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Cheung K, Chan V, Chan S, Wong MMH, Chung GKK, Cheng WY, Lo K, Zeng F. Effect of Intermittent Fasting on Cardiometabolic Health in the Chinese Population: A Meta-Analysis of Randomized Controlled Trials. Nutrients 2024; 16:357. [PMID: 38337642 PMCID: PMC10857210 DOI: 10.3390/nu16030357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The efficacy of intermittent fasting (IF), as an emerging weight management strategy, in improving cardiometabolic health has been evaluated in various populations, but that among Chinese individuals has not been systematically studied. A comprehensive search on multiple databases was performed to identify eligible randomized controlled trials (RCTs) up to October 2022. The primary outcome was post-intervention weight loss, and secondary outcomes included changes in cardiometabolic indicators. Effect estimates were meta-analyzed using a random-effects model. In total, nine RCTs with 899 Chinese participants were included. Time-restricted eating was the most adopted IF protocol in this study (six out of nine), followed by alternate-day fasting. The IF intervention significantly reduced body weight, body mass index, body fat mass, homeostatic model assessment of insulin resistance, low-density lipoprotein cholesterol, and triglycerides when compared with control groups. However, no statistically significant reductions in waist circumference, total cholesterol, high-density lipoprotein cholesterol, fasting glucose, systolic blood pressure, and diastolic blood pressure were found. To sum up, IF can be a weight management strategy and may improve the cardiometabolic health of Chinese adults, but more long-term trials using different IF strategies are required to generate robust evidence of its efficacy.
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Affiliation(s)
- Katy Cheung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China (G.K.-K.C.)
| | - Vicky Chan
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong 100872, China; (V.C.); (W.-Y.C.)
| | - Stephanie Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China (G.K.-K.C.)
| | - Martin Ming Him Wong
- Institute of Epidemiology and Health Care, University College London, London WC1E 6BT, UK;
| | - Gary Ka-Ki Chung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China (G.K.-K.C.)
| | - Wai-Yin Cheng
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong 100872, China; (V.C.); (W.-Y.C.)
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hong Kong 100872, China
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong 100872, China; (V.C.); (W.-Y.C.)
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hong Kong 100872, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 100872, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China
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Chan V, Cao L, Wong MMH, Lo K, Tam W. Diagnostic Accuracy of Waist-to-Height Ratio, Waist Circumference, and Body Mass Index in Identifying Metabolic Syndrome and Its Components in Older Adults: A Systematic Review and Meta-Analysis. Curr Dev Nutr 2024; 8:102061. [PMID: 38230348 PMCID: PMC10790020 DOI: 10.1016/j.cdnut.2023.102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024] Open
Abstract
Background Although numerous studies have indicated the utility of waist-to-height ratio (WHtR) in early screening for individuals with adverse cardiometabolic health, there is controversy on using WHtR as a one-size-fits-all approach, including in older adults. Objectives Our study aims to identify the pooled diagnostic accuracy of WHtR in screening for metabolic syndrome (MetS) and its components among older adults. Methods A systematic review of observational studies was performed using 4 databases. A diagnostic meta-analysis with a random effects model was conducted, and the pooled area under the summary receiver operating characteristic curve, sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (dOR) of each outcome compared with WHtR, body mass index (BMI), and waist circumference (WC) were calculated, with sex-stratified analysis. Results A total of 17 studies with 74,520 participants were included. As reflected by the dOR, WHtR (7.65; 95% CI: 6.00, 9.75) performed better than BMI (5.17; 95% CI: 4.75, 5.62) and WC (5.77; 95% CI: 4.60, 7.25) in screening for MetS among older adults and was potentially better among males. For hyperglycemia, hypertension, and dyslipidemia, the performances of WHtR, BMI, and WC were comparable. Conclusion More studies focusing on older adults are still needed to determine the cutoff values of WHtR to screen for MetS.The search strategy was registered in PROSPERO as CRD42022350379.
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Affiliation(s)
- Vicky Chan
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong, China
| | - Liujiao Cao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Martin Ming Him Wong
- Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Su X, Chen S, Liu J, Feng Y, Han E, Hao X, Liao M, Cai J, Zhang S, Niu J, He S, Huang S, Lo K, Zeng F. Composition of gut microbiota and non-alcoholic fatty liver disease: A systematic review and meta-analysis. Obes Rev 2024; 25:e13646. [PMID: 37813400 DOI: 10.1111/obr.13646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/03/2023] [Accepted: 09/09/2023] [Indexed: 10/11/2023]
Abstract
The present systematic review and meta-analysis aimed to summarize the associations between gut microbiota composition and non-alcoholic fatty liver disease. To compare the differences between individuals with or without NAFLD, the standardized mean difference and 95% confidence interval were computed for each α-diversity index and relative abundance of gut microbes. The β-diversity indices were summarized in a qualitative manner. A total of 54 studies with 8894 participants were included. Overall, patients with NAFLD had moderate reduction in α-diversity indices including Shannon (SMD = -0.36, 95% CI = [-0.53, -0.19], p < 0.001) and Chao 1 (SMD = -0.42, 95% CI = [-0.68, -0.17], p = 0.001), but no significant differences were found for Simpson, observed species, phylogenetic diversity, richness, abundance-based coverage estimator, and evenness (p ranged from 0.081 to 0.953). Over 75% of the included studies reported significant differences in β-diversity. Although there was substantial interstudy heterogeneity, especially for analyses at the phylum, class, and family levels, the majority of the included studies showed alterations in the depletion of anti-inflammatory microbes (i.e., Ruminococcaceae and Coprococcus) and the enrichment of proinflammatory microbes (i.e., Fusobacterium and Escherichia) in patients with NAFLD. Perturbations in gut microbiota were associated with NAFLD, commonly reflected by a reduction in beneficial species and an increase in the pathogenic species.
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Affiliation(s)
- Xin Su
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Shiyun Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Jiazi Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Yonghui Feng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Eerdun Han
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Xiaolei Hao
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Minqi Liao
- Helmholtz Zentrum München-German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, PR, Germany
| | - Jun Cai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Shiwen Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Jianxiang Niu
- General Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Shihua He
- Department of Infectious Disease, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Shaofen Huang
- Shenzhen Qianhai Shekou Free Zone Hospital, Shenzhen, China
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Research Institute for Future Food, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
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Li AB, Yang B, Li Y, Huynh R, Shim S, Lo K, Li J, Zullo A, Wu W, Liu S. A network meta-analysis of association between cardiometabolic risk factors and COVID-19 outcome severity. J Diabetes 2023; 15:968-977. [PMID: 37649300 PMCID: PMC10667650 DOI: 10.1111/1753-0407.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 06/11/2023] [Accepted: 07/09/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Cardiometabolic comorbidities have been associated with a higher risk of COVID-19 severity and mortality, but more investigations are needed to determine which comorbidity is more detrimental. METHODS Embase, Emcare, and MEDLINE were searched systematically for prospective and retrospective studies assessing the associations of cardiometabolic risk factors and COVID-19 outcomes of hospitalization, severity, and mortality among COVID-19-diagnosed patients. Literature search was performed from first publication to May 19, 2021. Study quality was assessed by the Newcastle-Ottawa Scale. RESULTS From the literature search, 301 studies suggested that all included cardiometabolic risk factors were associated with a higher risk of COVID-19 hospitalization, severity, and mortality, except that overweight was associated with a decreased risk of mortality (relative risk [RR] 0.88; 95% CI, 0.80-0.98). Patients with diabetes (RR 1.46; 95% CI, 1.45-1.47) were most likely to be hospitalized; patients with heart failure had the highest risk for severe COVID-19 outcomes (RR 1.89; 95% CI, 1.71-2.09); while patients with stroke were most susceptible to overall mortality (RR 1.99; 95% CI, 1.90-2.08). In the network meta-analysis, cerebrovascular disease had the highest impact (RR 1.69; 95% CI, 1.65-1.73) on COVID-19 outcomes compared to other cardiometabolic risk factors. For different combinations of risk factors, cardiovascular disease and diabetes combined (RR 6.98; 95% CI, 5.28-9.22) was more detrimental than others. CONCLUSIONS Considering the high prevalence of cardiometabolic comorbidities and risk of all severe outcomes, patients with cardiometabolic comorbidities should be prioritized in vaccination and treatment development of COVID-19.
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Affiliation(s)
- Alina Binbin Li
- Department of Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Bo Yang
- Department of Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Yufei Li
- Department of Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Rachel Huynh
- Department of Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Samuel Shim
- Department of Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Kenneth Lo
- Centre for Global Cardiometabolic Health, Departments of Epidemiology, Medicine, and SurgeryBrown UniversityProvidenceRhode IslandUSA
- Department of Applied Biology and Chemical TechnologyThe Hong Kong Polytechnic UniversityKowloonHong KongChina
| | - Jie Li
- Department of Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
- Global Health Research Center, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Andrew Zullo
- Department of Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Wen‐Chih Wu
- Department of Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
- Division of Cardiology, Veterans Affairs Medical Center and The Miriam Hospital, Department of MedicineAlpert Medical SchoolProvidenceRhode IslandUSA
| | - Simin Liu
- Department of Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
- Centre for Global Cardiometabolic Health, Departments of Epidemiology, Medicine, and SurgeryBrown UniversityProvidenceRhode IslandUSA
- Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
- Global Health Research Center, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
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Chen S, Su X, Feng Y, Li R, Liao M, Fan L, Liu J, Chen S, Zhang S, Cai J, Zhu S, Niu J, Ye Y, Lo K, Zeng F. Ketogenic Diet and Multiple Health Outcomes: An Umbrella Review of Meta-Analysis. Nutrients 2023; 15:4161. [PMID: 37836444 PMCID: PMC10574428 DOI: 10.3390/nu15194161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Numerous studies have examined the effects of ketogenic diets (KD) on health-related outcomes through meta-analyses. However, the presence of biases may compromise the reliability of conclusions. Therefore, we conducted an umbrella review to collate and appraise the strength of evidence on the efficacy of KD interventions. We conducted a comprehensive search on PubMed, EMBASE, and the Cochrane Database until April 2023 to identify meta-analyses that investigated the treatment effects of KD for multiple health conditions, which yielded 23 meta-analyses for quantitative analyses. The evidence suggests that KD could increase the levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C), the respiratory exchange rate (RER), and could decrease total testosterone and testosterone levels (all p-random effects: <0.05). The combination of KD and physical activity can significantly reduce body weight and increase the levels of LDL-C and cortisol. In addition, KD was associated with seizure reduction in children, which can be explained by the ketosis state as induced by the diet. Furthermore, KD demonstrated a better alleviation effect in refractory childhood epilepsy, in terms of median effective rates for seizure reduction of ≥50%, ≥90%, and seizure freedom. However, the strength of evidence supporting the aforementioned associations was generally weak, thereby challenging their credibility. Consequently, future studies should prioritize stringent research protocols to ascertain whether KD interventions with longer intervention periods hold promise as a viable treatment option for various diseases.
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Affiliation(s)
- Shiyun Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Xin Su
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Yonghui Feng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Ruojie Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Minqi Liao
- Institute of Epidemiology, Helmholtz Zentrum Munich-German Research Center for Environmental Health, Ingolstadt Landstr. 1, 85764 Neuherberg, Germany;
| | - Laina Fan
- Department of Clinical Medicine, International School, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China;
| | - Jiazi Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Shasha Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Shiwen Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Jun Cai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
| | - Jianxiang Niu
- General Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdao North Road, Hohhot 010000, China;
| | - Yanbin Ye
- Department of Clinical Nutrition, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China;
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong 100872, China
- Research Institute for Future Food, The Hong Kong Polytechnic University, Kowloon, Hong Kong 100872, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No. 601 Huangpu Road West, Guangzhou 510632, China; (S.C.); (X.S.); (Y.F.); (R.L.); (J.L.); (S.C.); (S.Z.); (J.C.); (S.Z.)
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Dehnen S, Steed JW, Lo K, Heinze K, Wenger OS, Singh S, Yang HB, Zang SQ. We Glow Together: A Dialogue on Luminescent Compounds. Inorg Chem 2023; 62:14823-14827. [PMID: 37681674 DOI: 10.1021/acs.inorgchem.3c02887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
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Lo K, Katz D, Chan V, Miler I. Successful delayed treatment of acute glans penis ischaemia after adult circumcision: a case report. Diving Hyperb Med 2023; 53:151-154. [PMID: 37365134 PMCID: PMC10584398 DOI: 10.28920/dhm53.2.151-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/04/2023] [Indexed: 06/28/2023]
Abstract
Penile glans ischaemia post-circumcision is very rare. A 20-year-old male presented with glans ischaemia following an elective circumcision and was successfully treated with a combination of subcutaneous injection of low molecular weight heparin 0.5 mg·kg⁻¹ twice-daily, oral Tadalafil 5 mg once-daily for three days and 12 hyperbaric oxygen treatments at 243 kPa (2.4 atmospheres absolute) beginning 48 hours after the onset of ischaemia.
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Affiliation(s)
- Kenneth Lo
- Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Australia
- Department of Emergency Medicine, Alfred Health, Melbourne, Australia
- Corresponding author: Dr Kenneth Lo, Hyperbaric Unit, Main Ward Block, Level 1, 55 Commercial Rd, Melbourne VIC 3004, Australia,
| | - Darren Katz
- Men's Health Melbourne, Victoria, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Victoria, Australia
- Department of Urology, Western Health, Victoria, Australia
| | - Vincent Chan
- Men's Health Melbourne, Victoria, Australia
- Department of Urology, Western Health, Victoria, Australia
| | - Ian Miler
- Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Australia
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Zatt WB, Lo K, Tam W. Pooled prevalence of depressive symptoms among medical students: an individual participant data meta-analysis. BMC Psychiatry 2023; 23:251. [PMID: 37059978 PMCID: PMC10103433 DOI: 10.1186/s12888-023-04745-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND The methodological choice of aggregated estimates for meta-analysis may be notable for some common drawbacks, including variations in the cut-off values of depression, and lower statistical power for analyzing the associated factors. The study aimed to refine the precision of previous findings on the prevalence of depressive symptoms among medical students, through gathering individual participant data (IPD) as identified from our previous reviews. MATERIAL AND METHODS In the present study, we searched MEDLINE, EMBASE, PsycINFO, WanFang, Scielo and LILACS to identify published systematic reviews and meta-analyses up to March 2018, then individual data was requested for further analysis (PROSPERO registration: CRD42018091917). The participants' age, sex, year of study, scores for depressive symptoms, and other predictor variables were requested. To pool the prevalence from the included studies, random-effects model (two-step method) was used. Multiple linear regression was used to examine the associated factors on the depression z-scores (one-step method). RESULTS Of the 249 studies, the datasets of 34 studies were included. The crude prevalence was 19.4% (95% CI: 18.8%, 19.9%) by one-step method and the pooled prevalence was 18.1% (95% CI: 14.1%, 22.1%) by two-step method. Multiple linear regression revealed that being a female, older age, and senior year of study were significantly associated with the z-score. CONCLUSION The pooled prevalence of depressive symptoms from the Individual Participant Data (IPD) meta-analysis was lower than the previous meta-analyses using aggregated data. Age, sex, and year of study were significantly associated with the depression z-score. IPD meta-analysis may provide a more accurate estimation of disease burden, and allow verification of associated factors.
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Affiliation(s)
- Wilson Baldin Zatt
- Department of Neuropsychiatry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong SAR, China.
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong SAR, China.
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Teoh Y, Chan T, Tsang C, Li K, Cheng KC, Cho C, Chan HC, Chiu Y, Ho B, Li T, Law M, Lee Y, Cheng C, Lo K, Lam K, Chan K, So HS, Leung C, Chan C, Yiu M, Ng C, Poon V, Leung C, Chi-Fai N. Transurethral en bloc resection versus standard resection of bladder tumour: A multi-center randomized trial (EB-StaR Study). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00751-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Yang B, Yang J, Wong MMH, Rana J, Yang Q, Chan V, Khan MS, Yang A, Lo K. Trends in elevated waist-to-height ratio and waist circumference in U.S. adults and their associations with cardiometabolic diseases and cancer, 1999-2018. Front Nutr 2023; 10:1124468. [PMID: 37113294 PMCID: PMC10126508 DOI: 10.3389/fnut.2023.1124468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Although waist-to-height ratio (WHtR) has established association with cardiometabolic disease, the trend of changes in elevated WHtR among general population have not been examined adequately. Methods This study examined the prevalence of elevated WHtR and waist circumference (WC) and their trends over time using Joinpoint regression models among adults who participated in the United States National Health and Nutrition Examination Survey (U.S. NHANES) 1999-2018. We performed weighted logistic regression to identify the association between central obesity subtypes and the prevalence of comorbidities, including diabetes, chronic kidney disease, hypertension, cardiovascular disease, and cancer. Results The prevalence of elevated WHtR has increased from 74.8% in 1999-2000 to 82.7% in 2017-2018 while elevated WC also increased from 46.9% in 1999-2000 to 60.3% in 2017-2018. Men, older adults, former smokers, and people with lower education levels were more likely to have elevated WHtR. A total of 25.5% of American adults had normal WC but elevated WHtR, and they had a significantly higher chance of suffering from diabetes (odds ratio [OR] = 2.06 [1.66, 2.55]), hypertension (OR = 1.75 [1.58, 1.93]) and CVD (OR = 1.32 [1.11, 1.57]). Discussion In conclusion, the burden of elevated WHtR and WC have been increasing among U.S. adults throughout the years, and the changes have been more significant across most subgroups. It is also notable that approximately a quarter of the population had normal WC but elevated WHtR, which had increased likelihood of having cardiometabolic diseases, especially diabetes. Future clinical practices should pay more attention to this subgroup of the population with overlooked health risks.
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Affiliation(s)
- Bo Yang
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI, United States
| | - Jingli Yang
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, China
| | - Martin Ming-him Wong
- School of Professional and Continuing Education, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Juwel Rana
- Department of Epidemiology, Biostatistics and Occupational Health, School of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
| | - Qinghua Yang
- Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Vicky Chan
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Moyukh Shabon Khan
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Aimin Yang,
| | - Kenneth Lo
- Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Kenneth Lo,
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11
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Glenn AJ, Li J, Lo K, Jenkins DJ, Boucher BA, Hanley AJ, Kendall CW, Shadyab AH, Tinker LF, Chessler SD, Howard BV, Liu S, Sievenpiper JL. The Portfolio Diet and Incident Type 2 Diabetes: Findings From the Women's Health Initiative Prospective Cohort Study. Diabetes Care 2023; 46:28-37. [PMID: 36162007 PMCID: PMC9797645 DOI: 10.2337/dc22-1029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A plant-based dietary pattern, the Portfolio Diet, has been shown to lower LDL cholesterol and other cardiovascular disease risk factors. However, no study has evaluated the association of this diet with incident type 2 diabetes. RESEARCH DESIGN AND METHODS This analysis included 145,299 postmenopausal women free of diabetes at baseline in the Women's Health Initiative (WHI) Clinical Trials and Observational Study from 1993 to 2021. Adherence to the diet was assessed with a score based on six components (high in plant protein [soy and pulses], nuts, viscous fiber, plant sterols, and monounsaturated fat and low in saturated fat and cholesterol) determined from a validated food-frequency questionnaire. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs of the association of the Portfolio Diet, alongside the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets, with incident type 2 diabetes, with adjustment for potential confounders. RESULTS Over a mean follow-up of 16.0 years, 13,943 cases of incident type 2 diabetes were identified. In comparisons of the highest with the lowest quintiles of adherence, the HRs for risk of incident type 2 diabetes were 0.77 (95% CI 0.72, 0.82) for the Portfolio Diet, 0.69 (0.64, 0.73) for the DASH diet, and 0.78 (0.74, 0.83) for the Mediterranean diet. These findings were attenuated by 10% after additional adjustment for BMI. CONCLUSIONS Greater adherence to the plant-predominant Portfolio, DASH, and Mediterranean diets was prospectively associated with lower risk of type 2 diabetes in postmenopausal women.
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Affiliation(s)
- Andrea J. Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jie Li
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI
| | - Kenneth Lo
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - David J.A. Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beatrice A. Boucher
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anthony J. Hanley
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cyril W.C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Lesley F. Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA
| | - Steven D. Chessler
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of California, Irvine, CA
| | - Barbara V. Howard
- MedStar Health Research Institute, Washington, DC
- Georgetown/Howard Universities Center for Clinical and Translational Sciences, Washington, DC
| | - Simin Liu
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI
- Departments of Surgery and Medicine, Alpert School of Medicine, Brown University, Providence, RI
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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12
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Yang B, Glenn AJ, Liu Q, Madsen T, Allison MA, Shikany JM, Manson JE, Chan KHK, Wu WC, Li J, Liu S, Lo K. Added Sugar, Sugar-Sweetened Beverages, and Artificially Sweetened Beverages and Risk of Cardiovascular Disease: Findings from the Women’s Health Initiative and a Network Meta-Analysis of Prospective Studies. Nutrients 2022; 14:nu14204226. [PMID: 36296910 PMCID: PMC9609206 DOI: 10.3390/nu14204226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 12/05/2022] Open
Abstract
Much remains unknown about the role of added sugar in relation to cardiovascular disease (CVD) and the relative contributions of sugar-sweetened beverages (SSB) or artificially sweetened beverages (ASB) to CVD risk. Among the 109,034 women who participated in Women’s Health Initiative, we assessed average intakes of added sugar, SSB and ASB, and conducted Cox regression to estimate the hazard ratios (HRs) and their 95% confidence intervals for CVD risk. The consistency of findings was compared to a network meta-analysis of all available cohorts. During an average of 17.4 years of follow-up, 11,597 cases of total CVD (nonfatal myocardial infarction, coronary heart disease (CHD) death, stroke, coronary revascularization, and/or incident heart failure) were confirmed. Added sugar as % energy intake daily (%EAS) at ≥15.0% was positively associated with total CVD (HR = 1.08 [1.01, 1.15]) and CHD (HR = 1.20 [1.09, 1.32]). There was also a higher risk of total CVD associated with ≥1 serving of SSB intake per day (HR = 1.29 [1.17, 1.42]), CHD (1.35 [1.16, 1.57]), and total stroke (1.30 [1.10, 1.53]). Similarly, ASB intake was associated with an increased risk of CVD (1.14 [1.03, 1.26]) and stroke (1.24 [1.04, 1.48]). According to the network meta-analysis, there was a large amount of heterogeneity across studies, showing no consistent pattern implicating added sugar, ASB, or SSB in CVD outcomes. A diet containing %EAS ≥15.0% and consuming ≥1 serving of SSB or ASB may be associated with a higher CVD incidence. The relative contribution of added sugar, SSB, and ASB to CVD risk warrants further investigation.
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Affiliation(s)
- Bo Yang
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
| | - Andrea J. Glenn
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Qing Liu
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
| | - Tracy Madsen
- Department of Emergency Medicine, Brown University, Providence, RI 02912, USA
| | - Matthew A. Allison
- Department of Family Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - James M. Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Kei Hang Katie Chan
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
- Department of Biomedical Sciences, Department of Electrical Engineering, City University of Hong Kong, Hong Kong, China
| | - Wen-Chih Wu
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
| | - Jie Li
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
| | - Simin Liu
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
- Correspondence: (S.L.); (K.L.); Tel.: +1-339-201-1388 (S.L.); +852-3400-8778 (K.L.)
| | - Kenneth Lo
- Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China
- Centre for Global Cardiometabolic Health, Departments of Epidemiology and Medicine, Brown University, Providence, RI 02912, USA
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
- Correspondence: (S.L.); (K.L.); Tel.: +1-339-201-1388 (S.L.); +852-3400-8778 (K.L.)
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Zhang SX, Yu YL, Tang ST, Lo K, Feng YQ, Chen JY. Association of serum uric acid levels with cardiovascular and all-cause mortality in hypertensive patients in China: a cohort study. Postgrad Med J 2022:7146674. [PMID: 37117041 DOI: 10.1136/pmj-2021-141313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/20/2022] [Indexed: 11/04/2022]
Abstract
PurposeThe present study aimed to assess the association of elevated serum uric acid (SUA) and hypouricemia with all-cause mortality and cardiovascular mortality in Chinese hypertensive patients.MethodsIn the present prospective cohort, 9325 hypertensive patients from Dongguan, China were enrolled from 2014 to 2018 for analysis. Participants were categorised by quintiles of SUA. The HRs and 95% CIs for the association between SUA, all-cause and cardiovascular mortality were evaluated using the multivariate Cox regression model. After adjusting for multiple confounders, restricted cubic spline analysis was conducted to demonstrate the shape of relationship.ResultsAfter a median follow-up of 4.18 years for 9325 participants, there were 409 (4.4%) and 151 (1.6%) reported cases of all-cause and cardiovascular mortality, respectively. By using the third quintile of SUA (6.68 mg/dL to <7.55 mg/dL for men, 5.63 mg/dL to <6.42 mg/dL for women) as reference, the highest quintiles of SUA were associated with an elevated risk of all cause (HR: 1.34, 95% CI 1.00 to 1.80) in the crude model, but the association was not significant after adjusting for multiple comparisons. The association between low SUA and mortality and the dose–response analysis on the non-linearity of SUA–mortality relationship were not statistically significant.ConclusionsAlthough the association between SUA levels, all-cause and cardiovascular disease mortality did not appear to be significant among Chinese hypertensive patients, the findings might be confounded by their medical conditions. Further studies are needed to verify the optimal SUA levels for hypertensive patients.
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Affiliation(s)
- Shu-Xian Zhang
- Department of Cardiology, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Song-Tao Tang
- Department of Cardiology, Community Health Center of Liaobu County, Dongguan, Guangdong, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Epidemiology, Centre for Global Cardiometabolic Health, Brown University, Providence, Rhode Island, USA
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Ji-Yan Chen
- Department of Cardiology, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
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14
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Li J, Glenn AJ, Yang Q, Ding D, Zheng L, Bao W, Beasley J, LeBlanc E, Lo K, Manson JE, Philips L, Tinker L, Liu S. Dietary Protein Sources, Mediating Biomarkers, and Incidence of Type 2 Diabetes: Findings From the Women's Health Initiative and the UK Biobank. Diabetes Care 2022; 45:1742-1753. [PMID: 35713602 PMCID: PMC9346982 DOI: 10.2337/dc22-0368] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Whether and how dietary protein intake is linked to type 2 diabetes (T2D) remains unclear. The aim of this study was to investigate the associations of protein intake with development of T2D and the potential mediating roles of T2D biomarkers. RESEARCH DESIGN AND METHODS We included 108,681 postmenopausal women without T2D at baseline from the Women's Health Initiative (WHI) (primary cohort) and 34,616 adults without T2D from the U.K. Biobank (UKB) (replication cohort). Cox proportional hazard models were used for estimation of protein-T2D associations. Mediation analysis was performed to assess the mediating roles of biomarkers in case-control studies nested in the WHI. RESULTS In the WHI, 15,842 incident T2D cases were identified during a median follow-up of 15.8 years. Intake of animal protein was associated with increased T2D risk (hazard ratio in comparing the highest to the lowest quintile = 1.31 [95% CI 1.24-1.37]) and plant protein with decreased risk (0.82 [0.78-0.86]). Intakes of red meat, processed meat, poultry, and eggs were associated with increased T2D risk and whole grains with decreased risk. Findings from the UKB were similar. These findings were materially attenuated after additional adjustment for BMI. Substituting 5% energy from plant protein for animal protein was associated with 21% decreased T2D risk (0.79 [0.74-0.84]), which was mediated by levels of hs-CRP, interleukin-6, leptin, and SHBG. CONCLUSIONS Findings from these two large prospective cohorts support the notion that substituting plant protein for animal protein may decrease T2D risk mainly by reducing obesity-related inflammation.
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Affiliation(s)
- Jie Li
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI
| | - Andrea J Glenn
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Qingling Yang
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ding Ding
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lingling Zheng
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Bao
- Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jeannette Beasley
- Division of General Internal Medicine and Clinical Innovation, New York University Langone Health, New York, NY
| | - Erin LeBlanc
- Kaiser Permanente Center for Health Research, Portland, OR
| | - Kenneth Lo
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region, China
| | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Lesley Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Simin Liu
- Global Health Research Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Brown University, Providence, RI.,Departments of Surgery and Medicine, The Warren Alpert Medical School, Brown University, Providence, RI
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15
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Lo K, Lockwood C. Improving cross-sector collaborations in place-based population health projects. Public Health Pract (Oxf) 2022; 4:100285. [PMID: 36570389 PMCID: PMC9773052 DOI: 10.1016/j.puhip.2022.100285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/20/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The objective of this study is to develop a practice-orientated partnership framework that can enable effective population health collaborations in rural areas, and to gain ground insights on the role and policies of the Department of Families, Fairness and Housing (DFFH) in administering population health projects. Study design Rapid evidence review and case study interviews with stakeholders. Methods The framework development started with a rapid review to identify evidence-based practices on collaboration for population health stakeholders. Best-practices from DFFH's policy document for place-based projects were also incorporated into the framework. After a preliminary draft of the framework was ready, semi-structured interviews were conducted with stakeholders to seek practitioner insights to validate the framework and contextualise it to local needs. Results Inputs from the stakeholder interviews were organised into two categories: "Inputs for framework" which contained responses that improved the framework, and "inputs for DFFH" which contained insights on the role and policies of DFFH in administering population health projects. Conclusions With its list of actionable activities and enablers organised into logical project phases, the framework provides a practical and intuitive guide that can help stakeholders navigate through complex place-based population health projects. The inputs for DFFH provided the department with valuable ground insights into the dynamics of cross-sector collaborations for further reflection about their roles and policies. Through the consultative interview process which meaningfully engaged key stakeholders, a level of understanding and support for the framework was gained, which would encourage future implementations of place-based population health projects.
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Affiliation(s)
- Kenneth Lo
- Faculty of Health and Medical Sciences, The University of Adelaide, SA, 5005, Australia,College of Medicine and Public Health, Flinders University, SA, 5042, Australia,Corresponding author. Faculty of Health and Medical Sciences, The University of Adelaide, SA, 5005, Australia.
| | - Craig Lockwood
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
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16
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Yang J, Chan K, Choi C, Yang A, Lo K. Identifying Effects of Urinary Metals on Type 2 Diabetes in U.S. Adults: Cross-Sectional Analysis of National Health and Nutrition Examination Survey 2011–2016. Nutrients 2022; 14:nu14081552. [PMID: 35458113 PMCID: PMC9031490 DOI: 10.3390/nu14081552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 12/19/2022] Open
Abstract
Growing evidence supports the associations of metal exposures with risk of type 2 diabetes (T2D), but the methodological limitations overlook the complexity of relationships within the metal mixtures. We identified and estimated the single and combined effects of urinary metals and their interactions with prevalence of T2D among 3078 participants in the NHANES 2011–2016. We analyzed 15 urinary metals and identified eight metals by elastic-net regression model for further analysis of the prevalence of T2D. Bayesian kernel machine regression and the weighted quantile sum (WQS) regression models identified four metals that had greater importance in T2D, namely cobalt (Co), tin (Sn), uranium (U) and strontium (Sr). The overall OR of T2D was 1.05 (95% CI: 1.01–1.08) for the positive effects and 1.00 (95% CI: 0.98–1.02) for the negative effect in the WQS models. We observed positive (Poverall = 0.008 and Pnon-linear = 0.100 for Co, Poverall = 0.011 and Pnon-linear = 0.138 for Sn) and inverse (Poverall = 0.001, Pnon-linear = 0.209 for Sr) linear dose–response relationships with T2D by restricted cubic spline analysis. Both additive and multiplicative interactions were found in urinary Sn and Sr. In conclusion, urinary Co, Sn, U and Sr played important roles in the development of T2D. The levels of Sn might modify the effect of Sr on T2D risk.
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Affiliation(s)
- Jingli Yang
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China;
| | - Kayue Chan
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.C.); (C.C.)
| | - Cheukling Choi
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.C.); (C.C.)
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
- Correspondence: (A.Y.); (K.L.)
| | - Kenneth Lo
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.C.); (C.C.)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Correspondence: (A.Y.); (K.L.)
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17
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Yang J, Lo K, Yang A. Trends in Urinary and Blood Cadmium Levels in U.S. Adults with or without Comorbidities, 1999-2018. Nutrients 2022; 14:nu14040802. [PMID: 35215454 PMCID: PMC8880632 DOI: 10.3390/nu14040802] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022] Open
Abstract
Although cadmium (Cd) exposure has been declining in the United States (U.S.) over the years, the level of exposure for people with pre-existing comorbidities is unclear. This study characterized the trends of blood Cd levels (bCd) (n = 44,498) and urinary Cd levels (uCd) (n = 15,107) by pre-existing comorbidities among adults participating in the U.S. National Health and Nutrition Examination Survey. We calculated age- and sex-standardized annual geometric mean (GM) levels, and used aJoinpoint regression model to examine the trends over time. The GM levels of bCd declined from 1999–2000 to 2017–2018 survey cycles (from 0.49 to 0.33 μg/L), while women and current smokers had higher levels. Participants with comorbidities had higher bCd and declined over time: cardiovascular disease (CVD) (0.50 to 0.42 μg/L), hypertension (0.49 to 0.35 μg/L), chronic kidney disease (CKD) (0.54 to 0.37 μg), and cancer (0.57 to 0.38 μg) versus those without these comorbidities. We observed the similar pattern of changes for uCd and participants with CVD, CKD, and cancer had higher levels. To conclude, the trend in urinary and blood Cd levels in U.S adults decreased in the past 20 years, and the levels varied by sex, smoking status, and comorbidities.
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Affiliation(s)
- Jingli Yang
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou 730000, China;
| | - Kenneth Lo
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong SAR, China
- Correspondence: (K.L.); (A.Y.)
| | - Aimin Yang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Correspondence: (K.L.); (A.Y.)
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Tran N, Shaar M, Al-Sudani H, Sedhom R, Akhtar H, Lo K, Pressman G. The importance of right heart function in heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Heart failure (HF) is a complex clinical syndrome that is a frequent cause of morbidity and mortality. Although half of patients with HF have a preserved ejection fraction (HFpEF), the majority of studies have examined the prognostic impact of left heart parameters instead of the right. We thus evaluated associations of right heart hemodynamics and echocardiographic measures with outcomes in HFpEF subjects.
Purpose
To perform long-term mortality analysis of patients with decompensated HFpEF using strain imaging and right heart catheterization hemodynamics.
Methods
This was a retrospective cross-sectional study which included patients hospitalized for acute heart failure exacerbation as the primary admitting diagnosis based on clinical and laboratory parameters as determined by the primary medical team. Patients included were only those with HFpEF and with available echocardiographic and right heart catheterization (RHC) hemodynamic data done during the index admission. 2D strain analysis software was used to automatically calculate right ventricular free wall strain (RVFWS), fractional area change (FAC), and left ventricular global longitudinal strain (LVGLS). Demographic and clinical parameters were obtained including RHC hemodynamics. The outcome of interest was long term 6-year all-cause mortality. Right and left ventricular echocardiographic strain and hemodynamic parameters were compared between patients with mortality and those who survived using independent T tests and non-parametric methods as appropriate. Multivariable logistic regression was used to identify echocardiographic and hemodynamic factors independently associated with all-cause mortality. Results From a total of 100 patients, 47% were Caucasian and 53% were female. The mean age was 67.4 ± 14.3. There was an 18% long term all cause mortality rate. Of the right sided echocardiographic strain parameters, only RVFWS was statistically significantly lower among those who died (12.0 vs 15.7 p = 0.038). Meanwhile, 4 chamber LVGLS was significantly lower (13.8 vs 15.1 p = 0.016) and mean right atrial (RA) pressure was higher (13.6 vs 10.7 p = 0.076) although this did not reach statistical significance. Looking at echocardiographic strain and hemodynamic parameters as predictors of mortality, after adjusting for age, gender and race accounting for the major differences in these parameters between the survival groups, only RVFWS (OR 1.90, 95% CI 1.12-3.28; p = 0.02) and RA pressure (OR 1.85, 95% CI 1.12-3.28; p = 0.016) remained independently associated with long term all-cause mortality with C statistic of 0.751 for the overall predictive model.
Conclusion
Among patients with HFpEF admitted for acute heart failure exacerbation, baseline RVFWS and RA hemodynamic pressure measurements were independently associated with long term all-cause mortality. This suggests that right heart diagnostic parameters may hold more prognostic utility in HFpEF. Abstract Figure. Abstract Figure.
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Affiliation(s)
- N Tran
- Albert Einstein Medical Center, Philadelphia, United States of America
| | - M Shaar
- Albert Einstein Medical Center, Philadelphia, United States of America
| | - H Al-Sudani
- Albert Einstein Medical Center, Philadelphia, United States of America
| | - R Sedhom
- Albert Einstein Medical Center, Philadelphia, United States of America
| | - H Akhtar
- Albert Einstein Medical Center, Philadelphia, United States of America
| | - K Lo
- Albert Einstein Medical Center, Philadelphia, United States of America
| | - G Pressman
- Albert Einstein Medical Center, Philadelphia, United States of America
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Zhou D, Liu X, Lo K, Huang Y, Feng Y. The effect of total cholesterol/high-density lipoprotein cholesterol ratio on mortality risk in the general population. Front Endocrinol (Lausanne) 2022; 13:1012383. [PMID: 36589799 PMCID: PMC9797665 DOI: 10.3389/fendo.2022.1012383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/24/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The relationship between the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio and all-cause and cardiovascular mortality has not been elucidated. Herein, we intend to probe the effect of the TC/HDL-C ratio on all-cause and cardiovascular mortality in the general population. METHODS From the 1999-2014 National Health and Nutrition Examination Surveys (NHANES), a total of 32,405 health participants aged ≥18 years were included. The TC/HDL-C levels were divided into five groups: Q1: <2.86, Q2: 2.86-3.46, Q3: 3.46-4.12, Q4: 4.12-5.07, Q5: >5.07. Multivariate Cox regression models were used to explore the relationship between the TC/HDL-C ratio and cardiovascular and all-cause mortality. Two-piecewise linear regression models and restricted cubic spline regression were used to explore nonlinear and irregularly shaped relationships. Kaplan-Meier survival curve and subgroup analyses were conducted. RESULTS The population comprised 15,675 men and 16,730 women with a mean age of 43 years. During a median follow-up of 98 months (8.1 years), 2,859 mortality cases were recorded. The TC/HDL-C ratio and all-cause mortality showed a nonlinear association after adjusting for confounding variables in the restricted cubic spline analysis. Hazard ratios (HRs) of all-cause mortality were particularly positively related to the level of TC/HDL-C ratio in the higher range >5.07 and in the lower range <2.86 (HR 1.26; 95% CI 1.10, 1.45; HR 1.18; 95% CI 1.00, 1.38, respectively), although the HRs of cardiovascular disease mortality showed no difference among the five groups. In the two-piecewise linear regression model, a TC/HDL-C ratio range of ≥4.22 was positively correlated with cardiovascular mortality (HR 1.13; 95% CI 1.02, 1.25). In the subgroup analysis, a nonlinear association between TC/HDL-C and all-cause mortality was found in those aged <65 years, men, and the no lipid drug treatment population. CONCLUSION A nonlinear association between the TC/HDL-C ratio and all-cause mortality was found, indicating that a too-low or too-high TC/HDL-C ratio might increase all-cause mortality. However, for cardiovascular mortality, it does not seem so. The cutoff value was 4.22. The individuals had higher cardiovascular mortality with a TC/HDL-C ratio >4.22.
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Affiliation(s)
- Dan Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaocong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, RI, United States
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Yuqing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Yingqing Feng,
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Lo K, Au M, Ni J, Wen C. Association between hypertension and osteoarthritis: A systematic review and meta-analysis of observational studies. J Orthop Translat 2022; 32:12-20. [PMID: 35591938 PMCID: PMC9072802 DOI: 10.1016/j.jot.2021.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Literature examining the relationship between elevated blood pressure and osteoarthritis (OA) has yielded conflicting results. This study aimed to systematically review the relationship between hypertension and OA in both load-bearing and non-load-bearing joints. Methods A systematic literature search was performed on Embase, Emcare, MEDLINE and Ovid Nursing Database. The associations between hypertension and OA development in knees, hips and hands were analysed by calculating the odds ratio (OR). Results A total of 26 studies with 97,960 participants were included. The overall odds of having OA significantly increased in the people with hypertension compared to the normotensive ones (OR = 1.60, 95%CI = 1.33, 1.94). The association of hypertension with OA was detected in knee (OR = 1.62, 95%CI = 1.32, 1.98), not in hand (OR = 1.19, 95%CI = 0.92, 1.53). Moreover, there existed a stronger association of hypertension with radiographic knee OA (OR = 1.89, 95%CI = 1.40, 2.54) than symptomatic knee OA (OR = 1.39, 95%CI = 1.17, 1.65). The association between hypertension and radiographic knee OA remained statistically significant for the studies that adjusted for body mass index (BMI) (OR = 1.42, 95%CI = 1.13, 1.78), and was particularly strong in women (OR = 2.27, 95%CI = 1.17, 4.39). Conclusion A BMI-independent association between hypertension and radiographic knee OA existed with potential sex variation, which warrants further investigations into the underlying genetic, hormonal and environmental factors. The translational potential of this article: Blood pressure has been reported to link with OA for years ago, however, its contribution to OA is still unclear and conflicted in different reports. This review indicated an intimate relationship between hypertension and structural damages of knee OA, rather than simply chronic joint pain, especially in women. This finding not only provides stronger support for further investigations into the causal risk factor, i.e. hypertension, of OA from tissue level to molecular level, but also putting forward a novel thinking in OA pathogenesis and its therapy strategies. Orthopedic translation This study further strengthen the association between hypertension and radiographic knee OA. It points in a vascular aetiology hypothesis of OA. It might open up a new avenue for repositioning anti-hypertensive medications for osteoarthritis treatment.
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Affiliation(s)
- Kenneth Lo
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, USA
| | - Manting Au
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Junguo Ni
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chunyi Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Corresponding author. Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong.
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Wong J, Chan KY, Lo K. Sodium-glucose co-transporter 2 inhibitors on weight change and cardiometabolic profiles in individuals with overweight or obesity and without diabetes: A meta-analysis. Obes Rev 2021; 22:e13336. [PMID: 34542222 DOI: 10.1111/obr.13336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 12/20/2022]
Abstract
Several meta-analyses have been conducted to evaluate the weight loss effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors in patients with type 2 diabetes, whereas pooled analysis focusing on individuals without diabetes is lacking. The objective of this systematic review and meta-analysis is to evaluate the effect of SGLT-2 inhibitor monotherapy on weight change and cardiometabolic profiles. Multiple databases were searched for randomized controlled trials reporting weight change effect of SGLT-2 inhibitor treatment compared with placebo for more than 12 weeks among individuals with overweight or obesity and without diabetes. A total of eight randomized controlled trials with 750 subjects were identified. SGLT-2 monotherapy was associated with significant reduction in body weight of -2.32 kg, compared to -1.01 kg for placebo, giving a mean difference of -1.31 kg. Significant reductions in body mass index and fasting blood glucose were observed, but not for the changes in waist circumference, fat mass, blood pressure, and lipid profile compared with placebo. SGLT-2 inhibitor monotherapy for 12 weeks or more can result in modest weight loss among people with overweight or obesity and without diabetes. Depending on pre-existing comorbidities or risk factors, SGLT-2 inhibitors can be considered adjuncts in the treatment of obesity.
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Affiliation(s)
- John Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kwan Yi Chan
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kenneth Lo
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
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He GD, Huang YQ, Liu L, Huang JY, Lo K, Yu YL, Chen CL, Zhang B, Feng YQ. Association of Circulating, Inflammatory-Response Exosomal mRNAs With Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:712061. [PMID: 34490374 PMCID: PMC8418229 DOI: 10.3389/fcvm.2021.712061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/29/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Although many cardiovascular disease studies have focused on the microRNAs of circulating exosomes, the profile and the potential clinical diagnostic value of plasma exosomal long RNAs (exoLRs) are unknown for acute myocardial infarction (AMI). Methods: In this study, the exoLR profile of 10 AMI patients, eight stable coronary artery disease (CAD) patients, and 10 healthy individuals was assessed by RNA sequencing. Bioinformatic approaches were used to investigate the characteristics and potential clinical value of exoLRs. Results: Exosomal mRNAs comprised the majority of total exoLRs. Immune cell types analyzed by CIBERSORT showed that neutrophils and monocytes were significantly enriched in AMI patients, consistent with clinical baseline values. Biological process enrichment analysis and co-expression network analysis demonstrated neutrophil activation processes to be enriched in AMI patients. Furthermore, two exosomal mRNAs, ALPL and CXCR2, were identified as AMI biomarkers that may be useful for evaluation of the acute inflammatory response mediated by neutrophils. Conclusions: ExoLRs were assessed in AMI patients and found to be associated with the acute inflammatory response mediated by neutrophils. Exosomal mRNAs, ALPL and CXCR2, were identified as potentially useful biomarkers for the study of AMI.
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Affiliation(s)
- Guo-Dong He
- Research Department of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Epidemiology, Centre for Global Cardiometabolic Health, Brown University, Providence, RI, United States
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Liu L, Chen C, Lo K, Huang J, Yu Y, Huang Y, Feng Y. Serum 25-hydroxyvitamin D, frailty, and mortality among the Chinese oldest old: Results from the CLHLS study. Nutr Metab Cardiovasc Dis 2021; 31:2707-2715. [PMID: 34348876 DOI: 10.1016/j.numecd.2021.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/24/2021] [Accepted: 05/31/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS In this study, the aim is to explore whether frailty status modified the associations of serum 25(OH)D levels with all-cause and cause-specific mortality in the oldest old Chinese population. METHODS AND RESULTS A total of 1411 participants aged at least 80 years were enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Information on serum 25(OH)D level, frailty status, and covariates were examined at baseline. All-cause and cause-specific mortality status were ascertained during the follow-up survey conducted in 2017-2018 by using the ICD-10 codes. Cox proportional hazard models with stratified analyses were performed to evaluate potential associations. Over a median follow-up of 3.2 years, 722 (51.2%) participants were deceased, including 202 deaths due to circulatory diseases, and 520 deaths due to noncirculatory causes. After multivariable adjustment, the lowest quartile of serum 25(OH)D levels (Hazard Ratios (95% Confidence Intervals), 1.85 (1.45-2.36), 1.85 (1.45-2.36), 1.73 (1.31-2.29), respectively) and frailty (Odd Ratios (95% Confidence Intervals), 1.91 (1.60-2.29), 2.67 (1.90-3.74), 1.64 (1.31-2.05)) were associated with significantly higher risk of all-cause mortality, circulatory mortality, and noncirculatory mortality, respectively. In addition, we observed significant interactions among 25(OH)D and frailty on the risk of all-cause and cause-specific mortality (all P-interaction < 0.001). Similar results were found in sensitivity analyses by excluding participants who died in the first year of follow-up and using clinical cutoffs of serum 25(OH)D levels. CONCLUSION Low serum 25(OH)D levels were associated with higher risk of all-cause and cause-specific mortality among the oldest old of the Chinese population, and the associations were significantly stronger in individuals with frailty.
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Affiliation(s)
- Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chaolei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, USA; Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Jiayi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuqing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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Glenn AJ, Lo K, Jenkins DJA, Boucher BA, Hanley AJ, Kendall CWC, Manson JE, Vitolins MZ, Snetselaar LG, Liu S, Sievenpiper JL. Relationship Between a Plant-Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study. J Am Heart Assoc 2021; 10:e021515. [PMID: 34346245 PMCID: PMC8475059 DOI: 10.1161/jaha.121.021515] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/27/2021] [Indexed: 01/22/2023]
Abstract
Background The plant-based Dietary Portfolio combines established cholesterol-lowering foods (plant protein, nuts, viscous fiber, and phytosterols), plus monounsaturated fat, and has been shown to improve low-density lipoprotein cholesterol and other cardiovascular disease (CVD) risk factors. No studies have evaluated the relation of the Dietary Portfolio with incident CVD events. Methods and Results We followed 123 330 postmenopausal women initially free of CVD in the Women's Health Initiative from 1993 through 2017. We used Cox proportional-hazard models to estimate adjusted hazard ratios (HRs) and 95% CI of the association of adherence to a Portfolio Diet score with CVD outcomes. Primary outcomes were total CVD, coronary heart disease, and stroke. Secondary outcomes were heart failure and atrial fibrillation. Over a mean follow-up of 15.3 years, 13 365 total CVD, 5640 coronary heart disease, 4440 strokes, 1907 heart failure, and 929 atrial fibrillation events occurred. After multiple adjustments, adherence to the Portfolio Diet score was associated with lower risk of total CVD (HR, 0.89; 95% CI, 0.83-0.94), coronary heart disease (HR, 0.86; 95% CI, 0.78-0.95), and heart failure (HR, 0.83; 95% CI, 0.71-0.99), comparing the highest to lowest quartile of adherence. There was no association with stroke (HR, 0.97; 95% CI, 0.87-1.08) or atrial fibrillation (HR, 1.10; 95% CI, 0.87-1.38). These results remained statistically significant after several sensitivity analyses. Conclusions In this prospective cohort of postmenopausal women in the United States, higher adherence to the Portfolio Diet was associated with a reduction in incident cardiovascular and coronary events, as well as heart failure. These findings warrant further investigation in other populations.
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Affiliation(s)
- Andrea J. Glenn
- Department of Nutritional SciencesUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael's HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials UnitSt. Michael's HospitalTorontoOntarioCanada
| | - Kenneth Lo
- Department of Applied Biology and Chemical TechnologyThe Hong Kong Polytechnic UniversityHung HomHong KongChina
- Centre for Global Cardiometabolic HealthBrown UniversityProvidenceRI
| | - David J. A. Jenkins
- Department of Nutritional SciencesUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael's HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials UnitSt. Michael's HospitalTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael's HospitalTorontoOntarioCanada
| | | | - Anthony J. Hanley
- Department of Nutritional SciencesUniversity of TorontoOntarioCanada
- Dalla Lana School of Public Health and Department of MedicineUniversity of TorontoOntarioCanada
- Leadership Sinai Centre for DiabetesMount Sinai HospitalTorontoOntarioCanada
| | - Cyril W. C. Kendall
- Department of Nutritional SciencesUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael's HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials UnitSt. Michael's HospitalTorontoOntarioCanada
- College of Pharmacy and NutritionUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - JoAnn E. Manson
- Channing Division of Network MedicineDepartment of MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Division of Preventive MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - Mara Z. Vitolins
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNC
| | - Linda G. Snetselaar
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIA
| | - Simin Liu
- Centre for Global Cardiometabolic HealthBrown UniversityProvidenceRI
- Division of EndocrinologyDepartment of Medicine, and Division of Cardiothoracic SurgeryDepartment of SurgeryThe Warren Alpert School of Medicine and Rhode Island HospitalProvidenceRI
- Department of EpidemiologyBrown University School of Public HealthProvidenceRI
| | - John L. Sievenpiper
- Department of Nutritional SciencesUniversity of TorontoOntarioCanada
- Clinical Nutrition and Risk Factor Modification CenterSt. Michael's HospitalTorontoOntarioCanada
- Toronto 3D Knowledge Synthesis and Clinical Trials UnitSt. Michael's HospitalTorontoOntarioCanada
- Li Ka Shing Knowledge InstituteSt. Michael's HospitalTorontoOntarioCanada
- Division of Endocrinology and MetabolismSt. Michael's HospitalTorontoOntarioCanada
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Lo K, Yang JL, Chen CL, Liu L, Huang YQ, Feng YQ, Yang AM. Associations between blood and urinary manganese with metabolic syndrome and its components: Cross-sectional analysis of National Health and Nutrition Examination Survey 2011-2016. Sci Total Environ 2021; 780:146527. [PMID: 33774283 DOI: 10.1016/j.scitotenv.2021.146527] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
Manganese (Mn) may improve cardiometabolic health with its anti-oxidative ability. However, epidemiological evidence on the overall and sex-specific relationship between Mn exposure and metabolic syndrome (MetS) has been inconclusive. We evaluated the associations of urinary (n = 1713) and blood (n = 3335) Mn levels with the prevalence of MetS, its components (elevated waist circumference, impaired glucose metabolism, elevated blood pressure and dyslipidemia) and sex-dependent heterogeneities among participants in the United States National Health and Nutrition Examination Survey 2011-2016. After adjusting for multiple covariates and the levels of other metals (Arsenic, Barium, Cadmium, Mercury, Molybdenum, Tin and Uranium), urinary Mn at the third quartile associated with a lower odd of MetS (odds ratio [OR] = 0.55, 95% confidence interval [C.I.] = 0.32-0.97), elevated waist circumference (OR = 0.56, 95% C.I. = 0.36-0.86) and elevated fasting plasma glucose (OR = 0.46, 95% C.I. = 0.27-0.76) among overall participants, and lower odds of MetS (OR = 0.40, 95% C.I. = 0.16-0.99), elevated waist circumference (OR = 0.39, 95% C.I. = 0.19-0.81) and elevated fasting plasma glucose (OR = 0.44, 95% C.I. = 0.22-0.90) among men. The U-shaped dose-response relationship between urinary Mn and MetS (P non-linear = 0.008) was observed among all participants. We did not observe the significant associations of blood Mn with the prevalence of MetS. Compared with other metals, urinary Mn played a less important role in development of MetS (posterior inclusion probabilities [PIP] = 0.49 for Mn versus 0.54 to 0.91 for other metals), but the contribution of blood Mn (PIP = 0.59 versus 0.60 to 0.61) was similar to other blood metals (Cadmium, Lead, Mercury and Selenium). These findings have provided new evidence of the potential roles of Mn in cardiometabolic health, and the needs to explore how Mn interacts with multiple metals in sex-specific manner.
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Affiliation(s)
- Kenneth Lo
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, RI, USA; Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Jing-Li Yang
- College of Earth and Environmental Sciences, Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Ai-Min Yang
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Tan QH, Huang YQ, Liu XC, Liu L, Lo K, Chen JY, Feng YQ. A U-Shaped Relationship Between Selenium Concentrations and All-Cause or Cardiovascular Mortality in Patients With Hypertension. Front Cardiovasc Med 2021; 8:671618. [PMID: 34395551 PMCID: PMC8360873 DOI: 10.3389/fcvm.2021.671618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Given the antioxidant activity of selenium, it has been reported benefits for blood pressure control and hypertension prevention, but few studies have investigated the association between serum selenium with mortality in hypertensive population. Methods: All participants with hypertension aged ≥18 years at baseline were recruited from the National Health and Nutritional Examination Surveys (NHANES) 2003-2004, and followed for mortality through December 31, 2015. Subjects were categorized by quartiles of serum selenium (Q1: ≤124 μg/L, Q2: 125-135 μg/L, Q3: 136-147 μg/L, Q4: ≥148 μg/L). Multivariate Cox regression were implemented to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic spline analysis and two-piecewise linear regression were used to evaluate the relationship of serum selenium with mortality. Survival curves were used to depict cause-specific mortalities. Results: A total of 929 participants (52.53% were male) were eligible for the current study with the average age of 63.10 ± 12.59 years. There were 307 deaths occurred including 56 cardiovascular death events during the mean follow-up time of 121.05 ± 40.85 months. A U-shaped association was observed between serum selenium and all-cause or cardiovascular mortality. In fully adjusted model, comparisons among quartiles revealed that risks of all-cause [HR (95%CI), 0.57 (0.39-0.81)] and cardiovascular death [HR (95%CI), 0.33 (0.13-0.86)] were lower in Q3. The nadir mortality of all-cause and cardiovascular was occurred at the serum selenium level of 136 μg/L and 130 μg/L, respectively. Conclusion: Serum selenium concentration showed a U-shaped association with all-cause and cardiovascular mortality.
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Affiliation(s)
- Qiu-hong Tan
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-cong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Epidemiology, Centre for Global Cardio-metabolic Health, Brown University, Providence, RI, United States
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-qing Feng
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Sun S, Liu XC, He GD, Lo K, Feng YQ, Huang YQ. The Non-linear Relationship Between Normal Range Systolic Blood Pressure and Cardiovascular or All-Cause Mortality Among Elderly Population. Front Cardiovasc Med 2021; 8:677189. [PMID: 34386527 PMCID: PMC8353072 DOI: 10.3389/fcvm.2021.677189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim was to explore the association of normal range SBP with cardiovascular and all-cause mortality in older adults without hypertension. Methods: Participants aged ≥ 65 years without hypertension and those had an SBP level between 90 and 129 mmHg were included from the National Health and Nutrition Examination Survey (1999-2014). SBP was categorized into: 90-99, 100-109, 110-119, and 120-129 mmHg. Multivariate Cox regression was performed with hazard ratio (HR) and 95% confidence interval (CI). Results: Of the 1,074 participants, 584 were men (54.38%). Compared with participants with SBP level ranged 110 to 119 mmHg, the HRs for all-cause mortality risk was 1.83 (95% CI: 1.04, 3.23) for SBP level ranged 90 to 99 mm Hg, 0.87 (95% CI: 0.54, 1.41) for SBP level ranged 100 to 109 mmHg, and 1.30 (95% CI: 0.96, 1.75) for SBP level ranged 120 to 129 mmHg (P for trend = 0.448), and the HR for cardiovascular mortality risk was 3.30 (95% CI: 0.87, 12.54) for SBP level ranged 90 to 99 mmHg, 0.35(95% CI: 0.08, 1.56) for SBP level ranged 100 to 109 mmHg, and 1.75 (95% CI: 0.78, 3.94) for SBP level ranged 120 to 129 mm Hg (P for trend = 0.349) after confounders were adjusted. Conclusion: These were a nonlinear association of normal range SBP level with all-cause and cardiovascular death in older adults.
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Affiliation(s)
- Shuo Sun
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Cong Liu
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guo-Dong He
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, RI, United States.,Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
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Glenn A, Lo K, Jenkins D, Boucher B, Hanley A, Kendall C, Shadyab A, Tinker L, Chessler S, Howard B, Liu S, Sievenpiper J. Greater Adherence to the Portfolio Diet Is Associated with Lower Incidence of Type 2 Diabetes in the Women's Health Initiative. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab053_027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To assess the association of the plant-based cholesterol-lowering diet, the Portfolio Diet, with incident type 2 diabetes in women.
Methods
We followed 147,732 postmenopausal women initially free of diabetes in the Women's Health Initiative (WHI) Clinical Trials and Observational Study from 1993 through 2017. Adherence to the Portfolio Diet was assessed using an a priori diet index based on six food categories (high in plant protein [soy & pulses], nuts, viscous fiber, plant sterols and monounsaturated fat, and low in saturated fat) that were previously found to lower cardiovascular risk factors in the Portfolio Diet trials. We used Cox proportional-hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of the association of adherence to a Portfolio Diet score with incident type 2 diabetes, adjusting for potential confounders (demographics, lifestyle behaviors, and medical history). The Portfolio Diet score was cumulatively assessed at baseline and year three using a validated food frequency questionnaire. Type 2 diabetes diagnosis was ascertained by self-reported medication use.
Results
There were 14,096 cases of incident type 2 diabetes over a mean follow-up of 14.3 years. In the fully adjusted models, adherence to the Portfolio Diet score was associated with a lower risk of incident type 2 diabetes (HR, 0.88, CIs, 0.83, 0.93; P for trend < 0.001), comparing the highest to lowest quartiles of adherence. Results remained similar across subgroup analyses (age, body mass index, family history of diabetes, and ethnicity) and several sensitivity analyses.
Conclusions
Among postmenopausal women, higher adherence to the Portfolio Diet was associated with lower incident type 2 diabetes. These findings are the first to show that the Portfolio Diet may be associated with a lower risk of type 2 diabetes and warrants further investigation.
Funding Sources
The WHI was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and the U.S. Department of Health and Human Services. AJG was supported by the Banting & Best Diabetes Centre Tamarack Graduate Award in Diabetes Research, the Peterborough K.M. Hunter Charitable Foundation Graduate Award, and an Ontario Graduate Scholarship. JLS was funded by a Diabetes Canada Clinician Scientist Award.
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Huang YQ, Liu L, Liu XC, Lo K, Tang ST, Feng YQ, Zhang B. The association of blood lipid parameters variability with ischemic stroke in hypertensive patients. Nutr Metab Cardiovasc Dis 2021; 31:1521-1532. [PMID: 33810958 DOI: 10.1016/j.numecd.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/23/2021] [Accepted: 02/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The relationship between lipid variability and stroke among patients with hypertension were inconclusive. We aimed to investigate the association of lipid variability with ischemic stroke in hypertensive patients. METHODS AND RESULTS This retrospective cohort study included 4995 individuals with hypertension between 2013 and 2015, and recorded their status of ischemic stroke until the end of 2018. The variability in total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were measured using the standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM) and average absolute difference between successive values (ASV). Multivariate Cox proportional hazards models with hazard ratios (HRs) and 95% confidence interval (CI) were performed. There were 110 cases of ischemic stroke during a median follow up of 4.2 years. The multivariable adjusted HRs and 95% CIs comparing the highest versus the lowest quartiles of SD of TC, LDL-C, HDL-C and TG were 4.429 (95% CI: 2.292, 8.560), 2.140 (95% CI: 1.264, 3.621), 1.368 (95% CI: 0.793, 2.359) and 1.421 (95% CI: 0.800, 2.525), respectively. High variability in TC and LDL-C were associated with a higher risk for ischemic stroke. Similarly, the results were consistent when calculating variability of TC and LDL-C using CV, ASV and VIM, and in various subgroup analyses. CONCLUSION Higher variability of TC and LDL-C associated with the risk of ischemic stroke among hypertensive patients. These findings suggest reducing variability of lipid parameters may decrease adverse outcomes.
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Affiliation(s)
- Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xiao-Cong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; Department of Epidemiology, Centre for Global Cardio-metabolic Health, Brown University, Providence, USA; Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Song-Tao Tang
- Community Health Center of Liaobu County, Dongguan, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
| | - Bin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
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Huang M, Lo K, Li J, Allison M, Wu WC, Liu S. Pasta meal intake in relation to risks of type 2 diabetes and atherosclerotic cardiovascular disease in postmenopausal women : findings from the Women's Health Initiative. BMJ Nutr Prev Health 2021; 4:195-205. [PMID: 34308127 PMCID: PMC8258098 DOI: 10.1136/bmjnph-2020-000198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022] Open
Abstract
Objective To evaluate the association between pasta meal intake and long-term risk of developing diabetes or atherosclerotic cardiovascular disease (ASCVD, including coronary heart disease (CHD) and stroke) in postmenopausal women. Design Prospective cohort study. Setting Women’s Health Initiative (WHI) in the USA. Participants 84 555 postmenopausal women aged 50–79 in 1994, who were free of diabetes, ASCVD and cancer at baseline who were not in the dietary modification trial of the WHI, completed a validated food frequency questionnaire, and were evaluated for incident diabetes and ASCVD outcomes during the follow-up until 2010. Main outcome measure Diabetes and ASCVD. Results Cox proportional hazards models were used to estimate the association (HR) between quartiles of pasta meal consumption (residuals after adjusting for total energy) and the risk of incidence diabetes, CHD, stroke or ASCVD, accounting for potential confounding factors, with testing for linear trend. We then statistically evaluated the effect of substituting white bread or fried potato for pasta meal on disease risk. When comparing the highest to the lowest quartiles of residual pasta meal intake, we observed significantly reduced risk of ASCVD (HR=0.89, 95% CI 0.83 to 0.96, p trend=0.002), stroke (HR=0.84, 95% CI 0.75 to 0.93, p trend=0.001), CHD (HR=0.91, 95% CI 0.83 to 1.00, p trend=0.058) and no significant alteration in diabetes risk (HR=1.02, 95% CI 0.96 to 1.07, p trend=0.328). Replacing white bread or fried potato with pasta meal was statistically associated with decreased risk of stroke and ASCVD. Conclusions Pasta meal intake did not have adverse effects on long-term diabetes risk and may be associated with significant reduced risk of stroke and ASCVD. The potential benefit of substituting pasta meal for other commonly consumed starchy foods on cardiometabolic outcomes warrants further investigation in additional high-quality and large prospective studies of diverse populations.
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Affiliation(s)
- Mengna Huang
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Global Cardiometabolic Health, Brown University, Providence, Rhode Island, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth Lo
- Center for Global Cardiometabolic Health, Brown University, Providence, Rhode Island, USA.,Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Jie Li
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Global Cardiometabolic Health, Brown University, Providence, Rhode Island, USA.,Center for International Health, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Matthew Allison
- Department of Family Medicine and Public Health, San Diego School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Wen-Chih Wu
- Center for Long term Services and Support, Providence VA Medical Center, Alpert Medical School, Brown University School of Public Health and the Miriam Hospital Center for Cardiac Fitness, Providence, Rhode Island, USA
| | - Simin Liu
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Global Cardiometabolic Health, Brown University, Providence, Rhode Island, USA.,Division of Endocrinology, Department of Medicine, and Division of Cardiothoracic Surgery, Department of Surgery, The Warren Alpert School of Medicine and Rhode Island Hospital, Providence, Rhode Island, USA
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Abstract
Osteoarthritis (OA) is a prevalent debilitating age-related skeletal disease. The hallmark of OA is the degradation of articular cartilage that cushions the joint during movement. It is characterized by chronic pain and disability. Magnesium, a critical trace element in the human body, plays a pivotal role in metabolism homeostasis and the energy balance. Humans obtain magnesium mainly from the diet. However, inadequate magnesium intake is not uncommon. Moreover, the magnesium status deteriorates with ageing. There has been a growing body of clinical studies pointing to an intimate relationship between dietary magnesium and OA although the conclusion remains controversial. As reported, the magnesium ion concentration is essential to determine cell fate. Firstly, the low-concentration magnesium ions induced human fibroblasts senescence. Magnesium supplementation was also able to mitigate chondrocyte apoptosis, and to facilitate chondrocyte proliferation and differentiation. In this literature review, we will outline the existing evidence in animals and humans. We will also discuss the controversies on plasma or intracellular level of magnesium as the indicator of magnesium status. In addition, we put forward the interplay between dietary magnesium intake and intestinal microbiome to modulate the inflammatory milieu in the conjecture of OA pathogenesis. This leads to an emerging hypothesis that the synergistic effect of magnesium and probiotics may open a new avenue for the prevention and treatment of OA.
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Affiliation(s)
- Xiaoqing Kuang
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jiachi Chiou
- Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kenneth Lo
- Department of Applied Biology and Chemical Technology, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Chunyi Wen
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Kowloon, Hong Kong.
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Liu L, Huang YQ, Lo K, Chen CL, Li J, Feng YQ. Early-life exposure to the Chinese famine and risk of carotid intima-media thickness increased in adulthood. Nutr Metab Cardiovasc Dis 2021; 31:841-848. [PMID: 33549438 DOI: 10.1016/j.numecd.2020.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/01/2020] [Accepted: 08/21/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIMS Little was known about the effect of famine exposure on carotid intima-media thickness (cIMT). The present study aimed to explore the relationship in a Chinese population. METHODS AND RESULTS Participants were divided into five groups: not exposed to famine, exposed to famine in fetal, early, mid or late childhood. Elevated cIMT was defined as a thickness of >0.9 mm measured by carotid ultrasound. Multivariate logistic regression was performed to calculate odds ratio (OR) and confidence interval (CI) between famine exposure and cIMT. A total of 2637 (970 male, mean age 59.1 ± 3.65 years) participants were recruited, and 491 (18.62%) of them had elevated cIMT. When compared with the non-exposure group, the fully adjusted ORs for increased cIMT for exposure in fetal, early, mid to late childhood were 1.321 (95%CI: 0.872, 1.994, P = 0.186), 1.713 (95% CI: 1.188, 2.483, P = 0.004), 2.359 (95% CI: 1.674, 3.357, P < 0.001) and 2.485 (95% CI: 1.773, 3.518, P < 0.001), respectively. Subgroup analyses showed that the exposure to famine did not interact with body mass index, gender, smoking status, hypertension and diabetes history on its effect on cIMT. CONCLUSION Our findings indicated that early-life exposure to the Chinese famine might be associated with an increased risk of increased cIMT in adulthood.
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Affiliation(s)
- Lin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China
| | - Jie Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China.
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510080, China.
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He GD, Liu XC, Liu L, Yu YL, Chen CL, Huang JY, Lo K, Huang YQ, Feng YQ. A nonlinear association of total cholesterol with all-cause and cause-specific mortality. Nutr Metab (Lond) 2021; 18:25. [PMID: 33691735 PMCID: PMC7945313 DOI: 10.1186/s12986-021-00548-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/27/2021] [Indexed: 01/14/2023] Open
Abstract
Background The link between total cholesterol (TC) and all-cause and specific mortality has not been elucidated. Herein, we aimed to evaluate the effect of TC levels on all-cause, cardiovascular disease (CVD), and cancer mortality. Methods All data analyzed were obtained from the National Health and Nutrition Examination Survey 1999–2014. The relationship between levels of TC and mortality was determined through Cox proportional hazard regression analysis coupled with multivariable adjustments. Two-piecewise linear regression models and Cox models with penalized splines were applied to explore nonlinear and irregular shape relationships. Kaplan–Meier survival curve and subgroup analyses were conducted. Results The sample studied comprised 14,662 men and 16,025 women, categorized as 25,429 adults aged 18–65 and 5,258 adults over 65 years old. A total of 2,570 deaths were recorded. All-cause, cardiovascular, and cancer mortality showed U-curve associations after adjusting for confounding variables in the restricted cubic spline analysis. Hazard ratios (HRs) of all-cause and cancer mortality were particularly negatively related to TC levels in the lower range < 200 mg/dL, especially in the range < 120 mg/dL (HR 1.97; 95% CI 1.38, 2.83, HR 2.39; 95% CI 1.21, 4.71, respectively). However, the HRs of cardiovascular disease mortality in the range < 120 mg/dL were the lowest (HR 0.60; 95% CI 0.15, 2.42). In the upper range, a TC range of ≥ 280 mg/dL was correlated with mortality as a result of CVD and cancer (HR 1.31; 95% CI 0.87, 1.97 and HR 1.22; 95% CI 0.82, 1.79). The lowest cumulative survival rate of all-cause mortality was recorded in the lowest TC-level group, while the lowest cumulative survival rate of CVD mortality was recorded in the highest TC-level group. Conclusions A nonlinear association of TC level with all-cause, cancer, and CVD mortality in the American population was observed, suggesting that too low or too high serum total cholesterol levels might correlate with adverse outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12986-021-00548-1.
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Affiliation(s)
- Guo-Dong He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Xiao-Cong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Kenneth Lo
- Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, USA
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
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Huang YQ, Liu L, Huang JY, Chen CL, Yu YL, Lo K, Feng YQ. Prediabetes and risk for all-cause and cardiovascular mortality based on hypertension status. Ann Transl Med 2021; 8:1580. [PMID: 33437779 PMCID: PMC7791204 DOI: 10.21037/atm-20-1155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Current recommendations suggest prediabetes testing for overweight or obese adults with at least one cardiovascular risk factor. However, it is important to understand whether testing should be conducted in adults with hypertension regardless of their cardiovascular risk factors. Methods Participants from the 1999–2014 National Health and Nutrition Examination Surveys (NHANES) aged at least 18 years and without diabetes were enrolled in the study. Participants were classified according to their prediabetes and hypertension status and followed up to track cardiovascular and all-cause mortality until December 31, 2015. Cox proportional hazards models were built to estimate the hazard ratios (HRs). Results were stratified by age, sex, ethnicity, body mass index, and cardiovascular disease history. Results At baseline, 5,011 (14.72%) out of 34,047 participants had combined prediabetes and hypertension. Prediabetes alone was not associated with all-cause or cardiovascular mortality. Hypertension alone was significantly associated with all-cause (HR: 1.30) and cardiovascular (HR: 1.89) mortality, and combined prediabetes and hypertension were significantly associated with all-cause (HR: 1.37) and cardiovascular (HR: 2.11) mortality. Age and ethnicity were significantly associated with combined prediabetes and hypertension and all-cause mortality, where the association was stronger among people aged <60 years (HR: 1.94 vs. 1.22) and White (HR: 1.50 vs. 1.21). Conclusions Prediabetes might elevate the risk of all-cause and cardiovascular mortality among people with hypertension. This relationship is more evident among younger and White individuals.
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Affiliation(s)
- Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Liu XC, He GD, Lo K, Huang YQ, Feng YQ. The Triglyceride-Glucose Index, an Insulin Resistance Marker, Was Non-linear Associated With All-Cause and Cardiovascular Mortality in the General Population. Front Cardiovasc Med 2021; 7:628109. [PMID: 33521071 PMCID: PMC7840600 DOI: 10.3389/fcvm.2020.628109] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Background: The triglyceride-glucose (TyG) index could serve as a convenient substitute of insulin resistance (IR), but epidemiological evidence on its relationship with the long-term risk of mortality is limited. Methods: Participants from the National Health and Nutrition Examination Survey during 1999–2014 were grouped according to TyG index (<8, 8–9, 9–10, >10). Cox regression was conducted to compute the hazard ratios (HRs) and 95% confidence interval (CI). Restricted cubic spline and piecewise linear regression were performed to detect the shape of the relationship between TyG index and mortality. Results: A total of 19,420 participants (48.9% men) were included. On average, participants were followed-up for 98.2 months, and 2,238 (11.5%) and 445 (2.3%) cases of mortality due to all-cause or cardiovascular disease were observed. After adjusting for confounders, TyG index was independently associated with an elevated risk of all-cause (HR, 1.10; 95% CI, 1.00–1.20) and cardiovascular death (HR, 1.29; 95% CI, 1.05–1.57). Spline analyses showed that the relationship of TyG index with mortality was non-linear (All non-linear P < 0.001), and the threshold value were 9.36 for all-cause and 9.52 for cardiovascular death, respectively. The HRs above the threshold point were 1.50 (95% CI, 1.29–1.75) and 2.35 (95% CI, 1.73–3.19) for all-cause and cardiovascular death. No significant difference was found below the threshold points (All P > 0.05). Conclusion: Elevated TyG index reflected a more severe IR and was associated with mortality due to all-cause and cardiovascular disease in a non-linear manner.
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Affiliation(s)
- Xiao-Cong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guo-Dong He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Epidemiology, Center for Global Cardio-Metabolic Health, Brown University, Providence, RI, United States.,Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Chan V, Lo K. Efficacy of dietary supplements on improving sleep quality: a systematic review and meta-analysis. Postgrad Med J 2021; 98:285-293. [PMID: 33441476 DOI: 10.1136/postgradmedj-2020-139319] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/22/2020] [Accepted: 12/03/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Different dietary supplements aimed at improving sleep quality are available on the market, but there has not been a comprehensive review to evaluate the efficacy of these dietary supplements on subjective sleep quality. We aimed to summarise up-to-date research evidence and to identify the types of dietary supplement that improve subjective sleep quality. METHODS Multiple databases (Ovid Emcare, Ovid MEDLINE (R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and APA PsycInfo) were used for searching papers published until August 2020. The changes in sleep quality indices, intervention duration and sample size were extracted from every paper. To analyse the effect of dietary supplements on sleep quality, a random effects model with mean difference (MD) and 95% CI was adopted. The heterogeneity across studies was measured by I2 statistics. The quality of included studies was evaluated by Cochrane's risk of bias tool. RESULTS Thirty-one randomised controlled trials of dietary supplements were included. Subjective sleep quality was significantly improved by supplementation of amino acids (MD -1.27, 95% CI -2.35 to -0.20; I2=0%), melatonin (MD -1.21, 95% CI -2.17 to -0.24; I2=79%) and vitamin D (MD -1.63, 95% CI -3.15 to -0.10; I2=85%). Although not all studies provided adequate data for meta-analysis, we also discussed how magnesium, zinc, resveratrol and nitrate supplementation may improve sleep quality. CONCLUSIONS Amino acids, vitamin D and melatonin supplements were significantly beneficial to improve sleep quality. However, high heterogeneity and wide confidence levels were observed in vitamin D and melatonin. Further research on the effect of magnesium, zinc, resveratrol and nitrate supplementation on improving sleep quality is required.
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Affiliation(s)
- Vicky Chan
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Kenneth Lo
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Liu XC, Huang Y, Lo K, Huang YQ, Chen JY, Feng YQ. Quotient of Waist Circumference and Body Mass Index: A Valuable Indicator for the High-Risk Phenotype of Obesity. Front Endocrinol (Lausanne) 2021; 12:697437. [PMID: 34135867 PMCID: PMC8202120 DOI: 10.3389/fendo.2021.697437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Measuring the body mass index (BMI) or waist circumference (WC) alone is insufficient for assessing possible health risks due to obesity. This study aimed to investigate whether the quotient of WC and BMI can be used as a proxy of the high-risk phenotype of obesity. METHODS Data for analysis were derived from the National Health and Nutrition Examination Survey (NHANES 1999-2014). The Waist-BMI Ratio was defined as WC divided by BMI. The associations between Waist-BMI Ratio and mortality were estimated using Cox regression models. Restricted cubic spline and two-piecewise linear regression models were used to identify non-linear relationships. The discriminative abilities of different anthropometric measures were compared using receiver operating characteristic curves (ROC). RESULTS This study is based on data from 35557 adults (51.1% female, mean age 44.9 years). During an average follow-up of 101.8 months, 3680 participants died, including 807 of cardiovascular causes. In fully adjusted models, Waist-BMI Ratio was independently associated with overall (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.48-2.13) and cardiovascular (HR, 1.77; 95% CI, 1.25-2.52) mortality. Spline analyses revealed that dose-response relationships existed between Waist-BMI Ratio and death. The mortality risk rises dramatically above the cut-off point of the Waist-BMI Ratio (HR, 3.22; 95% CI, 2.43-4.26 for overall mortality and HR, 3.07; 95% CI, 1.71-5.52 for cardiovascular mortality). ROC curve analysis suggested that Waist-BMI Ratio was a better discriminator of mortality (AUC 0.637 for overall and 0.639 for cardiovascular mortality) than BMI, WC, and waist-to-height ratio (Delong's test all P <0.001). CONCLUSIONS Waist-BMI Ratio was independently associated with overall and cardiovascular mortality in a J-shaped pattern, offering an immense potential risk marker for obesity in the clinical setting.
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Chen CL, Liu L, Lo K, Huang JY, Yu YL, Huang YQ, Feng YQ. Association Between Triglyceride Glucose Index and Risk of New-Onset Diabetes Among Chinese Adults: Findings From the China Health and Retirement Longitudinal Study. Front Cardiovasc Med 2020; 7:610322. [PMID: 33330672 PMCID: PMC7728664 DOI: 10.3389/fcvm.2020.610322] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/02/2020] [Indexed: 12/14/2022] Open
Abstract
The triglyceride glucose (TyG) index has been proposed to be a surrogate of insulin resistance. In the present study, we aimed to examine the relationship between TyG index and the risk of incident diabetes in middle-age and older adults in China using nationally representative data from the China Health and Retirement Longitudinal Study 2011-2015. Information on socio-demographics, medical background, anthropometric measurement, and laboratory information were collected. The association between TyG index and diabetes was examined by Cox proportional hazards models and restricted cubic spline regression, and the results were presented in hazard ratio (HR) with 95% confidence interval (CI). Subgroup analyses were also conducted to examine potential interactions between demographics and TyG index. Among 7,428 participants, 791 (10.6%) of them developed diabetes over 3.4 years of follow-up. The multivariate HR for every SD increment in TyG index was 1.22 (95% CI, 1.14-1.31). When comparing to the lowest quartile of TyG index, the multivariate HRs for new-onset diabetes were 1.22 (0.96-1.54) for Q2, 1.61 (1.28-2.01) for Q3, and 1.73 (1.38-2.16) for Q4 (P for trend <0.001). The restricted cubic spline regression also showed a linear association. No interaction was found between subgroup variables and the association between TyG index and the risk of diabetes. In conclusion, higher TyG index associated with the elevated risk of new-onset diabetes in middle-aged and older adults.
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Affiliation(s)
- Chao-lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Epidemiology, Centre for Global Cardiometabolic Health, Brown University, Providence, RI, United States
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, China
| | - Jia-yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Liu L, Lo K, Huang C, Feng YQ, Zhou YL, Huang YQ. Derivation and validation of a simple nomogram prediction model for all-cause mortality among middle-aged and elderly general population. Ann Palliat Med 2020; 10:1167-1179. [PMID: 33183041 DOI: 10.21037/apm-20-580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 08/28/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND A simple clinical model that can predict all-cause mortality in the middle-aged and older adults in general population based on demographics and physical measurement indicators. The aim of this study was to develop a simple nomogram prediction model for all-cause mortality in middle-aged and elderly general population based on demographics and physical measurement indicators. METHODS This was a prospective cohort study. We used data from the 1999-2006 National Health and Nutrition Examination Survey (NHANES), which included adults aged ≥40 years with mortality status updated through 31 December 2015. Cox proportional hazards regression, nomogram and least absolute shrinkage and selection operator (LASSO) binomial regression model were performed to evaluate the prediction model in the derivation and validation cohort. RESULTS A total of 13,026 participants (6,414 men, mean age was 61.59±13.80 years) were included, of which 6,671 (3,263 men) and 6,355 (3,151 men) were included in the derivation cohort and validation cohort, respectively. During an average follow-up period of 129.23±9.62 months, 4,321 died. We developed a 9-item nomogram mode included age, gender, smoking, alcohol intake, diabetes, hypertension, marriage status, education and poverty to income ratio (PIR). The area under the curve (AUC) was 0.842 and had good calibration. Internal validation showed good discrimination of the nomogram model with AUC of 0.849 and good calibration. Application of the LASSO regression model in the validation cohort also revealed good discrimination (AUC =0.854) and good calibration. A time-dependent and optimism-corrected AUC value for the model showed no significant relationship with the change of follow-up time. CONCLUSIONS A simple nomogram model, including age, gender, smoking, alcohol intake, diabetes, hypertension, marriage, education and PIR, could predict all-cause mortality well in middle-aged and elderly general population.
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Affiliation(s)
- Lin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheng Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying-Ling Zhou
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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Chen CL, Liu L, Huang JY, Yu YL, Shen G, Lo K, Huang YQ, Feng YQ. Thigh Circumference and Risk of All-Cause, Cardiovascular and Cerebrovascular Mortality: A Cohort Study. Risk Manag Healthc Policy 2020; 13:1977-1987. [PMID: 33116978 PMCID: PMC7549877 DOI: 10.2147/rmhp.s264435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The relationship between thigh circumference and all-cause and cause-specific mortality has not been consistent. We aimed to examine how thigh circumference associates with all-cause, cardiovascular, and cerebrovascular mortality among US adults. Patients and Methods This cohort study included 19,885 US adults who participated in the 1999–2006 National Health and Nutrition Examination Survey (NHANES) with thigh circumference being measured at baseline, and survival status was ascertained until 31 December 2015. We used Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for mortality according to thigh circumference in quartiles. Kaplan–Meier survival curve and restricted cubic spline regression were performed to evaluate the prospective association. Finally, subgroup analyses by age, gender, body mass index (BMI), and medical history at baseline were conducted. Results During a median follow-up of 11.9 years, 3513 cases of death, 432 death cases due to cardiovascular disease, and 143 death cases due to cerebrovascular disease have occurred. Multivariate Cox regression indicated that every 1cm increase in thigh circumference was related to 4% and 6% decreased risk of all-cause mortality and cardiovascular mortality, respectively. Compared to the reference group, the highest quartile of thigh circumference significantly decreased all-cause mortality by 21% (HR 0.79, 95% CI 0.62–1.00, P<0.05). However, the association of thigh circumference with cerebrovascular mortality was not significant. BMI was a significant effect modifier among individuals with a BMI of less than 25 kg/m2 (P<0.0001). Conclusion A low thigh circumference appears to be associated with increased risk of all-cause and cardiovascular mortality, but not cerebrovascular mortality.
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Affiliation(s)
- Chao-Lei Chen
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Lin Liu
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Jia-Yi Huang
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Yu-Ling Yu
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Geng Shen
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Kenneth Lo
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China.,Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USA
| | - Yu-Qing Huang
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Ying-Qing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
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Yu Y, Liu L, Lo K, Tang S, Feng Y. Prevalence and associated factors of inter-arm blood pressure difference in Chinese community hypertensive population. Postgrad Med 2020; 133:188-194. [PMID: 32942940 DOI: 10.1080/00325481.2020.1826184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence and associated factors of inter-arm blood pressure difference (IAD) in Chinese community hypertensive population. METHODS The cross-sectional study included 7788 hypertensive patients (3673 male and 4115 female, aged 62.3 ± 13.6 years) in Guangdong, China. IAD was defined as the absolute value of blood pressure (BP) difference between left and right arms. Bilateral BP was measured simultaneously by automated devices. RESULTS The mean IAD was 4.04 ± 4.33 mm Hg in systolic and 3.19 ± 3.43 mm Hg in diastolic. The prevalence rates of systolic IAD (sIAD)≥5 mm Hg and ≥10 mmHg were 28.9% (n = 2247) and 12.8% (n = 996), respectively. By univariate linear regression, higher sIAD correlated with aging, higher SBP, higher DBP, lower baseline estimated glomerular filtration rate (eGFR), and anti-hypertensive medication (p < 0.05). In multivariate linear regression analysis, higher sIAD was significantly associated with systolic BP (SBP, β = 0.033; 95%CI, 0.025-0.041; p < 0.001), triacylglycerol (β = 0.093; 95%CI, 0.017-0.169; p = 0.016), total cholesterol (β = -0.202; 95%CI, -0.396to -0.009; p = 0.04), and low-density lipoprotein cholesterol (LDL-C; β = 0.304; 95%CI, 0.027-0.582; p = 0.032). CONCLUSION The elevated prevalence of large IAD was shown in hypertensive population. Meanwhile, higher levels of SBP, triacylglycerol, total cholesterol, LDL-C, and lower eGFR were associated with higher sIAD.
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Affiliation(s)
- Yuling Yu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China.,Second Clinical Medical College, Southern Medical University, 510080 Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China.,Center for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USA
| | - Songtao Tang
- Department of Cardiology, Community Health Center of Liaobu Town, 523400 Dongguan, Guangdong, China
| | - Yingqing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, China
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Huang YQ, Liu XC, Lo K, Feng YQ, Zhang B. A dose-independent association of triglyceride levels with all-cause mortality among adults population. Lipids Health Dis 2020; 19:225. [PMID: 33059659 PMCID: PMC7566122 DOI: 10.1186/s12944-020-01400-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background The relationship between triglyceride (TG) level and the mortality risk of all-cause and cardiovascular disease is not entirely consistent among adults. Methods The present analysis included adult participants from National Health and Nutrition Examination Surveys (NHANES) between the periods 1999–2014. The levels of TG were categorized into < 150, 150–199, 200–250 and ≥ 250 mg/dL respectively. Multivariate Cox regression analysis, stratified analysis and generalized additive model were conducted to reveal the correlation between TG and mortality risk. Results were presented in hazard ratio (HRs) and 95% confidence intervals (CIs). Results There were 18,781 (9130 males, mean age was 45.64 years) participants being included in the analysis. The average follow-up period was 8.25 years, where 1992 (10.61%) cases of all-cause and 421 (2.24%) cardiovascular death have occurred. In the multivariate Cox model, every 1 mg/dL raise in TG has significantly associated with all-cause mortality (HR: 1.08, 95% CI: 1.02, 1.15) but not cardiovascular mortality (HR: 1.10, 95% CI: 0.97, 1.24). When using TG < 150 mg/dL as reference, TG ≥ 250 mg/dL associated with death from all-cause (HR = 1.34, 95% CI: 1.12, 1.60; P = 0.0016 but not cardiovascular death (HR = 1.26, 95% CI: 0.85, 1.88; P = 0.2517). According to smoothing spline plots, the risk of all-cause was the lowest when TG was approximately 135 mg/dL. Conclusion TG might have a dose-independent association with all-cause mortality among adults in United States.
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Affiliation(s)
- Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Xiao-Cong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.,Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USA.,Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
| | - Bin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, No. 106, Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.
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Chen CL, Liu XC, Liu L, Lo K, Yu YL, Huang JY, Huang YQ, Chen JY. U-Shaped Association of High-Density Lipoprotein Cholesterol with All-Cause and Cardiovascular Mortality in Hypertensive Population. Risk Manag Healthc Policy 2020; 13:2013-2025. [PMID: 33116982 PMCID: PMC7549655 DOI: 10.2147/rmhp.s272624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/12/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose Whether the paradox of high-density lipoprotein cholesterol (HDL-C) and elevated mortality risk extends to hypertensive patients is unclear. We aimed to investigate the association between HDL-C and all-cause and cardiovascular disease mortality in adults with hypertension. Methods In the National Health and Nutrition Examination Surveys, 11,497 hypertensive participants aged ≥18years old and examined at baseline between 1999 and 2014 were followed up until December 2015. We categorized the HDL-C concentration as ≤30, 31–40, 41–50, 51–60 (reference), 61–70, >70 mg/dL and examined their associations with all-cause and cardiovascular mortality, respectively. Multivariate Cox regression was used to calculated hazard ratio (HR) and 95% confidence interval (CI) for mortality risk. Results During follow-up (median: 9.2 ± 3.8 years), 3012 deaths and 713 cardiovascular deaths were observed. In the restrictive cubic curves, associations of HDL-C levels and all-cause and cardiovascular mortality were detected to be U-shaped. After multivariable adjustment, HRs for all-cause mortality were for the lowest HDL-C concentration (≤30 mg/dL) 1.29 (95% CI, 1.07–1.56) and the highest (>70 mg/dL) 1.20 (1.06–1.37), comparing with the reference group. For cardiovascular mortality, HRs were 1.31 (0.83–1.48) and 1.09 (0.83–1.43), respectively. Similar results were obtained in subgroups stratified by age, gender, race, and taking lipid-lowering drugs. The lowest all-cause mortality risk was observed at HDL-C 66 mg/dL (concentration) and 51–60 mg/dL (range). Conclusion Both lower and higher HDL-C concentration appeared to be associated with higher mortality in hypertensive population. Further investigation is warranted to clarify the underlying mechanisms.
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Affiliation(s)
- Chao-Lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Xiao-Cong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Kenneth Lo
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USA
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
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Huang YQ, Liu XC, Lo K, Liu L, Yu YL, Chen CL, Huang JY, Feng YQ, Zhang B. The U Shaped Relationship Between High-Density Lipoprotein Cholesterol and All-Cause or Cause-Specific Mortality in Adult Population. Clin Interv Aging 2020; 15:1883-1896. [PMID: 33061337 PMCID: PMC7537851 DOI: 10.2147/cia.s271528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/27/2020] [Indexed: 01/22/2023] Open
Abstract
Purpose The associations of high-density lipoprotein cholesterol (HDL-C) with mortality are still unclear. We explored the associations of HDL-C with all-cause and cause-specific mortality in an adult population. Methods Deaths were classified into all-cause, cardiovascular, and cancer mortality. Survival curve, multivariate Cox regression, and subgroup analyses were conducted, and hazard ratio (HR) and 95% confidence interval (CI) were performed. We fitted Cox regression models for all-cause, cardiovascular, and cancer mortality to evaluate their associations with categories of HDL-C (≤30, 31-40, 41-50, 51-60 [reference], 61-70, >70 mg/dL). Results A total of 42,145 (20,415 (48.44%) males, mean age 47.12±19.40 years) subjects were enrolled. At an average follow-up of 97.52±54.03 months, all-cause, cardiovascular, and cancer mortality numbers were 5,061 (12.01), 1,081 (2.56%), and 1,061 (2.52%), respectively. When compared with the reference group (HDL-C: 51-60 mg/dL), a U-shaped association was apparent for all-cause mortality, with elevated risk in participants with the lowest (≤30 mg/dL) (HR=1.33; 95% CI=1.14- 1.56) and highest (>70 mg/dL) (HR=1.14; 95% CI=1.02-1.27) HDL-C concentration. Associations for cardiovascular and cancer mortality were non-linear. An elevated risk for cancer mortality was observed in those with the highest HDL-C concentration (HR=1.06; 95% CI-0.84-1.34) compared with the reference group, although it was not statistically significant. The effect of HDL-C on mortality was adjusted by some traditional risk factors including age, gender, race, or comorbidities. Conclusion A U-shaped association was observed between HDL-C and all-cause mortality among an adult population.
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Affiliation(s)
- Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Xiao-Cong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China.,Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, RI, USA
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
| | - Bin Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, People's Republic of China
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Lo K, Stephenson M, Lockwood C. Extending the hierarchical decision matrix to incorporate a dominance ranking score for economic systematic reviews. MethodsX 2020; 7:101047. [PMID: 32983920 PMCID: PMC7498707 DOI: 10.1016/j.mex.2020.101047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/24/2020] [Indexed: 11/09/2022] Open
Abstract
As the base of clinical evidence grows, it is increasingly common to conduct economic evaluations in addition to clinical evaluations of effectiveness in order to inform health policies. For economic systematic reviews there is currently no agreed-upon quantitative method to obtain a pooled economic effect size. With no suitable quantitative method available, the hierarchical decision matrix stands out as a tool that enables a visual summary of different types of economic studies, but there are limitations with the hierarchical decision matrix. We extended the hierarchical decision matrix with a weighted scoring system (termed dominance ranking score) to allow for useful information of a study design to be incorporated. The scoring system of the dominance ranking score incorporates weighting factors that are based on sample size and effect size of a study. The dominance ranking score enables a more differentiating analysis of dominance levels. For systematic reviews that include partial economic studies, both the hierarchical decision matrix and the dominance ranking score assist to indicate the level of economic potential for a particular intervention, which facilitates the conduct of subsequent full economic studies.
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Affiliation(s)
- Kenneth Lo
- Faculty of Health and Medical Sciences, The Joanna Briggs Institute (JBI), The University of Adelaide, Australia.,College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Australia
| | - Matthew Stephenson
- Faculty of Health and Medical Sciences, The Joanna Briggs Institute (JBI), The University of Adelaide, Australia
| | - Craig Lockwood
- Faculty of Health and Medical Sciences, The Joanna Briggs Institute (JBI), The University of Adelaide, Australia
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Liu L, Chen CL, Lo K, Huang JY, Yu YL, Huang YQ, Feng YQ. Trends of Status of Hypertension in Southern China, 2012-2019. Int J Gen Med 2020; 13:599-608. [PMID: 32982377 PMCID: PMC7500839 DOI: 10.2147/ijgm.s267346] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Little is known about the recent trends of hypertension in southern China. The aim of the study was to investigate the trends of hypertension in Guangdong Province between 2012 and 2019. Methods We conducted two cross-sectional surveys in 2012 and 2019 in southern China, which included 10,970 and 27,483 participants, respectively, aged 35 to 75 years old using a method of stratified, multistage, and cluster sampling. Hypertension was defined as a mean systolic/diastolic blood pressure (SBP/DBP) ≥140/90mmHg, or a self-reported condition, or any pharmacological treatment in the last 2 weeks. In addition, according to the 2017 ACC/AHA guideline for high blood pressure, we estimated the prevalence and control rate of hypertension. Results According to the 2010 Chinese guideline, the age-standardized rate of hypertension prevalence was 34.7% in 2012 and 36.9% in 2019 with a slight increase, while the prevalence of prehypertension was stable (14.5% vs 14.3%). Over the period of our study, 45.6% and 60.7% of hypertensive patients knew their diagnosis in 2012 and 2019, and 40.8% and 51.5% were using antihypertensive medications, respectively. The control rates increased from 15.1% to 23.6%. Hypertension prevalence was 64.5% in 2012 and 63.2% in 2019, and the control rate increased from 3.0% to 4.8% during the study period under the 2017 ACC/AHA guideline. Conclusion Although the past 7 years have seen some progress in hypertension management, the rates of hypertension awareness, treatment, and control in southern Chinese remained regrettably low, and the prevalence rate was still high.
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Affiliation(s)
- Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Kenneth Lo
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USA
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
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Huang JY, Liu L, Yu YL, Chen CL, Lo K, Zhang B, Tang ST, Huang YQ, Feng YQ. A nonlinear relationship between low-density-lipoprotein cholesterol levels and atrial fibrillation among patients with hypertension in China. Ann Palliat Med 2020; 9:2953-2961. [PMID: 32819119 DOI: 10.21037/apm-20-451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/14/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The association between low-density-lipoprotein cholesterol (LDL-C) and atrial fibrillation (AF) in hypertensive population remains controversial. Therefore, we explored the relationship between LDL-C and AF among patients with hypertension in a Chinese community. METHODS This is a retrospective cross-sectional study that enrolled 7808 hypertensive patients between January 2013 and December 2013 in Guangdong, China. AF was diagnosed by 12-lead electrocardiogram (ECG) or self-reported status. LDL-C value were categorized by quartiles. Univariate and multivariate logistic regression were performed to examine the relation between LDL-C and AF. LDL-C values were expressed in continuous (every 1 mg/dL increment) or categorical variables in each regression model. RESULTS Among 7,808 (47.1% man, with mean age 62.3 years) participants, 78 AF cases were identified. In multivariate logistic regression, when LDL-C was presented as continuous variable, it was inversely associated with the occurrence of new onset AF (OR =0.99, 95% CI: 0.98, 1.00; P=0.018). Meanwhile, when LDL-C was presented as categorical variable, the negative association between LDL-C and AF was attenuated after adjusting for confounders. Adjusted restricted cubic spline demonstrated a non-linear correlation between LDL-C and AF. CONCLUSIONS Lower levels of LDL-C was associated with increased incidence of AF in a Chinese community hypertensive population.
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Affiliation(s)
- Jia-Yi Huang
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China; Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI, USA
| | - Bin Zhang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Song-Tao Tang
- Community Health Center of Liaobu County, Dongguan, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ying-Qing Feng
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
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Tsai M, Chen F, Luh D, Wang Y, Lo K. Effectiveness of health promoting school program: The relationship of HPS award level and outcome. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
According to Taiwan health promoting school (HPS) accreditations program, the school was recognized with a gold award, silver award, bronze award, participation award, and non-awards. Previous studies have foci on the effectiveness of the HPS from the perspective of students' health behaviors. The main purpose of this study is to compare the students' health and social outcomes in different HPS award levels to assess the effectiveness of the HPS program.
Methods
This cross-sectional survey was conducted to 121 schools registering HPS accreditation program in 2018. Overall, a total of 8812 elementary, junior and senior high school students completed the questionnaire. The accredited schools were classified into four categories according to the award level: excellent (5 schools with gold), good (32 schools with silver), fair (23 schools with bronze and 18 schools with participation), and poor (44 schools with non-award). The outcome variables included perceived health status, well-being, and quality of life. The descriptive statistics and ANOVA were analysed using SPSS 20.0 software.
Results
There were awards level differences of students' health (F = 10.66, p<.001) and social outcomes (e.g. well-being: F = 3.76, p<.01; quality of life: F = 11.58, p<.001). From the perspective of health outcomes, the results found that schools with excellent level (Mean=3.59), good level (Mean=3.52), and fair level (Mean=3.47) were better in students' perceived health status than schools with poor level (Mean=3.38). Similarly, the results showed that schools with excellent level were better in students' well-being (Mean=7.63) and quality of life (Mean=34.56) than schools with poor level (Mean=7.25; 33.56).
Conclusions
Students from schools with excellent levels exhibited better health and social outcomes. The finding suggests that future studies evaluate and track the effectiveness to conduct the longitudinal study, and the HPS program should be effectively implemented and sustained.
Key messages
To explore the effectiveness of the health promoting school program in health and social outcomes. Note: This work was funded by the Health Promotion Administration, Ministry of Health and Welfare. Health promoting schools award level is related to students’ perceived health status, well-being, and quality of life.
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Affiliation(s)
- M Tsai
- Department of Psychology, Fu Jen Catholic University, New Taipei City, Taiwan
| | - F Chen
- Department of Public Health, Fu Jen Catholic University, New Taipei City, Taiwan
| | - D Luh
- Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan
| | - Y Wang
- Health Promotion Administration, Ministry of Health and Welfare, Taipei City, Taiwan
| | - K Lo
- Center for Physical and Health Education, National Sun Yat-sen University, Kaohsiung City, Taiwan
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Huang YQ, Liu L, Yu YL, Lo K, Chen CL, Huang JY, Zhou YL, Feng YQ. The relationship between famine exposure in early life and left atrial enlargement in adulthood. J Hum Nutr Diet 2020; 34:356-364. [PMID: 32830406 DOI: 10.1111/jhn.12802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Increased left atrium diameter (LAD) is associated with an elevated risk of cardiovascular diseases. The relationship between nutrition status and left atrial enlargement (LAE) is still unclear. The present study aimed to investigate the association of famine exposure in early life with LAE in adulthood. METHODS Participants were divided into non-exposed, fetal, early, middle and late childhood exposed groups according to birth data. LAE was defined when LAD was ≥3.9 cm in women and ≥4.1 cm in men, or ≥2.3 cm m-2 by a sex-independent cut-off normalised for body surface area. Multivariate logistic regression was performed to calculate the odds ratio (OR) and confidence interval (CI) between famine exposure and LAE. RESULTS In total, 2522 [905 male, mean (SD) age 59.1 (3.65) years] subjects were enrolled, including 392 (15.5%) LAE subjects. The prevalence of LAE in non-exposed, fetal, early, middle and late childhood exposed groups was 55 (10.8%), 38 (11.2%), 88 (18.1%), 102 (16.7%) and 109 (19.0%), respectively. Compared to the non-exposed group, the ORs for LAE were in fetal (OR = 0.956, 95% CI = 0.605-1.500, P = 0.847), late (OR = 1.748, 95% CI = 1.208-2.555, P = 0.003), middle (OR = 1.647, 95% CI = 1.140-2.403, P = 0.008) and early (OR = 1.630, 95% CI = 1.116-2.399, P = 0.012) childhood exposed groups after adjusting potential cofounders. When stratified by gender, smoking, body mass index, hypertension and diabetes, we found that the effect of famine exposure on LAE was only modified by diabetes (Pinteraction = 0.007). CONCLUSIONS Famine exposure during childhood stage might increase the risk of LAE in adults, and this effect interacts with diabetes.
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Affiliation(s)
- Y-Q Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - L Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Y-L Yu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - K Lo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China.,Department of Epidemiology, Centre for Global Cardio-metabolic Health, Brown University, Providence, USA
| | - C-L Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - J-Y Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Y-L Zhou
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Y-Q Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
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Huang YQ, Lo K, Liu XC, Tang ST, Huang C, Feng YQ. The Relationship Between Fasting Blood Glucose Levels and First Ischemic Stroke in Elderly Hypertensive Patients. Healthc Policy 2020; 13:777-784. [PMID: 32765132 PMCID: PMC7367736 DOI: 10.2147/rmhp.s263213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/01/2020] [Indexed: 01/14/2023] Open
Abstract
Objective The relationship between fasting blood glucose and first ischemic stroke in older adults was unclear, so we explored this association among older patients with hypertension in China. Methods We recruited hypertensive participants with 60 or more of age. Fasting blood glucose concentrations were categorized into quartiles. Hazard ratio (HR) and 95% confidence interval (CI) for ischemic stroke were estimated using multivariate Cox regression analysis and subgroup analysis. Results A total of 3310 (1474 (44.53%) male) patients with mean age of 71.41±7.20 years were included. During the mean follow-up period of 5.5 years, 206 cases of ischemic stroke occurred. After adjusting for potential confounding variables, multivariate adjusted HRs for each standard deviation increment of fasting blood glucose, the risk of ischemic stroke increased by 11% (95% CI: 1.03, 1.21; P= 0.008). In addition, when using the lowest group (Q1) as reference, the multivariate adjusted HRs for first ischemic stroke were 1.76 (95% CI: 1.08, 2.86; P=0.023), 1.73 (95% CI: 1.06, 2.81; P=0.027) and 2.42 (95% CI: 1.49, 3.93; P<0.001) (P for trend<0.001). Subgroup analysis revealed that the association between fasting blood glucose and the risk of ischemic stroke was higher in male (HR: 1.22 vs 1.10), those with uncontrolled hypertension (HR: 1.22 vs 1.10), subjects with diabetes (HR: 1.19 vs 1.10), overweight (HR: 1.19 vs 1.09), smoking habits (HR: 1.33 vs 1.13) and those whose eGFR< 90 (HR: 1.16 vs 1.09). Conclusion Fasting blood glucose was an independent risk factor for the first ischemic stroke among older adults with hypertension. Managing fasting blood glucose may be beneficial for participants with diabetes, poorly controlled blood pressure, had smoking habits, being overweight, and with reduced renal function.
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Affiliation(s)
- Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Xiao-Cong Liu
- Department of Cardiology, Guangdong Cardiovascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Song-Tao Tang
- Department of Internal Medicine, Community Health Center of Liaobu County, Dongguan, People's Republic of China
| | - Cheng Huang
- Department of Cardiology, Guangdong Cardiovascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
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