Association of the Apolipoprotein A5 Gene -1131T>C Polymorphism with Serum Lipids in Korean Subjects: Impact of Sasang Constitution

Effects of Acupuncture on Lowering Blood Pressure in Postmenopausal Women with Prehypertension or Stage 1 Hypertension: A Propensity Score-Matched Analysis

Postmenopausal women have a higher prevalence of hypertension compared to premenopausal women. Hypertension is a risk factor for cardiovascular diseases, the prevalence of which is ever increasing. This study investigated the effects of long-term acupuncture on lowering the blood pressure of postmenopausal women with prehypertension and stage 1 hypertension. Participants were 122 postmenopausal women aged less than 65 years, diagnosed with prehypertension or stage 1 hypertension (systolic blood pressure 120–159 mmHg or diastolic blood pressure 80–99 mmHg). We used a propensity score-matched design. The experimental group (n = 61) received acupuncture for four weeks every six months over a period of two years. The control group (n = 61) received no intervention. An Analysis of covariance (ANCOVA) was performed for the primary efficacy analysis. Relative risk ratios were used to compare group differences in treatment effects. Acupuncture significantly reduced the participants’ diastolic blood pressure (−9.92 mmHg; p < 0.001) and systolic blood pressure (−10.34 mmHg; p < 0.001) from baseline to follow-up. The results indicate that acupuncture alleviates hypertension in postmenopausal women, reducing their risk of developing cardiovascular diseases and improving their health and quality of life.

Machine learning-based prediction of Sasang constitution types using comprehensive clinical information and identification of key features for diagnosis

Background

Despite the importance of accurate Sasang type diagnosis, a unique form of Korean medicine, there have been concerns about consistency among diagnoses. We investigate a data-driven integrative diagnostic model by applying machine learning to a multicenter clinical dataset with comprehensive features.

Methods

Extremely randomized trees (ERT), support vector machines, multinomial logistic regression, and K-nearest neighbor were applied, and performances were evaluated by cross-validation. The feature importance of the classifier was analyzed to understand which information is crucial in diagnosis.

Results

The ERT classifier showed the highest performance, with an overall f1 score of 0.60 ± 0.060. The feature classes of body measurement, personality, general information, and cold–heat were more decisive than others in classifying Sasang types. Costal angle was the most informative feature. In pairwise classification, we found Sasang type-dependent distinctions that body measurement features played a key role in TE-SE and TE-SY datasets, while personality and cold–heat features showed importance in SE-SY dataset.

Conclusion

Current study investigated a comprehensive diagnostic model for Sasang type using machine learning and achieved better performance than previous studies. This study helps data-driven decision making in clinics by revealing key features contributing to the Sasang type diagnosis.

Analysis of Facial Features according to Sasang Types between Native Japanese and Native Korean Populations

Background. Facial diagnosis is a common practice and essential diagnostic method used in the Sasang Constitution Medicine (SCM). SCM is a kind of personalized medicine in Traditional Korean Medicine which categorizes people into four types, namely, Tae-Yang (TY) type, Tae-Eum type (TE), So-Yang (SY) type, and So-Eum (SE) type. This study was conducted to compare and analyze the differences in the facial feature across Sasang types among native Japanese and native Koreans. Methods. A total of 843 subjects were recruited for this study, 127 native Japanese and 716 native Koreans, respectively. Facial feature points and the measurements of facial features were assigned and calculated automatically using a facial analysis program. Data of each Sasang type for both genders were also extracted and analyzed. Analysis of covariance was then used to examine the differences in facial feature variables among native Japanese and native Koreans and Sasang types. Results. Significant differences were seen in the facial feature variables related to lower face area and eye shape. In males, TE types had wider mid-face and lower face as compared to other constitutions. Male TE types were also seen to have narrower eyes whereas male SY types had rounder eyes. In females, TE types had wider lower face width and area compared to SY types and SE types. Female SY types also had rounder eyes. Conclusions. This study presented distinctive feature in the lower face area and eye shape among the Sasang types in both native Japanese and native Koreans. This proposed that facial feature variables can also be used as an objective tool in distinguishing the Sasang types in native Japanese. Further studies are needed in the future to generalize these results.

Body composition and personality traits in so-Yang type males

BACKGROUND

The purpose of the present study was to examine the body composition of So-Yang type males according to Sasang constitutional medicine, which is popular in Korea. Different Sasang constitutional types are associated with different muscle distributions, body shapes, and disease susceptibilities. We used the Sasang Personality Questionnaire (SPQ) as a measure of the temperament of each Sasang type.

METHODS

In total, 953 subjects aged over 20 years were recruited in Korea. We collected anthropometric parameters and bioimpedence information from the subjects and administered the SPQ. A logistic regression was conducted to calculate propensity scores.

RESULTS

The percentage of skeletal muscle mass in So-Yang (SY) and non-So-Yang (non-SY) males was 45.8 ± 2.7 and 44.2 ± 3.3, respectively, before matching and 45.8 ± 2.6 and 44.9 ± 3.0, respectively, after propensity score matching. The extracellular water (ECW)/intracellular water (ICW) and extracellular water (ECW)/total body water (TBW) ratios and SPQ scores were significantly different between the SY and non-SY types.

CONCLUSIONS

This study suggested that the SY type may be significantly and independently associated with body composition and could be associated with personality.

Genome-Wide Association Study Reveals Four Loci for Lipid Ratios in the Korean Population and the Constitutional Subgroup

Circulating lipid ratios are considered predictors of cardiovascular risks and metabolic syndrome, which cause coronary heart diseases. One constitutional type of Korean medicine prone to weight accumulation, the Tae-Eum type, predisposes the consumers to metabolic syndrome, hypertension, diabetes mellitus, etc. Here, we aimed to identify genetic variants for lipid ratios using a genome-wide association study (GWAS) and followed replication analysis in Koreans and constitutional subgroups. GWASs in 5,292 individuals of the Korean Genome and Epidemiology Study and replication analyses in 2,567 subjects of the Korea medicine Data Center were performed to identify genetic variants associated with triglyceride (TG) to HDL cholesterol (HDLC), LDL cholesterol (LDLC) to HDLC, and non-HDLC to HDLC ratios. For subgroup analysis, a computer-based constitution analysis tool was used to categorize the constitutional types of the subjects. In the discovery stage, seven variants in four loci, three variants in three loci, and two variants in one locus were associated with the ratios of log-transformed TG:HDLC (log[TG]:HDLC), LDLC:HDLC, and non-HDLC:HDLC, respectively. The associations of the GWAS variants with lipid ratios were replicated in the validation stage: for the log[TG]:HDLC ratio, rs6589566 near APOA5 and rs4244457 and rs6586891 near LPL; for the LDLC:HDLC ratio, rs4420638 near APOC1 and rs17445774 near C2orf47; and for the non-HDLC:HDLC ratio, rs6589566 near APOA5. Five of these six variants are known to be associated with TG, LDLC, and/or HDLC, but rs17445774 was newly identified to be involved in lipid level changes in this study. Constitutional subgroup analysis revealed effects of variants associated with log[TG]:HDLC and non-HDLC:HDLC ratios in both the Tae-Eum and non-Tae-Eum types, whereas the effect of the LDLC:HDLC ratio-associated variants remained only in the Tae-Eum type. In conclusion, we identified three log[TG]:HDLC ratio-associated variants, two LDLC:HDLC ratio-associated variants, and one non-HDLC:HDLC-associated variant in Koreans and the constitutional subgroups.

A Systematic Review on Sasang Constitutional Type-Associated Susceptibility to Disorders in Korea

BACKGROUND/OBJECTIVE

Sasang constitutional medicine is a component of traditional Korean medicine that classifies individuals into four Sasang constitutional types (SCTs) by their physical and psychological traits. Each SCT is known to show different susceptibilities to disorders. This systematic review investigated the effect of SCT as a risk factor for various disorders.

METHODS

A systematic literature survey was conducted by searching seven databases for all articles on the prevalence rates of disorders according to SCT and sex.

RESULTS

From 14,272 relevant articles, 15 studies (13 disorders) were ultimately identified to verify different prevalence rates by SCT. Of the 13 disorders, 6 (prehypertension, general obesity, abdominal obesity, metabolic syndrome, diabetes mellitus, and irritable bowel syndrome [IBS]) had a significantly different prevalence by SCT. Metabolic syndrome and its associated disorders showed the highest prevalence in Taeumin-type individuals, whereas IBS was most prevalent in Soeumin-type individuals. In general, these findings were consistent with the results obtained in an analysis of male and female participants.

CONCLUSIONS

This study revealed that susceptibility to disorders was affected by SCT to some extent. Further studies are needed to determine the concrete features of SCT-related susceptibility, which may be helpful in preventive medicine with Sasang constitutional practice.

The APOA5 rs662799 polymorphism is associated with dyslipidemia and the severity of coronary heart disease in Chinese women

BACKGROUND

The APOA5 rs662799 polymorphism has been widely reported regarding its associations with the plasma lipid levels and the occurrence of coronary heart disease (CHD), whereas its relationship with the severity of CHD has not yet been explored.

METHODS

Four hundred and seventy-eight angiografically defined subjects (325 CHD patients and 153 CHD-free controls) were enrolled in this study. The rs662799 polymorphism was genotyped, and the fasting lipid data were collected for all participants. The severity of CHD was evaluated for the CHD patients by using Gensini scores.

RESULTS

The variant C allele of the rs662799 polymorphism was associated with lower levels of HDL-C in CHD-free women, and higher levels of TG and TG/HDL-C in women with CHD (P < 0.05 for all). The C allele was associated with higher prevalence of dyslipidemia and higher levels of Gensini scores only in women (P < 0.05 for both), but not in men. Multivariate linear regression analysis showed that the rs662799 polymorphism was independently associated with the Gensini scores in women after adjustment for other potential CHD risk factors (Beta = 0.157, 95 % CI: 0.017-0.298, P = 0.028).

CONCLUSION

Our data indicate that the rs662799 polymorphism is associated with dyslipidemia and the severity of CHD in Chinese women.

Sasang constitution may act as a risk factor for prehypertension

Background

Prehypertension (pre-HTN), similar to hypertension, has been associated with an elevated risk of cardiovascular disease. The aim of this study was to determine whether the Sasang constitution (SC) types could also be independent risk factors for pre-HTN.

Methods

A total of 2,806 eligible subjects, older than 20 years old from 25 medical clinics, participated. Clinical data, including the blood pressure, age, height, weight, and data from blood tests, were collected. One-way ANOVA with Scheffé’s post-hoc analysis and the chi-square test were used, according to the SC and sex. Logistic regression was used to generate the odds ratios (ORs) and 95 % confidence interval (CI) for pre-HTN.

Results

The pre-HTN prevalence rates of the Soeumin type, Soyangin type and Tae-eumin type were 59.4 %, 60.1 % and 74.9 %, respectively, in men (p < 0.001) and 41.7 %, 44.4 % and 58.3 % in women (p < 0.001). The Soyangin type was not more associated with increased ORs than the Soeumin type in any of the subjects with pre-HTN. Even after adjusting for sex, BMI, FBG, TC, TGs, HDL, and LDL, the Tae-eumin type in men was associated with increased ORs of pre-HTN compared with the Soeumin type (OR 1.57, 95 % CI 1.03–2.39), but the Tae-eumin type in women was not associated with pre-HTN.

Conclusions

This study suggested that the Tae-eumin type combined with sex might be significantly and independently associated with pre-HTN, especially high pre-HTN.

The obesity-risk variant of FTO is inversely related with the So-Eum constitutional type: genome-wide association and replication analyses

Background

Body constitutional types described in the traditional Korean medicine system, Sasang constitutional medicine, are heritable, as has been revealed by twin and family studies. Thus, individuals with the same constitution type usually have similar pathophysiological and psychological traits. In several recent genome-wide association (GWA) analyses performed to identify constitution-associated variants, the association signals were not replicated due to small sample size and dissimilar, non-objective methods for classification of the constitutional types.

Methods

We conducted GWA analysis and followed replication analysis in two large populations (5,490 subjects: 3,810 subjects at discovery stage and 1,680 subjects at replication stage) to identify the replicable constitution-associated variants, wherein subjects with the highest tertile of constitution probability values versus the reference with the lowest tertile of the values obtained from a recently developed constitution analysis tool were compared.

Results

We found that the obesity-risk variant in intron 1 of the fat mass and obesity–associated (FTO) gene was replicably inversely associated with the So-Eum (SE) type, characterized by reduced appetite, slim body, and cautious personality (rs7193144 in combined samples: odds ratio = 0.729, p = 1.47 × 10⁻⁷), and substantial association signal remained after controlling for body mass index (BMI). In contrast, the association of the variant with the Tae-Eum type, characterized by high body mass, disappeared after controlling BMI.

Conclusions

In summary, the obesity-risk variant in FTO intron 1 was inversely associated with the SE type, independent of BMI, which corresponded well with the characteristics of the SE type, such as the lowest body mass and lowest susceptibility to metabolic disorders among the constitutional types. Therefore, the obesity-risk variant of FTO associated with body mass increase might be involved in the determination of body constitution type.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-015-0609-4) contains supplementary material, which is available to authorized users.

Constitutional multicenter bank linked to Sasang constitutional phenotypic data

Background

Biobanks are more important in medical area because they can give researchers data for demonstrating and validating their research. In this study, we developed a biobank called the Korea Constitutional Multicenter Bank (KCMB) based on Sasang Constitutional Medicine (SCM). The aim of the KCMB was a foundation to providing the scientific basis of SCM.

Methods

The KCMB has been constructed since 2006 in 24 Korean medical clinics with collection of questionnaire data, physical measurements and biological information comprised the results from blood test and DNA analyses. All participants were prescribed Sasang Constitution (SC)-specific herbal remedies for the treatment, and showed improvement of original symptoms as confirmed by Korean medicine doctor. Collected data went through de-identification process using the electronic case report form system. For calculation of several SC type specific tendencies, we used the direct standardization and Chi-square tests.

Results

The KCMB collected clinical information from 3,711 study participants (1,353 men and 2,358 women) aged more than 10 years. The mean age (± standard deviation) was 47.1 (±16.6) and 47.7 (±15.8) years for men and women respectively. After applying the direct standardization, the estimated constitutional distributions for the SC types were as follows: 39.2% for Tae-eumin(TE), 27.1% for Soeumin(SE), 33.7% for Soyangyin(SY), and non-zero but below 0.1% for Taeyangyin(TY). The estimated distribution of TE was about 10% less, while that of SY and SE were slightly more than the distribution reported by Jema Lee established the SCM. Based on the participants’ medical history within the KCMB, each SC type had notably different frequencies for some diseases such as hypertension, diabetes, hyperlipidemia, stroke, and obesity (P < 0.001).

Conclusions

The KCMB may serve to verify and validate SCM theories and practices. It may also provide new insights into SCM mechanisms. The results from many studies using the KCMB data are of great importance and value for making decisions in healthcare policy and developing novel therapies.

Best-fit index for describing physical perspectives in Sasang typology

INTRODUCTION

We examined the best-fit index for describing the constitutional or physical characteristics of Sasang typology for its universal application.

METHODS

Ponderal index (PI), body mass index (BMI), and basal metabolic rate (BMR) of the nationwide participants (n = 1663; age, 31-60 years) were calculated. We described and analyzed the usefulness of each index for maximizing the differences between Sasang types across age and sex using box plots, Pearson's correlation, and analysis of variance.

RESULTS

We found that the So-Eum, So-Yang, and Tae-Eum Sasang types were significantly (p < 0.001) different from each other in terms of PI, BMI, and BMR by the World Health Organization with weight (BMR-WHOw). The BMI was significantly correlated with PI (r = 0.933) and BMR-WHOw (r = 0.577).

DISCUSSION AND CONCLUSION

These study results show that PI, BMR, and BMI have their own clinical values, and could contribute to the study of the pathophysiological mechanism underlying the Sasang typology as the hypothalamus hypothesis.

The prevalence of general and abdominal obesity according to sasang constitution in Korea

Background

Obesity is an important risk factor for cardiovascular and metabolic diseases and could affect mortality rates. Body mass index (BMI) and waist circumference (WC) have been used to classify obesity, and waist-to-hip ratio (WHR) has recently emerged as a discriminator of cardiovascular disease. Sasang constitution (SC) is a kind of well-known traditional Korean medicine: Tae-eumin (TE), Soeumin (SE), Taeyangin (TY) and Soyangin (SY) carrying a different level of susceptibility to chronic diseases. We aimed to examine the prevalence in general and abdominal obesity (AO) using BMI, WC and WHR according to SC in the Korean population.

Methods

A total of 3,348 subjects were recruited from 24 Korean medicine clinics. Obesity was divided into three categories: general obesity by BMI, abdominal obesity by waist circumference (WC AO) and abdominal obesity by waist-to-hip ratio (WHR AO). A Chi-square test was performed to compare prevalence, and logistic regression was conducted to generate odds ratios (ORs) according to SC (p < .05).

Results

The prevalence of general obesity was significantly higher in males than in females. The highest prevalence of general obesity, WC AO and WHR AO were all observed in the TE type, and the SY and SE types were followed in order, for both males and females respectively.

The TE type was highly associated with increased risk of general obesity (OR = 20.2, 95% CI: 12.4-32.9 in males and OR = 14.3, 95% CI: 10.1-20.2 in females), of WC AO (OR = 10.7, 95% CI: 7.2-15.9 in males and OR = 7.5, 95% CI: 5.8-9.6 in females), and of WHR AO (OR = 4.6, 95% CI: 3.3-6.4 in males and OR = 3.8, 95% CI: 2.9-4.9 in females) compared with the SE type. In addition, after controlling for age, social status and eating habits, the ORs were similar to the crude model according to gender and SC.

Conclusions

This study shows that the prevalence of obesity varies according to SC in the Korean population. In particular, the TE type was highly associated with increased ORs for general obesity, WC AO and WHR AO in both genders.

Genetic loci associated with changes in lipid levels leading to constitution-based discrepancy in Koreans

Background

Abnormal lipid concentrations are risk factors for atherosclerosis and cardiovascular disease. The pathological susceptibility to cardiovascular disease risks such as metabolic syndrome, diabetes mellitus, hypertension, insulin resistance, and so on differs between Sasang constitutional types.

Methods

We used multiple regression analyses to study the association between lipid-related traits and genetic variants from several genome-wide association studies according to Sasang constitutional types, considering that the Tae-Eum (TE) has predominant cardiovascular risk.

Results

By analyzing 26 variants of 20 loci in two Korean populations (8,597 subjects), we found that 12 and 5 variants, respectively, were replicably associated with lipid levels and dyslipidemia risk. By analyzing TE and non-TE type (each 2,664 subjects) populations classified on the basis of Sasang constitutional medicine, we found that the minor allele effects of three variants enriched in TE type had a harmful influence on lipid risk (near apolipoprotein A-V (APOA5)-APOA4-APOC3-APOA1 on increased triglyceride: p = 8.90 × 10^-11, in APOE-APOC1-APOC4 on increased low-density lipoprotein cholesterol: p = 1.63 × 10^-5, and near endothelial lipase gene on decreased high-density lipoprotein cholesterol: p = 4.28 × 10^-3), whereas those of three variants (near angiopoietin-like 3 gene, APOA5-APOA4-APOC3-APOA1, and near lipoprotein lipase gene on triglyceride and high-density lipoprotein cholesterol) associated in non-TE type had neutral influences because of a compensating effect.

Conclusions

These results implied that the minor allele effects of lipid-associated variants may predispose TE type subjects to high cardiovascular disease risk because of their genetic susceptibility to lipid-related disorders.

Absence of Association between -1131T>C Polymorphism in the Apolipoprotein APOA5 Gene and Pediatric Metabolic Syndrome

OBJECTIVE

In the present study, we evaluated the association of rs662799 variant of the APOA5 gene with Metabolic syndrome (MetS) in a sample of children and adolescents from Isfahan.

METHODS

This case control study comprised 50 cases of MetS and 50 controls. Mismatched polymerase chain reaction-restriction fragment length polymorphism (mPCR-RFLP) was used to genotype -1131T>C polymorphism. Findings : No significant association was documented for APOA5 genotypes with the measured laboratory parameters for CC, CT, and TT genotypes in the two groups studied. By logistic regression using a dominant model, the odds ratio (95% confidence interval0 for the MetS was 0.38 (0.139-1.0350 and 0.29 (0.08-1.071 for the unadjusted and adjusted models, respectively.

CONCLUSION

This study suggests that among studied children and adolescents, -1131T>C polymorphism in the APOA5 gene may not be a major contributor to the MetS risk.

Comparison of Gut Microbiota between Sasang Constitutions

The Sasang constitutional medicine has long been applied to diagnose and treat patients with various diseases. Studies have been conducted for establishment of scientific evidence supporting Sasang Constitutional (SC) diagnosis. Recent human microbiome studies have demonstrated individual variations of gut microbiota which can be dependent on lifestyle and health conditions. We hypothesized that gut microbial similarities and discrepancies may exist across SC types. We compared the difference of gut microbiota among three constitutions (So-Yang, So-Eum, and Tae-Eum), along with the investigation of anthropometric and biochemical parameters. Firmicutes and Bacteroidetes were predominant phyla in all SC types. The median plot analysis suggested that Firmicutes and Bacteroidetes appeared more abundant in SE and TE, respectively, in the male subjects of 20–29 years old. At the genus level, Bifidobacterium and Bacteroides manifested the difference between SE and TE types. For anthropometry, body weight, body mass index, and waist circumference of the TE type were significantly higher than those of the other types. Overall, findings indicated a possible link between SC types and gut microbiota within a narrow age range. Further investigations are deemed necessary to elucidate the influences of age, gender, and other factors in the context of SC types and gut microbiota.

The sasang constitution as an independent risk factor for metabolic syndrome: propensity matching analysis

THE SASANG CONSTITUTIONAL MEDICINE IS A TRADITIONAL KOREAN CUSTOMIZED MEDICINE THAT CLASSIFIES PEOPLE INTO FOUR TYPES: Tae-eumin (TE), Soyangin (SY), Soeumin (SE), and Taeyangin. The aim of this study was to show whether the Sasang Constitution (SC) could be an independent risk factor for the metabolic syndrome (MS). Totally, 3,334 subjects from 24 Korean medicine clinics participated in this study. A one-way ANOVA for the continuous variables and a chi-square test for the prevalence of MS were conducted. A logistic regression was conducted to calculate the propensity score and the odds ratios (ORs). The prevalence for MS in TE, SY, and SE was 50.6%, 30.9%, and 17.7% (P < 0.001) before matching, and 36.7%, 28.6% and 28.2% (P = 0.042) after matching, respectively. The TE was associated with an increased OR for MS compared with the SE and SY in both crude (OR 4.773, 95% CI 3.889-5.859, and OR 2.292, 95% CI 1.942-2.704, resp.) and matched groups (OR 1.476, 95% CI 1.043-2.089, and OR 1.452, 95% CI 1.026-2.053, resp.). This study reveals that the SC, especially the TE type, could be considered as a risk element for MS even in people with otherwise similar physical characteristics.

A practical approach to Sasang constitutional diagnosis using vocal features

BACKGROUND

Sasang constitutional medicine (SCM) is a type of tailored medicine that divides human beings into four Sasang constitutional (SC) types. Diagnosis of SC types is crucial to proper treatment in SCM. Voice characteristics have been used as an essential clue for diagnosing SC types. In the past, many studies tried to extract quantitative vocal features to make diagnosis models; however, these studies were flawed by limited data collected from one or a few sites, long recording time, and low accuracy. We propose a practical diagnosis model having only a few variables, which decreases model complexity. This in turn, makes our model appropriate for clinical applications.

METHODS

A total of 2,341 participants' voice recordings were used in making a SC classification model and to test the generalization ability of the model. Although the voice data consisted of five vowels and two repeated sentences per participant, we used only the sentence part for our study. A total of 21 features were extracted, and an advanced feature selection method-the least absolute shrinkage and selection operator (LASSO)-was applied to reduce the number of variables for classifier learning. A SC classification model was developed using multinomial logistic regression via LASSO.

RESULTS

We compared the proposed classification model to the previous study, which used both sentences and five vowels from the same patient's group. The classification accuracies for the test set were 47.9% and 40.4% for male and female, respectively. Our result showed that the proposed method was superior to the previous study in that it required shorter voice recordings, is more applicable to practical use, and had better generalization performance.

CONCLUSIONS

We proposed a practical SC classification method and showed that our model having fewer variables outperformed the model having many variables in the generalization test. We attempted to reduce the number of variables in two ways: 1) the initial number of candidate features was decreased by considering shorter voice recording, and 2) LASSO was introduced for reducing model complexity. The proposed method is suitable for an actual clinical environment. Moreover, we expect it to yield more stable results because of the model's simplicity.

Apolipoprotein A5 gene variants and the risk of coronary heart disease: a case‑control study and meta‑analysis

Previous studies have shown that apolipoprotein A5 (APOA5) gene variants are genetic determinants of the concentration of triglycerides, which are a known risk factor for coronary heart disease (CHD). Using the standardized coronary angiography method, 290 CHD patients and 198 non‑CHD controls were recruited from Ningbo Lihuili Hospital. In addition, 331 unrelated healthy volunteers were recruited as healthy controls from Ningbo Ximen Community residents. Three variants of the APOA5 gene, S19W, ‑1131T>C and 553G>T, were analyzed for their association with CHD. Under a dominant inheritance model, ‑1131CT>C was shown to be a CHD risk factor (P=0.030; OR, 1.422; 95% CI, 1.036‑1.952). The single nucleotide polymorphism, 553G>T, was found to correlate with the severity of CHD in males (P=0.032). Meta‑analysis showed that ‑1131T>C was significantly associated with CHD (P<0.0001). By contrast, negative correlations with CHD were observed for S19W and 553G>T. In the present case‑control study, APOA5 gene variants were not found to correlate with the risk of CHD in the populations studied; however, ‑1131CT>C was shown to be a CHD risk factor under a dominant inheritance model. Meta‑analysis showed a significant contribution of ‑1131T>C to the risk of CHD, implying an ethnic difference in APOA5 gene variants.

Recent progress in voice-based sasang constitutional medicine: improving stability of diagnosis

Sasang constitutional medicine is a unique form of tailored medicine in traditional Korean medicine. Voice features have been regarded as an important cue to diagnose Sasang constitution types. Many studies tried to extract quantitative voice features and standardize diagnosis methods; however, they had flaws, such as unstable voice features which vary a lot for the same individual, limited data collected from only few sites, and low diagnosis accuracy. In this paper, we propose a stable diagnosis model that has a good repeatability for the same individual. None of the past studies evaluated the repeatability of their diagnosis models. Although many previous studies used voice features calculated by averaging feature values from all valid frames in monotonic utterance like vowels, we analyse every single feature value from each frame of a sentence voice signal. Gaussian mixture model is employed to deal with a lot of voice features from each frame. Total 15 Gaussian models are used to represent voice characteristics for each constitution. To evaluate repeatability of the proposed diagnosis model, we introduce a test dataset consisting of 10 individuals' voice recordings with 50 recordings per each individual. Our result shows that the proposed method has better repeatability than the previous study which used averaged features from vowels and the sentence.

Could the Sasang constitution itself be a risk factor of abdominal obesity?

Background

Abdominal obesity (AO) is a medical condition in which excess body fat accumulates in the abdomen. It may cause adverse effects on health and result in reduced life expectancy or increased health problems. While various genetic approaches have explained the risks of AO in Western society, the Sasang constitution (SC) has been identified as a risk factor in Korean medicine. Different SC types are associated with different fat distribution, body shapes and susceptibility to diseases. We evaluated whether the SC type could be a risk for AO in a cross-sectional study among Koreans.

Methods

In total, 2,528 subjects aged over 30 years were recruited from 23 medical clinics. We collected waist circumference (WC), weight, height, and some clinical information for AO from the subjects. A Chi-square test and a one-way ANOVA were performed according to SC type (p < .05), while multiple logistic regression was used to produce odds ratios (ORs).

Results

The rates of AO in Tae-eumin (TE), Soeumin (SE), and Soyangin (SY) types were 63.7%, 14.7%, and 32.8% in males and 84.8%, 41.7%, and 52.8% in females, respectively. The TE type was associated with increased AO prevalence compared with the SE and SY types in males (OR 1.79; 95% CI 1.02–3.15, p = 0.044 and OR 1.74; 95% CI 1.18–2.58, p = 0.006, respectively) and females (OR 1.51; 95% CI 1.03–2.23, p = 0.037 and OR 1.88; 95% CI 1.32–2.68, p < 0.001, respectively) after adjusting for age, BMI, hypertension, diabetes mellitus, hypertriglyceridemia, and low HDL cholesterol.

Conclusions

This study suggested that SC, particularly the TE type, might be significantly and independently associated with AO and could be considered a risk factor in predicting AO.

Effects of APOA5 -1131T>C (rs662799) on fasting plasma lipids and risk of metabolic syndrome: evidence from a case-control study in China and a meta-analysis

The apolipoprotein A5 (APOA5) gene −1131T>C (rs662799) has been suggested to be involved in the pathway of lipid homeostasis and the development of metabolic syndrome (MetS). However, the findings are not consistent. To systematically evaluate the associations between −1131T>C polymorphism and fasting lipid parameters and the risk of MetS, we conducted a case-control study in a Chinese population and a meta-analysis. The findings from 1840 Chinese participants indicated that the C allele carriers had significantly higher fasting total cholesterol (TC), triglycerides (TG) and lower HDL-cholesterol (HDL-C) than the TT homozygotes carriers. The −1131C allele was also found to be significantly associated with increased risk of MetS (OR  =  1.40, 95% confidence interval (CI)  =  1.15, 1.69) compared to the TT homozygotes. In the meta-analysis of 51,868 participants from 46 East Asian studies, 26 European studies and 19 studies of other ethnic groups, the −1131C allele was associated with higher fasting TC (weighted mean difference (WMD)  =  0.08 mmol/L, 95% CI  =  0.05, 0.10, P = 1.74×10⁻⁹), TG (WMD  =  0.30 mmol/L, 95% CI  =  0.26, 0.33, P =  1.87×10⁻⁵⁵), LDL-cholesterol (LDL-C) (WMD  =  0.04 mmol/L, 95% CI  =  0.02, 0.07, P = 0.002), and lower HDL-C (WMD  =  −0.05 mmol/L, 95% CI  =  −0.06,−0.04, P = 1.88×10⁻²¹), respectively. Based on 12 studies with 5,573 MetS cases and 8,290 controls from 5 East Asian studies, 5 European studies and 2 studies of other ethnic groups, the −1131C allele was associated with increased risk of MetS with an OR (95% CI)  =  1.33 (1.16, 1.53) in the overall population, 1.43 (1.29, 1.58) in East Asian and 1.30 (0.94, 1.78) in European populations. In conclusion, the −1131C allele may be associated with elevated levels of fasting TG, TC, LDL-C and decreased HDL-C, and increased risk of MetS, especially in East Asians.

Association of apolipoprotein A5 gene -1131T>C polymorphism with the risk of metabolic syndrome in Korean subjects

We assessed the associations between the APOA5  −1131T>C polymorphism and lipid parameters and other risk factors of the metabolic syndrome in Korean subjects. A total of 2,901 participants from 20 oriental medical hospitals in Korea were enrolled between 2006 and 2011. According to the modified National Cholesterol Education Program Adult Treatment Panel III definitions, subjects were classified into the metabolic syndrome group and control group. The APOA5  −1131T>C genotype was significantly associated with serum high-density lipoprotein cholesterol levels (effect = − 1.700 mg/dL, P=6.550-E07) in the total study population after adjustment for differences in age and gender. The association of the APOA5  −1131T>C genotype with serum log-transformed triglyceride was also significant in an additive genetic model (effect = 0.056 mg/dL, P=2.286E-19). After adjustment for age and gender, we determined that the odds ratio for the occurrence of the metabolic syndrome was 1.322 for C-allele carriers in the additive model (95% CI = [1.165 − 1.501], P=1.48E-05). In the current study, we demonstrated that the APOA5  −1131T>C polymorphism is associated with the metabolic syndrome because of its remarkable effect on serum triglyceride levels in Korean subjects.

Re-interpretation of traditional Asian medicine with constitutional perspective

There has been a rapid increase in tailored medicine that emphasizes the complex inter-individual interactions, and this increase has paralleled recent significant achievements in genomics and Systems Biology. However, attempts to create a virtual human have been limited to low-levels of organization, such as gene-protein networks, due to the lack of systematic concepts at the higher levels of organisms (organ, individual, and environment). Constitutional perspective of various forms of traditional Asian medicine through the ancient, middle, and modern eras, particularly the holistic approach of Sasang constitutional medicine (SCM), may provide a novel framework for creating tailored medicine. This article aims to review the theoretical development of traditional Chinese medicine and the initiation of SCM in addition to summarizing current evidence on the genetic basis, bio-physiological features, and risk of disease of different SCM phenotypes. We also suggest that the patho-physiological principle and scientific evidence underlying SCM, particularly for the TaeEum type, can be effective in dealing with obesity-linked disease, which is a predominant disease in today's society.

Analysis of Sasang constitutional types using facial features with compensation for photographic distance

Background

Facial features are regarded as representative and reliable characteristics for diagnosing a person's Sasang Constitution (SC). However, the description of these features tends to depend on the interpretation and the opinion of the doctor that follows the SC approach. In this paper, we performed a facial feature analysis of SC types in an objective and quantitative manner. Here, site-to-site variability can be an obstacle to properly analyzing facial features when images are taken from various sites, which may have different experimental environments. A compensation technique to reduce the site-to-site variability was proposed before performing the feature analysis.

Methods

The frontal and profile images of 1464 patients recruited from various oriental medical clinics (19 sites) were used. Candidate feature variables were created, which were inspired by the facial characteristics of the SC types described in the Sasang constitutional medicine literature. To resolve the problems involved in processing data collected from various sites with heterogeneous experimental environments, a compensation technique was proposed. Statistical analysis techniques were employed to observe the differences among the SC types and to demonstrate how effectively the site-to-site variability was reduced.

Results

The facial features that were significant for diagnosing the SC types were identified by a statistical analysis, and it was verified that the compensation technique reduced the site-to-site variability produced by the differences in photographic distance.

Conclusion

It is noted that the significant facial features represent common characteristics of each SC type in the sense that we collected extensive opinions from many Sasang constitutional medicine doctors with various points of view. Additionally, a compensation method for the photographic distance is needed to find the significant facial features. We expect these findings and the related compensation technique to contribute to establishing a scientific basis for the precise diagnosis of SC types in clinical practice.

Development of an integrated Sasang constitution diagnosis method using face, body shape, voice, and questionnaire information

Background

Sasang constitutional medicine (SCM) is a unique form of traditional Korean medicine that divides human beings into four constitutional types (Tae-Yang: TY, Tae-Eum: TE, So-Yang: SY, and So-Eum: SE), which differ in inherited characteristics, such as external appearance, personality traits, susceptibility to particular diseases, drug responses, and equilibrium among internal organ functions. According to SCM, herbs that belong to a certain constitution cannot be used in patients with other constitutions; otherwise, this practice may result in no effect or in an adverse effect. Thus, the diagnosis of SC type is the most crucial step in SCM practice. The diagnosis, however, tends to be subjective due to a lack of quantitative standards for SC diagnosis.

Methods

We have attempted to make the diagnosis method as objective as possible by basing it on an analysis of quantitative data from various Oriental medical clinics. Four individual diagnostic models were developed with multinomial logistic regression based on face, body shape, voice, and questionnaire responses. Inspired by SCM practitioners’ holistic diagnostic processes, an integrated diagnostic model was then proposed by combining the four individual models.

Results

The diagnostic accuracies in the test set, after the four individual models had been integrated into a single model, improved to 64.0% and 55.2% in the male and female patient groups, respectively. Using a cut-off value for the integrated SC score, such as 1.6, the accuracies increased by 14.7% in male patients and by 4.6% in female patients, which showed that a higher integrated SC score corresponded to a higher diagnostic accuracy.

Conclusions

This study represents the first trial of integrating the objectification of SC diagnosis based on quantitative data and SCM practitioners’ holistic diagnostic processes. Although the diagnostic accuracy was not great, it is noted that the proposed diagnostic model represents common rules among practitioners who have various points of view. Our results are expected to contribute as a desirable research guide for objective diagnosis in traditional medicine, as well as to contribute to the precise diagnosis of SC types in an objective manner in clinical practice.

Predicting sasang constitution using body-shape information

Objectives. Body measurement plays a pivotal role not only in the diagnosis of disease but also in the classification of typology. Sasang constitutional medicine, which is one of the forms of Traditional Korean Medicine, is considered to be strongly associated with body shape. We attempted to determine whether a Sasang constitutional analytic tool based on body shape information (SCAT-B) could predict Sasang constitution (SC). Methods. After surveying 23 Oriental medical clinics, 2,677 subjects were recruited and body shape information was collected. The SCAT-Bs for males and females were developed using multinomial logistic regression. Stepwise forward-variable selection was applied using the score statistic and Wald's test. Results. The predictive rates of the SCAT-B for Tae-eumin (TE), Soeumin (SE), and Soyangin (SY) types in males and females were 80.2%, 56.9%, and 37.7% (males) and 69.3%, 38.9%, and 50.0% (females) in the training set and were 74%, 70.1%, and 35% (males), and 67.4%, 66.3%, and 53.7% (females) in the test set, respectively. Higher constitutional probability scores showed a trend for association with higher predictability. Conclusions. This study shows that the Sasang constitutional analytic tool, which is based on body shape information, may be relatively highly predictive of TE type but may be less predictive when used for SY type.

Prevalence of Metabolic Syndrome according to Sasang Constitutional Medicine in Korean Subjects

Metabolic syndrome (MS) is a complex disorder defined by a cluster of abdominal obesity, atherogenic dyslipidemia, hyperglycemia, and hypertension; the condition is recognized as a risk factor for diabetes and cardiovascular disease. This study assessed the effects of the Sasang constitution group (SCG) on the risk of MS in Korean subjects. We have analyzed 1,617 outpatients of Korean oriental medicine hospitals who were classified into three SCGs, So-Yang, So-Eum, and Tae-Eum. Significant differences were noted in the prevalence of MS and the frequencies of all MS risk factors among the three SCGs. The odds ratios for MS as determined via multiple logistic regression analysis were 2.004 for So-Yang and 4.521 for Tae-Eum compared with So-Eum. These results indicate that SCG may function as a significant risk factor of MS; comprehensive knowledge of Sasang constitutional medicine may prove helpful in predicting susceptibility and developing preventive care techniques for MS.