Association of betel nut chewing with exercise performance in a military male cohort: the CHIEF study

A comparison of various insulin resistance indices and the possibility of hypertension in military adults: CHIEF study

BACKGROUND

Insulin resistance is associated with the development of hypertension, whereas there were rare studies comparing various non-insulin based insulin resistance (NI-IR) indices for the possibility of hypertension among young and middle-aged adults.

METHODS

This cross-sectional study included a total of 4,080 military personnel, aged 18-50 years, without antihypertensive medications therapy in 2014. All subjects received annual health examinations for blood pressure (BP) measurements. Stage I isolated diastolic hypertension (IDH) and isolated systolic hypertension (ISH) and combined hypertension were respectively defined as systolic BP (SBP) < 130 mmHg/diastolic BP (DBP) 80-89 mmHg, SBP 130-139 mmHg/DBP < 80 mmHg, and SBP 130-139 mmHg/DBP 80-89 mmHg. The cut-off values of stage II hypertension for SBP and DBP were 140-159 mmHg and 90-99 mmHg, respectively. Four NI-IR indices included the serum triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio, TyG index, Metabolic Score for IR (METS-IR) and ZJU index which were defined according to their specific formula. Multiple logistic regression analysis with adjustments for age, sex, anthropometrics, substance use, kidney function, serum uric acid, atherogenic cholesterols and physical activity was performed to determine the associations.

RESULTS

There were 1,024 subjects with hypertension (25.1%) in which 739 were stage I hypertension, and 285 were stage II hypertension. For total hypertension, there were an association with TyG and METS-IR indices [odds ratios (ORs) and 95% confidence intervals: 1.432 (1.215-1.688) and 1.553 (1.040-2.321), respectively]. For hypertension subtypes, TyG index was positively associated with overall, stage I, and stage II ISH [ORs: 1.447 (1.149-1.823), 1.317 (1.029-1.687), and 2.011 (1.351-2.994), respectively], while TG/HDL-C, METS-IR and ZJU indices were merely associated with stage II ISH [ORs: 1.053 (1.006-1.103), 3.001 (1.171-7.696) and 1.009 (1.000-1.017), respectively]. In addition, TyG and METS-IR indices were positively associated with stage II IDH [ORs: 1.813 (1.207-2.721) and 2.85 (1.080-7.520), respectively], and TyG index was also associated with combined hypertension [OR: 1.425 (1.007-1.833)].

CONCLUSION

Among young and middle-aged adults, insulin resistance assessed by the four NI-IR indices was positively associated with stage II ISH, while only TyG index had a significant association for both stage II IDH and combined hypertension.

Association Between Dental Calculus and Hypertension Phenotypes in Highly Fit Adults: CHIEF Oral Health Study

BACKGROUND

Poor oral health evaluated by presence of dental calculus has been associated with hypertension (HTN) among middle- and old-aged adults. However, it is unclear for the association of HTN phenotypes with dental calculus in young adults.

METHODS

This study examined the association between dental calculus and HTN in 5,345 military personnel, aged 19-45 years, without antihypertensive medications therapy in Taiwan from 2018 to 2021. Dental calculus was defined as presence of supragingival calculus in any teeth, except impacted teeth, and third molar. Combined HTN (CHTN) was diagnosed as systolic blood pressure (SBP) ≥130 mm Hg and diastolic blood pressure (DBP) ≥80 mm Hg. Isolated systolic and diastolic HTN were, respectively, defined as SBP ≥130 mm Hg only (ISHTN) and DBP ≥80 mm Hg only (IDHTN). Multiple logistic regression with adjustments for sex, age, toxic substance use, anthropometrics, lipid profiles, fasting glucose, and blood leukocyte counts were used to determine the association between dental calculus and HTN phenotypes in young adults.

RESULTS

The prevalence of those with dental calculus, CHTN, ISHTN, and IDHTN was 20.8%, 10.8%, 10.2%, and 7.0%, respectively. The dental calculus was associated a greater possibility with CHTN [odds ratio (OR) and 95% confidence interval: 1.60 (1.31-1.95)]. However, the associations of dental calculus with ISHTN and IDHTN were null [OR: 1.05 (0.81-1.27) and 1.12 (0.86-1.46), respectively].

CONCLUSIONS

Our findings suggest that among young adults, poor oral health manifested by presence of dental calculus was associated with a greater possibility of CHTN, while not for ISHTN and IDHTN.

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.

Erythrocyte Indices and Long-term Blood Pressure Variability in Military Males

BACKGROUNDS

Severe microcytic anemia has been associated with BP changes.

AIMS AND OBJECTIVES

Whether the erythrocyte indices are associated with long-term BPV is unknown. This study aimed to investigate the association of hemoglobin levels and erythrocyte size with long-term blood pressure variability (BPV) in young males.

METHODS

This study included 1,112 healthy military males, averaging 32 years of age, in Taiwan. All participants took a measurement of systolic and diastolic BP (SBP and DBP) every two-year from 2012 to 2018 (2012-14, 2014-15, 2015-16, 2016-18). Lev-els of hemoglobin and mean corpuscular volume (MCV) of erythrocytes were obtained at the first visit. Long-term BPV was assessed by the standard deviation (SD) and aver-age real variability (ARV). Multivariate linear regression analysis with adjustment for the baseline BP levels and other covariates was used to elucidate the association.

RESULTS

Hemoglobin levels were borderline positively correlated with SD DBP (β and standard errors = 0.016 (0.009), P =0.06). In those with hemoglobin levels of 10.0-13.9 g/dL, hemoglobin was negatively correlated with SDSBP (β= -0.039 (0.018), P =0.03). In contrast, MCV levels were borderline positively correlated with SDSBP (β =0.085 (0.052), P =0.09). In those with MCV levels <80 fL, MCV was positively correlated with SDSBP and ARVSBP (β= 0.445 (0.210) and 0.286 (0.149), p = 0.03 and 0.05, re-spectively).

CONCLUSION

There were inconsistent patterns for the associations of erythrocyte indices with long-term BPV. We found a U-shaped relationship of hemoglobin levels with sys-tolic BPV, whereas there was a positive linear relationship of hemoglobin and MCV levels with diastolic BPV, respectively.

Association between hepatic and systemic inflammation and localized stage II/III periodontitis in young males: The CHIEF Oral Health study

AIM

To clarify the role of systemic inflammation in the associations between hepatic inflammation and localized periodontitis, which were conflicting among races.

MATERIALS AND METHODS

The study included 1112 military personnel (males), aged 18-40 years, in Taiwan. Localized periodontitis was classified into healthy/stage I (n = 796) and stage II/III (n = 316) according to the 2017 criteria. Systemic and hepatic inflammation were defined by the greatest tertiles of blood leukocyte counts (7.51 × 10³ /μl) and alanine aminotransferase (30 U/L), respectively. Multiple logistic regression analysis with adjustments for age, metabolic syndrome, betel nut consumption, and smoking were utilized to determine the associations.

RESULTS

There was a significant association between having a high systemic inflammation, whatever the hepatic inflammation severity, and the risk of having a localized stage II/III periodontitis (odds ratio [OR]: 1.62 [1.09-2.42] and 1.47 [1.00-2.15], respectively, for the presence of a high hepatic inflammation or not). However, no significant association was found among participants with low systemic inflammation, whatever the hepatic inflammation severity (OR: 1.31 [0.91-1.91]).

CONCLUSIONS

An association between hepatic inflammation and localized periodontitis in Taiwanese was observed only if systemic inflammation co-existed, possibly accounting for the racial difference in the association significantly reported in Japanese but not in non-Asian populations in prior studies.

Tobacco Smoking and Association between Betel Nut Chewing and Metabolic Abnormalities Among Military Males: The CHIEF Study

AIM

To investigate the effect of smoking and alcohol intake on the association between betel nut chewing and each metabolic abnormality.

BACKGROUND

Betel nut chewing has been associated with metabolic syndrome.

OBJECTIVE

Whether the association is affected by tobacco or alcohol use is not clarified so far.

METHODS

The authors conducted a cross-sectional study using 6,657 military males, aged 18-50 years in eastern Taiwan in 2013-2014. Metabolic syndrome was defined according to the International Diabetes Federation's ethnic criteria for Asians. The population was classified as non-betel nut chewers (N =5,749), current chewers with both tobacco and alcohol use (N =615), and current chewers without tobacco and/or alcohol use (N =293). Multiple logistic regression analyses were stepwise adjusted for the confounders including alcohol and tobacco use to determine the association of betel chewing with the metabolic abnormalities.

RESULTS

As compared to the non-current chewers, the current chewers with both tobacco/alcohol use and those without had a higher risk of metabolic syndrome (odds ratios (OR) and 95% confidence intervals: 2.46 (2.00-3.02), and 2.04 (1.53-2.73), respectively) after controlling for age, service specialty, total cholesterol levels ≥200 mg/dL and exercise frequency (model 1). The association did not change much in the two chewing groups after additionally adjusting for alcohol consumption (model 2) (OR: 2.49 (1.99-3.12), and 2.04 (1.52-2.73), respectively), whereas the relationship reduced significantly in the chewers with both tobacco/alcohol use rather than those without after further adjusting for smoking (model 3) (OR: 2.18 (1.71-2.78) and 2.02 (1.51-2.71), respectively). This was in parallel with the pattern for the association of betel nut chewing with serum triglycerides >150 mg/dL in the chewers with both tobacco/alcohol use and those without in model 1 (OR: 2.90 (2.40-3.51) and 1.90 (1.45-2.49), respectively, p =0.011), in model 2 (OR: 2.82 (2.30-3.46) and 1.89 (1.44-2.49), respectively, p =0.040), and in model 3 (2.26 (1.81-2.81) and 1.87 (1.42-2.45), respectively, p =0.76).

CONCLUSION

Our findings suggest that tobacco smoking but not alcohol intake could increase the relationship of betel nut chewing with metabolic syndrome, which is likely mediated by a synergic effect on increasing serum triglycerides levels.

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 various anthropometric indexes with localized Stage II/III periodontitis in young adults: The CHIEF oral health study

BACKGROUND

A J-shaped relationship of body mass index (BMI) with severe periodontitis has been reported. However, it is unknown for other anthropometric indexes in young adults.

METHODS

A cross-sectional study examined the relationships in 325 military men and women, aged 20 to 45 years in Taiwan. Anthropometric indexes included BMI, waist circumference (WC), and waist-to-height ratio (WHtR). The severity of localized periodontitis was defined as healthy (n = 42), Stage I (initial) (n = 228), and Stage II/III (moderate/severe) (n = 55) according to the 2017 Periodontal Diseases Classification. Smooth curve fitting and multiple logistic regression analyses adjusting for age, sex, betel nut consumption, and smoking were used to determine the threshold effect between various anthropometric and the risk of localized Stage II/III periodontitis.

RESULTS

In the spline smoothing plot, the turning points for BMI, WC, and WHtR were 26.1 kg/m² , 90.0 cm, and 0.50, respectively, and a J-shaped relationship was found for BMI (the likelihood ratio test, P <0.001). In the multiple logistic regressions, BMI ≥27.0 kg/m² , WC ≥90.0 cm and WHtR ≥0.50 were associated with higher risk of localized Stage II/III periodontitis than their counterparts (24.0 to 26.9 kg/m² for BMI) (odds ratios [OR] and 95% confidence intervals: 4.16 [1.39 to 12.49], 2.65 [1.01 to 7.11], and 2.95 [1.20 to 7.24], respectively; all P values <0.05). However, the risk for BMI <24.0 kg/m² was not significant (OR, 1.47 [0.47 to 4.54]).

CONCLUSION

In young adults, obesity defined by various anthropometrics was consistently associated with localized Stage II/III periodontitis and a J-shaped association was suggestive for BMI.

Association of red blood cell size and physical fitness in a military male cohort: The CHIEF study

Anemia manifested as reduced red blood cell (RBC) amounts or hemoglobin levels has been associated with lower cardiorespiratory fitness. However, the relationship of smaller RBC with physical fitness was unknown. We included 2933 non-anemic military males (hemoglobin levels: 11.1-15.9 g/dL and mean corpuscular volume (MCV) <100 fL) in Taiwan during 2014. Aerobic fitness was assessed by time for a 3000-meter run, and anaerobic fitness was evaluated by numbers of sit-ups and push-ups, each performed within 2 minutes. Multiple linear and logistic regression models adjusting for age, service specialty, lipid profiles, and hemoglobin levels were used to determine the associations. Microcytosis and normocytosis were defined as MCV ≤ 70 fL (n = 190) and MCV > 70 fL (n = 2743), respectively. The linear regression shows that as compared with microcytosis, normocytosis was associated with more numbers of sit-ups performed within 2 minutes (β = 1.51, P-value = 0.02). The logistic regression also reveals that those males with microcytosis had higher probability as the worst 10% performers in the 2-minute push-up test (odds ratio: 1.91, 95% confidence intervals: 1.18-3.12). By contrast, there was no association of microcytosis with 3000-meter running time. Our study suggests that non-anemic microcytosis was associated with lower anaerobic fitness but not with aerobic fitness. Whether the causative factors for microcytosis such as iron deficiency status and thalassemia trait unavailable in the study might account for the relationship needs further investigations.

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.

Association of Single Measurement of dipstick proteinuria with physical performance of military males: the CHIEF study

BACKGROUND

Proteinuria, a marker of kidney injury, may be related to skeletal muscle loss. Whether the severity of proteinuria is associated with physical performance is unclear.

METHODS

We examined the association of proteinuria severity with physical performance cross-sectionally in 3357 military young males, free of chronic kidney disease, from the cardiorespiratory fitness and hospitalization events in armed Forces (CHIEF) study in Taiwan. The grades of proteinuria were classified according to one dipstick urinalysis which were collected at morning after an 8-h fast as unremarkable (0, +/-, and 1+), moderate (2+) and severe (3+ and 4+). Aerobic physical performance was evaluated by time for a 3000-m run and anaerobic physical performance was evaluated by numbers of 2-min sit-ups and 2-min push-ups, separately. Multiple linear regressions were used to determine the relationship.

RESULTS

As compared with unremarkable proteinuria, moderate and severe proteinuria were dose-dependently correlated with 3000-m running time (β: 4.74 (95% confidence intervals (CI): - 0.55, 10.02) and 7.63 (95% CI: 3.21, 12.05), respectively), and inversely with numbers of 2-min push-ups (β = - 1.13 (- 1.97, - 0.29), and - 1.00 (- 1.71, - 0.28), respectively) with adjustments for age, service specialty, body mass index, blood pressure, alcohol intake, smoking, fasting plasma glucose, blood urea nitrogen, serum creatinine and physical activity. However, there was no association between proteinuria severity and 2-min sit-ups.

CONCLUSIONS

Our findings show a relationship of dipstick proteinuria with aerobic physical performance and parts of anaerobic physical performance in military healthy males. This mechanism is not fully understood and requires further investigations.

Social and behavioural determinants of areca nut consumption in adolescents

OBJECTIVE

This study aimed to investigate the prevalence of areca nut consumption and to identify social and behavioural determinants among a Taiwanese adolescent population.

SUBJECTS AND METHODS

A random sample of 5,343 high school students aged between 15-18 years in Kaohsiung, Taiwan, participated in the study. Participants underwent a clinical dental examination and completed a self-administered questionnaire. Data analyses were performed using multivariate logistic regression to establish a relationship between areca nut consumption as well as social and behavioural characteristics.

RESULTS

The prevalence of areca nut consumption was 3.0%. The chewing habit was more prevalent among older adolescents (p < .001, OR = 1.50, 95% CI: 1.26, 1.78), males (p < .001, OR = 17.91, 95% CI: 8.57, 37.40), pupils living with non-birth parent(s) (p = .003, OR = 2.13, 95% CI: 1.29, 3.50), children of family heads with primary (p = .001, OR = 2.90, 95% CI: 1.50, 5.59) or secondary level of education (p < .001, OR = 2.78, 95% CI: 1.74, 4.46), frequent risk takers (p < .001, OR = 1.35, 95% CI: 1.27, 1.43) and students of low physical fitness (p < .001, OR = 3.65, 95% CI: 1.81, 7.35).

CONCLUSIONS

Areca nut consumption has become an ongoing pertinent issue in adolescent health. Future investigations into neurocognitive influences of risk-taking behaviour on areca nut consumption and social dependence of the habit are indicated.

Metabolic biomarkers and long-term blood pressure variability in military young male adults

BACKGROUND

Metabolic syndrome is a cluster of cardiovascular risk factors, including central obesity, high blood pressure, elevated plasma glucose, reduced high-density lipoprotein and elevated triglyceride levels.

AIM

To investigate the relationship between metabolic biomarkers and long-term blood pressure variability (BPV) in young males.

METHODS

A cohort of 1112 healthy military males aged 18-40 years from the cardiorespiratory fitness and hospitalization events in armed forces study in eastern Taiwan was prospectively included. The following metabolic biomarkers were used: Waist circumference, serum uric acid (SUA), triglycerides, high density lipoprotein, triglycerides, and fasting glycose. BPV was assessed by average real variability (ARV) and standard deviation (SD) across 4 clinic visits during the study period (2012-14, 2014-15, 2015-16, and 2016-18). Multivariable linear regression analysis was used to determine the association after adjusting for age, body mass index, systolic and diastolic blood pressure (SBP and DBP), lipid profiles, physical activity, alcohol intake and tobacco smoking status.

RESULTS

In the unadjusted model, waist circumference was significantly and positively correlated with ARV_DBP and SD_DBP [β (standard errors) = 0.16 (0.049) and 0.22 (0.065), respectively], as was SUA [β = 0.022 (0.009) and 0.038 (0.012), respectively]. High-density lipoprotein was negatively correlated with ARV_SBP [β = −0.13 (0.063)]. There were no associations with the other metabolic biomarkers. In contrast, only SUA was significantly correlated with SD_SBP and SD_DBP [β = 0.019 (0.011) and 0.027 (0.010), respectively] in the adjusted model.

CONCLUSION

Our findings showed that of traditional metabolic biomarkers, SUA had the strongest positive correlation with long-term systolic and diastolic BPV in young male adults, and the clinical relevance needs further investigation.

The association between physical activity and risk of falling in older adults: A systematic review and meta-analysis of prospective cohort studies

This study investigated the association between physical activity (PA) and risk of falling in older adults and suggests effective PA guidelines based on intensity and amount of PA. We found 10 prospective cohort studies with a total of 58,241 older adult participants and summarized the relative ratio of risk of falling. Older adults who participated in PA had a decreased risk of falling [0.976 (95% CI: 0.957-0.996, p = 0.019)], and inactive older adults had an increased risk of falling [1.082 (95% CI: 1.007-1.163, p = 0.031)]. Older adults who participated in moderate to vigorous intensity PA with low amount of PA had an increased risk of falling [1.217 (95% CI: 1.055-1.403, p<0.007)], when older adults who participated in moderate (3 Metabolic Equivalent: METs or higher) to vigorous intensity PA (6 METs or higher) with very high amount of PA were used as a reference. We recommend participating in PA, including moderate to vigorous intensity PA and a more than medium amount of PA, and avoiding inactivity for older adults to reduce the risk of falling.

A 12-Lead ECG-Based System With Physiological Parameters and Machine Learning to Identify Right Ventricular Hypertrophy in Young Adults

OBJECTIVE

The presence of right ventricular hypertrophy (RVH) accounts for approximately 5-10% in young adults. The sensitivity estimated by commonly used 12-lead electrocardiographic (ECG) criteria for identifying the presence of RVH is under 20% in the general population. The aim of this study is to develop a 12-lead ECG system with the related information of age, body height and body weight via machine learning to increase the sensitivity and the precision for detecting RVH.

METHOD

In a sample of 1,701 males, aged 17-45 years, support vector machine is used for the training of 31 parameters including age, body height and body weight in addition to 28 ECG data such as axes, intervals and wave voltages as the inputs to link the output RVH. The RVH is defined on the echocardiographic finding for young males as right ventricular anterior wall thickness > 5.5 mm.

RESULTS

On the system goal for increasing sensitivity, the specificity is controlled around 70-75% and all data tested in the proposed method show competent sensitivity up to 70.3%. The values of area under curve of receiver operating characteristic curve and precision-recall curve using the proposed method are 0.780 and 0.285, respectively, which are better than 0.518 and 0.112 using the Sokolow-Lyon voltage criterion, respectively, for detecting unspecific RVH.

CONCLUSION

We present a method using simple physiological parameters with ECG data to effectively identify more than 70% of the RVH among young adults. Clinical Impact: This system provides a fast, precise and feasible diagnosis tool to screen RVH.

An Electrocardiographic System With Anthropometrics via Machine Learning to Screen Left Ventricular Hypertrophy among Young Adults

The prevalence of physiological and pathological left ventricular hypertrophy (LVH) among young adults is about 5%. A use of electrocardiographic (ECG) voltage criteria and machine learning for the ECG parameters to identify the presence of LVH is estimated only 20-30% in the general population. The aim of this study is to develop an ECG system with anthropometric data using machine learning to increase the accuracy and sensitivity for a screen of LVH. In a large sample of 2,196 males, aged 17–45 years, the support vector machine (SVM) classifier is used as the machine learning method for 31 characteristics including age, body height and body weight in addition to 28 ECG parameters such as axes, intervals and voltages to link the output of LVH. The diagnosis of LVH is based on the echocardiographic criteria for young males to be 116 gram/meter² (left ventricular mass (LVM)/body surface area) or 49 gram/meter^2.7 (LVM/body height^2.7). On the purpose of increasing sensitivity, the specificity is adjusted around 70-75% and all data tested in proposed model reveal high sensitivity to 86.7%. The area under curve (AUC) of the Precision-Recall (PR) curve is 0.308 in the proposed model which is better than 0.109 and 0.077 using Cornell and Sokolow-Lyon voltage criteria for LVH, respectively. Our system provides a novel screening tool using age, body height, body weight and ECG data to identify most of the LVH among young adults. It provides a fast, accurate and practical diagnosis tool to identify LVH.

Machine Learning Based Suicide Ideation Prediction for Military Personnel

Military personnel have greater psychological stress and are at higher suicide attempt risk compared with the general population. High mental stress may cause suicide ideations which are crucially driving suicide attempts. However, traditional statistical methods could only find a moderate degree of correlation between psychological stress and suicide ideation in non-psychiatric individuals. This article utilizes machine learning techniques including logistic regression, decision tree, random forest, gradient boosting regression tree, support vector machine and multilayer perceptron to predict the presence of suicide ideation by six important psychological stress domains of the military males and females. The accuracies of all the six machine learning methods are over 98%. Among them, the multilayer perceptron and support vector machine provide the best predictions of suicide ideation approximately to 100%. As compared with the BSRS-5 score ≥7, a conventional criterion, for the presence of suicide ideation ≥1, the proposed algorithms can improve the performances of accuracy, sensitivity, specificity, precision, the AUC of ROC curve and the AUC of PR curve up to 5.7%, 35.9%, 4.6%, 65.2%, 4.3% and 53.2%, respectively; and for the presence of more severely intense suicide ideation ≥2, the improvements are 6.1%, 26.2%, 5.8%, 83.5%, 2.8% and 64.7%, respectively.

Association between Leukocyte Counts and Physical Fitness in Male Military Members: The CHIEF Study

Low-grade inflammation, which is related to obesity and toxic substance use in young adults, may be associated with poor physical fitness. We investigated the association between total leukocyte count and physical fitness in a military cohort of 3,453 healthy young Taiwanese males aged 20-50 years in a cross-sectional study in 2014. Low-grade inflammation was defined according to equally sized quartiles of total leukocyte counts within the suggested normal limits (4.00-9.99 × 10³/mm³). Aerobic fitness was assessed by the time for a 3-kilometer run test, and anaerobic fitness was evaluated by the numbers of sit-ups and push-ups performed in 2 minutes. Automatic monitoring systems were used to verify the scores for all procedures. Multiple linear regression was utilized to identify the associations among variables. When compared with the lowest counts (4.00-5.49 × 10³/mm³), the second highest (6.50-7.49 × 10³/mm³) and highest normal leukocyte counts (7.50-9.99 × 10³/mm³) were correlated with longer times for a 3-kilometer run (β and 95% confidence intervals =4.93 (1.61, 8.25) and 4.65 (2.20, 7.10), respectively) and fewer numbers of push-ups performed in 2 minutes (β = -0.59 (-1.15, -0.03) and -0.56 (-0.96, -0.17), respectively), after adjustments for age, service specialty, waist circumference, body mass index, alcohol consumption, tobacco smoking, and physical activity. However, the association with 2-minute sit-ups was null. Our study suggested an inverse association between total leukocyte count and not only aerobic fitness but also parts of anaerobic fitness in young males. The temporal association needs confirmation in longitudinal studies.

Cross-Sectional Associations of Physical Fitness Performance Level and Sleep Duration among Older Adults: Results from the National Physical Fitness Survey in Taiwan

Research on relationships between physical fitness and sleep duration among older adults is scarce, especially in Taiwanese representative samples of elderly people who undergo physical fitness measurements. This study aimed to determine the associations between physical fitness and short and long sleep durations among older adults in Taiwan. We conducted a cross-sectional study and reviewed data derived from the National Physical Fitness Survey in Taiwan. A total of 24,125 Taiwanese adults aged 65 years and older participated in this study between October 2014 and March 2015. Each individual's sleep duration was recorded with a standard questionnaire method. Sleep duration data were stratified into short (≤5 h), normal (6-7 h), and long (≥8 h) sleep duration groups. Physical fitness was assessed by five components: aerobic endurance (2 min step test), muscle strength and endurance (30 s arm curl and 30 s chair stand tests), flexibility (back scratch and chair sit-and-reach tests), body composition (body mass index (BMI) and waist-to-hip ratio (WHR)), and balance (one-leg stance with eye open and 8-foot up-and-go tests). To understand whether a dose-response relationship exists between physical fitness and short or long sleep duration, we analyzed four levels of performance on the basis of quartiles of physical fitness measurements by using logistic regression. The first quartile of physical fitness performance was the baseline level. The odds ratio (OR) for short sleep duration for the third quartile of BMI was 0.8031 times (95% CI, 0.7119-0.9061) lower than the baseline. For the fourth quartile of BMI, the OR was 0.8660 times (95% CI, 0.7653-0.9800) lower than the baseline. The adjusted OR for long sleep duration significantly decreased in the second, third, and fourth quartiles of the 30 s chair stand, back scratch, chair sit-and-reach test, one-leg stance with one eye open, and BMI. The adjusted OR was increased in the third and fourth quartiles of the 8-foot up-and-go and WHR. The results of the current study suggest that physical fitness performance may influence sleep duration as an associated factor, and the relationship is much stronger for long sleep duration than for short sleep duration.

Prevalence and Correlates of Betel Quid Chewing among Bhutanese Adults

Background: Chewing of betel quid, popularly known as doma khamdo, is prevalent in Bhutan and is associated with Bhutanese customs and traditions. The objective of this paper was to determine the prevalence and explore the correlates of current betel quid use in Bhutan. Materials and methods: This is a retrospective study of secondary data from the National Health Survey 2012 (NHS 2012) of Bhutan. The outcome variable of interest was current betel quid use. The self-reported demographic characteristics were obtained using a questionnaire developed following the WHO STEPwise approach to the surveillance of non-communicable diseases (STEP). Univariate and multivariate logistic regression were performed to identify correlates for betel quid use. Results: The prevalence of current betel quid use in this study was 45.0%. The correlates associated with current betel quid use were: being female; having a primary, high school or a monastic education; being professionals in the armed forces, managers, technicians, service and sales workers, and machine operators; being current smokers; alcohol consumption; and intake of drugs. Correlates associated with decreased betel quid use were: having a diploma/certificate-level and non-formal education, and living in urban areas. Conclusion: The findings indicate that betel quid was consumed by nearly half of the Bhutanese population. Bhutan should immediately initiate national prevention programs targeting these correlates of betel quid use.

Association between mild anemia and physical fitness in a military male cohort: The CHIEF study

Anemia defined as reduced hemoglobin levels of red blood cells may carry less oxygen to skeletal muscle and impair physical performance. Previous studies have shown that exercise intolerance was related to moderate or severe anemia, however, the relationship to mild anemia was unknown. We investigated the cross-sectional association of mild anemia defined as a hemoglobin level of 10.0-13.9 g/dL with physical fitness in 3,666 military young males in Taiwan in 2014. Aerobic fitness was evaluated by 3000-meter run test, and anaerobic fitness was evaluated by 2-minute sit-ups and 2-minute push-ups, respectively. Multiple logistic regressions for the best 10% and the worst 10% performers were used to determine the relationship. There were 343 mild anemic males in whom 47.8% were microcytic anemia and 3,323 non-anemic males for the analysis. The multiple logistic regression shows that as compared with non-anemic males, mild anemic males were more likely to be the worst 10% performers in the 3000-meter run test (odds ratios (OR) and 95% confidence intervals: 1.47, 1.01-2.14) after adjusting for age, service specialty, body mass index, waist size, mean blood pressure, unhealthy behaviors, lipid profiles, and exercise frequency. On the contrary, mild anemic males had higher possibility to be the best 10% performers in the 2-minute push-ups test (OR: 1.48, 1.08-2.04). However, there was no association between mild anemia and 2-minute sit-ups. Our findings suggest that unspecified mild anemia might be associated with lower cardiorespiratory fitness but not with anaerobic fitness in physically active military males.