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Lee JSW, Auyeung TW. When haemoglobin drops in the older hospitalized patient. Maturitas 2024:108002. [PMID: 38653624 DOI: 10.1016/j.maturitas.2024.108002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Jenny Shun Wah Lee
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong.
| | - Tung Wai Auyeung
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong
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Arai H, Maeda K, Wakabayashi H, Naito T, Konishi M, Assantachai P, Auyeung WT, Chalermsri C, Chen W, Chew J, Chou M, Hsu C, Hum A, Hwang IG, Kaido T, Kang L, Kamaruzzaman SB, Kim M, Lee JSW, Lee W, Liang C, Lim WS, Lim J, Lim YP, Lo RS, Ong T, Pan W, Peng L, Pramyothin P, Razalli NH, Saitoh M, Shahar S, Shi HP, Tung H, Uezono Y, von Haehling S, Won CW, Woo J, Chen L. Diagnosis and outcomes of cachexia in Asia: Working Consensus Report from the Asian Working Group for Cachexia. J Cachexia Sarcopenia Muscle 2023; 14:1949-1958. [PMID: 37667992 PMCID: PMC10570088 DOI: 10.1002/jcsm.13323] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/05/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
Chronic diseases often lead to metabolic disorders, causing anabolic resistance and increased energy consumption, which result in cachexia. Cachexia, in turn, can lead to major clinical consequences such as impaired quality of life, shortened life expectancy, and increased healthcare expenditure. Existing international diagnostic criteria for cachexia employ thresholds derived from Western populations, which may not apply to Asians due to differing body compositions. To address this issue, the Asian Working Group for Cachexia (AWGC) was initiated. The AWGC comprises experts in cachexia research and clinical practice from various Asian countries and aims to develop a consensus on diagnostic criteria and significant clinical outcomes for cachexia in Asia. The AWGC, composed of experts in cachexia research and clinical practice from several Asian countries, undertook three-round Delphi surveys and five meetings to reach a consensus. Discussions were held on etiological diseases, essential diagnostic items for cachexia, including subjective and objective symptoms and biomarkers, and significant clinical outcomes. The consensus highlighted the importance of multiple diagnostic factors for cachexia, including chronic diseases, either or both weight loss or low body mass index, and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>5 mg/L [0.5 mg/dL]). The AWGC proposed a significant weight change of 2% or more over a 3-6 month period and suggested a tentative cut-off value of 21 kg/m2 for low body mass index in diagnosing cachexia. Critical clinical outcomes were determined to be mortality, quality of life as assessed by tools such as EQ-5D or the Functional Assessment of Anorexia/Cachexia Therapy, and functional status as measured by the Clinical Frailty Scale or Barthel Index, with significant emphasis on patient-reported outcomes. The AWGC consensus offers a comprehensive definition and user-friendly diagnostic criteria for cachexia, tailored specifically for Asian populations. This consensus is set to stimulate future research and enhance the multidisciplinary approach to managing cachexia. With plans to develop further guidelines for the optimal treatment, prevention, and care of cachexia in Asians, the AWGC criteria are expected to drive research across chronic co-morbidities and cancer in Asia, leading to future refinement of diagnostic criteria.
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Affiliation(s)
- Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
| | - Keisuke Maeda
- Nutrition Therapy Support CenterAichi Medical University HospitalNagakuteJapan
- Department of Geriatric MedicineNational Center for Geriatrics and GerontologyObuJapan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation MedicineTokyo Women's Medical University HospitalTokyoJapan
| | - Tateaki Naito
- Division of Thoracic OncologyShizuoka Cancer CenterShizuokaJapan
| | - Masaaki Konishi
- Department of CardiologyYokohama City University School of MedicineYokohamaJapan
| | | | - Wai Tung Auyeung
- Jockey Club Institute of AgeingThe Chinese University of Hong KongShatinHong KongChina
| | - Chalobol Chalermsri
- Department of Preventive and Social Medicine, Division of Geriatric Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Wei Chen
- Department of Clinical Nutrition, Department of Health MedicinePeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Justin Chew
- Department of Geriatric MedicineTan Tock Seng HospitalSingapore
- Institute of Geriatrics and Active AgeingTan Tock Seng HospitalSingapore
| | - Ming‐Yueh Chou
- Center for Geriatrics and GerontologyKaohsiung Veterans General HospitalKaohsiung CityTaiwan
| | - Chih‐Cheng Hsu
- National Center for Geriatrics and Welfare ResearchMiaoli CountyTaiwan
| | - Allyn Hum
- Department of Geriatrics and Palliative CareTan Tock Seng HospitalSingapore
| | - In Gyu Hwang
- Department of Internal MedicineChung‐Ang University Hospital, Chung‐Ang University College of MedicineSeoulRepublic of Korea
| | - Toshimi Kaido
- Department of Gastroenterological and General SurgerySt. Luke's International HospitalTokyoJapan
| | - Lin Kang
- Department of Geriatric MedicinePeking Union Medical College HospitalBeijingChina
| | | | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East‐West Medical Research InstituteKyung Hee UniversitySeoulRepublic of Korea
| | - Jenny Shun Wah Lee
- Institute of AgingThe Chinese University of Hong Kong, Department of Medicine, Alice Ho Miu Ling Nethersole HospitalTai PoHong Kong
| | - Wei‐Ju Lee
- Aging and Health Research CenterNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Chih‐Kuang Liang
- Center for Geriatrics and GerontologyKaohsiung Veterans General HospitalKaohsiung CityTaiwan
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatric MedicineTan Tock Seng HospitalSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingapore
| | - Jae‐Young Lim
- Department of Rehabilitation MedicineSeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Yen Peng Lim
- Department of Nutrition and DieteticsTan Tock Seng HospitalSingapore
| | - Raymond See‐Kit Lo
- Department of Medicine and TherapeuticsChinese University of Hong Kong, Shatin HospitalMa On ShanHong Kong
| | - Terence Ong
- Department of Medicine, Faculty of MedicineUniversity MalayaKuala LumpurMalaysia
| | - Wen‐Harn Pan
- Institute of Biomedical SciencesAcademia Sinica, TaiwanTaipei CityTaiwan
| | - Li‐Ning Peng
- Aging and Health Research CenterNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Pornpoj Pramyothin
- Division of Nutrition, Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Nurul Huda Razalli
- Centre for Healthy Aging and Wellness (H‐CARE), Faculty of Health SciencesUniversiti Kebangsaan Malaysia, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul AzizKuala LumpurMalaysia
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health ScienceJuntendo UniversityTokyoJapan
| | - Suzana Shahar
- Center for Healthy Aging and Wellness, Faculty Health SciencesUniversiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | - Han Ping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan HospitalCapital Medical University of ChinaBeijingChina
| | - Heng‐Hsin Tung
- National Yang Ming Chiao Tung UniversityTaipei CityTaiwan
| | - Yasuhito Uezono
- Department of Pain Control ResearchThe Jikei University School of MedicineTokyoJapan
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Goettingen Medical Center, Georg‐August‐University GoettingenGoettingenGermany
- German Center for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Chang Won Won
- Department of Family MedicineCollege of Medicine, Kyung Hee UniversitySeoulRepublic of Korea
| | - Jean Woo
- Department of Medicine & TherapeuticsThe Chinese University of Hong Kong, Prince of Wales HospitalHong Kong SARChina
| | - Liang‐Kung Chen
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipei CityTaiwan
- Center for Geriatrics and GerontologyTaipei Veterans General Hospital; Taipei Municipal Gan‐Dau HospitalTaipei CityTaiwan
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Auyeung TW, Leung JCS, Lu ZH, Tsang C, Lee JSW, Kwok TCY, Woo J. Comparison of the Physical Function Trajectories in Three Birth Cohorts of Chinese Older Adults: A 14-Year Longitudinal Study. J Nutr Health Aging 2023; 27:1056-1062. [PMID: 37997728 DOI: 10.1007/s12603-023-2026-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES It remains uncertain whether the favorable trend of reduction in physical disabilities has become reversed in the recent-born cohorts of older adults. This study aimed to compare the rate of decline with time in self-reported Instrumental Activity of Daily Living (IADL) difficulties, objective measurement of gait speed and grip strength, in three birth cohorts of Chinese older adults. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS Four thousand Chinese older adults aged 65 years or above in three birth cohorts (1934-1938, 1929-1933, 1905-1928) were recruited from the community in Hong Kong. MEASUREMENTS Grip strength, gait speed and IADL difficulties were measured between 2001 to 2017. Joint models were used to examine the trajectories of grip strength, gait speed and IADL difficulties over time, and the interaction effect of age-by-cohort (or also age2-by-cohort) was also examined. RESULTS The recently born cohort (1934 - 1938) had worse grip strength and more IADL difficulties at the same age than the earlier two cohorts (1929 - 1933; 1905 - 1928). Furthermore, the most recently born cohort also followed a more rapid decline longitudinally with a greater decline observed in gait speed, grip strength and IADL difficulties for women whereas a greater decline in grip strength and IADL difficulties for men. CONCLUSIONS The continuous improvement of physical limitations in old age may have halted and there appears to be a reversal of this favourable trend in the recent born cohort of older adults living in Hong Kong.
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Affiliation(s)
- T W Auyeung
- Zhi-Hui Lu, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China, Tel: (852) 2252 8895
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Lam LCW, Chan WC, Kwok TCY, Lee JSW, Yu BML, Lee S, Lee ATC, Ma SL, Cheng ST. Combined physical exercise-working memory training on slowing down cognitive decline in elders with mild clinical Alzheimer disease: a randomised controlled study (abridged secondary publication). Hong Kong Med J 2022; 28 Suppl 3:28-30. [PMID: 35701227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - T C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - J S W Lee
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
| | - B M L Yu
- Social Welfare Department, Hong Kong SAR Government
| | - S Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - A T C Lee
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S L Ma
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S T Cheng
- Department of Health and Physical Education, The Education University of Hong Kong
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Chung BPH, Chiang WKH, Lau H, Lau TFO, Lai CWK, Sit CSY, Chan KY, Yeung CY, Lo TM, Hui E, Lee JSW. Pilot study on comparisons between the effectiveness of mobile video-guided and paper-based home exercise programs on improving exercise adherence, self-efficacy for exercise and functional outcomes of patients with stroke with 3-month follow-up: A single-blind randomized controlled trial. Hong Kong Physiother J 2020; 40:63-73. [PMID: 32489241 PMCID: PMC7136530 DOI: 10.1142/s1013702520500079] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/20/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To compare the effectiveness of mobile video-guided home exercise program and standard paper-based home exercise program. METHODS Eligible participants were randomly assigned to either experimental group with mobile video-guided home exercise program or control group with home exercise program in a standard pamphlet for three months. The primary outcome was exercise adherence. The secondary outcomes were self-efficacy for exercise by Self-Efficacy for Exercise (SEE) Scale; and functional outcomes including mobility level by Modified Functional Ambulatory Category (MFAC) and basic activities of daily living (ADL) by Modified Barthel Index (MBI). All outcomes were captured by phone interviews at 1 day, 1 month and 3 months after the participants were discharged from the hospitals. RESULTS A total of 56 participants were allocated to the experimental group ( n = 27 ) and control group ( n = 29 ) . There were a significant between-group differences in 3-months exercise adherence (experimental group: 75.6%; control group: 55.2%); significant between-group differences in 1-month SEE (experimental group: 58.4; control group: 43.3) and 3-month SEE (experimental group: 62.2; control group: 45.6). For functional outcomes, there were significant between-group differences in 3-month MFAC gain (experimental group: 1.7; control group: 1.0). There were no between-group differences in MBI gain. CONCLUSION The use of mobile video-guided home exercise program was superior to standard paper-based home exercise program in exercise adherence, SEE and mobility gain but not basic ADL gain for patients recovering from stroke.
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Affiliation(s)
- Bryan Ping Ho Chung
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Wendy Kam Ha Chiang
- Physiotherapy Department, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Herman Lau
- Hospital Chief Executive, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Titanic Fuk On Lau
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Charles Wai Kin Lai
- Physiotherapy Department, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Claudia Sin Yi Sit
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Ka Yan Chan
- Physiotherapy Department, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Chau Yee Yeung
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Tak Man Lo
- Physiotherapy Department, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
| | - Elsie Hui
- Department of Medicine and Geriatrics, Shatin Hospital, 33A Kung Kok Street, Shatin, New Territories, Hong Kong
| | - Jenny Shun Wah Lee
- Department of Medicine and Geriatrics, Tai Po Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong
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Abstract
OBJECTIVES Screening questions for sarcopenia used in the community (SARC-F) may be regarded as indicators of exercise tolerance. DESIGN Observational study. SETTING We tested the hypothesis that community-living older people who are screened positive for sarcopenia using the SARC-F tool but without a history of heart failure (HF) have a higher prevalence of cardiac abnormalities compared with those who are SARC-F negative. PARTICIPANTS Participants were recruited from a territory-wide primary care needs assessment for older people based in community centres, and from non-acute hospitals in the same region as the study centre. MEASUREMENTS Participants with a total score of >=4 and who did not have any history of HF were invited to attend for further cardiac assessment. Grip strength, walking speed, and the 6-minute walk test and echocardiography were carried out. Patients with frailty and at least Grade II diastolic dysfunction were considered to have heart failure with preserved ejection fraction (HFpEF) if they also had concomitant elevated N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) of at least 300 pg/ml. RESULTS Diastolic dysfunction (DD) was significantly associated with SARC-F score >=4 and higher circulating NT-proBNP levels. ROC curves evaluating the predictive values of SARC-F, HGS and gait speed for DD showed that a combination of SARC-F and HGS or gait speed provided significant incremental value in predicting DD. CONCLUSIONS Community living older people with sarcopenia detected using a simple questionnaire have a higher prevalence of DD accompanied by elevated NT proBNP. Addition of hand grip strength or walking speed improve the magnitude of the association. SARC-F may be used as a tool to detect early cardiac dysfunction in the community.
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Affiliation(s)
- X Yang
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T., Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
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Sng G, Lim DYZ, Sia CH, Lee JSW, Shen XY, Lee ECY, Dalakoti M, Wang KJ, Kwan CKW, Chow WE, Tan RS, Lam CSP, Chua T, Yeo TJ, Chong DTT. P1925Machine learning versus classic electrocardiographic criteria for left ventricular hypertrophy in a young pre-participation cohort: results from the SAFE protocol study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Classic electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) have been well studied in Western populations, particularly in hypertensive patients. However, their utility in Asian populations is not well studied, and their applicability to young pre-participation cohorts is unclear. We sought to evaluate the performance of classical criteria against that of machine learning models.
Aims
We sought to evaluate the performance of classical criteria against the performance of novel machine learning models in the identification of LVH.
Methodology
Between November 2009 and December 2014, pre-participation screening ECG and subsequent echocardiographic data was collected from 13,954 males aged 16 to 22, who reported for medical screening prior to military conscription.
Final diagnosis of LVH was made on echocardiography, with LVH defined as a left ventricular mass index >115g/m2. The continuous and binary forms of classical criteria were compared against machine learning models using receiver-operating characteristics (ROC) curve analysis. An 80:20 split was used to divide the data into training and test sets for the machine learning models, and three fold cross validation was used in training the models. We also compared the important variables identified by machine learning models with the input variables of classical criteria.
Results
Prevalence of echocardiographic LVH in this population was 0.91% (127 cases). Classical ECG criteria had poor performance in predicting LVH, with the best predictions achieved by the continuous Sokolow-Lyon (AUC = 0.63, 95% CI = 0.58–0.68) and the continuous Modified Cornell (AUC = 0.63, 95% CI = 0.58–0.68). Machine learning methods achieved superior performance – Random Forest (AUC = 0.74, 95% CI = 0.66–0.82), Gradient Boosting Machines (AUC = 0.70, 95% CI = 0.61–0.79), GLMNet (AUC = 0.78, 95% CI = 0.70–0.86). Novel and less recognized ECG parameters identified by the machine learning models as being predictive of LVH included mean QT interval, mean QRS interval, R in V4, and R in I.
ROC curves of models studies
Conclusion
The prevalence of LVH in our population is lower than that previously reported in other similar populations. Classical ECG criteria perform poorly in this context. Machine learning methods show superior predictive performance and demonstrate non-traditional predictors of LVH from ECG data. Further research is required to improve the predictive ability of machine learning models, and to understand the underlying pathology of the novel ECG predictors identified.
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Affiliation(s)
- G Sng
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - D Y Z Lim
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - C H Sia
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - J S W Lee
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - X Y Shen
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - E C Y Lee
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - M Dalakoti
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - K J Wang
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - C K W Kwan
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - W E Chow
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - R S Tan
- National Heart Centre Singapore, Singapore, Singapore
| | - C S P Lam
- National Heart Centre Singapore, Singapore, Singapore
| | - T Chua
- National Heart Centre Singapore, Singapore, Singapore
| | - T J Yeo
- National University Heart Centre, Singapore, Singapore
| | - D T T Chong
- National Heart Centre Singapore, Singapore, Singapore
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Lee JSW, Lim DYZ, Sng G, Shen XY, Wang KJ, Tan BYQ, Sia CH, Dalakoti M, Kwan CKW, Chow WE, Chua TSJ, Yeo TJ, Chong DTT. P308Utility of a prominent R wave in lead V1 of a resting electrocardiogram for detecting significant cardiac pathology in an unselected population of young males. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pre-participation electrocardiogram (ECG) screening is proposed as a means to detect cardiac pathology in asymptomatic individuals, and to select individuals for further cardiac investigation. Isolated ECG finding of Right Ventricular Hypertrophy (RVH) does not require further investigation based on the recent 2017 International Criteria. However, a prominent R wave in V1 has been described in cardiac abnormalities such as Wolff-Parkinson-White syndrome, hypertrophic cardiomyopathy, cardiomyopathy in Duchenne muscular dystrophy, arrhythmogenic right ventricular cardiomyopathy (ARVC), atrial septal defect and pulmonary hypertension.
Purpose
We sought to examine the utility of a prominent R wave in V1 as a screening criterion in an asymptomatic young male population of predominantly non-athletes, to detect significant structural cardiac pathology.
Methods
As part of the Singapore Armed Forces Electrocardiographic and Echocardiographic (SAFE) Protocol Study, pre-military enlistment screening ECG data was collected from 144,346 males between the ages of 16 to 22 from November 2009 to December 2014. Patients with ECGs with a prominent R wave, defined as an R wave ≥0.5mV in lead V1 with an R/S ratio of ≥1, were sent to a tertiary medical facility for a detailed transthoracic echocardiogram and subsequent cardiologist review. Any cardiac pathology identified was deemed significant if it led to the patient being excluded from participation in vigorous physical activity.
Results
1,144 patients with an isolated prominent R wave in V1 were studied. The mean age was 18.2±1.09 years and 81% were of Chinese ethnicity. None of the patients had echocardiographic evidence of RVH, 5 patients had a dilated right ventricle and 3 individuals had an elevated pulmonary artery systolic pressure. 11 patients (0.96%) had significant structural heart disease known to be associated with a prominent R wave in V1 that excluded them from participation in physical activity. These included large atrial septal defects (n=8), pulmonary stenosis (n=1), total anomalous pulmonary venous return (n=1) and hypertrophic cardiomyopathy (n=1). The test has a sensitivity of 21.6%, specificity of 93.4%, positive predictive value of 0.96% and negative predictive value of 99.8%,
Performance As Screening Criteria Number of Patients With Cardiac Pathology In Those Tested Positive Number of Patients With Cardiac Pathology In Those Tested Negative Positive Predictive Value (%) Negative Predictive Value (%) Sensitivity (%) Specificity (%) 11 40 0.96 99.8 21.6 93.4
Significant Cardiac Pathology Identified
Conclusion
A prominent R in V1 is not associated with echocardiographic RVH, or ARVC even in a large predominantly non-athletic male population. However, 0.96% of such patients would have other significant cardiac pathologies such as a large atrial septal defect.
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Affiliation(s)
- J S W Lee
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - D Y Z Lim
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - G Sng
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - X Y Shen
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - K J Wang
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - B Y Q Tan
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - C H Sia
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - M Dalakoti
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - C K W Kwan
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - W E Chow
- Singapore Armed Forces Medical Corps, Singapore, Singapore
| | - T S J Chua
- National Heart Centre Singapore, Singapore, Singapore
| | - T J Yeo
- National University Hospital, Singapore, Singapore
| | - D T T Chong
- National Heart Centre Singapore, Singapore, Singapore
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Woo J, Yang X, Tin Lui L, Li Q, Fai Cheng K, Fan Y, Yau F, Lee APW, Lee JSW, Fung E. Utility of the FRAIL Questionnaire in Detecting Heart Failure with Preserved Ejection Fraction. J Nutr Health Aging 2019; 23:373-377. [PMID: 30932136 DOI: 10.1007/s12603-019-1158-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To test the utility of the FRAIL questionnaire as a screening tool for heart failure. DESIGN Cross sectional study. SETTING Chinese older people in Hong Kong. PARTICIPANTS Participants aged 60 years and over were recruited from a territory-wide primary care needs assessment for older people based in community centers as well as two nonacute hospitals. MEASUREMENTS Questionnaire administered included the five-item FRAIL scale, and information regarding sociodemographic data, smoking and alcohol use, history of cardiovascular disease and diabetes, and heart failure symptoms. Handgrip strength, walking speed and 6 minute walk distance were recorded. Cardiac assessment included electrocardiogram, echocardiography, and blood assay for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). RESULTS The prevalence of diastolic dysfunction was high, being 52% in the robust group, increasing to 65% in the pre-frail and 85% in the frail group. This finding is accompanied by a corresponding increase in NT-proBNP from 64.18 pg/ml in the robust group, to 118.57 pg/ml in the pre-frail and 167.98 pg/ml in the frail group. Three of the five components of the FRAIL scale, fatigue, resistance and ambulation, were associated with increased odds ratios of diastolic dysfunction among those aged 75 years and older, while resistance alone was associated with increased odds ratio among those less than 75 years old. CONCLUSION Frailty is associated with heart failure with preserved ejection fraction (HFpEF), and frailty screening may be used to detect undiagnosed HFpEF. The findings support the proposal that HFpEF be considered a geriatric syndrome.
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Affiliation(s)
- J Woo
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
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Chan RSM, Yu BWM, Leung J, Lee JSW, Auyeung TW, Kwok T, Woo J. How Dietary Patterns are Related to Inflammaging and Mortality in Community-Dwelling Older Chinese Adults in Hong Kong - A Prospective Analysis. J Nutr Health Aging 2019; 23:181-194. [PMID: 30697629 DOI: 10.1007/s12603-018-1143-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Studies examining dietary patterns and inflammageing in relation to mortality are limited. OBJECTIVE We examined the influence of various dietary patterns on all-cause and cardiovascular disease (CVD) mortality, taking into account demographics, lifestyle factors, and serum inflammatory markers. METHODS We conducted multivariate Cox regression analyses using data from a cohort of community-dwelling older Chinese adults (1,406 men, 1,396 women) in Hong Kong. Baseline interviewer administered questionnaires covered dietary intake estimation and dietary pattern generation from the food frequency questionnaire, demographic and lifestyle factors, cognitive function and depressive symptoms. Serum high-sensitivity C-reactive protein (hsCRP) and 25-hydroxyvitamin D (25OHD) were measured. All-cause and CVD mortality data at 14-year follow up were retrieved from an official database. RESULTS In men, higher hsCRP level was associated with lower Diet Quality Index-International (DQI-I) score, Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND) score, Okinawan diet score, "vegetables-fruits" pattern score and "snacks-drinks-milk" pattern score. Higher serum 25OHD level was associated with higher Mediterranean Diet Score (MDS) but lower "snacks-drinks-milk" pattern score. None of the dietary pattern scores was associated with all-cause or CVD mortality after adjusting for all covariates. In women, hsCRP level and serum 25OHD level were not associated with any dietary patterns. Higher DQI-I score (HR=0.77 (95% CIs: 0.59, 0.99) highest vs. lowest tertile, p-trend=0.038) and Okinawan diet score (HR=0.78 (95% CIs: 0.61, 1.00) highest vs lowest tertile, p-trend=0.046) was associated with a lower risk of all-cause mortality, whereas higher MIND score (HR=0.63 (95% CI: 0.36, 1.09) highest vs. lowest tertile, p-trend=0.045) was associated with a reduced risk of CVD morality in the multivariate adjusted model. CONCLUSION Higher DQI-I score and Okinawan diet score were associated with a lower risk of all-cause mortality, and higher adherence to the MIND diet was related to a reduced risk of CVD mortality in community-dwelling Chinese older women.
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Affiliation(s)
- R S M Chan
- Dr Ruth Chan, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T., Hong Kong, Tel: 852-3505-2190, Fax: 852-2637-9215,
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Shen X, Lee JSW, Tan BYQ, Dalakoti M, Sia CH, Yeo TJ, Wang L, Tan BY, Lim PCY, Chua KCM, Ho KL, Lim ETS, Ching CK, Teo WS, Chong DTT. 4286Population based prevalence of Brugada syndrome in a young male population in southeast asia. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- X Shen
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - J S W Lee
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - B Y Q Tan
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - M Dalakoti
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - C H Sia
- Singapore Armed Forces Medical Corps, Medical Classification Centre, Central Manpower Base, Singapore, Singapore
| | - T J Yeo
- National University Heart Centre, Department of Cardiology, Singapore, Singapore
| | - L Wang
- Singapore Armed Forces Medical Corps, HQ Medical Corps, Singapore, Singapore
| | - B Y Tan
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - P C Y Lim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - K C M Chua
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - K L Ho
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - E T S Lim
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - C K Ching
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - W S Teo
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - D T T Chong
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
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AuYeung TW, Leung J, Yu R, Lee JSW, Kwok T, Woo J. Decline and Peripheral Redistribution of Fat Mass in Old Age - A Four-Year Prospective Study in 3018 Older Community-Living Adults. J Nutr Health Aging 2018; 22:847-853. [PMID: 30080230 DOI: 10.1007/s12603-018-1026-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND It is widely recognized that fat will accumulate with ageing and is more prominent centrally. However, there were studies reported that fat might not gain either centrally or generally with ageing. METHODS The baseline, 2-year and 4-year total body fat mas, trunk fat mass and percentage fat mass, were measured by DXA in 3018 community-living Chinese older than 65 years. The respective 4-year trajectories of adiposity were analyzed by repeated measure ANOVA p-for-trend test. RESULTS There was a trend of increase in total body fat mass in men and a decreasing trend in women but neither reached statistical significance. However, there was a significant increase in percent fat mass in both genders. Fat mass was relatively stable in the 2 young-old groups but it declined in the oldest group, aged 75 years or above. (men, p=0.017; women, p<0.001). On the contrary, a corresponding rise of percent fat mass was observed, which was steeper in the 2 younger age groups but did not change in the oldest group. For trunk fat mass, there was a statistically significant decreasing trend in women (p < 0.001) but it remained static in men (p = 0.092). The fat mass in upper limbs of both genders did not change but for the lower limbs, there was a statistically significant increase in both men (p < 0.001) and women (p < 0.02). CONCLUSION Absolute total body fat mass does not accumulate in old age and in the contrary, in the oldest old group (75 years or above), it declined instead. With ageing, fat will redistribute from the central region to the lower limbs.
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Affiliation(s)
- T W AuYeung
- TW AuYeung, Chinese University of Hong Kong, Hong Kong,
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Auyeung TW, Kwok T, Leung J, Lee JSW, Ohlsson C, Vandenput L, Wing YK, Woo J. Sleep Duration and Disturbances Were Associated With Testosterone Level, Muscle Mass, and Muscle Strength—A Cross-Sectional Study in 1274 Older Men. J Am Med Dir Assoc 2015; 16:630.e1-6. [DOI: 10.1016/j.jamda.2015.04.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 01/18/2023]
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Chan WC, Fai Yeung JW, Man Wong CS, Wa Lam LC, Chung KF, Hay Luk JK, Wah Lee JS, Kin Law AC. Efficacy of Physical Exercise in Preventing Falls in Older Adults With Cognitive Impairment: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2015; 16:149-54. [DOI: 10.1016/j.jamda.2014.08.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
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Auyeung TW, Lee JSW, Leung J, Kwok T, Woo J. The selection of a screening test for frailty identification in community-dwelling older adults. J Nutr Health Aging 2014; 18:199-203. [PMID: 24522474 DOI: 10.1007/s12603-013-0365-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Frailty in older Chinese has been less often studied and the selection of one screening test feasible in primary care and population survey is needed. We attempted to examine the sensitivity and specificity of each of the five Fried's criteria as a single screening test in the identification of frailty. METHODS We recruited 4000 community-dwelling Chinese adults 65 years or older stratified by 3 age-stratum and identified frailty as having 3 or more of Fried's criteria: underweight(BMI<18.5), handgrip strength( RESULTS The proportion of frailty in the 3 age groups (65-69 years, 70-74 years, 75 years and above) were 2.3%, 3.4% and 11.9% respectively in men and 1.4%, 2.6% and 11.6% in women. Among the 5 criteria, walking speed, grip strength and physical activity (PASE score) divided at their respective lowest quintile values, achieved similar Area Under Curve in the Receiver Operating Characteristics analysis. For walking speed, the sensitivity and specificity were 82.7% and 83.1% in men and 91.9% and 84.5% in women respectively. For grip strength, the corresponding values were 89.5% and 80.6% in men; and 84.5% and 81.9% in women. For physical activity, they were 83.7% and 83.5% in men; and 82.8% and 84.7% in women. CONCLUSION Either walking speed or grip strength measurement may be suitable for frailty screening in primary care or population health survey. A cut-off value of 0.9 m/s in walking speed and 28 kg in grip strength for older men; and a corresponding value of 0.8 m/s and 18 kg for older women is recommended for the screening of frailty in community-dwelling older Chinese adults.
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Affiliation(s)
- T W Auyeung
- Tung Wai Auyeung, The S. H. Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Department of Medicine and Geriatrics, Pok Oi Hospital, Au Tau, NT, Hong Kong, Email : , Telephone: 852 24868985, Fax: 852 24868976
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Auyeung TW, Lee JSW, Leung J, Kwok T, Woo J. Adiposity to muscle ratio predicts incident physical limitation in a cohort of 3,153 older adults--an alternative measurement of sarcopenia and sarcopenic obesity. Age (Dordr) 2013; 35:1377-85. [PMID: 22614096 PMCID: PMC3705102 DOI: 10.1007/s11357-012-9423-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 11/09/2011] [Accepted: 04/30/2012] [Indexed: 05/21/2023]
Abstract
Conventionally, sarcopenia is defined by muscle mass and physical performance. We hypothesized that the disability caused by sarcopenia and sarcopenic obesity was related to the amount of adiposity or body weight bearing on a unit of muscle mass, or the adiposity to muscle ratio. We therefore examined whether this ratio could predict physical limitation by secondary analysis of the data in our previous study. We recruited 3,153 community-dwelling adults aged >65 years and their body composition was measured by dual-energy X-ray absorptiometry. Assessment of physical limitation was undertaken 4 years later. The relationship between baseline adiposity to muscle ratio and incident physical limitation was examined by logistic regression. In men, the adiposity to muscle ratios, namely total body fat to lower-limb muscle mass, total body fat to fat-free mass (FFM), and body weight to FFM, were predictive of physical limitation before and after adjustment for the covariates: age, Mini-mental Status Examination score, Geriatric Depression Scale score >8, and the diagnosis of chronic obstructive pulmonary disease, diabetes mellitus, hypertension, heart disease, and stroke (all p values < 0.001), when the total body fat to lower-limb muscle mass ratio was greater than or equal to 0.75. In women, throughout the entire range of that ratio, all three adiposity to muscle ratios were associated with physical limitation 4 years later both before and after adjustment for the same set of covariates (all p values < 0.05). Sarcopenia and sarcopenic obesity as measured by the body weight or adiposity bearing on a unit of muscle mass (the adiposity to muscle ratio) could predict incident or worsening physical limitation in older women across the entire range of the total body fat to lower-limb muscle mass ratio; and in older men when this ratio was equal to or greater than 0.75.
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Affiliation(s)
- Tung Wai Auyeung
- The S. H. Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Auyeung TW, Lee JSW, Leung J, Kwok T, Leung PC, Woo J, Wing YK. Cognitive deficit is associated with phase advance of sleep-wake rhythm, daily napping, and prolonged sleep duration--a cross-sectional study in 2,947 community-dwelling older adults. Age (Dordr) 2013; 35:479-486. [PMID: 22215376 PMCID: PMC3592949 DOI: 10.1007/s11357-011-9366-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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: 07/15/2011] [Accepted: 12/06/2011] [Indexed: 05/31/2023]
Abstract
This study aims to examine the phase advance of sleep-wake rhythm, napping habit, nocturnal sleep duration, prolonged sleep latency and insomnia and their relationship with cognitive function. This is a cross-sectional study. Participants in this study are 2,947 community-dwelling adults older than 65 years old. Measurements of mini-mental examination (MMSE) score, go-to-bed time, wake-up time, nocturnal sleep duration, prolonged sleep latency, napping, and insomnia were done. The mean (standard deviation) nocturnal sleep hours was 7.96 (1.39) h. Twenty-one percent and 16.2% of the participants complained of prolonged sleep latency longer than 1 h and insomnia, respectively. Fifty-six percent of the participants napped once or more than once weekly. With advancing age, the participants reported longer sleep duration (p<0.001), went to bed earlier, and woke up earlier, which were significant both before and after adjustment. The participants who had lower MMSE score went to bed earlier and woke up earlier, which were statistically significant both before and after adjustment. An inverted U-shaped relationship was observed between MMSE score and napping frequency, p for tend 0.026.The MMSE score decreased when the sleep duration prolonged from 7 h to ≧10 h (p for trend 0.006). No trend was observed from the sleep duration <4 up to 7.9 h (p for trend 0.500). Modest age-independent phase advance of the sleep-wake rhythm is associated with lower cognitive function. Whether this is a manifestation of early pre-clinical dementia and whether its recognition with early stabilization can slow cognitive decline remain elusive.
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Affiliation(s)
- Tung Wai Auyeung
- The S. H. Ho Centre for Gerontology and Geriatrics, The Chinese University Of Hong Kong, Shatin, Hong Kong.
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Lee JSW, Auyeung TW, Kwok T, Li M, Leung J, Woo J. Survival benefit of abdominal adiposity: a 6-year follow-up study with Dual X-ray absorptiometry in 3,978 older adults. Age (Dordr) 2012; 34:597-608. [PMID: 21667162 PMCID: PMC3337922 DOI: 10.1007/s11357-011-9272-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [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: 12/14/2010] [Accepted: 05/18/2011] [Indexed: 05/30/2023]
Abstract
In contrast to that in the middle-aged, higher body mass index (BMI) in older people is associated with higher survival rates. Yet, BMI makes no distinction between fat elsewhere and abdominal fat, the latter being metabolically more harmful. We hypothesized that overall adiposity might be protective in old age, but that central fat might offset that benefit and remained harmful as in the middle-aged. Three thousand nine hundred seventy-eight Chinese elderly ≥65 years had demographics, medical conditions, physical activity, and body composition by DXA recorded at baseline. Overall adiposity was measured as whole body fat%, and abdominal adiposity as waist circumference, waist-hip ratio, and relative abdominal fat (RAF) (relative abdominal fat = abdominal fat according to anatomical landmarks/whole body fat). Deaths within 1 year from baseline were excluded from analysis. All-cause and cardiovascular mortality were analyzed using Cox regression, adjusted for covariates. The lowest quintile of adiposity measurements was used for comparison. After a mean follow-up of 72.3 months, 13.7% men and 4.5% women had died. In men, the highest two quintiles of whole body fat % and the upper four quintiles of RAF were associated with significantly lower all-cause mortality, and adjusted hazard ratio (95% CI) in ascending quintiles of RAF compared with the lowest quintile was 0.62 (0.43-0.89), 0.58 (0.4-0.85), 0.52 (0.36-0.77), and 0.67 (0.47-0.96). No relationship was found between abdominal adiposity and cardiovascular mortality in both genders. Higher whole body fat % as well as higher proportion of abdominal fat was associated with lower all-cause mortality in men. No such relation was found in women.
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Affiliation(s)
- Jenny Shun Wah Lee
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- The S H Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Geriatrics, Shatin Hospital, 33 A Kung Kok Street, Shatin, Hong Kong, China
| | - Tung Wai Auyeung
- The S H Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Geriatrics, Pok Oi Hospital, Hong Kong, China
| | - Timothy Kwok
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Martin Li
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason Leung
- The Jockey Club Centre of Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean Woo
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- The S H Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
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Lee JSW, Auyeung TW, Leung J, Kwok T, Leung PC, Woo J. Physical frailty in older adults is associated with metabolic and atherosclerotic risk factors and cognitive impairment independent of muscle mass. J Nutr Health Aging 2011; 15:857-62. [PMID: 22159773 DOI: 10.1007/s12603-011-0134-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Metabolic and atherosclerotic diseases are known risk factors for disability in old age, and can result in sarcopenia as well as cognitive impairment, which are both components of frailty syndrome. As muscle loss increases with ageing, it is unclear whether muscle loss per se, or the diseases themselves, are the underlying cause of physical frailty in those suffering from these diseases. We tested the hypothesis that metabolic and atherosclerotic diseases and cognitive impairment are associated with physical frailty independent of muscle loss in old age, and further examined their impact on the relationship between physical frailty and mortality. DESIGN Prospective. SETTING Community. PARTICIPANTS 4000 community dwelling Chinese elderly ≥65 years. MEASUREMENTS Diabetes, hypertension, stroke, heart disease, cognitive impairment, smoking, physical activity, waist hip ratio (WHR) and ankle-brachial index (ABI)) were recorded. Physical frailty measurements (grip-strength, chair-stands, stride length and 6-metre walks) were summarized into a composite frailty score (0-20), 0 being the most frail) according to quartiles of performance. Appendicular muscle mass (ASM) was measured using dual X-ray absorptiometry. Relationships between the score and covariates were analyzed. Cox regression was used to study the impact of metabolic and atnerosclerotic risk factors on the relationship between physical frailty and 6-year mortality. RESULTS After adjustment for ASM, all metabolic diseases and indexes, and cognitive impairment were significantly associated with the composite physical frailty score in univariate analysis. In multivariate analysis, cognitive impairment, high WHR, diabetes, stroke and heart disease were all independently associated with higher physical frailty with adjustment for age, physical activity level and ASM. Hypertension was associated with physical frailty in men but not in women. In Cox regression, increased physical frailty was associated with higher 6-year mortality. The impact of metabolic and atherosclerotic risk factors was however only modest after adjustment for age and cognitive function. CONCLUSION Metabolic and atherosclerotic diseases and high WHR, was associated with physical frailty, independent of their adverse effect on cognitive function and muscle mass.
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Affiliation(s)
- J S W Lee
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
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Auyeung TW, Lee JSW, Kwok T, Woo J. Physical frailty predicts future cognitive decline - a four-year prospective study in 2737 cognitively normal older adults. J Nutr Health Aging 2011; 15:690-4. [PMID: 21968866 DOI: 10.1007/s12603-011-0110-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the association between baseline frailty measurements and cognitive function 4 years later. DESIGN Prospective observational study. SETTING Community. PARTICIPANTS Two thousand seven hundred and thirty seven cognitively normal older adults. MEASUREMENT The appendicular muscle mass (ASM), hand grip strength, timed chair-stand test, walking speed and step length were measured at baseline. The Mini-mental state examination (MMSE) was administered at baseline and 4 years later. RESULTS In men, all baseline frailty measurements, namely, being underweight, lower ASM, weaker grip strength, slower chair-stand test, shorter step length, slower timed walk were significantly associated with a lower MMSE score 4 years afterwards. After adjustment for age, years of education and baseline MMSE score, ASM and timed walk became insignificant. In women, all frailty measurements except underweight and low ASM were significantly associated with MMSE score 4 years later. Moreover, only weaker grip strength persisted to be significant after adjustment for age, years of education and baseline MMSE score. CONCLUSION Physical frailty, as represented by being underweight, weaker grip strength, slower chair-stand test, shorter step-length in men and weaker grip strength in women, was associated with cognitive decline over a four year period.
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Affiliation(s)
- T W Auyeung
- S.H. Ho Centre for Gerontology and Geriatric, The Chinese University of Hong Kong and Pok Oi Hospital, Hong Kong, China.
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Lee JSW, Wang K, Cheung TCY, Kwok TCY, Ahuja AT. An uncommon cause of recurrent falls in an elderly man. Hong Kong Med J 2011; 17:328-331. [PMID: 21813904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Falls are common among the elderly population. Examinations for the cause of falls are usually mundane, but may be challenging, leading to surprising diagnoses. We report on a previously healthy elderly man who presented with repeated falls and rapidly progressive limitations in mobility, in addition to a stutter. Neuroimaging was particularly helpful for making the diagnosis in this patient.
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Affiliation(s)
- J S W Lee
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong.
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Auyeung TW, Lee JSW, Kwok T, Leung J, Ohlsson C, Vandenput L, Leung PC, Woo J. Testosterone but not estradiol level is positively related to muscle strength and physical performance independent of muscle mass: a cross-sectional study in 1489 older men. Eur J Endocrinol 2011; 164:811-7. [PMID: 21346095 DOI: 10.1530/eje-10-0952] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the relationship between different measures of testosterone and estradiol (E(2)), muscle mass, muscle strength, and physical performance; and to test whether the association of sex hormone level with muscle strength and physical performance was independent of muscle mass. DESIGN AND METHODS A cross-sectional survey on 1489 community-dwelling men older than 64 years of age. Serum levels of testosterone and E(2) were measured by mass spectrometry, and sex hormone-binding globulin (SHBG) levels were measured by immunoradioassay. Muscle mass was examined by dual-energy X-ray absorptiometry and physical performance was assessed by hand-grip strength, gait speed, step length and chair-stand test. RESULTS Appendicular skeletal mass (ASM) was positively associated with total testosterone (TT; P<0.001), free testosterone (FT; P<0.001), and total E(2) (P<0.001) but not with free E(2) (P=0.102). After adjustment for age, serum SHBG and relative ASM, both TT and FT were significantly associated with grip strength, narrow-walk speed and the composite neuromuscular score. Higher total E(2), but not free E(2) was associated with lower grip strength (P<0.05) after adjustment for age, FT, SHBG and relative ASM. CONCLUSIONS Testosterone level was related to both muscle mass, strength and physical performance. Total E(2) level, though related to muscle mass positively, affected muscle strength adversely in older men.
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Affiliation(s)
- Tung Wai Auyeung
- The S H Ho Centre of Gerontology and Geriatrics, The Chinese University of Hong Kong, Shatin, Hong Kong, People's Republic of China.
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Abstract
AIMS Diabetes mellitus may be associated with excessive lean mass loss. Other diabetes-related conditions may also play a role. We assessed body composition changes associated with diabetes in older adults with adjustment for diabetes-related co-morbidities. METHODS Three thousand, one hundred and fifty-three community-living adults aged ≥ 65 years were examined for lifestyle factors, diabetes-related medical conditions and body composition by dual energy X-ray absorptiometry at baseline and 4 years later. Body composition changes were compared between participants with diabetes and those without diabetes. Multivariate linear regression was used to examine the relationship between appendicular lean mass loss and confounders. RESULTS Appendicular lean mass loss in men with diabetes was two times that of men without diabetes (-1.5% in 'no diabetes' vs. -3.0% in 'diabetes') and in women with diabetes was 1.8 times that of those without diabetes (-1.9% in 'no diabetes' vs. -3.4% in 'diabetes') over 4 years. Men with diabetes also had higher total body mass loss and higher total body fat loss than men without diabetes. Women with diabetes had higher total body mass loss but total body fat loss was similar. After adjusting for age, body mass index, diabetes-related conditions, lifestyle factors and total body mass loss, diabetes remained an independent predictor of appendicular lean mass loss in both men and women. CONCLUSION Diabetes was associated with higher body mass loss and higher appendicular lean mass loss in older adults. In men, diabetes was also associated with total body fat loss.
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Affiliation(s)
- J S W Lee
- Division of Geriatrics, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
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Auyeung TW, Lee JSW, Leung J, Kwok T, Leung PC, Woo J. Effects of height loss on morbidity and mortality in 3145 community-dwelling Chinese older women and men: a 5-year prospective study. Age Ageing 2010; 39:699-704. [PMID: 20817934 DOI: 10.1093/ageing/afq101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND height loss beginning in mid-life and post-menopausal period was associated with adverse health outcomes. However, height loss occurring after old age has been little studied. We examined how height loss was related to bone mineral density (BMD) change, fracture incidence and cause-specific mortality in older adults. METHODS the stature and BMD of 3145 community-dwelling men and women aged ≥65 were measured at baseline and after 4 years. All fracture and cause-specific mortality events were searched in a territory-wide clinical information database and death registry. RESULTS twenty-five (1.6%) men and 64 (4.0%) women lost >2 cm after 4 years. In women, the BMD decline was faster in the rapid height losers (adjusted difference = 4.18%, P < 0.001). There was no corresponding difference observed in men. Rapid height loss was associated with excess all fractures and hip fractures (adjusted HR for all fractures = 2.86, P < 0.001; adjusted HR for hip fractures = 4.74, P < 0.01) in women but only hip fractures (adjusted HR = 4.93, P < 0.05) in men. The all-cause (adjusted HR = 3.43, P < 0.01) and respiratory disease mortality (adjusted HR = 5.64, P < 0.05) were higher in men with rapid height loss, whereas those in women were insignificant. CONCLUSIONS modest height loss occurring after old age, >2 cm in 4 years, was associated with excess hip fracture, total and respiratory disease mortality in older men. In women, it was associated with excess BMD decline, all fractures and hip fractures but not mortality. Further research is needed to determine the usefulness of regular stature measurement as an indicator of bone health in the primary-care setting in older adults.
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Affiliation(s)
- Tung Wai Auyeung
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong.
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Auyeung TW, Lee JSW, Kwok T, Leung J, Leung PC, Woo J. Estimation of stature by measuring fibula and ulna bone length in 2443 older adults. J Nutr Health Aging 2009; 13:931-6. [PMID: 19924356 DOI: 10.1007/s12603-009-0254-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 12/10/2008] [Indexed: 10/19/2022]
Abstract
UNLABELLED Estimation of Stature by Measuring Fibula and Ulna Bone Length in 2443 Older Adults. OBJECTIVES Knee height has been commonly used to estimate stature but may not always be possible in the frail older adults with compromised posture. Measurement of fibula and ulna bone length could be an alternative method. We attempted to develop and validate regression models to predict measured and reported height using age, fibula length, ulna length, hip circumferences and body weight. DESIGN A cross-sectional survey. SETTING The study was conducted in the Jockey Club Centre for Osteoporosis Care and Control, School of Public Health, The Chinese University of Hong Kong. PARTICIPANTS Two thousand four hundred and forty three community-dwelling older Chinese aged from 65 to 98 years were recruited. MEASUREMENTS The standing height, fibula length, ulna length, hip circumference and body weight were measured and the reported height was recorded. Three separate multiple linear regression models were developed to predict measured-height and reported-height respectively. RESULTS In predicting measured-height by the bone-length model, the mean errors were +0.52 cm (over-estimation) in men and +0.45 cm (over-estimation) in women and the SDs were +/- 3.5 cm in both genders. The 95% limits of agreement were: -6.65 to +7.70 cm for men and -6.59 to +7.49 cm for women. CONCLUSION The accuracy and precision of stature estimation by fibula and ulna bone length is comparable to that by knee height. This may be an acceptable alternative method when knee height measurement is difficult or when the knee height caliper is not available.
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Affiliation(s)
- T W Auyeung
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong.
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Lee JSW, Kwok T, Chui PY, Ko FWS, Lo WK, Kam WC, Mok HLF, Lo R, Woo J. Can continuous pump feeding reduce the incidence of pneumonia in nasogastric tube-fed patients? A randomized controlled trial. Clin Nutr 2009; 29:453-8. [PMID: 19910085 DOI: 10.1016/j.clnu.2009.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 10/12/2009] [Accepted: 10/20/2009] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Continuous pump feeding is often used to reduce aspiration risk in older patients on tube feeding, but its effectiveness in preventing aspiration pneumonia is unproven. A randomized controlled trial was therefore performed to examine the effectiveness of continuous pump feeding in decreasing the incidence of pneumonia in tube-fed older hospital patients. METHODS One hundred and seventy eight elderly patients from three convalescence hospitals and one infirmary, on nasogastric tube feeding, were randomly assigned to have intermittent bolus (bolus) or continuous pump (pump) feeding for 4weeks. The primary outcome was the incidence of pneumonia. The secondary outcome was mortality. RESULTS Eighty five subjects were randomized into the pump group and 93 in the bolus group. The groups were comparable in age, nutritional and functional status, co-morbidities and history of pneumonia, except that there were more women in the pump group. Within 4weeks, 15 subjects (17.6%) in the pump group and 18 (19.4%) in the bolus group developed pneumonia. Seven subjects (8.2%) in pump group and 13 subjects (14.0%) in bolus group died. There was no significant difference in either pneumonia or death rates between the two groups. CONCLUSION Continuous pump feeding did not significantly affect the rates of pneumonia or mortality in tube-fed older hospital patients when compared with intermittent bolus feeding.
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Affiliation(s)
- J S W Lee
- Department of Medicine & Geriatrics, Shatin Hospital, Hong Kong SAR, China
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Abstract
The study is to determine the optimal MRI bowel preparation regime for visualization of the stomach anatomy. Eight healthy volunteers were asked to take water, 75% barium and blueberry juice. The image quality and tolerance of different stomach distension regime were evaluated. Blueberry juice gave the best distension, but the signal intensity was not very homogeneous. Taking into account the image quality, tolerability and adverse effects, it is concluded that water is the most desirable oral contrast for MR stomach imaging.
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Affiliation(s)
- W W M Lam
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR.
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Chan JCM, Lee JSW, Dai DLK, Woo J. Unusual cases of human myiasis due to Old World screwworm fly acquired indoors in Hong Kong. Trans R Soc Trop Med Hyg 2005; 99:914-8. [PMID: 16154168 DOI: 10.1016/j.trstmh.2005.06.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 06/20/2005] [Accepted: 06/23/2005] [Indexed: 11/24/2022] Open
Abstract
Myiasis is the infestation of tissue by the larvae of flies. We report eight cases of human myiasis in Hong Kong. All patients were nursing home residents with an average age of 81.8 years. Seven patients were bedridden with advanced dementia. Four patients had pre-existing wounds. Five had poor oral hygiene and four of those were on tube feeding. All of the five patients with poor oral hygiene suffered from oral myiasis. Two patients had vaginal infestations and one had wound myiasis in his diabetic foot ulcer. Seven cases were infested by Chrysomya bezziana, an obligatory parasite that requires living mammalian tissue for its larval development. Larvae of the Calliphoridae family were responsible for the remaining case. Patients were managed with manual removal of larvae and irrigation of the site of infestation with saline. All infestations were nosocomial, being acquired in nursing homes. Carers of the old and debilitated should be made aware of the need for better oral care, especially for those on tube feeding. The use of window screens in nursing homes should be encouraged to reduce the chance of flies entering the vicinity of these patients. Electrocuters could also be mounted indoors to kill flies that do enter.
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Affiliation(s)
- J C M Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, New Territories, Hong Kong SAR, China
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Lee JSW, Auyeung TW. A comparison of two feeding methods in the alleviation of diarrhoea in older tube-fed patients: a randomised controlled trial. Age Ageing 2003; 32:388-93. [PMID: 12851181 DOI: 10.1093/ageing/32.4.388] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to compare the effect of two feeding methods on older tube-fed patients suffering from diarrhoea. DESIGN randomised controlled study. SETTING geriatric wards in a regional hospital. SUBJECTS 105 patients over the age of 60 who developed diarrhoea while on intermittent bolus tube feeding. METHODS subjects were randomised either to switch to continuous tube feeding or to continue with intermittent bolus tube feeding for 3 days, with some extended to 5 days. Incontinence pads were inspected 6 times per day by independent observers. Each motion was evaluated using a validated score according to its volume and consistency. Stools were sent for pathogen culture and Clostridium difficile cytotoxin assay. Those with positive assays were excluded from analysis. Gastric aspirations were performed at regular intervals and significant residual volumes recorded. RESULTS 86 patients completed the study. Twelve patients (14%) were excluded due to positive CD stool assays. Seventy-four patients were entered into analysis. The median diarrhoea scores of the continuous infusion group and the intermittent bolus group were: day 0 (12 versus 10, P=0.18), day 3 (4 versus 6, P=0.23) and day 5 (5 versus 4, P=0.83) respectively. There was no statistical difference between the two groups. Two patients in the continuous infusion group (n=37) and 4 patients in the intermittent bolus group (n=37) had significant gastric residual volumes. The incidence did not differ significantly. CONCLUSION contrary to common belief and recommendation, we could not find a significant difference between the continuous feeding method and the intermittent feeding method in the alleviation of diarrhoea in tube-fed patients. We do not recommend routine switch to continuous pump feeding in the management of tube-fed patients suffering from diarrhoea.
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Affiliation(s)
- Jenny Shun Wah Lee
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, New Territories, Hong Kong, China.
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