL among Bangladeshi patients corresponding to the socio-demographic condition, comorbid conditions, treatment, and health outcomes. Methods A hospital based cross-sectional study was conducted using a pre-tested structured questionnaire among patients with hypertension in 22 tertiary medical college hospitals in Bangladesh. The study recruited male and female hypertensive patients of age ≥18 years between July 2020 to February 2021 using consecutive sampling methods. Health related quality of life was measured using the widely-used index of EQ-5D that considers 243 different health-related attributes and uses a scale in which 0 indicates a health state equivalent to death and 1 indicates perfect health status. The five dimensions of the quality index included mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. Ordered logit regression and linear regression models were used to estimate the predictors of comorbidity and HRQoL. Results Of the 1,912 hypertensive patients, 56.2% were female, 86.5% were married, 70.7% were either overweight or obese, 67.6% had a family history of hypertension, and 85.5% were on anti-hypertensive medication. Among the individuals with comorbidities, 47.6% had diabetes, 32.3% were obese, 16.2% had heart disease, 15% were visually impaired, and 13.8% were suffering from psychological diseases. HRQoL was found to be inversely proportional to the number of comorbidities. The most frequent comorbidities of diabetes and obesity showed the highest EQ- 5D mean utilities of 0.59 and 0.64, respectively. Conclusions Prevalent comorbidities, diabetes and obesity were found to be the significant underlying causes of declining HRQoL. It is recommended that the comorbidities should be adequately addressed for better HRQoL. Special attention should be given to address mental health issues of patients with hypertension. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12562-w.
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Affiliation(s)
- Adnan Mannan
- Department of Genetic Engineering & Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chattogram, 4331, Bangladesh.
| | - Kazi Mahmuda Akter
- Department of Obstetrics and Gynaecology, Sir Salimullah Medical College Mitford Hospital, Dhaka, 1206, Bangladesh
| | - Farhana Akter
- Department of Endocrinology, Chittagong Medical College, Chattogram, 4203, Bangladesh
| | - Naim Uddin Hasan A Chy
- Health Economics Research Group, Department of Economics, University of Chittagong, Chattogram, 4331, Bangladesh
| | - Nazmul Alam
- Department of Public Health, Asian University for Women, Chattogram, 4000, Bangladesh
| | - Susmita Dey Pinky
- Department of Medicine, Chittagong Medical College, Chattogram, 4203, Bangladesh
| | | | - Parijat Biswas
- Department of Medicine, Chittagong Medical College, Chattogram, 4203, Bangladesh
| | - Afrin Sultana Chowdhury
- Department of Biotechnology and Genetic Engineering, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh
| | | | - Md Mashud Rana
- Department of Pharmacology and Therapeutics, Chittagong Medical College, 4203, Chattogram, Bangladesh
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Cheang I, Zhu X, Zhu Q, Li M, Liao S, Zuo Z, Yao W, Zhou Y, Zhang H, Li X. Inverse association between blood ethylene oxide levels and obesity in the general population: NHANES 2013-2016. Front Endocrinol (Lausanne) 2022; 13:926971. [PMID: 36171904 PMCID: PMC9510609 DOI: 10.3389/fendo.2022.926971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ethylene oxide (EO) has been shown to associate with increased cardiovascular risk. This study aimed to explore the relationship and its meditating factors between EO exposure and the major cardiovascular risk factor of obesity among the general adult population. METHODS Cross-sectional data of 3,220 participants from National Health and Nutritional Examination Survey (NHANES) 2013-2016 were enrolled. Obesity was defined as body mass index (BMI) ≥30 kg/m2, and abdominal obesity was defined as waist circumference (WC) ≥102 cm in men and ≥88 cm in women. The association among hemoglobin adduct of EO (HbEO), inflammatory biomarkers, and obesity was evaluated using restricted cubic splines and the multivariable linear regression model. Mediation analysis was used to further assess their association. RESULTS The increased quartiles of HbEO were inversely associated with BMI and WC [Q1 vs. Q4, BMI: β = -2.98 (-3.74, -2.22), WC: β = -6.50 (-8.60, -4.39); all p for trend < 0.05], and were inversely associated with obesity after full adjustment [obesity: OR = 0.43 (0.31, 0.58), abdominal obesity: OR = 0.42 (0.27, 0.65); all p for trend < 0.05]. The levels of alkaline phosphatase, white blood cells, lymphocytes, and neutrophils were also positively associated with BMI and WC (all p < 0.05). Mediation analysis showed that exposure of EO not only had a negative direct effect on BMI and WC, but also generated an inverse indirect effect. CONCLUSIONS Current findings showed an inverse association between HbEO and obesity, and suggested that systemic inflammation may not be their only mediator. Additional research is required to explore the underlying link of EO and system metabolism.
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Affiliation(s)
- Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Qingqing Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Menghuan Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Shengen Liao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Zhi Zuo
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Department of Cardiology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- *Correspondence: Xinli Li,
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Gum Arabic modifies anti-inflammatory cytokine in mice fed with high fat diet induced obesity. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.bcdf.2020.100258] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Wärnberg J, Pérez-Farinós N, Ajejas-Bazán MJ, Pérez-López J, Benavente-Marín JC, Crespo-Oliva E, Castillo-Antúnez V, Fernández-Barceló O, Valenzuela-Guerrero S, Silva-Soto MÁ, Barón-López FJ. Lack of Social Support and Its Role on Self-Perceived Health in a Representative Sample of Spanish Adults. Another Aspect of Gender Inequality. J Clin Med 2021; 10:1502. [PMID: 33916528 PMCID: PMC8038426 DOI: 10.3390/jcm10071502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
Self-perceived health has been used as a good estimator of health status and receiving affection can be a determining factor for good self-perceived health. The aim of the present study was to assess whether lack of social support (measured through Duke scale, which ranges from 11 to 55) was associated with poorer health status measured as self-perceived health, and whether that association was different between women and men. A cross-sectional study was conducted using data from the 2017 Spanish National Health Survey. A descriptive study was performed, and logistic regression models were applied using self-perceived health as a dependent variable. Mean Duke score was 47.6 for men and 47.9 for women (p = 0.016). Moreover, 36.3% of women and 27.6% of men reported poor self-perceived health (p < 0.001). The multivariate analysis revealed that lower scores in Duke-UNC social support scale were associated with poorer health status. That association was higher in women than in men. Poor self-perceived health was also associated with low level of education and obesity, especially among women. There was gender inequality as regards health status associated with lack of social support. These results can help design prevention strategies to improve health.
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Affiliation(s)
- Julia Wärnberg
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain; (J.W.); (J.P.-L.); (J.C.B.-M.); (E.C.-O.); (V.C.-A.); (O.F.-B.); (S.V.-G.); (M.Á.S.-S.); (F.J.B.-L.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Napoleón Pérez-Farinós
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Epi-PHAAN Research Group, School of Medicine, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain
| | | | - Jéssica Pérez-López
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain; (J.W.); (J.P.-L.); (J.C.B.-M.); (E.C.-O.); (V.C.-A.); (O.F.-B.); (S.V.-G.); (M.Á.S.-S.); (F.J.B.-L.)
| | - Juan Carlos Benavente-Marín
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain; (J.W.); (J.P.-L.); (J.C.B.-M.); (E.C.-O.); (V.C.-A.); (O.F.-B.); (S.V.-G.); (M.Á.S.-S.); (F.J.B.-L.)
| | - Edelys Crespo-Oliva
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain; (J.W.); (J.P.-L.); (J.C.B.-M.); (E.C.-O.); (V.C.-A.); (O.F.-B.); (S.V.-G.); (M.Á.S.-S.); (F.J.B.-L.)
| | - Virginia Castillo-Antúnez
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain; (J.W.); (J.P.-L.); (J.C.B.-M.); (E.C.-O.); (V.C.-A.); (O.F.-B.); (S.V.-G.); (M.Á.S.-S.); (F.J.B.-L.)
| | - Olga Fernández-Barceló
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain; (J.W.); (J.P.-L.); (J.C.B.-M.); (E.C.-O.); (V.C.-A.); (O.F.-B.); (S.V.-G.); (M.Á.S.-S.); (F.J.B.-L.)
| | - Silvia Valenzuela-Guerrero
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain; (J.W.); (J.P.-L.); (J.C.B.-M.); (E.C.-O.); (V.C.-A.); (O.F.-B.); (S.V.-G.); (M.Á.S.-S.); (F.J.B.-L.)
| | - María Ángeles Silva-Soto
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain; (J.W.); (J.P.-L.); (J.C.B.-M.); (E.C.-O.); (V.C.-A.); (O.F.-B.); (S.V.-G.); (M.Á.S.-S.); (F.J.B.-L.)
| | - F. Javier Barón-López
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain; (J.W.); (J.P.-L.); (J.C.B.-M.); (E.C.-O.); (V.C.-A.); (O.F.-B.); (S.V.-G.); (M.Á.S.-S.); (F.J.B.-L.)
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
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Chen C, Chen H, Liu C, Liao H, Chou C, Chen C. Association of obesity with inflammation, disease severity and cardiovascular risk factors among patients with ankylosing spondylitis. Int J Rheum Dis 2020; 23:1165-1174. [DOI: 10.1111/1756-185x.13912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/22/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Chun‐Hsiung Chen
- Division of Allergy, Immunology and Rheumatology Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation School of Medicine Tzu Chi University Hualien Taiwan
| | - Hung‐An Chen
- Division of Allergy, Immunology and Rheumatology Chi Mei Medical Center Tainan Taiwan
| | - Chin‐Hsiu Liu
- Division of Allergy, Immunology and Rheumatology Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation School of Medicine Tzu Chi University Hualien Taiwan
| | - Hsien‐Tzung Liao
- Taipei Veterans General Hospital National Yang‐Ming University Taipei Taiwan
| | - Chung‐Tei Chou
- Taipei Veterans General Hospital National Yang‐Ming University Taipei Taiwan
| | - Chen‐Hung Chen
- Division of Allergy, Immunology and Rheumatology Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation School of Medicine Tzu Chi University Hualien Taiwan
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