Localized periodontitis severity associated with carotid intima-media thickness in young adults: CHIEF atherosclerosis study

This study aimed to investigate the association of periodontitis with subclinical atherosclerosis in young adults. In total, 486 non-diabetic military personnel were included in Taiwan. Carotid intima-media thickness (cIMT) was assessed utilizing sonography for subclinical atherosclerosis. Periodontitis severity was defined based on the 2017 US/European consensus. Mean cIMT was compared by analysis of covariance (ANCOVA), and multiple logistic regression model was used to determine the association of periodontitis severity and the highest quintile of cIMT (≥ 0.8 mm) with adjustments for age, sex, metabolic risk factors and leukocyte counts. The mean cIMT increased in those with greater stages (periodontal health (N = 349): 0.65 mm, Stage I (N = 41): 0.72 mm, Stage II (N = 57): 0.74 mm and Stage III: 0.76 mm, respectively, p < 0.01). In multiple logistic regression, a dose-response association from Stage I to Stage III periodontitis for cIMT ≥ 0.8 mm was also found [ORs and 95% CIs 1.41 (0.60-3.29), 1.62 (0.79-3.31) and 3.20 (1.42-7.18)]. Leucocyte counts ≥ 7.6 × 103/µL (the highest quintile) was associated with cIMT ≥ 0.8 mm [OR 1.86 (1.11-3.12)], while no association existed for other metabolic risk factors. In conclusion, severe periodontitis and leukocyte counts are independent risk factors of increased cIMT, emphasizing the critical role of inflammation in subclinical atherosclerosis.

Electrocardiographic and echocardiographic predictors of greater carotid intima-media thickness in tactical athletes: The CHIEF atherosclerosis study

OBJECTIVE

Both electrocardiographic and echocardiographic left ventricular hypertrophy (LVH) have been reported with an association with greater carotid intima-media thickness (cIMT), a marker of subclinical atherosclerosis in patients with hypertension, while the associations are unclear in physically fit young adults.

METHODS

A total of 1822 Taiwanese military personnel, aged 18-40 years, received an annual health examination including electrocardiography (ECG) and echocardiography in 2018-2020. Left carotid bulb cIMT was measured by high-resolution ultrasonography. Multiple logistic regression analysis with adjustments for age, sex, smoking, alcohol consumption, body mass index, mean blood pressure, and physical fitness was used to determine the associations between echocardiographic and ECG parameters and the highest quintile of cIMT (≥0.8 mm).

RESULTS

Cornell-based LVH, Myers et al.-based RVH and heart rate ≥75/min were associated with cIMT ≥0.8 mm [odds ratios (ORs) and 95% confidence intervals: 1.54 (1.01, 2.35), 1.66 (1.18, 2.33), and 1.39 (1.06, 1.83), respectively], while echocardiographic LVH defined as ≥46.0 g/m^2.7 for men and ≥38.0 g/m^2.7 for women was inversely associated with cIMT ≥0.8 mm [OR: 0.45 (0.24, 0.86)].

CONCLUSION

In tactical athletes of military, the associations of ECG and echocardiographic LVH with cIMT were in opposite directions. Higher physical fitness may cause cardiac muscle hypertrophy and reduce the atherosclerosis severity, possibly leading to the paradoxical echocardiographic finding. This study suggests that ECG-based LVH remains a good marker of subclinical atherosclerosis in our military population.

Estimated power output for a distance run and maximal oxygen uptake in young adults

Background: Both cardiopulmonary exercise testing (CPET) and run field tests are recommended by the American Heart Association for assessing the maximal oxygen uptake (VO₂ max) of youth. Power output was highly correlated with VO₂ max in CPET. However, it is unclear regarding the correlations of time and estimated power output (EPO) for a run field test with VO₂ max obtained from CPET in young adults. Methods: This study included 45 participants, aged 20-40 years, from a sample of 1,120 military personnel who completed a 3,000-m run field test in Taiwan in 2020. The participants subsequently received CPET using the Bruce protocol to assess VO₂ max in the same year. According to the physics rule, EPO (watts) for the run field test was defined as the product of half body mass (kg) and [distance (3000-m)/time (s) for a run field test]. Pearson product-moment correlation analyses were performed. Results: The Pearson correlation coefficient (r) of time against EPO for the run field test was estimated to be 0.708 (p <0.001). The correlation coefficient between the time for the run field test and VO₂ max (L/min) in CPET was estimated to be 0.462 (p = 0.001). In contrast, the correlation coefficient between time for the run field test and VO₂ max scaled to body mass in CPET was estimated to be 0.729 (p <0.001). The correlation coefficient of EPO for the run field test against VO₂ max in CPET was estimated to be 0.813 (p <0.001). Conclusion: In young adults, although the time for a run field test was a reliable estimate of VO₂ max scaled to body mass, EPO proportional to the mean square velocity was found as a superior estimate of VO₂ max.

Associations of decayed teeth and localized periodontitis with mental stress in young adults: CHIEF oral health study

The associations of mental stress with decayed teeth in children and periodontitis in old-aged adults have been described. However, the associations for young adults were not clear. This study aimed to examine the associations of decayed teeth and localized periodontitis with mental stress in young adults. This study included 334 military recruiters, aged 19-45 years in Taiwan. Mental stress was assessed by the brief symptom rating scale-5 (BSRS-5), including five domains: anxiety, depression, hostility, interpersonal sensitivity and insomnia (maximum score of 20). Those with symptomatic mental stress were defined as having BSRS-5 > 5 (n = 34). Multiple linear and logistic regression models were used to determine the associations of decayed tooth numbers and periodontitis with BSRS-5, with adjustments for age, sex, education level, physical activity, body weight category and smoking status. The BSRS-5 was positively correlated with decayed tooth numbers [β: 0.26 (95% confidence interval: 0.01-0.52)]. Those who had more than two decayed teeth [odds ratio: 3.59 (1.52-8.46)] had a higher risk of symptomatic mental stress. In contrast, the correlation between BSRS-5 and localized severer periodontitis was null. Our study recommended that decayed teeth instead of localized periodontitis, was a risk factor for mental stress in young adults.

Localized periodontitis and kidney function for the risk of proteinuria in young adults in the CHIEF oral health study

This study aimed to investigate the association of localized periodontitis with proteinuria in 1281 military young adults in Taiwan. Localized periodontitis was classified as Healthy/Stage I (N = 928) or Stage II/III (N = 353). Stage 2 chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) of 60-89 mL/min/1.73 m². Proteinuria was defined as protein levels of 2+ or 3+ on the dipstick test. Multiple logistic regression analysis with adjustments for age, sex, body mass index, remaining teeth number and other potential covariates were used to determine the association between localized Stage II/III periodontitis and dipstick proteinuria in patients with and without CKD. Localized stage II/III periodontitis was associated with a higher risk of dipstick proteinuria [odds ratio (OR) and 95% confidence interval: 1.89 (1.04-3.42)], but not with stage 2 CKD. However, the association between localized stage II/III periodontitis and dipstick proteinuria was observed only in patients with stage 2 CKD [OR: 3.80 (1.56-9.27)], while the association was null in participants without stage 2 CKD [OR: 1.02 (0.42-2.45)]. Our findings suggest that among young adults, especially those with a mildly impaired eGFR, localized periodontitis might contribute to acute or chronic kidney injury, which manifests as proteinuria.

Muscular Strength and Carotid Intima-Media Thickness in Physically Fit Young Adults: The CHIEF Atherosclerosis Study

Background: Greater muscular strength (MusS) has been found to have an inverse association with subclinical atherosclerosis in children, as well as with mortality from cardiovascular diseases (CVDs) in middle-aged and elderly individuals. However, the association of the degree of MusS with atherosclerosis may differ by sex and has not been clarified in young adults. Methods and Results: A total of 1021 Taiwanese military personnel, aged 18−40 years, participated in annual health examinations in 2018−2020. MusS was separately assessed by 2-min push-up and 2-min sit-up numbers. Subclinical atherosclerosis was measured by the left carotid bulb intima−media thickness (cIMT) using high-resolution ultrasonography. Multiple linear regression with adjustments for age, sex, alcohol intake, cigarette smoking, anthropometric indices, blood pressure, and lipid profiles was utilized to determine the correlation between MusS and cIMT. Both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.089 and −0.072, respectively; both p-values < 0.05). In men, both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.076 and −0.086, respectively; both p-values < 0.05), while in women, 2-min push-up numbers but not 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.204 and −0.01; p = 0.03 and 0.99, respectively). Conclusions: Among young adults, there was an inverse association between MusS and cIMT, emphasizing the beneficial impact of MusS on the regression of atherosclerosis. The study also revealed a sex difference and suggested that training of the upper arm muscles may be an effective preventive measure for young women to reduce the risk of early cardiovascular diseases.

Dental caries and periodontitis and the risk of myopia in young adults: CHIEF oral health study

Aim

Oral health and ocular diseases may be associated with collagen defects and inflammation status. However, the results from prior studies are conflicting. The aim of this study was to explore the association of dental caries and periodontitis with myopia in young adults.

Materials and methods

A total of 938 military personnel aged 19–39 years receiving both oral and eye examinations from 2018 through 2020 were included in this study in Taiwan. The severity of myopia was graded as no myopia (diopters > − 0.5, N = 459), low myopia (diopters: − 0.5 to -5.9, N = 225) and high myopia (diopters ≤ − 6.0, N = 254). A multiple logistic regression analysis with adjustments for age, body mass index, systolic blood pressure, smoking, alcohol consumption, missing teeth numbers, blood leucocyte counts, triglycerides, high-density lipoprotein, and uric acid were used to determine the associations of actively dental caries, filled teeth and stage II/III periodontitis with myopia.

Results

The presence of any actively dental caries was significantly associated with a higher risk of any myopia (low or high) (odds ratio [OR] and 95% confidence intervals [95% CI] 1.42 [1.04–1.94]), whereas there was no association for filled teeth. Moreover, the association for stage II/III periodontitis was only observed with high myopia (OR: 1.52 [1.07–2.15]) and was not observed with low myopia.

Conclusions

Our findings suggest that only actively dental caries and a higher severity of periodontitis were associated with myopia among young adults, thus highlighting the dental inflammation status in the oral cavity as a potential link to ocular diseases.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02413-w.

Electrocardiographic and cardiometabolic risk markers of left ventricular diastolic dysfunction in physically active adults: CHIEF heart study

Aim

This study was aimed to investigate the association of cardiometabolic and ECG markers with left ventricular diastolic dysfunction (LVDD) in physically active Asian young adults, which has not been clarified in prior studies.

Methods and results

A total of 2,019 men aged 18–43 years were included from the military in Taiwan. All the subjects underwent anthropometric, hemodynamic, and blood metabolic marker measurements. Physical fitness was investigated by time for a 3,000-m run. LVDD was defined by presence of either one of the three echocardiographic criteria: (1) mitral inflow E/A ratio < 0.8 with a peak E velocity of > 50 cm/s, (2) tissue Doppler lateral mitral annulus e′ <10 cm/s, and (3) E/e′ ratio > 14. Multiple logistic regressions with adjustments for age, physical fitness, and pulse rate were conducted to determine the association of cardiometabolic and ECG markers with LVDD. The prevalence of LVDD was estimated to be 4.16% (N = 84). Of the cardiometabolic markers, central obesity, defined as waist circumference ≥ 90 cm, was the only independent marker of LVDD [odds ratio (OR) and 95% confidence interval: 2.97 (1.63–5.41)]. There were no association for hypertension, prediabetes, and dyslipidemia. Of the ECG markers, left atrial enlargement and incomplete right bundle branch block/intraventricular conduction delay were the independent ECG markers of LVDD [OR: 2.98 (1.28–6.94) and 1.94 (1.09–3.47), respectively]. There was borderline association for Cornell-based left ventricular hypertrophy and inferior T wave inversion [OR: 1.94 (0.97–3.63) and 2.44 (0.98–6.08), respectively].

Conclusion

In the physically active Asian young male adults, central obesity and some ECG markers for left heart abnormalities were useful to identify LVDD.

Sex-specific cardiometabolic risk markers of left ventricular mass in physically active young adults: the CHIEF heart study

Greater physical fitness may lead to greater left ventricular mass (LVM) and reduce the effect of cardiometabolic risk factors on LVM. However, the cardiometabolic biomarkers associations for LVM have not been clarified in physically active young adults. This study included 2019 men and 253 women, aged 18-43 years, from the military in Taiwan. All participants underwent anthropometric and blood metabolic markers measurements, and completed a 3000-m run test for assessing fitness. LVM was calculated on the basis of an echocardiography. Multiple linear regression was used to determine the sex-specific associations between cardiometabolic risk markers and LVM indexed for the body height (g/m^2.7). In men, age, systolic blood pressure (SBP), 3000-m running time, serum triglycerides, serum uric acid and waist circumference (WC) were correlated with LVM index (β = 0.07, 0.10, - 0.01, 0.01, 0.24 and 0.24, respectively; all p-values < 0.05). The correlations were not significant for fasting plasma glucose, total cholesterol and high-density lipoprotein cholesterol (HDL-C). In women, SBP, HDL-C and WC were correlated with LVM index in the univariate analysis (β = 0.07, - 0.05 and 0.32, respectively; all p-values < 0.05), whereas the correlation was only significant for WC in the multiple linear regression analysis (β = 0.20; p-value < 0.001). In physically active adults, the associations of cardiometabolic risk markers with LVM might vary by sex. Better endurance exercise performance associated with greater LVM was noted only in men, while greater WC was the only metabolic risk marker for greater LVM in both men and women.

Cardiorespiratory Fitness and Carotid Intima-Media Thickness in Physically Active Young Adults: CHIEF Atherosclerosis Study

Background: The relationship of cardiorespiratory fitness (CRF) with subclinical atherosclerosis affected by the body adiposity has been observed in children, whereas this relationship remains unclear in young adults. Methods and Results: A total of 1520 military recruits, aged 18−40 years, were included in Taiwan in 2018−2020. All subjects underwent detailed physical and blood laboratory examinations. CRF was evaluated by time for a 3000 m run, and subclinical atherosclerosis was evaluated by intima−media thickness of the bulb of the left common carotid artery (cIMT) utilizing high-resolution ultrasonography. Multivariable linear regression analysis with adjustments for age, sex, cigarette smoking, alcohol intake, systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterols, fasting glucose, waist circumference, serum uric acid and serum triglycerides were utilized to determine the correlation between CRF and cIMT. CRF was independently correlated with cIMT (standardized β: 0.11, p < 0.001). Of the cardiometabolic risk markers, serum triglycerides were the only independent risk marker of cIMT (standardized β: 0.063, p = 0.03). In addition, the association of CRF with cIMT did not differ between those with a body mass index (BMI) ≥ 25 kg/m2 and those with BMI < 25 kg/m2 (standardized β: 0.103 and 0.117; p = 0.01 and 0.005, respectively). Conclusions: In physically active young men and women, there was an inverse association of cIMT with CRF, which was observed in both overweight/mild obesity and normal-weight individuals, highlighting the importance of endurance capacity on reducing risk of early atherosclerosis and implying that the moderation effect of body adiposity might not be present in this population.

Athlete's Heart Assessed by Sit-Up Strength Exercises in Military Men and Women: The CHIEF Heart Study

Background

Greater changes in cardiac structure and function in response to physical training have been observed more often in male athletes than in female athletes compared with their sedentary controls. However, studies for the sex-specific cardiac remodeling related to strength exercises in Asian athletes are rare.

Methods

This study included 580 men and 79 women, with an average age of 25 years, for a 6-month military training program in Taiwan. Both men and women attended a 2-min sit-up test to assess muscular strength after the training. The test performance falling one standard deviation above the mean (16%) was to define the superior eliteness of athletes. Cardiac structure and function were investigated by electrocardiography and echocardiography for men and women. Multiple logistic regression was used to determine the predictors of elite athlete status.

Results

In men, greater QTc interval, left ventricular mass adjusted to body surface area (LVMI), lateral mitral E'/A' ratio and right ventricular systolic pressure, and lower diastolic blood pressure were independent predictors of elite strength athletes in the sit-up test [odds ratio (OR) and 95% confidence intervals: 1.01 (1.00, 1.02), 1.02 (1.00, 1.04), 1.45 (1.06, 1.98), 1.13 (1.06, 1.23), and 0.96 (0.93, 0.99), respectively. In contrast, in women, the greater right ventricular outflow tract dimension was the only independent predictor of elite strength athletes in the sit-up test [OR: 1.26 (1.04, 1.53)].

Conclusions

In the 2-min sit-up test, cardiac characteristics differ between elite male and female athletes. While greater QTc interval, LVMI, and diastolic function of left ventricle predict the eliteness of male strength athletes, greater right ventricular chamber size characterizes elite female strength athletes.

Obesity Phenotypes and Electrocardiographic Characteristics in Physically Active Males: CHIEF Study

Background: Metabolically unhealthy obesity (MUO) has been associated with surface electrocardiographic (ECG) left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and inferior T wave inversions (TWI) in the middle- and old-aged populations. However, the relationship between obesity phenotypes and these ECG abnormalities in physically active young adults is yet to be determined.

Methods: A total of 2,156 physically active military males aged 18–50 in Taiwan were analyzed. Obesity and metabolically unhealthy status were, respectively, defined as the body mass index ≥27 kg/m² and the presence of metabolic syndrome based on the ATPIII criteria for Asian male adults. Four groups were classified as the metabolically healthy non-obesity (MHNO, n = 1,484), metabolically unhealthy non-obesity (MUNO, n = 86), metabolically healthy obesity (MHO, n = 376), and MUO (n = 210). ECG-LVH was based on the Sokolow–Lyon and Cornell voltage criteria, ECG-LAE was defined as a notched P wave ≥0.12 s in lead II or a notch of ≥0.04 s, and inferior TWI was defined as one negative T wave axis in limb leads II, III, or aVF. Physical performance was evaluated by time for a 3-km run. Multiple logistic regression analysis with adjustment for age, smoking, alcohol drinking, and physical performance was utilized to investigate the associations between obesity phenotypes and the ECG abnormalities.

Results: As compared to MHNO, MUNO, MHO, and MUO were associated with lower risk of Sokolow–Lyon-based ECG-LVH [odds ratios (OR) and 95% confidence intervals: 0.80 (0.51–1.25), 0.46 (0.36–0.58), and 0.39 (0.28–0.53), respectively; p for trend <0.001], and with greater risk of ECG-LAE [OR: 0.87 (0.44–1.72), 2.34 (1.77–3.10), and 3.02 (2.13–4.28), respectively; p for trend <0.001] and inferior TWI [OR: 2.21 (0.74–6.58), 3.49 (1.97–6.19), and 4.52 (2.38–8.60), respectively; p for trend <0.001]. However, no associations between obesity phenotypes and Cornell-based ECG-LVH were found.

Conclusion: In physically active young males, obesity was associated with higher risk of ECG-LAE and inferior TWI, whereas the risk between obesity and ECG-LVH might vary by the ECG criteria, possibly due to a high prevalence of exercise induced-LVH in military and greater chest wall thickness in obesity. The cardiovascular prognosis of ECG-LVH in physically active obese adults requires further study.

Associations of decayed and filled teeth with localized stage II/III periodontitis in young adults: The CHIEF oral health study

Background/purpose

To investigate the associations between treated and untreated dental caries and periodontitis in young adults.

Materials and methods

The study enrolled 1289 participants aged 18–45 years in Taiwan. Localized periodontitis was categorized into healthy and stage II/III (n = 936 and n = 353, respectively) based on the 2017 criteria of the World Workshop. Multivariable logistic regression analysis with adjustments for sex, age, tobacco smoking status, betel nut consumption status, metabolic syndrome, and total white blood cell count was used to determine the associations.

Results

Decayed tooth numbers were positively associated with localized stage II/III periodontitis [odds ratio (OR): 1.15 (95% confidence intervals (CI): 1.06–2.25)], while filled tooth numbers were inversely associated with localized stage II/III periodontitis in young adults [OR: 0.96 (95% CI: 0.92–0.99)].

Conclusion

Our study confirms the relationship between dental caries and periodontitis by direct evidence that the more decayed teeth there are, the higher the risk of periodontitis and by indirect evidence that the more treated decayed teeth there are, the lower the risk of periodontitis in young adults.

Athlete's Heart in Asian Military Males: The CHIEF Heart Study

Background: Elite athlete's heart is characterized by a greater left ventricular mass indexed by body surface area (LVMI) and diastolic function; however previous studies are mainly conducted in non-Asian athletes compared to sedentary controls.

Methods: This study included 1,388 male adults, aged 18–34 years, enrolled in the same unified 6-month physical training program in Taiwan. During the midterm exams of 2020, all trainees completed a 3-km run (endurance) test, and 577 were randomly selected to attend a 2-min push-up (muscular strength) test. Elite athletes were defined as the performance of each exercise falling one standard deviation above the mean (16%). Cardiac structure and function were measured by echocardiography and compared between elite and non-elite athletes. Multiple logistic regression analysis was used to determine the independent predictors of elite athlete status at each exercise modality.

Results: As compared to non-elite controls, elite endurance athletes had greater LVMI (84.4 ± 13.6 vs. 80.5 ± 12.9 g/m², p < 0.001) and lateral mitral E'/A' ratio (2.37 ± 0.73 vs. 2.22 ± 0.76, p < 0.01) with lower late diastolic A' (7.77 ± 2.16 vs. 8.30 ± 3.69 cm/s, p = 0.03). Elite strength athletes had greater LVMI (81.8 ± 11.4 vs. 77.5 ± 12.1, p = 0.004) and lateral mitral E'/A' ratio (2.36 ± 0.70 vs. 2.11 ± 0.71, p < 0.01) with a greater early diastolic E' (19.30 ± 4.06 vs. 18.18 ± 4.05 cm/s, p = 0.02). Greater LVMI and lower heart rate were independent predictors of elite endurance athletes [odds ratio (OR) and 95% confidence intervals: 1.03 (1.02, 1.04) and 0.96 (0.95, 0.98), respectively]. Greater LVMI, lateral mitral E'/A' ratio and right ventricular systolic pressure were independent predictors of elite strength athletes [OR: 1.03 (1.01, 1.05), 1.50 (1.06, 2.12), and 1.12 (1.05, 1.19), respectively].

Conclusions: Cardiac structural and functional characteristics differ between endurance and strength elite athletes. While greater LVMI predicts elite status in both groups of Asian athletes, consistent with findings from Western elite athletes, greater diastolic function, and right ventricular systolic pressure characterize strength elite athletes, while lower heart rate at rest predicts endurance elite athletic status.

Pros and cons of continuous glucose monitoring in the intensive care unit

Diabetes mellitus affects people worldwide, and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients. Previous reports have confirmed that hyperglycemia can increase the risk of mortality in patients cared in the intensive care unit (ICU). In addition, severe and multiple hypoglycemia increases the risk of mortality when using insulin or intensive antidiabetic therapy. The innovation of continuous glucose monitoring (CGM) may help to alert medical caregivers with regard to the development of hyperglycemia and hypoglycemia, which may decrease the potential complications in patients in the ICU. The major limitation of CGM is the measurement of interstitial glucose levels rather than real-time blood glucose levels; thus, there will be a delay in the treatment of hyperglycemia and hypoglycemia in patients. Recently, the European Union approved a state-of-art artificial intelligence directed loop system coordinated by CGM and a continuous insulin pump for diabetes control, which may provide a practical way to prevent acute adverse glycemic events related to antidiabetic therapy in critically ill patients. In this mini-review paper, we describe the application of CGM to patients in the ICU and summarize the pros and cons of CGM.

Metabolically healthy obesity and physical fitness in military males in the CHIEF study

The metabolically healthy obese (MHO) characterized by the absence of metabolic syndrome have shown superior cardiorespiratory fitness (CRF) and similar muscular strength as compared with the metabolically unhealthy obese (MUO). However, this finding might be biased by the baseline sedentary behavior in the general population. This study utilized 3669 physically active military males aged 18-50 years in Taiwan. Obesity and metabolically unhealthy were respectively defined as body mass index ≥ 27.5 kg/m² and presence of at least two major components of the metabolic syndrome, according to the International Diabetes Federation criteria for Asian male adults. Four groups were accordingly classified as the metabolically healthy lean (MHL, n = 2510), metabolically unhealthy lean (MUL, n = 331), MHO (n = 181) and MUO (n = 647). CRF was evaluated by time for a 3-km run, and muscular strengths were separately assessed by numbers of push-up and sit-up within 2 min. Analysis of covariance was utilized to compare the difference in each exercise performance between groups adjusting for age, service specialty, smoking, alcohol intake and physical activity. The metabolic syndrome prevalence in MUL and MUO was 49.8% and 47.6%, respectively. The performance of CRF did not differ between MHO and MUO (892.3 ± 5.4 s and 892.6 ± 3.0 s, p = 0.97) which were both inferior to MUL and MHL (875.2 ± 4.0 s and 848.6 ± 1.3 s, all p values < 0.05). The performance of muscular strengths evaluated by 2-min push-ups did not differ between MUL and MUO (45.3 ± 0.6 and 45.2 ± 0.4, p = 0.78) which were both less than MHO and MHL (48.4 ± 0.8 and 50.6 ± 0.2, all p values < 0.05). However, the performance of 2-min sit-ups were only superior in MHL (48.1 ± 0.1) as compared with MUL, MHO and MUO (45.9 ± 0.4, 46.7 ± 0.5 and 46.1 ± 0.3, respectively, all p values < 0.05). Our findings suggested that in a physically active male cohort, the MHO might have greater muscle strengths, but have similar CRF level compared with the MUO.

Prevalence and characteristics of mitral valve prolapse in military young adults in Taiwan of the CHIEF Heart Study

The prevalence of mitral valve prolapse (MVP) among middle- and older-aged individuals is estimated to be 2–4% in Western countries. However, few studies have been conducted among Asian individuals and young adults. This study included a sample of 2442 consecutive military adults aged 18–39 years in Hualien, Taiwan. MVP was defined as displacement of the anterior or posterior leaflet of the mitral valve to the mid portion of the annular hinge point > 2 mm in the parasternal long-axis view of echocardiography. Cardiac chamber size and wall thickness were measured based on the latest criteria of the American Society of Echocardiography. The clinical features of participants with MVP and those without MVP were compared using a two-sample t test, and the cardiac structures were compared using analysis of covariance with adjustment for body surface area (BSA). Eighty-two participants were diagnosed with MVP, and the prevalence was 3.36% in the overall population. Compared with those without MVP, participants with MVP had a lower body mass index (kg/m²) (24.89 ± 3.70 vs. 23.91 ± 3.45, p = 0.02) and higher prevalence of somatic symptoms related to exercise (11.0% vs. 4.9%, p = 0.02) and systolic click in auscultation (18.3% vs. 0.6%, p < 0.01). In addition, participants with MVP had greater left ventricular mass (gm) and smaller right ventricular wall thickness (mm) and dimensions (mm) indexed by BSA than those without MVP (149.12 ± 35.76 vs. 155.38 ± 36.26; 4.66 ± 0.63 vs. 4.40 ± 0.68; 26.57 ± 3.99 vs. 25.41 ± 4.35, respectively, all p-values < 0.01). In conclusion, the prevalence and clinical features of MVP in military young adults in Taiwan were in line with those in Western countries. Whether the novel MVP phenotype found in this study has any pathological meaning needs further investigation.

Psychological stress and long-term blood pressure variability of military young males: The cardiorespiratory fitness and hospitalization events in armed forces study

BACKGROUND

Acute stress might increase short-term heart rate variability and blood pressure variability (BPV); however, chronic stress would not alter short-term BPV in animal models.

AIM

To examine the association of psychological stress with long-term BPV in young male humans.

METHODS

We prospectively examined the association of chronic psychological stress with long-term BPV in 1112 healthy military males, averaged 32.2 years from the cardiorespiratory fitness and hospitalization events in armed forces study in Taiwan. Psychological stress was quantitatively evaluated with the Brief Symptom Rating Scale (BSRS-5), from the least symptom of 0 to the most severe of 20, and the five components of anxiety, insomnia, depression, interpersonal sensitivity, and hostility (the severity score in each component from 0 to 4). Long-term BPV was assessed by standard deviation (SD) for systolic and diastolic blood pressure (SBP and DBP), and average real variability (ARV), defined as the average absolute difference between successive measurements of SBP or DBP, across four visits in the study period from 2012 to 2018 (2012-14, 2014-15, 2015-16, and 2016-18).

RESULTS

The results of multivariable linear regressions showed that there were no correlations of the BSRS-5 score with SD_SBP, SD_DBP, ARV_SBP, and ARV_DBP after adjusting for all the covariates [β(SE): -0.022 (0.024), -0.023 (0.026), -0.001 (0.018), and 0.001 (0.020), respectively; P > 0.05 for all]. In addition, there were also no correlations between each component of the BSRS score and the long-term BPV indexes.

CONCLUSION

Our findings suggest that chronic psychological stress might not be associated with long-term BPV in military young male humans.

Comparisons of traditional electrocardiographic criteria for left and right ventricular hypertrophy in young Asian women: The CHIEF heart study

The performance of electrocardiographic (ECG) voltage criteria to identify left and right ventricular hypertrophy (LVH and RVH) in young Asian female adults have not been clarified so far.In a sample of 255 military young female adults, aged 25.2 years on average, echocardiographic LVH was respectively defined as the left ventricular mass (LVM) indexed by body surface area (BSA) (≥88 g/m) and by height (≥41 g/m), and RVH was defined as anterior right ventricular wall thickness >5.2 mm. The performance of ECG voltage criteria for the echocardiographic LVH and RVH were assessed by area under curve (AUC) of receiver operating characteristic (ROC) curve to estimate sensitivity and specificity.For the Sokolow-Lyon (the maximum of SV1 or SV2 + RV5 or RV6) and Cornell (RaVL + SV3) voltage criteria with the LVM/BSA ≥88 g/m, the AUC of ROC curves were 0.66 (95% confidence intervals [CI]: 0.52-0.81, P = .039) and 0.61 (95% CI: 0.44-0.77, P = .18), respectively. For these 2 ECG voltage criteria with the LVM/height ≥41 g/m, the AUC of ROC curves were 0.64 (95% CI: 0.52-0.75, P = 0.11) and 0.73 (95% CI: 0.61-0.85, P = 0.0074), respectively. The best cut-off points selected for the Sokolow-Lyon and Cornell voltage criteria with echocardiographic LVH in young Asian females were 26 mm and 6 mm, respectively. In contrast, all the AUC of ROC curves were less than 0.60 and not significant according to the Sokolow-Lyon (the maximum of RV1 + SV5 or V6) and Myers' voltage criteria (eg, the voltage of R wave in V1 and the ratios of R/S in V1, V5 and V6) with echocardiographic RVH.There was a suggestion that the ECG voltage criteria to screen the presence of LVH should be adjusted for the young Asian female adults, and with regard to RVH, the ECG voltage criteria were found ineffective.

Quantitative Physical Fitness Measures Inversely Associated With Myopia Severity in Military Males: The CHIEF Study

Myopia has been linked to body weight and sedentary status, but the association with quantitatively measured physical fitness in adults has not been examined. Cross-sectional analyses were performed to investigate the association between physical fitness and myopia in 3,669 military men (aged 29.4 years) in Taiwan. The severity of myopia obtained from the left eye was classified as mild (−0.5 to −3.0 diopters; n = 544), moderate −3.1 to −6.0 diopters; n = 563), and high (<−6.0 diopters; n =150); others were defined as nonmyopia (n = 2,412). Aerobic fitness was evaluated by time for a 3000-meter run test, and muscular endurance was evaluated by numbers of 2-min sit-ups and 2-min push-ups. A value of p < .0125 was considered significant. A multiple linear regression analysis was used to determine the relationship. Individuals who were less physically fit had higher risk of myopia. The associations were dose-dependently significant with mild, moderate, and high myopia for 3000-meter running time (β = 9.64; 95% confidence intervals [3.22, 16.05], β = 12.41; 95% CI [6.05, 18.76], and β = 20.87; 95% CI [9.22, 32.51], respectively) after controlling for the potential covariates. There tended to be an inverse association with moderate and high myopia for numbers of 2-min push-ups (β = −1.38; 95% CI [−2.43, −0.34] and β = −2.10; 95% CI [− 3.97, −0.22], respectively) and 2-min sit-ups (β = −0.83; 95% CI [−1.54, −0.12] and β = −1.29; 95% CI [−2.56, −0.02], respectively), respectively. This study suggested that physical fitness, particularly aerobic fitness of the military males who received regular training, is inversely associated with myopia severity, independent of service specialty, body mass index, and educational level.

Association of Liver Transaminase Levels and Long-Term Blood Pressure Variability in Military Young Males: The CHIEF Study

Background: An inverse relationship of serum liver transaminases and mortality might be due to better blood pressure control in hypertensive patients. Whether it holds true regarding such an association for long-term blood pressure variability (BPV) in those without antihypertensive therapy is unclear. Methods: A population of 1112 military males without antihypertensive medications, aged 32 years, was collected from a retrospective longitudinal study in Taiwan. Serum liver aspartate and alanine transaminase (AST and ALT) levels were obtained from a 12 h-fast blood sample of each participant. BPV was assessed by standard deviation (SD) and average real variability (ARV) of systolic and diastolic blood pressure (SBP and DBP), respectively across 4 visits during the study period (2012–2014, 2014–2015, 2015–2016, and 2016–2018). Multivariable linear regression analysis was utilized to determine the association adjusting for demographics, anthropometric indexes, SBP, DBP, and lipid profiles. Results: In the unadjusted model, ALT was significantly and positively correlated with SD_DBP and ARV_DBP (β (standard errors) = 0.36 (0.16) and 0.24 (0.12), respectively), and so was AST (β = 0.19 (0.08) and 0.14 (0.06), respectively). All the associations were insignificant with adjustments. However, ALT was significantly and negatively correlated with SD_SBP and ARV_SBP (β = −0.35 (0.14) and −0.25 (0.11), respectively) and so was AST (β = −0.14 (0.07) and −0.12 (0.06), respectively) with adjustments. Conclusion: Our findings suggested that serum liver transaminases were negatively correlated with long-term systolic BPV in young male adults without antihypertensive therapy, and the clinical relevance needs further investigations.