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Lee C, Tseng T, Chang R, Yen H, Chen Y, Chen Y, Wu C, Hu M, Yen M, Bongers M, Groot OQ, Lai C, Lin W. Psoas muscle area is an independent survival prognosticator in patients undergoing surgery for long-bone metastases. Cancer Med 2024; 13:e7072. [PMID: 38457220 PMCID: PMC10922028 DOI: 10.1002/cam4.7072] [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: 09/13/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Predictive analytics is gaining popularity as an aid to treatment planning for patients with bone metastases, whose expected survival should be considered. Decreased psoas muscle area (PMA), a morphometric indicator of suboptimal nutritional status, has been associated with mortality in various cancers, but never been integrated into current survival prediction algorithms (SPA) for patients with skeletal metastases. This study investigates whether decreased PMA predicts worse survival in patients with extremity metastases and whether incorporating PMA into three modern SPAs (PATHFx, SORG-NG, and SORG-MLA) improves their performance. METHODS One hundred eighty-five patients surgically treated for long-bone metastases between 2014 and 2019 were divided into three PMA tertiles (small, medium, and large) based on their psoas size on CT. Kaplan-Meier, multivariable regression, and Cox proportional hazards analyses were employed to compare survival between tertiles and examine factors associated with mortality. Logistic regression analysis was used to assess whether incorporating adjusted PMA values enhanced the three SPAs' discriminatory abilities. The clinical utility of incorporating PMA into these SPAs was evaluated by decision curve analysis (DCA). RESULTS Patients with small PMA had worse 90-day and 1-year survival after surgery (log-rank test p < 0.001). Patients in the large PMA group had a higher chance of surviving 90 days (odds ratio, OR, 3.72, p = 0.02) and 1 year than those in the small PMA group (OR 3.28, p = 0.004). All three SPAs had increased AUC after incorporation of adjusted PMA. DCA indicated increased net benefits at threshold probabilities >0.5 after the addition of adjusted PMA to these SPAs. CONCLUSIONS Decreased PMA on CT is associated with worse survival in surgically treated patients with extremity metastases, even after controlling for three contemporary SPAs. Physicians should consider the additional prognostic value of PMA on survival in patients undergoing consideration for operative management due to extremity metastases.
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Affiliation(s)
- Chia‐Che Lee
- Graduate Institute of Biomedical Electronics and BioinformaticsNational Taiwan UniversityTaipeiTaiwan
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
| | - Ting‐En Tseng
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
| | - Ruey‐Feng Chang
- Graduate Institute of Biomedical Electronics and BioinformaticsNational Taiwan UniversityTaipeiTaiwan
| | - Hung‐Kuan Yen
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
- Department of Orthopaedic SurgeryNational Taiwan University HospitalHsinchuTaiwan
- Department of Medical EducationNational Taiwan University HospitalHsinchuTaiwan
| | - Yu‐An Chen
- Department of Medical EducationNational Taiwan University HospitalTaipeiTaiwan
| | - Yu‐Yung Chen
- Department of Medical EducationNational Taiwan University HospitalTaipeiTaiwan
| | - Chih‐Horng Wu
- Department of Medical ImagingNational Taiwan University HospitalTaipeiTaiwan
| | - Ming‐Hsiao Hu
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
| | - Mao‐Hsu Yen
- Department of Computer Science and EngineeringNational Taiwan Ocean UniversityKeelungTaiwan
| | - Michiel Bongers
- Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
| | - Olivier Q. Groot
- Department of Orthopaedic SurgeryMassachusetts General HospitalBostonMassachusettsUSA
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Cheng‐Yo Lai
- Department of Orthopaedic SurgeryNational Taiwan University HospitalHsinchuTaiwan
| | - Wei‐Hsin Lin
- Department of Orthopaedic SurgeryNational Taiwan University HospitalTaipeiTaiwan
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Lee TY, Chen YA, Groot OQ, Yen HK, Bindels BJJ, Pierik RJ, Hsieh HC, Karhade AV, Tseng TE, Lai YH, Yang JJ, Lee CC, Hu MH, Verlaan JJ, Schwab JH, Yang RS, Lin WH. Comparison of eight modern preoperative scoring systems for survival prediction in patients with extremity metastasis. Cancer Med 2023. [PMID: 37306656 DOI: 10.1002/cam4.6097] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/20/2023] [Accepted: 05/06/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Survival is an important factor to consider when clinicians make treatment decisions for patients with skeletal metastasis. Several preoperative scoring systems (PSSs) have been developed to aid in survival prediction. Although we previously validated the Skeletal Oncology Research Group Machine-learning Algorithm (SORG-MLA) in Taiwanese patients of Han Chinese descent, the performance of other existing PSSs remains largely unknown outside their respective development cohorts. We aim to determine which PSS performs best in this unique population and provide a direct comparison between these models. METHODS We retrospectively included 356 patients undergoing surgical treatment for extremity metastasis at a tertiary center in Taiwan to validate and compare eight PSSs. Discrimination (c-index), decision curve (DCA), calibration (ratio of observed:expected survivors), and overall performance (Brier score) analyses were conducted to evaluate these models' performance in our cohort. RESULTS The discriminatory ability of all PSSs declined in our Taiwanese cohort compared with their Western validations. SORG-MLA is the only PSS that still demonstrated excellent discrimination (c-indexes>0.8) in our patients. SORG-MLA also brought the most net benefit across a wide range of risk probabilities on DCA with its 3-month and 12-month survival predictions. CONCLUSIONS Clinicians should consider potential ethnogeographic variations of a PSS's performance when applying it onto their specific patient populations. Further international validation studies are needed to ensure that existing PSSs are generalizable and can be integrated into the shared treatment decision-making process. As cancer treatment keeps advancing, researchers developing a new prediction model or refining an existing one could potentially improve their algorithm's performance by using data gathered from more recent patients that are reflective of the current state of cancer care.
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Affiliation(s)
- Tse-Ying Lee
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-An Chen
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Olivier Q Groot
- Department of Orthopaedic Surgery, University Medical Center Utrecht-Utrecht University, Utrecht, Netherlands
- Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, USA
| | - Hung-Kuan Yen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Hsin-Chu, Taiwan
- Department of Medical Education, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Bas J J Bindels
- Department of Orthopaedic Surgery, University Medical Center Utrecht-Utrecht University, Utrecht, Netherlands
| | - Robert-Jan Pierik
- Department of Orthopaedic Surgery, University Medical Center Utrecht-Utrecht University, Utrecht, Netherlands
- Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, USA
| | - Hsiang-Chieh Hsieh
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Aditya V Karhade
- Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, USA
| | - Ting-En Tseng
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Hsiang Lai
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Jing-Jen Yang
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Che Lee
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Hsiao Hu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jorrit-Jan Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht-Utrecht University, Utrecht, Netherlands
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, USA
| | - Rong-Sen Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Hsin Lin
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Phikulsod P, Sukpanichnant S, Kunacheewa C, Chieochansin T, Junking M, Yenchitsomanus PT. High prevalence of Wilms tumor 1 expression in multiple myeloma and plasmacytoma: A cohort of 142 Asian patients' samples. Pathol Oncol Res 2023; 29:1610844. [PMID: 36760714 PMCID: PMC9902379 DOI: 10.3389/pore.2023.1610844] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
Wilms tumor 1 (WT1) is a promising target antigen for cancer immunotherapy. However, WT1 protein expression and its clinical correlation in multiple myeloma (MM) patients are still limited. We, therefore, investigated WT1 expression in 142 bone marrow and plasmacytoma samples of MM patients at different stages of the disease by immunohistochemistry. The correlations between WT1 expression and clinical parameters or treatment outcomes were evaluated. The overall positive rate of WT1 expression was 91.5%; this high prevalence was found in both bone marrow and plasmacytoma samples, regardless of the disease status. Cytoplasmic WT1 expression was correlated with high serum free light chain ratio at presentation. However, no significant association between WT1 expression and treatment outcome was observed. This study confirms the high prevalence of WT1 expression in an Asian cohort of MM, encouraging the development of immunotherapy targeting WT1 in MM patients, particularly in those with extramedullary plasmacytoma or relapsed disease.
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Affiliation(s)
- Ployploen Phikulsod
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Division of Molecular Medicine, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,International Graduate Program in Immunology, Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sanya Sukpanichnant
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chutima Kunacheewa
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thaweesak Chieochansin
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Division of Molecular Medicine, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mutita Junking
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Division of Molecular Medicine, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,*Correspondence: Mutita Junking, ; Pa-Thai Yenchitsomanus,
| | - Pa-Thai Yenchitsomanus
- Siriraj Center of Research Excellence for Cancer Immunotherapy (SiCORE-CIT), Division of Molecular Medicine, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,*Correspondence: Mutita Junking, ; Pa-Thai Yenchitsomanus,
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Prateepchaiboon T, Chang A, Pungpipattrakul N, Akarapatima K, Rattanasupar A, Songjamrat A, Pakdeejit S, Piratvisuth T. Factors affecting prognosis in hepatocellular carcinoma patients post-transarterial chemoembolization. Indian J Gastroenterol 2022; 41:352-361. [PMID: 36029371 DOI: 10.1007/s12664-021-01227-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/27/2021] [Accepted: 10/08/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND To evaluate the factors influencing the achievement of a sustained complete response (CR) and overall survival (OS) in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). METHODS We retrospectively reviewed the records of HCC patients who underwent TACE as the first modality of treatment between 2014 and 2019. We investigated the factors affecting sustained CR (no recurrence within 6 months) and OS (time from diagnosis until either death or last follow-up). RESULTS The study enrolled 161 patients; 159 (98.8%) had cirrhosis. Post-TACE, 19.9% (32/161) achieved sustained CR. In the multivariate analysis, a tumor size < 5 cm was a positive factor for achieving sustained CR (odds ratio, 5.012; p = 0.006). In the proportional hazards model, the factors associated with decreased survival included alcohol-related liver disease (hazards ratio [HR] 1.683; p = 0.036), presence of symptoms (HR 1.816; p = 0.005) and portal hypertension (HR 1.608; p = 0.038) at initial diagnosis, serum alpha-fetoprotein (AFP) > 100 ng/mL (HR 2.082; p < 0.001), and higher Child-Pugh classification (HR 1.1.639; p = 0.024). Achievement of sustained CR (HR, 0.355; p = 0.002) was independently associated with increased survival. CONCLUSIONS The tumor size was a predictive factor for sustained CR. Alcohol-related liver disease, presence of symptoms and portal hypertension at initial diagnosis, elevated serum AFP, liver reserve status, and achieved sustained CR were independent factors affecting survival. We demonstrated the effect of alcohol-related liver disease on survival after TACE. Our results will aid physicians in the management and prognostication of HCC.
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Affiliation(s)
| | - Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand.
| | | | - Keerati Akarapatima
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand
| | - Attapon Rattanasupar
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand
| | - Apiradee Songjamrat
- Division of Intervention Radiology, Department of Radiology, Hatyai Hospital, Songkhla, Thailand
| | - Songklod Pakdeejit
- Division of Intervention Radiology, Department of Radiology, Hatyai Hospital, Songkhla, Thailand
| | - Teerha Piratvisuth
- NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkhla University, Songkhla, Thailand
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Yen HK, Ogink PT, Huang CC, Groot OQ, Su CC, Chen SF, Chen CW, Karhade AV, Peng KP, Lin WH, Chiang H, Yang JJ, Dai SH, Yen MH, Verlaan JJ, Schwab JH, Wong TH, Yang SH, Hu MH. A machine learning algorithm for predicting prolonged postoperative opioid prescription after lumbar disc herniation surgery. An external validation study using 1,316 patients from a Taiwanese cohort. Spine J 2022; 22:1119-30. [PMID: 35202784 DOI: 10.1016/j.spinee.2022.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Preoperative prediction of prolonged postoperative opioid prescription helps identify patients for increased surveillance after surgery. The SORG machine learning model has been developed and successfully tested using 5,413 patients from the United States (US) to predict the risk of prolonged opioid prescription after surgery for lumbar disc herniation. However, external validation is an often-overlooked element in the process of incorporating prediction models in current clinical practice. This cannot be stressed enough in prediction models where medicolegal and cultural differences may play a major role. PURPOSE The authors aimed to investigate the generalizability of the US citizens prediction model SORG to a Taiwanese patient cohort. STUDY DESIGN Retrospective study at a large academic medical center in Taiwan. PATIENT SAMPLE Of 1,316 patients who were 20 years or older undergoing initial operative management for lumbar disc herniation between 2010 and 2018. OUTCOME MEASURES The primary outcome of interest was prolonged opioid prescription defined as continuing opioid prescription to at least 90 to 180 days after the first surgery for lumbar disc herniation at our institution. METHODS Baseline characteristics were compared between the external validation cohort and the original developmental cohorts. Discrimination (area under the receiver operating characteristic curve and the area under the precision-recall curve), calibration, overall performance (Brier score), and decision curve analysis were used to assess the performance of the SORG ML algorithm in the validation cohort. This study had no funding source or conflict of interests. RESULTS Overall, 1,316 patients were identified with sustained postoperative opioid prescription in 41 (3.1%) patients. The validation cohort differed from the development cohort on several variables including 93% of Taiwanese patients receiving NSAIDS preoperatively compared with 22% of US citizens patients, while 30% of Taiwanese patients received opioids versus 25% in the US. Despite these differences, the SORG prediction model retained good discrimination (area under the receiver operating characteristic curve of 0.76 and the area under the precision-recall curve of 0.33) and good overall performance (Brier score of 0.028 compared with null model Brier score of 0.030) while somewhat overestimating the chance of prolonged opioid use (calibration slope of 1.07 and calibration intercept of -0.87). Decision-curve analysis showed the SORG model was suitable for clinical use. CONCLUSIONS Despite differences at baseline and a very strict opioid policy, the SORG algorithm for prolonged opioid use after surgery for lumbar disc herniation has good discriminative abilities and good overall performance in a Han Chinese patient group in Taiwan. This freely available digital application can be used to identify high-risk patients and tailor prevention policies for these patients that may mitigate the long-term adverse consequence of opioid dependence: https://sorg-apps.shinyapps.io/lumbardiscopioid/.
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Luo Z, Dong X, Yu J, Xia Y, Berry KP, Rao R, Xu L, Xue P, Chen T, Lin Y, Yu J, Huang G, Li H, Zhou W, Lu QR. Genomic and Transcriptomic Analyses Reveals ZNF124 as a Critical Regulator in Highly Aggressive Medulloblastomas. Front Cell Dev Biol 2021; 9:634056. [PMID: 33681213 PMCID: PMC7930499 DOI: 10.3389/fcell.2021.634056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/26/2020] [Accepted: 01/28/2021] [Indexed: 12/21/2022] Open
Abstract
Medulloblastoma (MB) is the most common malignant pediatric brain tumor, however, the mechanisms underlying tumorigenesis in different MB subgroups remain incompletely understood. Although previous studies of MB predisposition have been conducted in tertiary referral centers primarily in Caucasian cohorts, it is not unclear clear whether there exist population-specific genetic alterations in MBs. In this study, we investigated the contribution of genomic and transcriptomic alterations to the risk of malignant MB in the Chinese population (designated as the Asian cohort). We analyze the genomic and transcriptomic alterations of the Asian MB cohort by using a combination of whole-exome sequencing (WES) and RNA-deep-sequencing. In addition, we integrate publicly available data with the Asian MB cohort and identify a subset of potential MB-driving genes specifically enriched in each of the MB subgroups. We further characterize a newly identified group-3-enriched transcriptional regulator, ZNF124, and demonstrate that ZNF124 is critical for the growth of the most aggressive group-3 MB cells. Together, our analyses indicate conserved yet distinct genetic alterations and gene expression patterns of MBs between different ethnic groups. Our studies further provide an important resource for identifying potential tumor-driving factors in MBs, enhancing our understanding of the disease process for developing ethnically targeted therapies in patients with MB.
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Affiliation(s)
- Zaili Luo
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Xinran Dong
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Jianzhong Yu
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Yong Xia
- Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Kalen P Berry
- Brain Tumor Center, Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rohit Rao
- Brain Tumor Center, Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lingli Xu
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Ping Xue
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Tong Chen
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Yifeng Lin
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Jiyang Yu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Guoying Huang
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Hao Li
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Wenhao Zhou
- Key Laboratory of Birth Defects, Children's Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Q Richard Lu
- Brain Tumor Center, Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Lee PC, Tham KW, Ganguly S, Tan HC, Eng AKH, Dixon JB. Ethnicity Does Not Influence Glycemic Outcomes or Diabetes Remission After Sleeve Gastrectomy or Gastric Bypass in a Multiethnic Asian Cohort. Obes Surg 2019; 28:1511-1518. [PMID: 29280058 DOI: 10.1007/s11695-017-3050-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/25/2022]
Abstract
BACKGROUND In Asia, metabolic-bariatric surgery (MBS) rates have grown rapidly in parallel with rising prevalence of obesity and type 2 diabetes (T2D). OBJECTIVE The objective of this study was to identify factors that influence glycemic outcomes and diabetes remission 12 months after sleeve gastrectomy (SG) or gastric bypass (GB) in a multiethnic Asian cohort. SETTING The study's setting was in a tertiary hospital in Singapore. METHODS Data from 145 T2D patients who had SG (37%) or GB (63%) and at least 1-year follow-up were analyzed. Diabetes remission was defined as hemoglobin A1c ≤ 6.0% without diabetes medications. Analysis involved binary logistic regression to identify predictors and general linear regression for variables associated with glycemic improvement after surgery. RESULTS Baseline parameters are as follows: BMI 40.0 ± 7.6 kg/m2, A1c 8.4 ± 1.6%, diabetes duration 9.3 years, ethnic composition: Chinese (51.7%), Malay (23.4%), Indian (20.7%), Others (4.1%). 55.9% achieved diabetes remission at 1 year. Baseline A1c, baseline BMI, and diabetes duration were significant pre-operative factors for remission (cumulative R 2 = 0.334). At 12 months, percentage weight loss was similar after SG (24.1 ± 7.4%) and GB (25.4 ± 7.4%, p = 0.31). Greater A1c decrease was seen with GB compared to SG (2.7 ± 1.6 vs 2.0 ± 1.5%, p = 0.006), significant even after adjustment for weight loss, age, BMI, baseline A1c, and diabetes duration (p = 0.033). Weight loss at 12 months also correlated independently with A1c reduction. Ethnicity did not influence weight loss, diabetes remission, or glycemic control after MBS. CONCLUSION Baseline A1c, baseline BMI, and diabetes duration independently predict diabetes remission after MBS. GB is more effective in controlling T2D compared to SG despite similar weight loss, whereas ethnicity does not play a significant role in the multiethnic Asian cohort.
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Affiliation(s)
- Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, 20 College Rd, Singapore, 169856, Singapore.
| | - Kwang Wei Tham
- Department of Endocrinology, Singapore General Hospital, 20 College Rd, Singapore, 169856, Singapore
| | - Sonali Ganguly
- Department of Endocrinology, Singapore General Hospital, 20 College Rd, Singapore, 169856, Singapore
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, 20 College Rd, Singapore, 169856, Singapore
| | - Alvin Kim Hock Eng
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - John B Dixon
- Clinical Obesity Research, Baker Heart and Diabetes Institute, Melbourne, Australia
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Quah PL, Ng JC, Fries LR, Chan MJ, Aris IM, Lee YS, Yap F, Godfrey KM, Chong YS, Shek LP, Tan KH, Forde CG, Chong MFF. Longitudinal Analysis Between Maternal Feeding Practices and Body Mass Index (BMI): A Study in Asian Singaporean Preschoolers. Front Nutr 2019; 6:32. [PMID: 31001535 PMCID: PMC6454195 DOI: 10.3389/fnut.2019.00032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/09/2018] [Accepted: 03/06/2019] [Indexed: 12/13/2022] Open
Abstract
Bidirectional studies between maternal feeding practices with subsequent child weight are limited, with no studies in Asian populations. In longitudinal analyses, we assessed the directionality of the associations between maternal feeding practices and body mass index (BMI) in preschoolers. Participants were 428 mother child dyads from the GUSTO (Growing Up in Singapore Toward healthy Outcomes) cohort. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ) at age 5 y. Child BMI was measured at ages 4 and 6 y. BMI and maternal feeding practices subscales were transformed to SD scores and both directions of their associations examined with multivariable linear regression and pathway modeling. Higher BMI at age 4 was associated with lower encouragement of balance and variety (β = −0.33; 95%CI: −0.53, −0.13), lower pressure to eat (β = −0.49; −0.68, −0.29) and higher restriction (β = 1.10; 0.67, 1.52) at age 5, adjusting for confounders and baseline feeding practices at 3 years. In the reverse direction, only pressure and restriction at age 5 were associated with lower and higher child BMI at age 6 years, respectively. After the adjustment for baseline BMI at age 5, the association with pressure was attenuated to non-significance (β = 0.01 (−0.01, 0.03), while the association with restriction remained significant (β = 0.02; 0.002, 0.03). Overall, associations from child BMI to maternal restriction for weight control and pressure feeding practices was stronger than the association from these maternal feeding practices to child BMI (Wald's statistics = 24.3 and 19.5, respectively; p < 0.001). The strength and directionality suggests that the mothers in the Asian population were likely to adopt these feeding practices in response to their child's BMI, rather than the converse. Clinical Trial Registry Number and Website This study was registered at clinicaltrials.gov as NCT01174875 (www.clinicaltrials.gov, NCT01174875).
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Affiliation(s)
- Phaik Ling Quah
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Jing Chun Ng
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Lisa R Fries
- Nestlé Research, Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Mei Jun Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.,Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Paediatric Endocrinology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Fabian Yap
- Departments of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital, Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.,Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lynette P Shek
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Divisions of Pediatric Allergy, Immunology, and Rheumatology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.,Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ciaran G Forde
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Clinical Nutrition Research Center, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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9
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Papier K, Jordan S, D'Este C, Banwell C, Yiengprugsawan V, Seubsman SA, Sleigh A. Social Demography of Transitional Dietary Patterns in Thailand: Prospective Evidence from the Thai Cohort Study. Nutrients 2017; 9:nu9111173. [PMID: 29077031 PMCID: PMC5707645 DOI: 10.3390/nu9111173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/18/2017] [Accepted: 10/25/2017] [Indexed: 12/01/2022] Open
Abstract
In recent decades, a health-risk transition with changes in diet and lifestyle in low and middle-income countries (LMICs) led to an emergence of chronic diseases. These trends in Southeast Asian LMICs are not well studied. Here, we report on transitional dietary patterns and their socio-demographic predictors in Thai adults. Dietary data in 2015 were from a random sub-sample (N = 1075) of 42,785 Thai Cohort Study (TCS) members who completed all three TCS surveys (2005, 2009, 2013). Principle Component Analysis identified dietary patterns and multivariable linear regression assessed associations (Beta estimates (ß) and confidence intervals (CIs)) between socio-demographic factors and dietary intake pattern scores. Four dietary patterns emerged: Healthy Transitional, Fatty Western, Highly Processed, and Traditional. In women, higher income (≥30,001 Baht/month vs. ≤10,000) and managerial work (vs. office assistant) was associated with lower scores for Traditional (ß = −0.67, 95% CI −1.15, −0.19) and Fatty Western diets (ß = −0.60, 95% CI −1.14, −0.05), respectively. University education associated with lower Highly Processed (ß = −0.57, 95% CI −0.98, −0.17) and higher Traditional diet scores (ß = 0.42, 95% CI 0.03, 0.81). In men and women, urban residence associated with higher Fatty Western and lower Traditional diets. Local policy makers should promote healthy diets, particularly in urban residents, in men, and in low-SEP adults.
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Affiliation(s)
- Keren Papier
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, ANU College of Health & Medicine, The Australian National University, Canberra 2601, Australia.
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia.
| | - Susan Jordan
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia.
- The School of Public Health, The University of Queensland, Brisbane 4006, Australia.
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, ANU College of Health & Medicine, The Australian National University, Canberra 2601, Australia.
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle 2308, Australia.
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, ANU College of Health & Medicine, The Australian National University, Canberra 2601, Australia.
| | - Vasoontara Yiengprugsawan
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, ANU College of Health & Medicine, The Australian National University, Canberra 2601, Australia.
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra 2601, Australia.
| | - Sam-Ang Seubsman
- Thai Health-Risk Transition Study, School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi 11120, Thailand.
| | - Adrian Sleigh
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, ANU College of Health & Medicine, The Australian National University, Canberra 2601, Australia.
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10
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Papier K, D'Este C, Bain C, Banwell C, Seubsman SA, Sleigh A, Jordan S. Body mass index and type 2 diabetes in Thai adults: defining risk thresholds and population impacts. BMC Public Health 2017; 17:707. [PMID: 28915801 PMCID: PMC5602842 DOI: 10.1186/s12889-017-4708-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/12/2017] [Accepted: 09/04/2017] [Indexed: 01/21/2023] Open
Abstract
Background Body mass index (BMI) cut-off values (>25 and >30) that predict diabetes risk have been well validated in Caucasian populations but less so in Asian populations. We aimed to determine the BMI threshold associated with increased type 2 diabetes (T2DM) risk and to calculate the proportion of T2DM cases attributable to overweight and obesity in the Thai population. Methods Participants were those from the Thai Cohort Study who were diabetes-free in 2005 and were followed-up in 2009 and 2013 (n = 39,021). We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the BMI-T2DM association. We modelled non-linear associations using restricted cubic splines. We estimated population attributable fractions (PAF) and the number of T2DM incident cases attributed to overweight and obesity. We also calculated the impact of reducing the prevalence of overweight and obesity on T2DM incidence in the Thai population. Results Non-linear modelling indicated that the points of inflection where the BMI-T2DM association became statistically significant compared to a reference of 20.00 kg/m2 were 21.60 (OR = 1.27, 95% CI 1.00–1.61) and 20.03 (OR = 1.02, 95% CI 1.02–1.03) for men and women, respectively. Approximately two-thirds of T2DM cases in Thai adults could be attributed to overweight and obesity. Annually, if prevalent obesity was 5% lower, ~13,000 cases of T2DM might be prevented in the Thai population. Conclusions A BMI cut-point of 22 kg/m2, one point lower than the current 23 kg/m2, would be justified for defining T2DM risk in Thai adults. Lowering obesity prevalence would greatly reduce T2DM incidence. Electronic supplementary material The online version of this article (10.1186/s12889-017-4708-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keren Papier
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia. .,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia. .,National Centre for Epidemiology & Population Health, The Australian National University, Building 62, Mills Road, Canberra, ACT, 2601, Australia.
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | - Chris Bain
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | - Sam-Ang Seubsman
- Thai Health-Risk Transition Study, School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, Thailand
| | - Adrian Sleigh
- National Centre for Epidemiology and Population Health (NCEPH) and Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | - Susan Jordan
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,The School of Public Health, The University of Queensland, Brisbane, Australia
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