Colorectal Cancer and Subsequent Diabetes Risk: A Population-based Cohort Study in Taiwan

CONTEXT

The association between colorectal cancer (CRC) and new-onset diabetes mellitus remains unclear.

OBJECTIVE

To examine the association between CRC and the risk of subsequent diabetes mellitus and to further investigate the impact of chemotherapy on diabetes mellitus risk in CRC.

DESIGN

A nationwide cohort study.

METHODS

Using the Taiwan Cancer Registry Database (2007-2018) linked with health databases, 86,268 patients with CRC and an equal propensity score-matched cohort from the general population were enrolled. Among them, 37,277 CRC patients from the Taiwan Cancer Registry (2007-2016) were analyzed for diabetes mellitus risk associated with chemotherapy. Chemotherapy exposure within 3 years of diagnosis was categorized as no chemotherapy, <90 days, 90-180 days, and >180 days. Differences in diabetes mellitus risk were assessed across these categories.

RESULTS

Each group involved 86,268 participants after propensity score matching. The patients with CRC had a 14% higher risk of developing diabetes mellitus than the matched general population (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.09-1.20). The highest risk was observed within the first year after diagnosis followed by a sustained elevated risk. Long-term chemotherapy (>180 days within 3 years) was associated with a 60-70% increased risk of subsequent diabetes mellitus (HR: 1.64, 95% CI: 1.07-2.49).

CONCLUSION

Patients with CRC are associated with an elevated risk of diabetes mellitus, and long-term chemotherapy, particularly involving capecitabine, increases diabetes mellitus risk. Thus, monitoring blood glucose levels is crucial for patients with CRC, especially during extended chemotherapy.

Diabetic severity and oncological outcomes of colorectal cancer following curative resection: A population-based cohort study in Taiwan

BACKGROUND

Although diabetes is a poor prognostic factor for colorectal cancer (CRC), whether diabetes severity provides an additional predictive value for CRC prognosis remains unclear. The study aimed to investigate the prognostic differences after curative CRC resection among patients with different diabetic severities.

METHODS

This population-based retrospective cohort study analyzed data registered between 2007 and 2015 in the Cancer Registry Database, which is linked to the National Health Insurance Research Database and National Death Registry. Patients with CRC who underwent curative radical resection for stage I-III disease were evaluated, with their diabetic status subdivided into no diabetes, diabetes without complication, and diabetes with complications. Cox regressions were applied to determine the association between diabetes severity and CRC survival, including overall survival (OS), disease-free survival (DFS), time to recurrence, and cancer-specific survival (CSS).

RESULTS

A total of 59,202 patients with CRC were included. Compared with the no diabetes group, the diabetes without complication group has insignificantly worse OS (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01-1.09), DFS (HR, 1.08; 95% CI, 1.04-1.12), and CSS (HR, 0.98; 95% CI, 0.93-1.03), whereas those with complicated diabetes had a significantly higher risk of poor survival (OS: HR, 1.85; 95% CI, 1.78-1.92; DFS: HR, 1.75; 95% CI, 1.69-1.82; CSS: HR, 1.41; 95% CI, 1.33-1.49). Patients with CRC and diabetes also had a higher risk of recurrence than did those without diabetes. Sex and TNM staging were important effect modifiers.

CONCLUSIONS

Among patients with CRC who undergo curative resection, the severity of the diabetes is inversely correlated with long-term outcomes, especially in women and patients in the earlier stages of CRC.

PLAIN LANGUAGE SUMMARY

The prognostic impact of diabetes severity in colorectal cancer (CRC) is yet to be clarified. In this cohort study of 59,202 patients with CRC, compared with patients with CRC and without diabetes, those with uncomplicated diabetes had an insignificantly worse CRC survival, whereas those with complicated diabetes had a significantly higher risk of poor survival. Multidisciplinary medical care to prevent progression into diabetes with complications is needed to improve survival among patients with CRC and diabetes.

Incidence of Metabolic Syndrome and Its Risk Factors in Elderly with Nonalcoholic Fatty Liver Disease

Purpose

This study aimed to determine the incidence of metabolic syndrome (MetS) and its predictors in older patients with nonalcoholic fatty liver disease.

Patients and Methods

This retrospective cohort study analyzed repeated health surveillance data collected between 2009 and 2018 at Mackay Memorial Hospital, Taiwan. MetS was defined based on the modified National Cholesterol Education Program Adult Treatment Panel III (Taiwan revision). Participants were diagnosed with fatty liver disease using abdominal ultrasonography. The exclusion criteria included age <65 years, having viral hepatitis, frequent alcohol consumption, and pre-existing MetS. Logistic regression analysis was conducted, adjusting for sex and age.

Results

We enrolled 758 older participants; 457 (60.3%) with preexisting metabolic syndrome were excluded. We studied the remaining 301 participants (39.7%), with a mean age of 71.3 ± 5.4 years. The cumulative incidence of MetS was 43.5% after a mean follow-up period of 4.2 years; moreover, it was higher in women as well as in participants with diabetes and hypertriglyceridemia. After adjusting for age and sex, we identified the following risk factors for MetS: baseline high fasting plasma glucose levels (adjusted odds ratio [aOR] =1.75; 95% confidence interval [CI] 1.03-2.95), baseline hypertriglyceridemia (aOR = 2.26; 95% CI 1.15-4.47), and baseline large waist circumference (aOR =1.71; 95% CI 1.01-2.89). Furthermore, increased waist circumference and fasting plasma glucose levels at follow-up were significant risk factors.

Conclusion

There is a high incidence of MetS among older individuals with nonalcoholic fatty liver disease; further, women and individuals with diabetes or hypertriglyceridemia are at risk of developing MetS. Moreover, waist circumference and fasting plasma glucose levels were positively associated with the risk of MetS.

Association between Serum Uric Acid Levels and Bone Mineral Density in Taiwanese Elderly Population

Osteoporosis is a progressive metabolic bone disorder characterised by a decline in bone mineral density (BMD). Some previous studies have reported a controversial relationship between uric acid and osteoporosis. This cross-sectional study aimed to assess the association between serum uric acid levels and BMD in older adults from Taiwan. Data from participants aged ≥ 60 years were collected from 2008 to 2018. Furthermore, the participants were classified based on uric acid level quartiles. Regression models were used to assess the association between uric acid levels and bone health, including BMD values and risk of at least osteopenia. Crude and adjusted models of potential confounders, including age, sex and body mass index (BMI), were used. Compared with the first quartile of uric acid levels, the odds ratios for osteoporosis decreased in the higher uric acid level groups after adjustment for age, sex and BMI. The boxplot analysis showed that BMD values were higher in the groups with higher uric acid levels; moreover, the results of the multivariable linear regression model showed a consistent pattern. Notably, uric acid levels were positively correlated with BMD values. Higher uric acid levels in the elderly population might decrease the risk of at least osteopenia. As opposed to the anti-hyperuricemic policy for younger adults with a relatively lower risk of osteoporosis, BMD evaluation and urate-lowering therapy, goal adjustments should be considered for older adults with lower uric acid levels.

Association Between Premorbid Metabolic Syndrome and Coronary Arterial Stenosis: Results from One Medical Center in Taiwan

Background: Although the relationship between metabolic syndrome (MetS) and cardiovascular disease is already well-established, there is limited evidence as to whether individuals are at risk for cardiovascular disease during the premorbid state of MetS. The aim of this study is to explore the relationship between coronary arterial stenosis and MetS in a nonhypertensive and nondiabetic population. Methods: In this cross-sectional study, we analyzed the data of participants who underwent annual health checkups in a medical center. These data were collected from physical examination, blood tests, cardiac computed tomography examinations, and medical charts. We excluded those with established hypertension or diabetes and age of <50 or >75 years. Results: This study recruited 700 participants with a mean age of 59.5 years. More than 31% had MetS, and the overall prevalence of coronary arterial stenosis was 48.0% (grade 1, 2, 3, 4: 16.3%, 20.9%, 8.4%, 2.4%, respectively). In univariate analysis, older age, male sex, smoking, body mass index, elevated fasting plasma glucose (FPG), elevated triglyceride, lower level of high-density lipoprotein cholesterol, and presence of MetS were all positively correlated with coronary arterial stenosis. After adjustment for confounding factors, MetS still showed strong association with high grades of coronary arterial stenosis [odds ratio (OR) 2.86, confidence interval (95% CI) 1.30-4.01]. Specific components of MetS, such as elevated triglyceride [OR 2.02, 95% CI 1.14-3.57] and elevated FPG [OR 2.25, 95% CI 1.31-3.88], were also associated with coronary arterial stenosis. Conclusion: Our study concluded that premorbid MetS was significantly associated with coronary arterial stenosis. As for the individual components, elevated triglyceride and elevated FPG were both correlated with coronary arterial stenosis. Early preventive measures would be suggested at this stage of MetS to prevent future cardiovascular events.

Metabolically healthy overweight/obesity and cancer risk: A representative cohort study in Taiwan

OBJECTIVE

Many cancers are caused by overweight; however, cancer risk varies among individuals with obesity. Few studies are addressing the relationship between metabolic obesity phenotypes and cancer. This study investigates the association between metabolically healthy overweight (MHOW) or metabolically healthy obesity (MHO) and cancer incidence.

METHODS

In a nationwide, representative community-based prospective cohort study, 5734 Taiwanese adults were classified into eight phenotypes according to body mass index (underweight <18.5; normal weight 18.5-23.9; overweight 24-26.9; and obese ≥27 kg/m²) and metabolic status (healthy/unhealthy). Participants with healthy cardiometabolic blood profiles included in the metabolic syndrome criteria and an absence of hypertension, diabetes, and hyperlipidemia were considered metabolically healthy. We used the Cox proportional hazards models to estimate the adjusted hazard ratio (HR) and 95% confidence intervals (95% CI).

RESULTS

During 73,389 person-years of follow-up, 428 incident cancers were identified. Compared to the participants with metabolically healthy normal weight, participants with MHOW (adjusted HR 1.39, 95% CI, 0.90-2.13) or MHO (adjusted HR 1.07, 95% CI, 0.51-2.22) had a tendency toward a higher risk of cancer. These associations were stronger in MHOW (adjusted HR 1.77, 95% CI, 1.09-2.86) or MHO (adjusted HR 1.39, 95% CI, 0.66-2.93) participants younger than 65 years.

CONCLUSIONS

This study was the first to investigate the impact of metabolic obesity phenotype on the incidence of cancer in the Taiwanese population. Even in the absence of metabolic abnormalities, overweight, and obesity may cause a modest increase in the risk of developing cancer.

Obesity phenotypes and their relationships with atrial fibrillation

Background

This study assessed the associations of metabolic obesity phenotypes with the risk of atrial fibrillation (Afib).

Methods

This prospective cohort study categorized Taiwanese adults according to their body mass index (BMI) and metabolic health status at baseline. We assigned the participants to the underweight (BMI < 18.5 kg/m²), normal weight (BMI = 18.5-23.9 kg/m²), and overweight/obesity groups (BMI ≥ 24 kg/m²). Metabolically healthy was defined as absence of hypertension, diabetes, and hyperlipidemia and the presence of healthy metabolic profiles.

Results

In total, 5,742 adults were included. During a median follow-up of 13.7 years, 148 patients developed Afib. Compared to the metabolically healthy normal weight group, the risk of Afib was significantly higher than those in the metabolically unhealthy overweight/obesity (hazard ratio = 2.20, 95% confidence interval [1.12-4.33]) and metabolically unhealthy normal weight groups (HR = 2.64, 95% CI [1.34-5.17]). Additionally, the point estimate suggested a 1.97-fold greater risk among the metabolically healthy overweight/obesity group, although this difference was not significant given the wide confidence interval (HR = 1.97, 95% CI [0.80-4.86]).

Conclusion

Our results demonstrated the relationships of metabolic health and weight regarding the risk of Afib in Taiwanese adults. The Afib risk among metabolic and obesity phenotypes is associated with a metabolically unhealthy status. A trend toward a higher Afib risk with obesity among metabolically healthy subjects was observed. However, the result was not robust and it still suggested further study.

The role of smoking cessation programs in lowering blood pressure: A retrospective cohort study

INTRODUCTION

Cigarette smoking affects blood pressure and is a major risk factor for cardiovascular diseases. The role of smoking cessation programs with respect to blood pressure remains inconclusive. Thus, this study aimed to investigate the effects of a smoking cessation program on blood pressure.

METHODS

Participants who attended the smoking cessation program in an outpatient clinic of a tertiary medical center in Taiwan from 2017 to 2018 were enrolled in this retrospective cohort study. Their smoking cessation status was traced via phone calls during the third month, and the researchers collected participant characteristics and blood pressure before and after the program. Differences in the participants’ blood pressure, based on those with and those without hypertension, were compared using analysis of covariance. Univariable logistic regression models were used to determine factors associated with success in smoking cessation. In total, there were 721 participants. The participants had a mean age of 55.8±11.4 years and 68.1% of the participants were hypertensive.

RESULTS

During the program, the overall systolic blood pressure decreased by 4.0±17.9 mmHg and diastolic blood pressure decreased by 2.5±12.0 mmHg, from the baseline. Hypertensive participants showed a more prominent blood pressure lowering effect compared to non-hypertensive participants in terms of the subtraction difference of systolic blood pressure (-5.0±19.0 vs -1.9±15.2 mmHg, p=0.018) and diastolic blood pressure (-3.1±12.9 vs -1.1±9.6 mmHg, p=0.016). After multivariate control, the results showed that the adjusted subtraction difference of diastolic blood pressure was still more significant in the hypertensive group than in the non-hypertensive group.

CONCLUSIONS

The smoking cessation program significantly reduced both systolic blood pressure and diastolic blood pressure in the entire cohort. The results were more significant in the hypertensive group compared to the non-hypertensive group.

Development of Machine Learning Models for Prediction of Osteoporosis from Clinical Health Examination Data

Osteoporosis is treatable but often overlooked in clinical practice. We aimed to construct prediction models with machine learning algorithms to serve as screening tools for osteoporosis in adults over fifty years old. Additionally, we also compared the performance of newly developed models with traditional prediction models. Data were acquired from community-dwelling participants enrolled in health checkup programs at a medical center in Taiwan. A total of 3053 men and 2929 women were included. Models were constructed for men and women separately with artificial neural network (ANN), support vector machine (SVM), random forest (RF), k-nearest neighbor (KNN), and logistic regression (LoR) to predict the presence of osteoporosis. Area under receiver operating characteristic curve (AUROC) was used to compare the performance of the models. We achieved AUROC of 0.837, 0.840, 0.843, 0.821, 0.827 in men, and 0.781, 0.807, 0.811, 0.767, 0.772 in women, for ANN, SVM, RF, KNN, and LoR models, respectively. The ANN, SVM, RF, and LoR models in men, and the ANN, SVM, and RF models in women performed significantly better than the traditional Osteoporosis Self-Assessment Tool for Asians (OSTA) model. We have demonstrated that machine learning algorithms improve the performance of screening for osteoporosis. By incorporating the models in clinical practice, patients could potentially benefit from earlier diagnosis and treatment of osteoporosis.

Association of baseline as well as change in lipid levels with the risk of cardiovascular diseases and all-cause deaths

High baseline atherogenic lipid level has been an established risk factor for the risk of cardiovascular events. Evidence concerning the role of lipid changes in cardiovascular and death risks are inconclusive. A cohort study was conducted based on the Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (n = 4072, mean 44.8 years, 53.5% women) assessing lipid levels of the participants repeatedly measured in 2002 and 2007. Combined baseline and changes in lipid levels were classified into four groups-stable or decreasing lipid changes and increasing lipid changes with low- and high-risk baseline lipid levels. Developing cardiovascular events (n = 225) and all-cause deaths (n = 345) were ascertained during a median follow-up of 13.3 years. Participants with increasing and higher total cholesterol level were more likely to develop cardiovascular risks. Similar patterns for cardiovascular events were observed across other lipid profile changes. However, participants with increasing total cholesterol, LDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C) levels were more likely to be at a lower risk for all-cause deaths. Baseline and changes in total cholesterol, triglycerides, and LDL-C levels were positively associated with the risk of cardiovascular diseases, whereas baseline and changes in total cholesterol and LDL-C and non-HDL-C levels were inversely associated with all-cause deaths.

Prevalence of Postpartum Depression and Associated Predictors Among Taiwanese Women in a Mother-Child Friendly Hospital

Postpartum depression (PPD) is a highly prevalent disorder characterized by increased vulnerability to morbidity and mortality. This study explores the predictors and prevalence of PPD among Taiwanese women. A total of 914 postpartum women was recruited from a mother-child-friendly hospital. These participants completed self-report questionnaires at 1 month postpartum, and their medical records were also examined for relevant information. Multivariate analyses were used to identify independent predictors of PPD. At 1 month postpartum, 18.8% had developed PPD. Multivariate analysis showed that the odds ratios for PPD were significantly lower among women who were breastfeeding, had more family support, and attended a postpartum care center, while those who were younger, primiparous, and who experienced gestational complications had a higher prevalence of PPD. Meanwhile, structural equation modeling showed that family support from partners, parents, and parents-in-law diminished depression scores through direct effects.

The Association Between Different Obesity Phenotypes and Liver Fibrosis Scores in Elderly Individuals with Fatty Liver in Taiwan

PURPOSE

To examine the association between different phenotypes of obesity or metabolic syndromes and liver fibrosis score in a Taiwanese elderly population with fatty liver.

PATIENTS AND METHODS

This cross-sectional study included 1817 participants aged ≥65 years with fatty liver diagnosed by sonography. We used ethnicity-specific criteria for body mass index and metabolic syndrome, and to define obesity phenotypes as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Correlated fibrosis severity was calculated using the nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) and Fibrosis-4 (FIB-4). Fibrosis severity was divided into two categories according to NFS (no-to-mild fibrosis and advanced fibrosis, defined as NFS ≤ 0.676 and >0.676, respectively) and FIB-4 score (no-to-mild fibrosis and advanced fibrosis, defined as FIB-4 score ≤2.67 and >2.67, respectively).

RESULTS

Compared with that in the MHNO group, the associated risk (odds ratio [OR], 95% confidence interval [CI]) of advanced fibrosis by NFS was 2.43 (1.50-3.93), 2.35 (1.25-4.41), and 6.11 (3.90-9.59), whereas that of advanced fibrosis by FIB-4 score was 1.34 (0.83-2.18), 2.37 (1.36-4.13), and 1.38 (0.82-2.31) in the MUNO, MHO, and MUO groups, respectively.

CONCLUSION

Both metabolic syndrome and obesity were positively associated with more advanced fibrosis according to NFS. The detrimental effect of obesity appears to be more than metabolic abnormalities per se in the elderly with more advanced fibrosis severity according to the FIB-4 score.

Improvement in Cardiometabolic Risk Factors During Smoking Cessation Treatment in Patients with Type 2 Diabetes: A Retrospective Cohort Study

PURPOSE

Smoking cessation reduces morbidity and mortality of cardiovascular diseases. The purpose of this study was to evaluate the effect during smoking cessation treatment on glycemic control and cardiometabolic risk factors, including blood pressure and lipid levels, in patients with type 2 diabetes.

PATIENTS AND METHODS

This retrospective cohort study included patients with type 2 diabetes who participated in a smoking cessation program, which comprised health education and medication prescription at an outpatient clinic in combination with a 3-month follow-up by phone. Data on patient background characteristics, cardiometabolic factors, smoking status, body weight, and body mass index before and after the program were collected for analysis.

RESULTS

The analysis included 241 participants with an average age of 58.6 ± 10.6 years. The rate of successful cessation at three months was 34.0%. Compared with the baseline levels, there were significant decreases in the levels of fasting plasma glucose (10.0 ± 46.8 mg/dL, P = 0.001), HbA1c (0.3 ± 1.4%, P = 0.004), systolic blood pressure (4.6 ± 17.5 mmHg, P < 0.001), diastolic blood pressure (2.9 ± 11.3 mmHg, P < 0.001), and total cholesterol (7.9 ± 42.8 mg/dL, P = 0.020) after participation in the smoking cessation program while there was no significant difference in body weight (0.1 ± 1.2 kg, P = 0.444). After adjustment for covariates, the decreases in HbA1c and total cholesterol levels were significantly better in younger participants and higher baseline nicotine dependence scores were associated with decreases in the levels of blood pressure, fasting plasma glucose, and triglycerides. However, the decrease in smoking amount was not associated with the changes in cardiometabolic factors.

CONCLUSION

Participation in a smoking cessation program was associated with improvements in glycemic control and cardiometabolic risk factors in patients with type 2 diabetes. The observed improvements were associated with participation in the program but not with the decrease in smoking amount.

Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison

BACKGROUND

All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented older home care residents is increasing; however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF).

METHODS

Data from the in-home healthcare system between January 1 and December 31, 2017 were analyzed to identify 169 participants over 60 years of age in this retrospective longitudinal study. All subjects with severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates.

RESULTS

A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. 39 required AHF and 130 NGF. All subjects were bedridden; 129 (76%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (48%) than in the AHF group (26%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia was not significantly higher in the NGF group compared with the AHF group. One-year mortality rates in the AHF and NGF groups were 8 and 15%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38; 95% CI, 0.58-9.70). There were no significant differences in hospitalization rate and duration.

CONCLUSIONS

For older patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. On the contrary, a nonsignificant trend of increased risk of pneumonia was observed in NGF group. Therefore, the benefits of NGF are debatable in older patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on in-home healthcare would be required to support these results.

Factors associated with hospitalization for community-acquired pneumonia in home health care patients in Taiwan

Background

Pneumonia is a leading cause of hospitalization and death worldwide. However, studies focusing on risk factors of community-acquired pneumonia (CAP) in the home health care (HHC) population remain scarce.

Aims

This study aimed to evaluate risk factors associated with hospitalization for CAP among HHC patients in Taiwan.

Methods

This retrospective cross-sectional study extracted data from patients’ electronic medical records between 1 January 2017 and 31 December 2017. Multiple logistic regression analyses were performed to explore factors associated with hospitalization for CAP.

Results

In total, 598 patients (men/women: 236/362) were included. One hundred ninety-nine patients (33.28%) were hospitalized for pneumonia. Inpatients showed a higher proportion of the following: male sex, functional impairment, hypoalbuminemia, anemia, nasogastric tube use, excessive polypharmacy, stroke, dementia, heart failure, chronic respiratory disease, and chronic liver disease. Furthermore, nasogastric tube use (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.88–4.82), anemia (OR 2.37, 95% CI 1.48–3.80), male sex (OR 2.14, 95% CI 1.43–3.20), chronic respiratory disease (OR 2.09, 95% CI 1.33–3.30), dementia (OR 1.94, 95% CI 1.27–2.97), heart failure (OR 1.69, 95% CI 1.11–2.56), and hypoalbuminemia (OR 1.57, 95% CI 1.03–2.40) significantly increased the risk of hospitalization for CAP.

Conclusions

Our results revealed risk factors associated with hospitalization for CAP in HHC patients. In addition to chronic diseases, malnutrition is an important risk factor. Caregivers should make prompt assessments and take preventive measures for such patients.

Relationship Between Gallstone Disease and Cardiometabolic Risk Factors in Elderly People with Non-Alcoholic Fatty Liver Disease

BACKGROUND

The prevalence of gallstone disease (GSD) increases with age, and the elderly have a much higher mortality risk and incidence of surgical comorbidities. The aim of this study was to explore the relationship between GSD and cardiometabolic risk factors in elderly people with non-alcoholic fatty liver disease (NAFLD).

METHODS

In this cross-sectional study, we analyzed the data of elderly people who underwent annual health check-ups at a Northern Taiwan health examination center. These data were collected from physical examination, blood tests, abdominal ultrasonography, and medical histories. We excluded those with hepatitis B or C infections, heavy alcohol consumption, or cholecystectomy.

RESULTS

The analysis included 3,037 participants with a mean age of 73.6±6.0 years. Over 70% were overweight or obese, and the overall prevalence of GSD was 17.7%. In our univariate analysis, GSD was positively correlated with age, body mass index, metabolic syndrome, diabetes mellitus (DM), hypertension (HTN), and various metabolic factors (fasting plasma glucose [FPG], triglyceride, uric acid, and high-density lipoprotein cholesterol [HDL-C] levels). After adjustment for age, gender, and body mass index, metabolic syndrome showed a positive association with GSD (odds ratio [OR] 1.31 [95% confidence interval [CI], 1.05-1.64]; P=0.020). Specific components of metabolic syndrome that increased the risk for GSD in NAFLD elderly include lower levels of HDL-C (OR 1.35 [95% CI, 1.10-1.66]; P<0.001) and elevated FPG (OR 1.36 [95% CI, 1.10-1.69]; P<0.001).

CONCLUSION

Our study concluded that GSD is significantly associated with metabolic syndrome in elderly people with NAFLD. Reduced HDL-C and elevated FPG both heighten the risk of developing GSD. Therefore, to lower the risk of GSD in NAFLD patients, their FPG levels and HDL-C levels must be regularly followed-up, and these patients should be educated about the symptoms of GSD if they meet the criteria for metabolic syndrome.

Comparisons of early and delayed abstainers and its effects on long-term smoking cessation in Taiwan

Background

Different quitting trajectories may reflect the stages of behavior change among smokers. The nature of quitting patterns could help the public health sector to design appropriate cessation plans. This study compared demographic, health, and behavioral characteristics and the effects of long-term abstinence between early and delayed abstainers.

Methods

We retrospectively sampled 142 abstainers from smoking cessation clinic participants for a study conducted from January 1 to December 31, 2017. Baseline information was obtained at the first clinic visit, and phone interviews were conducted 2 weeks, 3 months, and 6 months later. The 7-day point prevalence abstinence was employed for measuring their quitting status. We defined early abstainers as those who attained abstinence by second week and delayed abstainers as those who had done so by the third month. We compared their characteristics and 6-month quit rates and examined potential predictors between the two quitting patterns.

Results

One hundred forty-two participants were included with 87 (61.3%) early abstainers and 55 (38.7%) delayed abstainers. Early abstainers were older with more comorbidities, presenting longer smoking duration, higher exhaled carbon monoxide (CO) concentration and Fagerstrom Test of Cigarette Dependence (FTCD) scores. The 6-month abstinence rate was high for both quitting patterns with no significant difference (83.9% versus 81.8%, p = 0.7462). Higher FTCD scores and exhaled CO concentration were potential predictors for early abstainers with adjusted odds ratio 1.16 (95% confidence interval [CI], 1.01–1.33) and 1.04 (95% CI, 1.00–1.08) respectively.

Conclusions

Our results associated early abstainers with older age, more comorbidities and higher nicotine dependence. Both groups achieved good long-term abstinence maintenance. Although early abstainers may achieve earlier reduction of health risks, smokers could still benefit from long-term abstinence if they can manage to quit smoking even at later phases of cessation courses.

Incidence and Risk Factors for Urinary Tract Infection in an Elder Home Care Population in Taiwan: A Retrospective Cohort Study

Urinary tract infection (UTI) is a common infection worldwide. Numerous studies have demonstrated risk factors for UTI in facilities and communities. In this study, we aimed to identify risk factors for UTI in home care patients. Patients who received home care for at least three months in 2017 were included. A UTI episode was defined by admission for UTI treatment, and/or a visit to an outpatient department for UTI and receiving antibiotic prescription. A total of 598 patients aged 81.9 years were included. Overall 47% (281) had at least one UTI episode. After analysis, urinary catheter indwelling was the most important risk factor (odds ratio (OR), 3.21). Underlying diseases (coronary artery disease (CAD), chronic kidney disease (CKD), diabetes mellitus (DM)) were related to UTI with OR ranging from 1.46 to 1.79. Higher Alb (albumin) (OR 0.68) and Hb (hemoglobin) (OR 0.91) were inversely related to UTI. Polypharmacy (OR 1.84) and lower Barthel index scores (OR 1.62) were also related to UTI by different degrees. In conclusion, apart from the unmodifiable factors, avoiding prolonged urinary catheter placement, unnecessary prescriptions, and keeping good nutritional status may help to prevent UTI in home care patients.

Morbidity associated with overweight and obesity in health personnel: a 10-year retrospective of hospital-based cohort study in Taiwan

PURPOSE

To investigate morbidity associated with overweight and obesity in health personnel and compare the differences among work roles.

MATERIALS AND METHODS

This retrospective cohort study examined measurements obtained during employee medical checkups between 2007 and 2016 in a Taiwan medical center. BMI was used to define overweight (≥24 and <27 kg/m²) and obesity (≥27 kg/m²). Morbidity refers to prevalence, period incidence proportion, and incidence rate. Multivariable Cox model was used to estimate the HRs and 95% CI of the incidence proportion across work roles.

RESULTS

Ten thousand six hundred fifty-one health personnel with 24,295 BMI measurements were recruited. Mean age was 33.4±10.7 years and 72.4% was female. In total, 1,992 (8.2%) health personnel were underweight, 13,568 (55.8%) had a normal BMI, 5,097 (21%) were overweight, and 3,638 (15%) were obese. Five thousand nine hundred one health personnel with 31,172 different interval-year arrangement combinations were obtained. The incidence proportion of overweight and obesity was 1,947 (6.2%) and 1,494 (4.8%), respectively. The incidence rate was 37/1,000 and 15/1,000 person-years, respectively. Compared with that in supporting staff, the HR of overweight in doctors, nurses, and allied health professionals was 0.93 (95% CI =0.73-1.18, P=0.553), 0.92 (95% CI =0.73-1.16, P=0.491), and 0.85 (95% CI =0.67-1.09, P=0.202), respectively. Similarly, the HR of obesity was 0.86 (95% CI =0.66-1.14, P=0.301), 0.89 (95% CI =0.67-1.18, P=0.430), and 0.84 (95% CI =0.63-1.13, P=0.248), respectively.

CONCLUSION

In health personnel, the prevalence of overweight and obesity was 21% and 15%, respectively. The incidence proportion was 6.2% and 4.8%, respectively. Morbidity across the four health work roles examined was not significantly different.

Inflammatory Biomarkers and Risk of Atherosclerotic Cardiovascular Disease

Background

Non-alcoholic fatty liver disease is an increasing health issue that associates with the development of atherosclerotic cardiovascular disease. This study correlates the association between fatty liver and inflammatory biomarkers with cardiovascular risk scores.

Methodology

This cross-sectional study enrolled 10,181 health examination participants from Northern Taiwan and administered a standardized questionnaire with important biochemical tests and abdominal sonography. To assess concentrations of inflammatory markers high sensitivity C-reactive protein (hs-CRP) and fibrinogen were used.

Results

Inflammatory marker levels were significantly increased with increasing fatty liver. In multivariate logistic regression analysis adjusted for major confounding factors, the odds ratios of elevated hs-CRP and fibrinogen were significantly higher in participants with mild or moderate-to-severe fatty liver compared to healthy individuals. The cardiovascular risk scores, above cut-off level 10%, were associated with higher levels of inflammatory biomarkers and fatty liver; odds ratio, 3.52 (2.60-4.77) for non-alcoholic fatty liver disease with hs-CRP, and 2.92 (2.12-4.00) for non-alcoholic fatty liver disease with fibrinogen.

Conclusion

Inflammatory biomarkers (hs-CRP and fibrinogen) are significantly associated with augmentation of fatty liver. Non-alcoholic fatty liver disease may be a predictor of future atherosclerotic cardiovascular disease, and the prediction value increases on adding inflammatory biomarkers levels.

Association between metabolic syndrome and osteoporosis in Taiwanese middle-aged and elderly participants

This study examined the association between metabolic syndrome and osteoporosis among middle-aged and elderly Taiwanese participants. After controlling for body mass index, age, liver and renal functions, and nutrition and exercise statuses, we found no significant association between MS and osteoporosis in either gender.

PURPOSE

The term metabolic syndrome (MS) encompasses different abnormalities with independent effects on bone metabolism, which has led to inconsistencies in the association between MS and osteoporosis. This study evaluated this association among middle-aged and elderly Taiwanese participants by adjusting relevant covariates.

METHODS

We enrolled 2007 participants (1045 men and 962 women) older than 50 years, who underwent a health examination at a preventive examination agency in urban Taiwan. We studied age, gender, diabetes mellitus and hypertension histories, smoking and exercise statuses, metabolic and nutrition indices, and liver and renal function profiles. We conducted multiple logistic regression analyses to examine the association between MS and osteoporosis by categorizing participants in terms of gender and body mass index (BMI).

RESULTS

Overall, men with osteoporosis were less likely to have MS, and displayed fewer MS components than men without osteoporosis; but we found no significant associations between MS, or its components, and osteoporosis in women. After forming two groups according to BMI and adjusting for covariates, we found no association between MS and osteoporosis in any group. Multiple logistic regression analysis revealed that regular exercise had a negative association with osteoporosis in the low BMI group for men (OR, 0.365; p = 0.008).

CONCLUSIONS

After BMI stratification and adjustments for age, nutrition status, liver and renal functions, and exercise status, we found no significant association between MS and osteoporosis in either gender. Regular exercise may prevent osteoporosis, particularly in men with a lean body mass.

Postpartum Weight Retention Risk Factors in a Taiwanese Cohort Study

OBJECTIVE

Excess postpartum weight retention (PPWR) is related to long-term weight gain. Therefore, this study was conducted to identify the risk factors for PPWR to provide guidance for preventive strategies.

METHODS

This cohort study surveyed 461 women who gave birth at a medical center between March 2014 and March 2016. The participants completed a questionnaire within 1 month of delivery, and their 6-month postpartum weight was tracked.

RESULTS

The results showed that the mean pre-pregnancy BMI was 21.4 ± 3.3 kg/m2, and the mean gestational weight gain (GWG) was 12.8 ± 4.1 kg. The mean PPWR was 4.6 ± 3.5 kg at 1 month and 2.1 ± 3.3 kg at 6 months. Multivariate analysis revealed that GWG (adjusted OR: 1.92 (1.70-2.17)), pre-pregnancy BMI (adjusted OR: 0.85 (0.77-0.94)), and exclusive breastfeeding (adjusted OR: 0.55 (0.32-0.94)) were significantly correlated with a 1-month PPWR higher than the median value. In addition, GWG (adjusted OR: 1.30 (1.22-1.39)) and exclusive breastfeeding (adjusted OR: 0.37 (0.24-0.58)) were significantly correlated with a 6-month PPWR higher than the median value.

CONCLUSION

Our findings indicate that the key to reducing PPWR is to control GWG and engage in exclusive breastfeeding.

The application of lidocaine to alleviate the discomfort of nasogastric tube insertion: A systematic review and meta-analysis

BACKGROUND

Nasogastric (NG) tube insertion is a common procedure in the clinical setting that causes much discomfort and pain for the patient. Pain control is often suboptimal, as many NG tube insertions are performed without any pain-relieving supplements. The aim of this study was to summarize and critically evaluate the evidence from randomized controlled trials (RCTs) on the effect and adverse effects of lidocaine agents in reducing pain and discomfort associated with NG tube insertion.

METHODS

Databases from the Cochrane Library, MEDLINE, EMBASE, Airiti Library, PerioPath Index to Taiwan Periodical Literature, and Cumulative Index of Nursing and Allied Health (CINAHL) were searched from inception to April 2017. RCTs focusing on lidocaine before NG tube insertion were appraised. The primary outcome was the visual analog scale (VAS) score. The modified Jadad scale was used for quality assessment. Mean difference (MD) with 95% confidence intervals (95% CIs) and odds ratio (OR) for binary outcomes were assessed by a random effects model. Heterogeneity was determined by using the Cochran Q test and I statistics. Publication bias was analyzed by using a funnel plot analysis.

RESULTS

Ten RCTs enrolling 734 patients were included in the meta-analysis. Eight of the 10 RCTs reporting VAS scores had sufficient quantitative data to be pooled through meta-analysis. Results revealed a significant reduction in VAS score, with a MD of -26.05 and a CI of -28.21 to -23.89 with moderate heterogeneity (P < .001, I = 56%). There were no significant changes in difficulty of NG tube insertions (MD = -0.30, 95% CI, -1.30 to 0.70, P = .55), number of NG tube insertion attempts (MD = -0.22, 95% CI, -0.98 to 0.53, P = .56), nasal bleeding (OR = 0.62, 95% CI, 0.11-3.41, P = .59), and vomiting (OR = 0.30, 95% CI, 0.07-1.27, P = .10).

CONCLUSION

This meta-analysis suggests that applying lidocaine before NG tube insertion can alleviate pain and discomfort by 26% without increasing nasal bleeding or vomiting.

Positive Association of Metabolic Syndrome with a Single Nucleotide Polymorphism of Syndecan-3 (rs2282440) in the Taiwanese Population

BACKGROUND/PURPOSE

Metabolic syndrome (MetS) poses a major public health burden on the general population worldwide. Syndecan-3 (SDC3), a heparin sulfate proteoglycan, had been found by previous studies to be linked with energy balance and obesity, but its association with MetS is not known. The objective of this study is to investigate whether SDC3 polymorphism (rs2282440) is associated with MetS in the Taiwanese population.

METHODS

Genotypes of SDC3 polymorphism (rs2282440) were analyzed in 545 Taiwanese adult subjects, of which 154 subjects had MetS.

RESULTS

Subjects with SDC3 rs2282440 TT homozygote had higher frequency of MetS than those with CC or CT genotype (p = 0.0217). SDC3 rs2282440 TT homozygote had a 1.96-fold risk of being obese and 1.8-fold risk of having MetS (with CC genotype as reference). As for the individual components of MetS, subjects with SDC3 rs2282440 TT homozygote were more likely to have large waist circumference and low high-density lipoprotein cholesterol (OR = 1.75 and OR = 1.84, resp.).

CONCLUSION

SDC3 rs2282440 polymorphism is positively associated with MetS in the Taiwanese population. Further investigation is needed to see if this association is mediated by mere adiposity or SDC3 polymorphism is also linked with other components of MetS such as lipid metabolism.

The effectiveness of Culturally Sensitive Collaborative Treatment of depressed Chinese in family medicine clinics: A randomized controlled trial

OBJECTIVE

To investigate whether the Culturally Sensitive Collaborative Treatment (CSCT) would improve outcomes for patients with major depression who were managed in family medicine clinics in Taiwan.

METHOD

A single-blinded randomized trial was conducted in 26 family medicine clinics. Patients with major depressive disorder were consecutively randomized to either CSCT or treatment as usual (TAU). The primary outcome was the severity of depression. Secondary outcomes included treatment response, treatment remission, quality of life, and medication adherence. Outcomes were compared using hierarchical linear models (mixed-effects models) from baseline to 26-week follow-up assessments.

RESULTS

Of the 280 patients, 141 were randomized to TAU and 139 to CSCT. Hierarchical linear modeling revealed that the CSCT group displayed significantly greater improvement in depressive symptoms over the study period when compared to the TAU group (B=-2.60, P<0.001). The odds of achieving the response, remission, and medication adherence were significantly greater for the CSCT group compared to the TAU group (odds ratio=4.65, 4.12, and 2.06, respectively; all Ps<0.05). However, both groups did not differ significantly in quality of life.

CONCLUSION

CSCT is effective in improving treatment outcomes for major depression in family medicine clinics in Taiwan.

Study of seven single-nucleotide polymorphisms identified in East Asians for association with obesity in a Taiwanese population

OBJECTIVE

This study aimed to examine single-nucleotide polymorphisms (SNPs) of seven previously reported obesity genes in East Asians and to analyse their associations and synergistic effects on obesity in the Taiwanese population.

DESIGN

Cross-sectional study.

SETTING

One medical centre in northern Taiwan.

PARTICIPANTS

A total of 323 non-obese and 264 obese participants were recruited. The threshold for obesity in this study was a body mass index of ≥27 kg/m(2), as defined by the Ministry of Health and Welfare in Taiwan. The study was performed with the approval of the institutional review board of MacKay Memorial Hospital, Taipei, Taiwan (application number 12MMHIS106).

OUTCOME MEASURES

We analysed the genotype distributions of seven SNPs localising to the PPARγ2, GNB3, SDC3, ADRB2, FTO, PPARγ and ESR1 genes in obese and non-obese groups and then paired obesity-related SNPs to determine if they have synergistic effects on obesity.

RESULTS

Analysis of the genotype distributions in obese and non-obese groups revealed only a significant positive correlation between an SNP in rs2282440-syndecan 3 (SDC3) and obesity in the Taiwanese population (p=0.006). In addition, the T/T genotype of SDC3 was significantly associated with a larger waist and hip circumference, higher body fat percentage and lower high-density lipoprotein cholesterol. Moreover, the combination of the rs2282440-SDC3T/T genotype with the rs1801282-peroxisome proliferator-activated receptor-gamma2 gene (PPARγ2) G carrier genotype was strongly associated with obesity (OR=6.77).

CONCLUSIONS

We found that the rs2282440-SDC3T/T genotype is associated with obesity in the Taiwanese population. Furthermore, there is a synergistic effect of the high-risk alleles of the SDC3 and PPARγ2 genes on the obese phenotype in the Taiwanese population.

TRIAL REGISTRATION NUMBER

12MMHIS106; Results.

The Link of Self-Reported Insomnia Symptoms and Sleep Duration with Metabolic Syndrome: A Chinese Population-Based Study

STUDY OBJECTIVES

The aims of this study are to investigate the relationships of metabolic syndrome (MetS) with insomnia symptoms and sleep duration in a Chinese adult population.

METHODS

Data from a nationwide epidemiological survey conducted on residents from randomly selected districts in Taiwan in 2007 were used for this cross-sectional population-based study. A total of 4,197 participants were included in this study. Insomnia symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), were assessed using the Insomnia Self-Assessment Inventory questionnaire. Subjects were divided into 3 groups based upon their reported sleep duration (< 7, 7-8, and ≥ 9 h per night). Odds ratios (ORs) and 95% confidence intervals (CIs) derived from multivariable logistic regression were used to evaluate the study aims.

RESULTS

The endorsement of DIS and DMS were cross-sectionally associated with the MetS after adjustment for sleep duration (OR [95% CI] was 1.24 [1.01-1.51] and 1.28 [1.02-1.61], respectively). In addition, short sleep duration was significantly associated with the prevalence of MetS independent of insomnia symptoms (OR [95% CI] was 1.54 [1.05-2.47]). However, there was no significant combined effect of insomnia symptoms and sleep duration on the prevalence of MetS.

CONCLUSIONS

The current investigation shows that short sleep duration and insomnia symptoms, specifically DIS and DMS, were significant correlates of MetS. These findings should be replicated in prospective studies using both sleep duration and sleep quality measures.

Predictive value of serum apolipoprotein B/apolipoprotein A-I ratio in metabolic syndrome risk: a Chinese cohort study

The purpose of this study was to evaluate whether the apolipoprotein B/apolipoprotein A-I (apoB/apoA-I) ratio is a promising risk predictor of metabolic syndrome (MetS) and to determine the optimal cut-off value of this ratio in detecting subjects with MetS in a Chinese population. A prospective study was conducted using a representative sample of non-institutionized people in Taiwan. A total of 3,343 participants with mean age (±SD) of 39.86 (±15.61) years old were followed up from 2002 to 2007. The primary outcome was the incidence of MetS. The MetS was defined according to a unified criterion established by several major organizations. There were 462 cases of incident MetS during a mean follow-up period of 5.26 years. A significantly stepwise increase in the incidence of MetS across quartiles of the apoB/apoA-I ratio was noted in both sexes after adjustment for potential confounders (p for trend <0.001). Compared with the lowest quartile of apoB/apoA-I ratio, participants in the highest quartile had a significantly higher risk of MetS in both men [adjusted hazard ratio (HR) = 6.29, 95 % confidence interval (CI) = 2.79-9.13] and women (adjusted HR = 3.82, 95 % CI = 1.06-6.63). Comparisons of receiver operating characteristics curves indicated that the predictive ability of apoB/apoA-I ratio to detect MetS was better than conventional lipid ratio measurements. Furthermore, the optimal cut-off value of apoB/apoA-I ratio for MetS diagnosis was 0.71 in men and 0.56 in women. These results suggest that an elevated apoB/apoA-I ratio might constitute a potentially crucial measure linked to the risk of developing MetS.

ABO blood group and the risk of cancer among middle-aged people in Taiwan

AIM

The relationship between ABO blood group and cancer was observed in many epidemiological researches. Our aim is to study the relationship between ABO blood group and the risk of cancer in the Taiwanese population.

METHODS

We followed 3180 men and 3124 women with baseline ages ranging from 20 to 65 years for 27 years. Blood group information was obtained from registration on Identity Card. Cancer incidence information was confirmed by reviewing National Cancer Registry. Hazard ratios (HRs) for cancers according to ABO blood group were calculated using Cox proportional hazards models with multivariate adjustment.

RESULTS

During an average of 27 years of follow-up, the adjusted HR of total cancer was 1.66 (95% CI, 1.20-2.30) for blood group AB in men and 1.28 (95% CI, 1.03-1.59) for blood group A in women, compared to blood group O of their respective gender. A significant excess risk was found among subjects with presence of A antigen. This positive association was mainly observed in cancers from lung cancer (HR: 1.88 [95% CI: 1.29-2.75]) and gastrointestinal cancer (HR: 1.25 [95% CI: 1.00-1.61]) in men, as well as liver cancer (HR: 1.69 [95% CI: 1.02-2.79]) and gastrointestinal cancer (HR: 1.49 [95% CI: 1.10-2.04]) in women.

CONCLUSION

These data suggest that ABO blood group is significantly associated with cancer risk. Men with blood group AB, women with blood group A, and subjects with presence of A antigen were more likely to develop cancers.

Description and prediction of the development of metabolic syndrome: a longitudinal analysis using a markov model approach

BACKGROUND

Delineating the natural history of metabolic syndrome (MetS) is prerequisite to prevention. This study aimed to build Markov models to simulate each component's progress and to test the effect of different initial states on the development of MetS.

METHODS

MetS was defined with revised AHA/NHLBI criteria. Each reversible multistate Markov chain consisted of 8 states (no component, five isolated component states, 2-component state, and MetS state). Yearly transition probabilities were calculated from a five-year population-based follow up studywhich enrolled 2,247 individuals with mean aged 32.4 years at study entry.

RESULTS

In men, high BP or a 2-component state was most likely to initiate the progress of MetS. In women, abdominal obesity or low HDL were the most likely initiators. Metabolic components were likely to occur together. The development of MetS was an increasing monotonic function of time. MetS was estimated to develop within 15 years in 12.7% of young men with no component, and 2 components developed in 16.3%. MetS was estimated to develop in 10.6% of women with at the age of 47, and 2 components developed in 14.3%. MetS was estimated to develop in 24.6% of men and 27.6% of women with abdominal obesity, a rate higher than in individuals initiating with no component.

CONCLUSIONS

This modeling study allows estimation of the natural history of MetS. Men tended to develop this syndrome sooner than women did, i.e., before their fifth decade of life. Individuals with 1 or 2 components showed increased development of MetS.

C-reactive protein concentration as a significant correlate for metabolic syndrome: a Chinese population-based study

Increasing evidence suggests that chronic, low-grade inflammation may be a common soil involving the pathogenesis of metabolic syndrome (MetS) and cardiovascular disease. We examined the association between C-reactive protein (CRP) concentration, an extensively studied biomarker of low-grade inflammation, and the MetS in a representative sample of Chinese adults in Taiwan. We performed a cross-sectional analysis of data from 4234 subjects [mean (±SD) age, 47.1 (±18.2) years; 46.4 % males] who participated in a population-based survey on prevalences of hypertension, hyperglycemia, and hyperlipidemia in Taiwan. CRP levels were measured by the immunoturbidimetric CRP-latex high-sensitivity assay. The MetS was defined by an unified criteria set by several major organizations. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated with logistic regression model. Overall, there were 938 subjects with MetS among 4,234 participants, resulting in a prevalence rate of 22.1 %. A significantly progressive increase in the prevalence of MetS across quartiles of CRP was observed (p for trend <0.001). Participants in the second, third, and upper quartiles of CRP had significantly higher risk of having MetS when compared with those in the lowest quartile [adjusted ORs (95 % CIs) were 2.18 (1.62-2.94), 4.39 (3.31-5.81), and 7.11 (5.39-9.38), respectively; p for trend <0.001]. Furthermore, there was a strong stepwise increase in CRP levels as the number of components of the MetS increased. The prevalence of MetS showed a graded increase according to CRP concentrations. The possible utility of CRP concentration as a marker for MetS risk awaits further evaluation in prospective studies.

Uric acid concentration as a risk marker for blood pressure progression and incident hypertension: a Chinese cohort study

OBJECTIVE

Little is known about serum uric acid (SUA) role for hypertension in the Asian countries with low cardiovascular events. We aimed to explore the relationship in a comprehensive Chinese cohort.

METHODS

Participants in the Taiwanese Survey on Prevalences of Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH) who were free of hypertension at baseline recruitment in 2002 (n=3257) were evaluated for the longitudinal association between baseline SUA and blood pressure progression (BPP) and incident hypertension.

RESULTS

During a mean follow-up of 5.41 years, 1119 persons (34.3%) had experienced progression to a higher blood pressure stage and 496 persons (15.2%) had developed hypertension. In multivariate analyses, the adjusted hazard ratios (HRs) [95% confidence intervals (CIs)] comparing the highest and lowest SUA quartiles were 1.78 (1.11-2.02, P for trend .004) for BPP and 1.68 (1.23-2.04, P for trend .028) for incident hypertension. The positively graded relationships between SUA concentration and blood pressure outcomes were observed in both males and females. More interestingly, a statistically significant trend for increasing risk of BPP and incident hypertension across SUA quartiles was most pronounced in participants with abdominal obesity.

CONCLUSION

We concluded that SUA level was an independent predictor of blood pressure progression and incident hypertension in a Chinese population.

Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan

Obesity is an epidemic health problem related to morbidity and mortality of metabolic and cardiovascular diseases. However, little is known regarding the development of cardiometabolic diseases in an obese subgroup with a healthy metabolic risk profile. This study examined the prevalence of baseline metabolically healthy obese subjects and its impacts on the incidences of cardiometabolic diseases using a nation-wide population cohort. Metabolically healthy obese were prevalent in 8.2% of the baseline population and 28.5% of the obese subjects. Subjects included were 1,547 men and women (age range, 18-59 years), who were free of components of the metabolic syndrome except waist criteria. During an average 5.4-year follow-up, the cumulative incidences of hypertension, type 2 diabetes and the metabolic syndrome were 7.8%, 1.2% and 5.6%, respectively. The hazard ratios (95% CIs) for the metabolic syndrome incidence were significantly higher at BMI levels of >=23.0 kg/m² [4.68 (2.22-9.86)] for BMI of 23-24.9 kg/m²; 8.82 (4.01-19.4) for BMI of 25-26.9 kg/m²; and 24.43 (12.33-48.41) for BMI of >=27 kg/m²). The hazard ratios for diabetes or hypertension incidence were significantly higher at BMI levels of >=25.0 kg/m2. Each kg/m² of BMI gained was associated with an 18% increase in the risk of developing hypertension and a 26% increase in risk for the metabolic syndrome. We conclude that metabolically healthy obese individuals are at higher risk to develop hypertension, type 2 diabetes and the metabolic syndrome than their non-obese counterparts. Our data provide further evidence that opposes the notion of metabolically healthy obese as harmless conditions.

Increased risk of mortality from overweight and obesity in middle-aged individuals from six communities in Taiwan

BACKGROUND/PURPOSE

Although obesity is becoming a major public health problem, data are limited on the relationship between body mass index (BMI) and survival in Taiwanese populations. Therefore, the aim of this study was to evaluate the long-term effects of obesity on the risk of death from any cause and from specific diseases in middle-aged Taiwanese adults.

METHODS

We investigated the association between BMI and mortality in a prospective cohort study. In all, 6603 men and women (age range, 20-65 years) were included.

RESULTS

The mean BMI at baseline was 22.7 kg/m². During an average 24-year follow-up, 1896 of the 6603 individuals died (28.7%). The relationship between death from any cause and BMI followed a J-shaped pattern. Hazard ratio (HR) estimates for all-cause mortality increased among participants who were obese [HR: 1.28, 95% confidence interval (CI): 1.12-1.47 for BMI 25-26.9 kg/m²; HR: 1.46, 95% CI: 1.27-1.68 for BMI ≥ 27 kg/m²]. This positive association was mainly observed in deaths from diabetes, cardiovascular diseases, or cancer. The HRs for diabetes mortality were significantly higher at BMI ≥ 23.0 kg/m² (HR: 1.93, 95% CI: 1.33-2.81 for BMI 23-24.9 kg/m²; HR: 2.59, 95% CI: 0.71-3.90 for BMI 25-26.9 kg/m²; and HR: 3.03, 95% CI: 2.01-4.58 for BMI ≥ 27 kg/m².

CONCLUSION

Increasing BMI (≥ 23 kg/m²) was positively associated with deaths from diabetes and cardiovascular diseases. We found that BMI ≥ 25 kg/m² was a significant predictor for all-cause mortality and ≥ 27 kg/m² was a significant predictor for cancer mortality. The relationship between BMI and mortality was J-shaped in Taiwanese adults.

Validation of Patient Health Questionnaire for depression screening among primary care patients in Taiwan

PURPOSE

The aim of this study was to determine the reliability and validity of a Chinese version of the Patient Health Questionnaire (PHQ-9) for the purpose of screening major depressive disorder (MDD) among primary care patients in Taiwan.

METHOD

A total of 1954 primary care patients completed the PHQ-9. Patients (n = 1532) were interviewed using the Schedule for Clinical Assessments in Neuropsychiatry and 17-item of Hamilton Rating Scale. Subsample cases were retested within 2 weeks.

RESULTS

The PHQ-9 had a good internal consistency (α = .80) and test-retest reliability (intraclass correlation coefficient = 0.87). A principal component factor analysis yielded 1-factor structure, which accounted for a total of 42.0% of the variance. The PHQ-9 was significantly correlated with the external validators such as the 17-item of Hamilton Rating Scale and the Short Form of the Quality of Life Enjoyment and Satisfaction Questionnaire (P < .001). Using the Schedule for Clinical Assessments in Neuropsychiatry interview as the criterion standard, a PHQ-9 score of 10 or higher had a sensitivity of 0.86 and a specificity of 0.94 for recognizing MDD. The screening accuracy of the 2 items version, PHQ-2, was also satisfactory (scores ≥ 2: sensitivity 0.88; specificity 0.82). The single-question screen, PHQ-1 (depressed mood), was 78% sensitive and 93% specific for detecting MDD (score ≥ 2).

CONCLUSION

The PHQ-9 and its 2 subscales, PHQ-2 and PHQ-1, seem reliable and valid for detecting MDD among Chinese primary care patients.

Gender difference on the development of metabolic syndrome: a population-based study in Taiwan

Little is known regarding the development of metabolic syndrome. This study examining gender difference in the characteristics of metabolic components aimed to estimate the development of metabolic syndrome in both genders. This nation-wide, population-based survey included 5,880 men and women aged 20-79 years in Taiwan. Metabolic syndrome was defined by the revised National Cholesterol Education Program Adult Treatment Panel III, with adoption of the Asian criteria for abdominal obesity. The results indicate that metabolic syndrome was prevalent in 20.4% of the men and 15.3% of the women. Lipid components occurred the earliest in both genders. The appearance of the first isolated component was earlier in women than in men (mean age 43.4 vs. 45.6 years, P < 0.05). In contrast, the mean prevalent age of metabolic syndrome appeared earlier in men than in women by 4.9 years (mean age 51.3 vs. 56.2 years, P < 0.05). The differences in prevalent age from the appearance of any isolated component to metabolic syndrome were 12.8 years in women and 5.7 years in men, respectively. If men had a body mass index less than 23 kg/m(2) and exercise habits, the difference in the prevalent age from the isolated component to metabolic syndrome was 15.4 years, longer than for all women subjects. We conclude lipid components appeared the earliest. Women had the first isolated component earlier, presenting as metabolic syndrome later than men. The development of metabolic syndrome was slower in subjects without overweight characteristics and with exercise habits.

Controlled trial of problem-solving therapy and consultation-liaison for common mental disorders in general medical settings in Taiwan

OBJECTIVE

Common mental disorders (CMD) are prevalent high-impact illnesses seen in general medical settings worldwide. There has been no investigation on the efficacy of enhanced care in Chinese societies. The aim of this study was to compare the outcome of three interventions for treating CMD: usual care (UC), problem-solving therapy plus UC (PST-UC), and psychiatric consultation plus UC (PC-UC).

METHOD

The sample for this randomized controlled trial consisted of 254 patients with CMD being managed in general medical care settings. Clinical and functional assessments were done at baseline and at 16 weeks.

RESULTS

Two hundred six patients had complete data at 16 weeks (66 in the UC group, 63 in the PST-UC group, 77 in the PC-UC group). All patients had significant improvement on all scales over time, with no significant differences among the three treatment groups.

CONCLUSION

This trial failed to demonstrate the efficacy of enhanced care with consultation-liaison by mental health professionals for patients with CMD in general medical settings in Taiwan. Improved outcomes may require more integrated interventions.

Obesity and changes in body weight related to 10-year diabetes incidence in women in Taiwan

This study aimed to investigate the relation of obesity and changes in body weight through adulthood with risks of type 2 diabetes. This study of 954 middle-aged women free of diabetes (mean age, 37.1 +/- 9.6 years) was conducted in a hospital. The baseline and biannual health check-ups were performed from 1993 to 2003. The cumulative incidence rate of type 2 diabetes was 3.64 per 1000 person-years during the mean follow-up period of 10 years. 73.3% of subjects who developed type 2 diabetes were overweight (16.6%) or obese (56.7%). Obese subjects (body mass index more than 25 kg/m2) had a relative risk of type 2 diabetes of 10.4 (95% confidence interval 2.95-36.9) compared with subjects with an optimal body mass index (18-22.9 kg/m2). Long-term weight gain was strongly related to the risk of type 2 diabetes. Each 1 kg of weight gain was associated with a 16% increase in risk of developing diabetes. This study indicated that obesity at young adult and weight gain appreciably increase risk for type 2 diabetes. Maintaining a lean weight throughout adulthood seems to be beneficial in the primary prevention of type 2 diabetes.

Overweight and Obesity-related Metabolic Disorders in Hospital Employees

BACKGROUND

Obesity is associated with metabolic disorders and cardiovascular diseases. This study investigated the relationship between overweight and obese status and the incidence of type 2 diabetes, hypertension, hyperlipidemia and hyperuricemia.

METHODS

This prospective cohort study comprised 1749 hospital employees who received baseline health check-ups in 1993. Data from the 1027 participants (832 women, 195 men; mean age, 36 +/- 7 years) who repeated check-ups in 2003 were used in the analysis. Relative risks (RRs) for development of metabolic disorders during follow-up associated with different body mass index (BMI) categories at baseline as defined by Asia-Pacific recommendations and the Department of Health in Taiwan were calculated after adjustment for covariates.

RESULTS

The prevalence of overweight and obesity at baseline check-up were 17.6% and 14.5%, respectively. Obese subjects with baseline BMI >or= 25 kg/m2 had a significant multivariate-adjusted RR of 2.7 for hypertension, 14.8 for type 2 diabetes, 3.2 for hypertriglyceridemia, and 2.8 for hyperuricemia, compared to subjects with baseline BMI < 23.0 kg/m2. RR for diabetes was higher in women than in men, but RR for hypertriglyceridemia was higher in men. The risks of hypertension and hyperuricemia significantly increased for subjects with baseline BMI >or= 23 kg/m2, while RRs for type 2 diabetes increased significantly for baseline BMI >or= 24 kg/m2 and hypertriglyceridemia increased for baseline BMI >or= 25 kg/m2. The risks attributable to obesity (baseline BMI >or= 25 kg/m2) were 23.0% for hypertension, 70.8% for diabetes, 27.9% for hypertriglyceridemia, and 24.1% for hyperuricemia.

CONCLUSION

This study revealed that a high prevalence of overweight and obesity was associated with significantly increased risk of development of type 2 diabetes, hypertension, hypertriglyceridemia and hyperuricemia in hospital employees, suggesting the need for programs to improve weight management.

Prevalence of Obesity and Metabolic Syndrome in Taiwan

BACKGROUND/PURPOSE

Obesity and metabolic syndrome (MS) are major risk factors for the development of type 2 diabetes and cardiovascular diseases (CVD). This study estimated the prevalence of obesity and MS in Taiwan.

METHODS

Data from a nationwide cross-sectional population-based survey of 5936 participants (2815 men, 3121 women; age range, 20-79.9 years) in 2002 were analyzed. Obesity was defined as a body mass index (BMI) > or = 27 kg/m(2) according to the criteria of the Department of Health in Taiwan. The prevalence of MS was estimated using the definitions of the modified Adult Treatment Panel III (ATP III), the International Diabetes Federation for Chinese (MS-IDF(C)) and the MS criteria for Taiwanese (MS-TW).

RESULTS

The overall prevalence of obesity in men was significantly greater than in women (19.2% vs. 13.4%, p < 0.0001). The age-standardized prevalence of MS was 15.7% by the modified ATP III criteria, 14.3% by the MS-IDF(C) criteria and 16.4% by the MS-TW criteria. The prevalence of obesity and MS significantly increased with age (trend test, p < 0.0001) in men and women. The risk of MS and its components increased significantly with BMI, and showed a marked increase with BMI > or = 24 kg/m(2). MS as classified by the MS-IDF(C) criteria failed to identify subjects at high risk of CVD who did not have abdominal obesity, including those with hypertension, type 2 diabetes and dyslipidemia.

CONCLUSION

This study found a high prevalence of obesity and MS in Taiwan. The definitions of MS by the modified ATP III and MS-TW criteria were better able to detect high CVD risk than the MS-IDF(C) criteria.

Identification of common mental disorders by general medical doctors in Taiwan

The aims of the study were to examine the detection rate of common mental disorders (CMD) by general medical doctors and which patient-related factors associated with increased chances of detection in Taiwan. A two-phase case-identification using the Chinese Health Questionnaire and the Revised Clinical Interview Schedule (CIS-R) was carried out among a sample of consecutive new attenders (n=990) in community and hospital-based clinics. Physicians completed a checklist of the problems that they identified during each consultation. General medical doctors missed more than 85% of the CIS-R cases of defined mental disorder. Physicians performed better identification of CMD among attenders with a higher socioeconomic status, without physical illness, having psychological presentation or attribution, suffering from more serious common mental disorders, or having a longer duration of illness. The very low identification rate of CMD has strongly implied the need to improve postgraduate training in psychiatry for general medical doctors in Taiwan. Simply adding one or two questions about mood and attributions of presenting symptoms might help physicians to identify CMD.

Intertrochanteric fractures in adults younger than 40 years of age

This study reviewed 66 intertrochanteric fractures in patients younger than 40 years old (average 33.0 years old; range 17-40 years old). In contrast to the usual population with intertrochanteric fractures, the factors male predominance (46/66), less pre-injury comorbidity (9/66), more outdoor high energy trauma (47/66), and more associated injuries (32/66) were evident. The distribution of associated injuries was wide. Some of them were life threatening. According to Boyd's classification, 20 were type I, 24 were type II, 13 were type III, and 9 were type IV. Twenty-nine were stable, and 37 were unstable. Stratified by the mechanism of injury, the difference in distribution between the subgroups was significant (p = 0.027, two-tail Fisher's exact test). Simple falls only caused Boyd type I and II fractures. Boyd type III or IV fractures were found more often after vehicular trauma or falls from a height. All the intertrochanteric fractures healed on average 70.5 days (range 31-213 days) after operation. The fractures resulting from vehicular trauma or fall from a height healed significantly more slowly (p = 0.02, univariant log-rank test). There were 6 intertrochanteric fracture-related complications. The mechanism of injury determines the character of intertrochanteric fractures in young adults. Given tougher bone stock, better healing ability, and less co-morbidity, proper management can lead to healing of all intertrochanteric fractures. The extent of functional recovery was also determined by the associated injuries.

Prostate cancer vaccines: current status

Recent insights into cell-mediated immunotherapy have led to a wave of new trials involving immunotherapy for prostate cancer. Vaccines have evolved from nonspecific immune stimulants like Bacillus Calmette-Guerin (BCG) to much more specific and potent strategies. Techniques currently being investigated include passive immunotherapy with monoclonal antibodies, adoptive transfer of activated effector T cells, and active immunotherapy involving immunization with whole-cell or antigen-specific vaccines. These therapies are being modified with cytokines and other immune modulating agents. Understanding the mechanisms of antitumor immunity and identifying relevant tumor-specific antigens will likely improve these vaccine strategies and provide them with a niche in the future of prostate cancer therapy.