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Hsu YC, Lin YH, Lee TY, Nguyen MH, Tseng CH, Ho HJ, Kao FY, Lin JT, Wu CY, Wu CY. Severe hepatitis B flares with hepatic decompensation after withdrawal of nucleos(t)ide analogues: A population-based cohort study. Aliment Pharmacol Ther 2023; 58:463-473. [PMID: 37341016 DOI: 10.1111/apt.17614] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/27/2023] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Finite nucleos(t)ide analogue (NUC) therapy has been proposed as an alternative treatment strategy for chronic hepatitis B (CHB). AIM To quantify the incidence of severe hepatitis flares following NUC cessation in everyday clinical practice. METHODS This population-based cohort study enrolled 10,192 patients (male 71.7%, median age 50.9 years, cirrhosis 10.7%) who had received first-line NUCs for at least 1 year before discontinuing treatment. The primary outcome was severe flare with hepatic decompensation. We used competing risk analyses to assess event incidences and associated risk factors. RESULTS During a median follow-up of 2.2 years, 132 patients developed severe flares with hepatic decompensation, yielding a 4-year cumulative incidence of 1.8% (95% confidence interval [CI], 1.5%-2.2%). Significant risk factors were cirrhosis (adjusted sub-distributional hazard ratio [aSHR], 2.74; 95% CI, 1.82-4.12), manifestations of portal hypertension (aSHR, 2.46; 95% CI, 1.45-4.18), age (aSHR, 1.21 per 10 years; 95% CI, 1.03-1.42) and male sex (aSHR, 1.58; 95% CI, 1.04-2.38). In patients without cirrhosis or portal hypertension (n = 8863), the 4-year cumulative incidence of severe withdrawal flares stood at 1.3% (95% CI, 1.0%-1.7%). For those patients with available data confirming adherence to the standard stopping rules (n = 1274), the incidence was 1.1% (95% CI, 0.6%-2.0%). CONCLUSIONS Severe flares with hepatic decompensation were observed in 1%-2% of patients with CHB after stopping NUC therapy in daily practice. Risk factors included older age, cirrhosis, portal hypertension and male sex. Our findings argue against NUC cessation as part of routine clinical care.
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Affiliation(s)
- Yao-Chun Hsu
- Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Internal Medicine, Fu-Jen Catholic University Hospital, New Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Yi-Hsian Lin
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Teng-Yu Lee
- Division of Gastroenterology and Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, California, USA
| | - Cheng-Hao Tseng
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Hsiu J Ho
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Feng-Yu Kao
- National Health Insurance Administration, Ministry of Health & Welfare, Taipei, Taiwan
| | - Jaw-Town Lin
- Division of Gastroenterology and Hepatology, E-Da Hospital, Kaohsiung, Taiwan
| | - Chen-Yi Wu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health and Department of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Ying Wu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
- National Institute of Cancer Research and Institute of Population Health Sciences, National Health Research Institutes, Maioli, Taiwan
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Lin KY, Yang HY, Yang SC, Chen YL, Watanabe Y, Chen JR. Caulerpa lentillifera improves ethanol-induced liver injury and modulates the gut microbiota in rats. Curr Res Food Sci 2023; 7:100546. [PMID: 37483276 PMCID: PMC10362798 DOI: 10.1016/j.crfs.2023.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
Caulerpa lentillifera (CL), also called sea grape, is a type of edible green alga which was reported to have antioxidative and immunomodulatory potential. This study aimed to investigate the hepatoprotective effects of CL in a rat model of chronic ethanol exposure. Wistar rats were assigned to four groups and supplied with an isocaloric control liquid diet (group C), an ethanol liquid diet (group E), a control liquid diet supplemented with 5% CL (group CC), or an ethanol liquid diet supplemented with 5% CL (group EC) for a 12-week experimental period. Ethanol feeding induced steatosis, inflammation, and changes in the gut microbiota by the end of the study, whereas CL supplementation significantly improved liver injuries and decreased circulatory endotoxin levels. Moreover, we also found that CL reversed ethanol-induced elevation of hepatic toll-like receptor 4 (TLR4), MyD88 protein expression, the phosphorylated-nuclear factor (NF)-κB-to-NF-κB ratio, and proinflammatory cytokine concentrations. Additionally, CL also increased the abundance of Akkermansia and tight junction proteins and diminished the Firmicutes-to-Bacteroidetes ratio. Dietary CL inhibited the progression of alcoholic liver disease, and some of the possible mechanisms may be strengthening the intestinal barrier function, alleviating dysbiosis, and modulating the TLR4 pathway.
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Affiliation(s)
- Kuan-Yu Lin
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Yi Yang
- Department of Nutritional Science, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Suh-Ching Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Ya-Ling Chen
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| | - Y. Watanabe
- General Health Medical Center, Yokohama University of Pharmacy, Yokohama, Japan
| | - Jiun-Rong Chen
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Chien JW, Wu C, Chan CC. The association of hypertension and prehypertension with greenness and PM 2.5 in urban environment. Sci Total Environ 2022; 821:153526. [PMID: 35101513 DOI: 10.1016/j.scitotenv.2022.153526] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The interplay of air pollution and urban greenness on hypertension (HTN) is not fully understood. METHODS We conducted a cross-sectional study to explore the role of greenness and PM2.5 on HTN for 40,375 adult residents in the New Taipei City, Taiwan. Normalized Difference Vegetation Index (NDVI) defined greenness and land use regression derived exposures of PM2.5 were used to calculate odds ratios (ORs) of HTN in logistic regression models and common OR of normal to stage 3 HTN in ordinal logistic regression models. Linear regression model was used to evaluate the association between NDVI and blood pressures, including systolic (SBP), diastolic (DBP) and mean (MBP) pressures. The mediation and moderation analysis were used to assess the mediation and moderation effect of PM2.5 on the association between greenness and SBP. RESULTS We found 37.3%, 21.4%, 8.2% and 2.7% of prehypertension and stage 1-3 hypertensions, respectively, for our study participants with annual PM2.5 exposures of 10.96-43.59 μg/m3 living in an urban environment with NDVI within 500 m buffer ranging from -0.22 to 0.26. The ORs of HTN were 0.744 (95% CI: 0.698-0.793) for NDVI (quartile 4 vs. quartile 1) and 1.048 (1.012-1.085) for each IQR (8.69 μg/m3) increase in PM2.5, respectively. The common OR of the higher level of 5 categories of BP was 1.1310 (1.241-1.383). With each IQR increase of NDVI (0.03), we found SBP, DBP and MBP were decreased by 0.78 mm Hg (-0.93-0.64), 0.52 mm Hg (-0.62-0.43) and 0.61 mm Hg (-0.71-0.51), respectively, in linear regression models. Stratified analysis found greenness effect was more prominent for people who are younger, female, never smoking, and without chronic diseases. PM2.5 is moderated rather than mediated the association between greenness and SBP. CONCLUSIONS Greenness was associated with lower prevalence of prehypertension and all stages of HTN and this relationship was moderated by PM2.5.
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Affiliation(s)
- Jien-Wen Chien
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Pediatric Nephrology, Changhua Christian Children's Hospital, Changhua, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan
| | - Charlene Wu
- Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan; Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University, Taipei, Taiwan.
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Lo WC, Ho CC, Tseng E, Hwang JS, Chan CC, Lin HH. Long-term exposure to ambient fine particulate matter (PM2.5) and associations with cardiopulmonary diseases and lung cancer in Taiwan: a nationwide longitudinal cohort study. Int J Epidemiol 2022; 51:1230-1242. [PMID: 35472171 DOI: 10.1093/ije/dyac082] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 04/10/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although a number of studies have reported on the health effects of fine particulate matter (PM2.5) exposure, particularly in North American and European countries as well as China, the evidence about intermediate to high levels of PM2.5 exposures is still limited. We aimed to investigate the associations between long-term exposure to PM2.5 and risk of cardiopulmonary disease incidence in Taiwan with intermediate levels of PM2.5 exposure. METHODS A cohort of Taiwanese adults, who participated in the 2001, 2005, 2009 and 2013 National Health Interview Surveys, was followed through 2016 to identify cardiopulmonary disease onset. Exposure to PM2.5 was estimated by incorporating a widespread monitoring network of air quality monitoring stations and microsensors. We used time-dependent Cox regression models to examine the associations between the PM2.5 exposures and health outcomes, adjusting for individual characteristics and ecological covariates. The natural cubic spline functions were used to explore the non-linear effects of the PM2.5 exposure. RESULTS A total of 62 694 adults from 353 towns were enrolled. Each 10-μg/m3 increase in 5-year average exposure to PM2.5 was associated with a 4.8% increased risk of incident ischaemic heart disease (95% CI: -3.3, 13.6), 3.9% increased risk of incident stroke (95% CI: -2.9, 11.1), 6.7% increased risk of incident diabetes (95% CI: 1.1, 12.7), 15.7% increased risk of incident lung cancer (95% CI: -0.9, 35.1) and 11.5% increased risk of incident chronic obstructive pulmonary disease (95% CI: -0.8, 25.2). The concentration-response curve showed that there was no statistical evidence of non-linearity for most of the disease outcomes except for ischaemic heart disease (P for non-linearity = 0.014). CONCLUSIONS Long-term exposure to intermediate levels of ambient PM2.5 was associated with cardiopulmonary health outcomes. Our study adds value to future application and national burden of disease estimation in evaluating the health co-benefits from ambient air pollution reduction policy in Asian countries.
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Affiliation(s)
- Wei-Cheng Lo
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University.,Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Chi-Chang Ho
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Eva Tseng
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine.,Global Health Program, College of Public Health, National Taiwan University, Taipei, Taiwan
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Abstract
The mechanisms of alcoholic liver diseases (ALD) are very complex and interrelated, including abnormal lipid metabolism, oxidative stress, and gut-derived endotoxin pathway. On the other hand, fish oil is rich in n-3 polyunsaturated fatty acids (PUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which decrease blood triglyceride concentration in hypertriglycemia patients and show protective effects against fatty liver. However, there is limited evidence from studies of the relationship between fish oil and ALD based on the viewpoint of the intestinal integrity and microflora. Therefore, this review discusses the mechanism of amelioration for ALD by fish oil. Based on our previous studies, partial replacement of olive oil by fish oil in alcohol-containing liquid diet ameliorated the liver damage including fatty liver and inflammation in rats. Based on these results, the mechanisms of hepatoprotective effects due to fish oil substitution were discussed in three parts, such as regulating lipid metabolism, decreasing oxidative stress and maintaining intestinal health. First of all, we found that fish oil substitution increased plasma adiponectin levels, and then increasing MCAD and CPT-1 mRNA levels to accelerate fatty acid oxidation in liver, then further prevent ethanol-induced hepatosteatosis in rats with chronic alcohol-feeding. Fish oil replacement also enhanced hepatic autophagy flux, which enhanced lipid degradation, then inhibited lipid accumulation in liver. Secondly, the appreciable proportion of fish oil decreased lipid peroxidation by reducing the protein expression of cytochrome p450 2E1 in chronic alcohol-feeding rats. We also speculated that the appropriate proportion of n-6 and n-3 PUFAs is very important for preventing alcoholic liver disease. At last, substituting fish oil for olive oil normalized the intestinal permeability and fecal microbiota composition, thus providing a low plasma endotoxin level and inflammatory responses, which exert ameliorative effects on ethanol-induced liver injuries in rats.
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Affiliation(s)
- Suh-Ching Yang
- School of Nutrition and Health Sciences, Taipei Medical University.,Research Center of Geriatric Nutrition, College of Nutrition, Taipei Medical University.,Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University.,School of Gerontology Health Management, College of Nursing, Taipei Medical University.,Nutrition Research Center, Taipei Medical University Hospital
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Chang A, Schulz PJ, Wenghin Cheong A. Online Newspaper Framing of Non-Communicable Diseases: Comparison of Mainland China, Taiwan, Hong Kong and Macao. Int J Environ Res Public Health 2020; 17:ijerph17155593. [PMID: 32756457 PMCID: PMC7432841 DOI: 10.3390/ijerph17155593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/18/2020] [Accepted: 07/27/2020] [Indexed: 12/16/2022]
Abstract
As non-communicable diseases (NCDs) are now well recognized as the leading cause of mortality among adult populations worldwide, they are also increasingly the focus of media coverage. As such, the objective of this study is to describe the framing of NCDs in the coverage of newspapers, with the understanding that it says something about the society producing it. Automatic content analysis was employed to examine disease topics, risks, and cost consequences, thus providing lay people with a chance of learning the etiology of NCDs and information available for fighting diseases. The result of the computational method identified a total of 152,810 news articles with one of the seven supra-categories of NCDs. The category of metabolic diseases was covered most frequently in the past ten years. Three health risks received ample attention in all 11 newspapers: stress burden, tobacco use, and genetic predispositions. The results evidenced how media framed risk information of illnesses would distort the way in which diseases were selected, interpreted, and the outcome communicated. Future research building on our findings can further examine whether news framing affects the way the readers perceive and prevent NCDs.
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Affiliation(s)
- Angela Chang
- Department of Communication, Faculty of Social Sciences, University of Macau, Macao, China
- Correspondence:
| | - Peter J. Schulz
- Institute of Communication and Health, Lugano University, 6900 Lugano, Switzerland;
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Liang CC, Hsu WC, Tsai YT, Weng SJ, Liu SC, Lin CH. Factors Related to Diabetes Mellitus in the Middle-Aged and Over in Taiwan. Healthcare (Basel) 2020; 8:E242. [PMID: 32751283 DOI: 10.3390/healthcare8030242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
Study Objective: to investigate the factors related to diabetes mellitus in the middle-aged and over in Taiwan. Method: data from seven surveys (in 1989–2011) from the “Taiwan Longitudinal Study on Aging” (TLSA), among cohort B (above the age 60 in 1989), cohort A (aged 50–66 in 1996), and cohort C (aged 50–66 in 2003), were analyzed by the interval-censored Cox model. Results: in the early aging stage (aged 60–64), diabetes mellitus prevalence among the same age appeared the lowest in cohort B, followed by cohort A; cohort C reveals the highest than the young generation. Moreover, suffering from hypertension and kidney diseases are closely related to diabetes mellitus, with the diabetes mellitus suffering hazard ratio of 2.53 (95%: 2.35, 2.73) and 1.26 (95%: 1.11, 1.44) times, respectively. For people with fair and poor self-rated health, the risk of suffering from diabetes mellitus is 1.16 (95%: 1.07, 1.27) and 1.50 (95%: 1.35, 1.67) times compared to people with good self-rated health, respectively. Conclusions: in this study, it is considered that an advanced interval censoring model analysis could more accurately grasp the characteristics of factors in people who are middle-aged and over suffering from diabetes mellitus in Taiwan.
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Mira JJ, Martin-Delgado J, Aibar C, Gómez G, Ramos JM, Aranaz J, Gómez-Muzas F, Ruguero MJ, Cobos A, Colmenero M, Gorricho J, Silvestre C, Egea-Valera MA, Marqués-Espí JA, García-Montero JI, Carrillo I. Bed 13 is not worse than any other. A retrospective cohort study. J Healthc Qual Res 2020; 35:79-85. [PMID: 32273107 DOI: 10.1016/j.jhqr.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Risk management and patient safety are closely related, following this premise some industries have adopted measures to omit number 13. Healthcare is not left behind, in some hospital the day of surgery's or bed numbering avoid number 13. The objective was to assess whether it is necessary to redesign the safety policies implemented in hospitals based on avoiding 13 in the numbering of rooms/beds. METHODS A retrospective cohort study was conducted. Mortality and the number of adverse events suffered by patients admitted to rooms/beds numbering 13 (bad chance) or 7 (fair chance) over a two-year period to Intensive Care Unit, Medicine, Gastroenterology, Surgery, and Paediatric service were registered and compared. RESULTS A total of 8553 admissions were included. They had similar length-of-stay and Charlson Index scores (p-value=0.435). Mortality of bed 13 was 268 (6.2%, 95% CI 5.5-6.9) and 282 in bed 7 (6.7%, 95% CI 5.9-7.5) (p-value=0.3). A total of 422 adverse events from 4342 admissions (9.7%, 95% CI 8.9-10.6) occurred in bed 13, while in bed 7 the count of adverse events was 398 in 4211 admissions (9.4%, 95% CI 8.6-10.4) (p-value=0.6). Odds Ratio for mortality was equal to 0.9 (95% CI 0.8-1.1) and suffering adverse events when admitted to bed 13 versus bed 7 was 1.03 (95% CI 0.9-1.2). CONCLUSIONS Bed 13 is not a risk factor for patient safety. Hospitals should pay attention to causes and interventions to avoid adverse events based on evidence rather than beliefs or myths.
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Affiliation(s)
- J J Mira
- Health District Alicante-Sant Joan, Alicante, Spain; Miguel Hernández University, Elche, Spain
| | - J Martin-Delgado
- Foundation for the Promotion of Health and Biomedical Research, Sant Joan d'Alacant, Spain.
| | - C Aibar
- Aragon Health Service, Zaragoza, Spain
| | - G Gómez
- Madrid Health Service, Madrid, Spain
| | - J M Ramos
- Madrid Health Service, Madrid, Spain
| | - J Aranaz
- Preventive Medicine and Public Health Service, Ramon y Cajal University Hospital, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - F Gómez-Muzas
- Department of Universal and Public Health, Alicante, Spain
| | - M J Ruguero
- Department of Universal and Public Health, Alicante, Spain
| | - A Cobos
- Andalusian Health Service, Granada, Spain
| | | | - J Gorricho
- Navarre Health Service - Osasunbidea, Pamplona, Spain
| | - C Silvestre
- Navarre Health Service - Osasunbidea, Pamplona, Spain
| | | | | | | | - I Carrillo
- Miguel Hernández University, Elche, Spain; Foundation for the Promotion of Health and Biomedical Research, Sant Joan d'Alacant, Spain
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Chou CW, Fang WH, Chen YY, Wang CC, Kao TW, Wu CJ, Chen WL. Association between Serum Calcium and Risk of Cardiometabolic Disease among Community-dwelling Adults in Taiwan. Sci Rep 2020; 10:3192. [PMID: 32081877 DOI: 10.1038/s41598-020-60209-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 02/10/2020] [Indexed: 11/26/2022] Open
Abstract
Serum calcium, although only comprising 1% of total body calcium, is involved in intracellular signal pathways, vascular dilatation/constriction, and muscle contraction, which are crucial for insulin secretion, cholesterol catabolism, and blood pressure regulation. As far as we know, research on the relationship between serum calcium level and metabolic syndrome (MetS), diabetes, and hypertension in one longitudinal study is rare. Owing to the crucial role of serum calcium in human cardiometabolic physiology and lack of related study so far, this study aims to describe the relationship between serum calcium level and the incidence of MetS, diabetes, and hypertension. During the period 2010–2016, there are two parts to our study: cross-sectional analysis and longitudinal analysis. Logistic regression was applied for cross-sectional analysis of the association between serum calcium level or albumin-corrected calcium (ACCA) and the prevalence of MetS, diabetes, or hypertension. Receiver operating characteristic (ROC) curve analysis was used for calculating of optimal cut-off value of serum calcium and ACCA. Cox proportional regression for development of MetS, diabetes, and hypertension according to different cut-off values of serum calcium level and ACCA were conducted. At baseline, there were 27,364 participants in our study. Serum calcium level had positive association with diabetes in the total population, male, and female. ACCA level had positive association with diabetes in the total population, male, and female. In unadjusted and multivariate Cox proportional hazard models, serum calcium level was associated with increased risk of incident MetS in the total population and male. ACCA was associated with increased risk of incident MetS in the total population and male. ACCA was associated with increased risk of incident diabetes in the total population and male participants. This study describes the relationship between serum calcium level and the incidence of MetS, diabetes, and hypertension. Higher serum calcium level is associated with increased risk of MetS, diabetes, and hypertension.
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Ng TC, Lo WC, Ku CC, Lu TH, Lin HH. Improving the Use of Mortality Data in Public Health: A Comparison of Garbage Code Redistribution Models. Am J Public Health 2020; 110:222-229. [PMID: 31855478 PMCID: PMC6951373 DOI: 10.2105/ajph.2019.305439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To describe and compare 3 garbage code (GC) redistribution models: naïve Bayes classifier (NB), coarsened exact matching (CEM), and multinomial logistic regression (MLR).Methods. We analyzed Taiwan Vital Registration data (2008-2016) using a 2-step approach. First, we used non-GC death records to evaluate 3 different prediction models (NB, CEM, and MLR), incorporating individual-level information on multiple causes of death (MCDs) and demographic characteristics. Second, we applied the best-performing model to GC death records to predict the underlying causes of death. We conducted additional simulation analyses for evaluating the predictive performance of models.Results. When we did not account for MCDs, all 3 models presented high average misclassification rates in GC assignment (NB, 81%; CEM, 86%; MLR, 81%). In the presence of MCD information, NB and MLR exhibited significant improvement in assignment accuracy (19% and 17% misclassification rate, respectively). Furthermore, CEM without a variable selection procedure resulted in a substantially higher misclassification rate (40%).Conclusions. Comparing potential GC redistribution approaches provides guidance for obtaining better estimates of cause-of-death distribution and highlights the significance of MCD information for vital registration system reform.
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Affiliation(s)
- Ta-Chou Ng
- Ta-Chou Ng, Wei-Cheng Lo, and Hsien-Ho Lin are with the Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Wei-Cheng Lo is also with the Institute of Statistical Science, Academia Sinica, Taipei, Taiwan. Chu-Chang Ku is with the School of Health and Related Research, University of Sheffield, Sheffield, UK. Tsung-Hsueh Lu is with the National Cheng Kung University Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Cheng Lo
- Ta-Chou Ng, Wei-Cheng Lo, and Hsien-Ho Lin are with the Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Wei-Cheng Lo is also with the Institute of Statistical Science, Academia Sinica, Taipei, Taiwan. Chu-Chang Ku is with the School of Health and Related Research, University of Sheffield, Sheffield, UK. Tsung-Hsueh Lu is with the National Cheng Kung University Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chu-Chang Ku
- Ta-Chou Ng, Wei-Cheng Lo, and Hsien-Ho Lin are with the Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Wei-Cheng Lo is also with the Institute of Statistical Science, Academia Sinica, Taipei, Taiwan. Chu-Chang Ku is with the School of Health and Related Research, University of Sheffield, Sheffield, UK. Tsung-Hsueh Lu is with the National Cheng Kung University Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Ta-Chou Ng, Wei-Cheng Lo, and Hsien-Ho Lin are with the Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Wei-Cheng Lo is also with the Institute of Statistical Science, Academia Sinica, Taipei, Taiwan. Chu-Chang Ku is with the School of Health and Related Research, University of Sheffield, Sheffield, UK. Tsung-Hsueh Lu is with the National Cheng Kung University Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsien-Ho Lin
- Ta-Chou Ng, Wei-Cheng Lo, and Hsien-Ho Lin are with the Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Wei-Cheng Lo is also with the Institute of Statistical Science, Academia Sinica, Taipei, Taiwan. Chu-Chang Ku is with the School of Health and Related Research, University of Sheffield, Sheffield, UK. Tsung-Hsueh Lu is with the National Cheng Kung University Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Lin CY, Cheng YT, Chang ML, Chien RN. The extrahepatic events of Asian patients with primary biliary cholangitis: A 30-year cohort study. Sci Rep 2019; 9:7577. [PMID: 31110209 PMCID: PMC6527707 DOI: 10.1038/s41598-019-44081-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/09/2019] [Indexed: 12/16/2022] Open
Abstract
The extrahepatic complications of primary biliary cholangitis (PBC) in Asian patients remain elusive. A 30-year cohort study of 150 Taiwanese PBC patients treated with ursodeoxycholic acid (UDCA) was conducted. Patients with alkaline phosphatase levels >1.67 × ULN after 1-year treatment were considered suboptimal responders. At baseline, of 150 patients (mean age: 53.75 years), 128 (85.3%) were females, and 34 (22.8%) had cirrhosis. The cumulative incidences of various incident events were all-cause mortality or liver transplantation: 46.7%; extrahepatic mortality: 24.5%; extrahepatic malignancies: 8.1%; hypertension: 46.2%; dyslipidemia: 44.1%; diabetes: 30.6%; hyperuricemia: 11.2%; acute coronary syndrome: 3.1%; cerebral vascular accident (CVA): 8.9%; autoimmune diseases: 16%; and osteoporosis: 20.9%. The 5- to 20-year cumulative incidences for all-cause mortality or liver transplantation and extrahepatic mortality were 16.2–41.3% and 3.1–11.9%, respectively. Baseline associations were age and alpha-fetoprotein levels with extrahepatic mortality, 80% due to sepsis; age with extrahepatic malignancies and hypertension; gender and hyperuricemia with CVA; and UDCA response with autoimmune disease. Conclusions: Sepsis accounted for most extrahepatic mortality in PBC patients, and the longer the follow-up was, the higher the extrahepatic/all-cause mortality ratio. Baseline age is crucial for incident extrahepatic events and only CVA shows gender-dimorphism; the association between UDCA response and autoimmune disease requires further investigation.
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Affiliation(s)
- Cheng-Yu Lin
- Liver Research Center, Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ya-Ting Cheng
- Liver Research Center, Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Ling Chang
- Liver Research Center, Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Rong-Nan Chien
- Liver Research Center, Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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12
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Wu MP, Wu SFV, Lee MC, Peng LN, Tsao LI, Lee WJ. Health-promotion interventions enhance and maintain self-efficacy for adults at cardiometabolic risk: A randomized controlled trial. Arch Gerontol Geriatr 2019; 82:61-66. [DOI: 10.1016/j.archger.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/08/2019] [Accepted: 01/19/2019] [Indexed: 12/14/2022]
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13
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Nfor ON, Wu MF, Lee CT, Wang L, Liu WH, Tantoh DM, Hsu SY, Lee KJ, Ho CC, Debnath T, Lung CC, Liaw YP. Body mass index modulates the association between CDKAL1 rs10946398 variant and type 2 diabetes among Taiwanese women. Sci Rep 2018; 8:13235. [PMID: 30185902 PMCID: PMC6125600 DOI: 10.1038/s41598-018-31415-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/14/2018] [Indexed: 12/14/2022] Open
Abstract
CDKAL1 rs10946398 is a type 2 diabetes (T2D)-associated variant. It is a new body mass index (BMI)-associated variant in Asian populations. We investigated the association between rs10946398 and T2D among 9908 participants aged 30–70 years based on BMI: normal weight; 18.5 ≤ BMI < 24 kg/m2, overweight; 24 ≤ BMI < 27 kg/m2, and obesity; BMI ≥27 kg/m2. The CC genotype conferred a higher risk of T2D than the CA genotype. The odds ratios (ORs) were 1.83; 95% confidence interval (CI) 1.49–2.26 and 1.20; 95% CI 1.02–1.40, respectively. The C allele was the significant risk allele compared with A allele (OR = 1.32; 95% CI 1.19–1.47). For normal, overweight and obese participants with CC genotype, the ORs were respectively 1.69; 95% CI 1.02–2.81, 2.34; 95% CI 1.50–3.66, and 1.58; 95% CI 1.02–2.45 among men and 1.22; 95% CI 0.67–2.22, 2.42; 95% CI 1.30–4.52, and 2.3; 95% CI 1.19–4.50 among women. The C allele ORs were higher in obese and overweight women. In conclusion, the rs10946398 CC/CA genotypes, as well as the C allele increased the risk of T2D. The ORs were higher in women who were overweight and obese than in those with normal weight. Nonetheless, significant results were prominent only among those with CC genotype and C allele.
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Affiliation(s)
- Oswald Ndi Nfor
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Ming-Fang Wu
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan.,Divisions of Medical Oncology and Pulmonary Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Chun-Te Lee
- School of Medicine, Chung Shan Medical University, Taichung City, Taiwan.,Department of Psychiatry, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Lee Wang
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Wen-Hsiu Liu
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Disline Manli Tantoh
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Shu-Yi Hsu
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Kuan-Jung Lee
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Chien-Chang Ho
- Department of Physical Education, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Tonmoy Debnath
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Chia-Chi Lung
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung City, Taiwan. .,Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung City, Taiwan.
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14
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Chiu THT, Pan WH, Lin MN, Lin CL. Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study. Nutr Diabetes 2018; 8:12. [PMID: 29549240 PMCID: PMC5856738 DOI: 10.1038/s41387-018-0022-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/03/2018] [Accepted: 01/29/2018] [Indexed: 01/29/2023] Open
Abstract
Background/objectives Vegetarian diets are inversely associated with diabetes in Westerners but their impact on Asians—whose pathophysiology differ from Westerners—is unknown. We aim to investigate the association between a vegetarian diet, change in dietary patterns and diabetes risk in a Taiwanese Buddhist population. Methods We prospectively followed 2918 non-smoking, non-alcohol drinking Buddhists free of diabetes, cancer, and cardiovascular diseases at baseline, for a median of 5 years, with 183 incident diabetes cases confirmed. Diet was assessed through a validated food frequency questionnaire at baseline and a simple questionnaire during follow-ups. Incident cases of diabetes were ascertained through follow-up questionnaires, fasting glucose and HbA1C. Stratified Cox Proportional Hazards Regression was used to assess the effect of diets on risk of diabetes. Results Consistent vegetarian diet was associated with 35% lower hazards (HR: 0.65, 95% CI: 0.46, 0.92), while converting from a nonvegetarian to a vegetarian pattern was associated with 53% lower hazards (HR: 0.47, 95% CI: 0.30, 0.71) for diabetes, comparing with nonvegetarians while adjusting for age, gender, education, physical activity, family history of diabetes, follow-up methods, use of lipid-lowering medications, and baseline BMI. Conclusion Vegetarian diet and converting to vegetarian diet may protect against diabetes independent of BMI among Taiwanese.
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Affiliation(s)
- Tina H T Chiu
- Department of Nutrition Therapy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation. No. 2, Min-Sheng Road, Dalin Town, Chiayi County, 622, Taiwan.,Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan.,Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan. No.701, Sec. 3, Chung Yang Road, Hualien, 970, Taiwan
| | - Wen-Harn Pan
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, No. 17, Xu-Zhou Road, Taipei, 100, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Address: 128 Sec. 2, Academia Road, Nankang, Taipei, 115, Taiwan
| | - Ming-Nan Lin
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation. No. 2, Min-Sheng Road, Dalin Town, Chiayi County, 622, Taiwan. .,Department of Family Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan. No.701, Sec. 3, Chung Yang Road, Hualien, 970, Taiwan.
| | - Chin-Lon Lin
- Department of Internal Medicine, Hualien Tzu Chi Medical Center, Hualien, Taiwan. No. 707, Sec. 3, Chung Yang Road, Hualien, 970, Taiwan.,Department of Internal Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan. No.701, Sec. 3, Chung Yang Road, Hualien, 970, Taiwan
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Huang CG, Lee LA, Fang TJ, Li HY, Liao CT, Kang CJ, Yen TC, Tsao KC, Chen TC, Shih SR. Human papillomavirus infection is not associated with laryngeal squamous cell carcinoma in Taiwan. J Microbiol Immunol Infect 2020; 53:79-86. [PMID: 29500045 DOI: 10.1016/j.jmii.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/27/2017] [Accepted: 02/05/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND/PURPOSE To examine whether the prevalence rate of human papillomavirus (HPV) infection in Taiwanese patients with primary laryngeal squamous cell carcinoma (LSCC) is different from that in those with a vocal polyp (VP) or vocal fold leukoplakia (VFL). METHODS This prospective cohort study recruited 41 consecutive patients with primary LSCC and 27 and 20 patients with VP and VFL, respectively. The HPV L1 gene in surgical specimens was detected using polymerase chain reaction. High-risk HPV DNA in tissue microarray specimens was detected using in situ hybridization. Expression of p16INK4a in tissue microarray specimens was determined through immunohistochemistry. RESULTS The prevalence of HPV L1 DNA in the LSCC group was equivalent to that in the VP and VFL groups (7.3% vs. 7.4% vs. 10.0%; P = 0.929; effect size = 0.20). High-risk HPV DNA detected using in situ hybridization was relatively rare in all groups (2.6% vs. 5.3% vs. 0.0%; P = 0.636; effect size = 0.81). The prevalence of p16INK4a positivity was significantly lower in the LSCC group than in the VP and VFL groups (5.1% vs. 58.8% vs. 14.3%; P < 0.001). Multivariate analysis results revealed that age ≥65 years (adjusted odds ratio, 4.09; 95% confidence interval, 1.21-13.91; P = 0.024) and p16INK4a positivity (adjusted odds ratio, 0.10; 95% confidence interval, 0.02-0.53; P = 0.006) were LSCC risk factors. CONCLUSION HPV infection is uncommon in Taiwanese patients with LSCC and seems not to be associated with an increased LSCC risk. Larger sample size is warranted for further study.
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