Predictive Value of the GLIM Criteria in Chinese Community-Dwelling and Institutionalized Older Adults Aged 70 Years and Over

OBJECTIVES

The Global Leadership Initiative on Malnutrition (GLIM) has recently published criteria for classifying malnutrition. This study investigated the associations between malnutrition and adverse outcomes, and identified which component(s) of the GLIM criteria is/are risk factor(s) of adverse outcomes in Chinese older adults.

DESIGN

A prospective cohort study of Chinese older adults in a healthy ageing study.

SETTING

Participants' place of residence.

PARTICIPANTS

Community-dwelling and institutionalized Chinese older adults aged ≥70 years living in Hong Kong.

MEASUREMENTS

Malnutrition at baseline was classified according to selected GLIM criteria. Adverse outcomes including poor self-rated health, functional limitation (Barthel Index), falls, frailty (FRAIL scale), hospitalization and mortality were assessed after a 3-year follow-up. Associations between malnutrition and components of selected GLIM criteria (weight loss, low body mass index (BMI), low muscle mass and disease burden) and each adverse outcome were examined using adjusted binary logistic regression and Cox proportional hazards model. Odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) are presented.

RESULTS

Data of 1576 community-dwelling (45.5% female, 78.1±6.5 years) and 427 institutionalized (69.6% female, 85.5±6.4 years) older adults were included at baseline. Among community-dwelling older adults, malnutrition was associated with frailty (n=899, OR: 2.44, 95% CI: 1.05-5.70) and mortality (n=1007, HR: 1.37, 95% CI: 1.12-1.66). No association was found for other outcomes. Among institutionalized older adults, malnutrition was not associated with any outcomes. Low BMI and low muscle mass were risk factors of frailty; while weight loss was a risk factor of mortality in community-dwelling older adults. Weight loss and disease burden were risk factors of mortality among institutionalized older adults.

CONCLUSION

The association between malnutrition and frailty and mortality was observed in community but not in institutional settings. Further studies are required to draw more definitive conclusions on the use of GLIM criteria in institutional settings.

Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies

BACKGROUND

Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men.

METHODS

In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes.

RESULTS

Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes.

INTERPRETATION

Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained.

FUNDING

UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).

Characterization of particulate-phase polycyclic aromatic hydrocarbons emitted from incense burning and their bioreactivity in RAW264.7 macrophage

This study investigated the effects of particle-bound polycyclic aromatic hydrocarbons (PAHs) produced from burning three incense types on and their bioreactivity in the RAW 264.7 murine macrophage cell line. Gas chromatography/mass spectrometry was used to determine the levels of 16 identified PAHs. Macrophages were exposed to incense particle extracts at concentrations of 0, 3.125, 6.25, 12.5, 25, 50, and 100 μg/mL for 24 h. After exposure, cell viability and nitric oxide (NO) and inflammatory mediator [tumor necrosis factor (TNF)-α] production of the cells were examined. The mean atomic hydrogen (H) to carbon (C) ratios in the environmentally friendly, binchotan charcoal, and lao shan incenses were 0.69, 1.13, and 1.71, respectively. PAH and total toxic equivalent (TEQ) mass fraction in the incenses ranged from 137.84 to 231.00 and 6.73-26.30 pg/μg, respectively. The exposure of RAW 264.7 macrophages to incense particles significantly increased TNF-α and NO production and reduced cell viability. The cells treated with particles collected from smoldering the environmentally friendly incense produced more NO and TNF-α compared to other incenses. Additionally, the TEQ of fluoranthene (FL), pyrene (Pyr), benzo[a]anthracene (BaA), chrysene (Chr), benzo[b]fluoranthene (BbF), benzo[k]fluoranthene (BkF), benzo[a]pyrene (BaP), indeno[1,2,3-cd]pyrene (INP), dibenz[a,h]anthracene (DBA), and benzo[g,h,i]perylene [B(ghi)P] had a significant correlation (R² = 0.64-0.98, P < 0.05) with NO and TNF-α production. The current findings indicate that incense particle-bound PAHs are biologically active and that burning an incense with a lower H/C ratio caused higher bioreactivity. The stimulatory effect of PAH-containing particles on molecular mechanisms of inflammation are critical for future study.

Effect of whole soy and purified daidzein on ambulatory blood pressure and endothelial function--a 6-month double-blind, randomized controlled trial among Chinese postmenopausal women with prehypertension

BACKGROUND/OBJECTIVES

Although observational studies suggest that soy foods or isoflavones are cardio-protective, clinical trials on whole soy or isoflavone daidzein (one major isoflavone and the precursor of equol) on blood pressure (BP) and endothelial function (EF) are few and have not been specifically conducted among equol producers, a population most likely to benefit from soy treatment.

SUBJECTS/METHODS

We performed a 6-month double-blind, randomized, placebo-controlled trial to examine the effect of whole soy (soy flour) or purified daidzein on BP and EF in prehypertensive or untreated hypertensive postmenopausal women verified to be equol producers. A total of 270 eligible women were recruited and randomized to either one of the three treatment groups, 40 g soy flour (whole soy group), 40 g low-fat milk powder+63 mg daidzein (daidzein group) or 40 g low-fat milk powder (active control group) daily, each given as a solid beverage powder for 6 months. The primary outcome measures were 24 h ambulatory BP (ABP) and EF assessed by flow-mediated dilation using brachial artery ultrasound.

RESULTS

A total of 253 subjects completed the study according to protocol. Urinary isoflavones indicated good compliance with the interventions. Intention to treat and per-protocol analysis indicated that there was no significant difference in the 6-month changes or % changes in parameters of ABP and brachial flow-mediated dilation among the three treatment groups. A further subgroup analysis among hypertensive women (n=138) did not alter the conclusions.

CONCLUSIONS

Whole soy and purified daidzein had no significant effect on BP and vascular function among equol-producing postmenopausal women with prehypertension or untreated hypertension.

Catalytic Properties of X-Prolyl Dipeptidyl Aminopeptidase fromLactococcus lactissubsp.cremorisnTR

An X-prolyl dipeptidyl aminopeptidase (X-PDAP; EC 3.4.14.5) was identified to be loosely bound on the inner cell membrane fraction of Lactococcus lactis subsp. cremoris nTR. The biosynthesis of X-PDAP was continuously increased before the late-log growth phase of the bacteria. Both Gly-Pro-pNA and Ala-Ala-pNA were hydrolyzed by X-PDAP; the kcat/Km value of the former was about 10-fold that of the latter. The Ki of X-Pro and Pro-X were more specific to X-PDAP than those of X-Ala. The enzyme splitting a dipeptide sequentially from beta-casomorphin as a model catalytic pattern was identified and some properties of the enzyme were further characterized.

Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults

We pooled bone mineral density (BMD) data published in 91 articles including 139,912 Chinese adults and then established a national-wide BMD reference database at the lumbar spine and femur neck for Chinese adults. The prevalence of osteoporosis in the middle-aged and elderly Chinese population was also estimated.

INTRODUCTION

Well-accepted reference value of BMD is lacking in Chinese. We established the reference database and assessed osteoporosis prevalence based on published literature conducted in the Mainland China, Taiwan, and Hong Kong Chinese.

METHODS

We searched for all published articles indexed in MEDLINE, PubMed, CNKI, and SinoMed up to January 2013. We included cross-sectional studies that examined BMD using a dual-energy X-ray absorptiometry at the femur neck (FN) and/or lumbar spine (LS) in healthy adults. Overall age-specific mean (SD) BMD were pooled after standardization.

RESULTS

Ninety-one studies including 51,906 males and 88,006 females (≥ 20 years) in 38 cities in China were included in this pooling study. Gender- and age-specific reference curves of standardized BMD (sBMD) at the LS and FN were constructed. The sBMD cutoffs for osteoporosis classification were 0.746 and 0.549 in women, and 0.680 and 0.568 g/cm(2) in men; age-standardized prevalence of osteoporosis was 23.9 % and 12.5 % in women and 3.2 % and 5.3 % in men aged ≥ 50 years at the LS and FN, respectively. Meta-regression analysis showed that greater age and altitude, lower latitude, smaller city size, earlier detection time, and random sample were correlated to lower sBMD in at least one gender-specific bone sites; the Hologic DXA produced a higher value of FN sBMD than the other two devices (Lunar and Norland).

CONCLUSION

We have established a national-wide BMD reference database at the LS and FN for Chinese adults and estimated the prevalence of osteoporosis in the middle-aged and elderly Chinese population.

Anti-neuroinflammatory capacity of fresh ginger is attributed mainly to 10-gingerol

Despite the anti-neuroinflammatory capacity of ginger, the corresponding active constituents are unclear. This study analyzed the composition of fresh ginger ethanolic extract by using LC-MS. Inhibitory activities of fresh ginger extract and seven gingerol-related compounds on the neuro-inflammation were also evaluated by using a lipopolysaccharide (LPS)-activated BV2 microglia culture model. Except for zingerone and 6-gingerol, other gingerols and shogaols at a concentration of 20 μM inhibited the production of nitric oxide, IL-1β, IL-6 and TNF-α as well as their mRNA levels in LPS-activated BV2 microglia. Blocking NF-κB activation was the underlying mechanism responsible for inhibiting the proinflammatory gene expression. Increasing the alkyl chain length enhanced the anti-neuroinflammatory capacity of gingerols yet, conversely, attenuated those of shogaols. 6-Gingerol was the most abundant compound in the fresh ginger extract, followed by 10-gingerol. Furthermore, fresh ginger extract exhibited a significant anti-neuroinflammatory capacity, which was largely owing to 10-gingerol, but not 6-gingerol.

Longitudinal changes in physical activity levels over 5 years and relationship to cardiorespiratory fitness in Chinese midlife women

AIM

Better understanding the impact of changes in physical activity levels on cardiorespiratory fitness, as measured by maximal oxygen uptake (VO(2max)) may inform preventive interventions. We aimed to determine longitudinal changes in physical activity levels over 5 years and the relationship between these changes with VO(2max) in a sample of Chinese midlife women.

METHODS

A total of 184 Chinese women aged 50-64 years in Hong Kong were enrolled for this study. Physical activity was assessed with the modified Chinese Baecke questionnaire at baseline (2002-2004) and follow-up (2008-2009). VO(2max) was measured with a symptom-limited maximal exercise test on an electrically braked cycle ergometer at follow-up.

RESULTS

Compared with subjects who were persistently inactive, those who were increasingly/persistently active had significantly higher levels of VO(2max) (P<0.05). Being persistently active was also independently associated with a high level of VO(2max) (OR: 4.4, 95%CI: 1.0-19.2). However, the rate of decline in VO(2max) with age was apparently greater in persistently active subjects compared with their persistently inactive peers, but the differences were not statistically significant.

CONCLUSION

Our findings suggest that maintaining a high level of physical activity may lead to higher levels of VO(2max).

Inhibition of neuroinflammation by cinnamon and its main components

Uncontrolled activation of microglia contributes to neuroinflammation, which is highly involved in the development of neurodegenerative diseases. Although cinnamon has neuro-protective properties, its capacity to inhibit neuroinflammation has not been investigated and its active compounds remain unclear. Therefore, the composition of cinnamon extract was analysed by LC-MS and the ability of cinnamon and its main constituents to inhibit neuroinflammation was evaluated using a lipopolysaccharide (LPS)-activated BV2 microglia culture system. In total, 50 μg/mL cinnamon extract decreased significantly the production and expression of nitric oxide (NO), interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α in LPS-activated BV2 microglia. Blocking of nuclear factor-κB (NF-κB) activation was the most likely mechanism responsible for inhibition by cinnamon of neuroinflammation. Among the eight tested compounds, cinnamaldehyde had the greatest anti-neuroinflammatory capacity. Experimental results suggest that cinnamon may have a potential therapeutic effect against neurodegenerative diseases and its potent anti-neuroinflammatory capacity was primarily attributed to cinnamaldehyde.

The effects of isoflavones combined with soy protein on lipid profiles, C-reactive protein and cardiovascular risk among postmenopausal Chinese women

BACKGROUND & AIMS

Observational studies note that regular dietary soy protein intake (6-11 g day(-1)) has a significant association with lower blood lipids; however, these observations have not been confirmed by clinical trials. This study aimed to ascertain the effects of moderate intake of soy protein (15 g) with isoflavones or isoflavones alone on serum lipid profiles, inflammatory markers (C-reactive protein and uric acid) and composite cardiovascular risk in Chinese postmenopausal, prediabetic women.

METHODS AND RESULTS

A double-blind randomised, placebo-controlled trial was conducted among 180 postmenopausal Chinese women with prediabetes or early untreated diabetes, aged 46-70 years and, on average, 6.0 years since menopause. Participants were randomly assigned to one of the three arms to receive 15-g soy protein and 100-mg isoflavone (Soy group), or 15-g milk protein and 100 mg isoflavone (Iso group) or 15-g milk protein (placebo group) on a daily basis for 6 months. The results showed that no significant difference was observed in serum high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), triaclyglycerol (TG), high sensitive C-reactive protein and a composite 10-year cardiovascular risk between the three groups at both 3 and 6 months. Serum uric acid marginally increased by 1.22% in the Soy group and decreased by 4.28% and 4.82% in the Iso and placebo groups at 3 months (P = 0.087), but no difference was observed at 6 months (P = 0.264).

CONCLUSION

Soy protein with isoflavones or isoflavones alone at the provided dosage showed no significantly beneficial effects on measured cardiovascular risk factors in postmenopausal Chinese women with early hyperglycaemia.

Higher sea fish intake is associated with greater bone mass and lower osteoporosis risk in postmenopausal Chinese women

SUMMARY

We examined the cross-sectional association of the intakes of different types of fishes with bone mass and osteoporosis risk in postmenopausal Chinese women. We found that higher intake of sea fish is independently associated with greater bone mass and lower osteoporosis risk among postmenopausal Chinese women.

INTRODUCTION

Fish contains many important nutrients that are beneficial on bone health, but limited data on the relationship between fish intake and bone health are available. We examined the association of the intakes of different types of fishes with bone mineral density (BMD) and bone mineral content (BMC) and osteoporosis risk.

METHODS

This population-based cross-sectional study was conducted among 685 postmenopausal Chinese women. Habitual dietary intakes were assessed using food frequency questionnaire. BMD and BMC at the whole body, lumbar spine, and left hip were measured with dual-energy x-ray absorptiometry.

RESULTS

After adjusting for the potential confounders, we observed dose-dependent relations between sea fish intake and BMDs, BMCs, and osteoporosis risk; the mean BMDs were 3.2-6.8% higher, and BMCs 5.1-9.4% higher in the top quintile groups (Q5) of sea fish intake than in the bottom quintile (Q1) at the whole body and hip sites (p < 0.05); the odds ratios (95% confidence interval (CI)) for osteoporosis (T-score < -2.5) in Q5 were 0.23 (0.08-0.66), 0.12 (0.03-0.59), and 0.06 (0.01-0.44) compared with those in Q1 at the whole body, total hip, and femur neck, respectively. No independent association between consumption of freshwater fish or shellfish and bone mass was observed.

CONCLUSION

Higher intake of sea fish is independently associated with greater bone mass and lower osteoporosis risk among postmenopausal Chinese women.

Menopausal transition and changes of body composition: a prospective study in Chinese perimenopausal women

OBJECTIVES

Whether age or menopause per se influences fat distribution remains controversial. This study aimed to investigate the change of body composition, particularly body fat distribution, in relation to menopausal transition in a 30-month prospective study of perimenopausal women.

METHODS

A total of 438 community-based healthy women aged 44-55 years participated in the Hong Kong Perimenopausal Women Osteoporosis Study. Data were obtained at baseline, and at 9-, 18- and 30-month during the follow-up. Soft tissue measurements consisting of fat mass and lean muscle mass of the trunk and whole body were obtained by the dual energy X-ray absorptiometry. Percentage change of body measurements over the follow-up period was compared between women who remained premenopausal, those who went through menopausal transition, and those who were menopausal since baseline.

RESULTS

A slight decrease in the lean mass but an increase in the total fat mass and trunk fat mass (TFM) over the follow-up period were noted. Multivariate linear regression analysis showed that age was negatively associated with an increase in central obesity. Adjusted for the important predictors--age, age of menarche and education level, menopausal status was a significant and independent predictor of the decrease in lean mass and the increase in percent of body fat, TFM and trunk-leg fat mass ratio.

CONCLUSION

Our 30-month longitudinal study showed that menopause has an independent effect on an increase in fat mass, and an increase in central obesity in perimenopausal Chinese women.

Cost-effectiveness analysis of influenza and pneumococcal vaccination for Hong Kong elderly in long-term care facilities

BACKGROUND

To compare cost and quality-adjusted life-years (QALYs) gained by influenza vaccination with or without pneumococcal vaccination in the elderly living in long-term care facilities (LTCFs).

METHODS

Cost-effectiveness analysis based on Markov modelling over 5 years, from a Hong Kong public health provider's perspective, on a hypothetical cohort of LTCF residents aged > or = 65 years. Benefit-cost ratio (BCR) and net present value (NPV) of two vaccination strategies versus no vaccination were estimated. The cost and QALYs gained by two vaccination strategies were compared by Student's t-test in probabilistic sensitivity analysis (10,000 Monte Carlo simulations).

RESULTS

Both vaccination strategies had high BCRs and NPVs (6.39 and US$334 for influenza vaccination; 5.10 and US$332 for influenza plus pneumococcal vaccination). In base case analysis, the two vaccination strategies were expected to cost less and gain higher QALYs than no vaccination. In probabilistic sensitivity analysis, the cost of combined vaccination and influenza vaccination was significantly lower (p<0.001) than the cost of no vaccination. Both vaccination strategies gained significantly higher (p<0.001) QALYs than no vaccination. The QALYs gained by combined vaccination were significantly higher (p = 0.030) than those gained by influenza vaccination alone. The total cost of combined vaccination was significantly lower (p = 0.011) than that of influenza vaccination.

CONCLUSION

Influenza vaccination with or without pneumococcal vaccination appears to be less costly with higher QALYs gained than no vaccination, over a 5-year period, for elderly people living in LTCFs from the perspective of a Hong Kong public health organisation. Combined vaccination was more likely to gain higher QALYs with lower total cost than influenza vaccination alone.

Public health significance of the frailty index

BACKGROUND

A quantifiable indicator of frailty would be very useful in assessing the health state of older populations, as well as enable the effect of interventions to be evaluated over time.

METHODS

A total of 2032 people aged 70 years and over recruited by stratified random sampling, and information obtained regarding physical and functional health, and psychological factors. The frailty index (FI) was constructed from 62 variables. Associations between the FI, and changes in ADL score, mental score, and hospitalization days over a 10-year period were evaluated.

RESULTS

For the baseline to 3-year changes, a 0.10 increase in baseline FI is accompanied by a 0.499-point faster drop in ADL score, a 0.223-point faster decline in mental score, and 4.57-day faster increase in hospital days. For 3-10-year changes, frailty was a significant predictor only of changes in mental score, with results indicating that, on average, each increase of 0.10 in the baseline frailty index was associated with 0.613-point drop in mental score during this period. Chronological age and frailty had differential associations with those changes.

CONCLUSION

The FI is a valid indicator of morbidity and requirement for health and social services for ageing populations.

Change in bone mineral density and its determinants in pre- and perimenopausal Chinese women: the Hong Kong Perimenopausal Women Osteoporosis Study

This 30-month study investigating bone change and its determinants in 438 perimenopausal Chinese women revealed that the fastest bone loss occurred in women undergoing menopausal transition but maintenance of body weight and physical fitness were beneficial for bone health. Soy protein intake also seemed to exert a protective effect.

INTRODUCTION

This 30-month follow-up study aims to investigate change in bone mineral density and its determinants in Hong Kong Chinese perimenopausal women.

METHODS

Four hundred and thirty-eight women aged 45 to 55 years were recruited through random telephone dialing and primary care clinic. Bone mass, body composition, lifestyle measurements were obtained at baseline and at 9-, 18- and 30-month follow-ups. Univariate and stepwise multiple regression analyses were performed with the regression coefficients of BMD/C (derived from baseline and follow-up measurements) as the outcome variables. Menopausal status was classified as pre- or postmenopausal or transitional.

RESULTS

Menopausal status was the strongest determinant of bone changes. An annual bone loss of about 0.5% was observed among premenopausal, 2% to 2.5% among transitional, and about 1.5% in postmenopausal women. Multiple regression analyses, revealed that a positive regression slope of body weight was protective for follow-up bone loss at all sites. Number of pregnancy, soy protein intake and walking were protective for total body BMC. Higher baseline LM was also protective for neck of femur BMD.

CONCLUSION

Maintenance of body weight and physical fitness were observed to have a protective effect on for bone loss in Chinese perimenopausal women.

Investigation of heat treating conditions for enhancing the anti-inflammatory activity of citrus fruit (Citrus reticulata) peels

In traditional Chinese medicine, dried citrus fruit peels are widely used as remedies to alleviate coughs and reduce phlegm in the respiratory tract. Induction of inducible nitric oxide synthase (iNOS) in inflammatory cells and increased airway production of nitric oxide (NO) are well recognized as key events in inflammation-related respiratory tract diseases. Despite the fact that the enhancing effect of heat treatment on the antioxidant activity of citrus fruit peels has been well documented, the impact of heat treatment on citrus peel beneficial activities regarding anti-inflammation is unclear. To address this issue, we determined the anti-inflammatory activities of heat-treated citrus peel extracts by measuring their inhibitory effect upon NO production by lipopolysaccharide-activated RAW 264.7 macrophages. Results showed that the anti-inflammatory activity of citrus peel was significantly elevated after 100 degrees C heat treatment in a time-dependent fashion during a period from 0 to 120 min. Inhibition of iNOS gene expression was the major NO-suppressing mechanism of the citrus peel extract. Additionally, the anti-inflammatory activity of citrus peel extract highly correlated with the content of nobiletin and tangeretin. Conclusively, proper and reasonable heat treatment helped to release nobiletin and tangeretin, which were responsible for the increased anti-inflammatory activity of heat-treated citrus peels.

Suppressive effect of a proanthocyanidin-rich extract from longan (Dimocarpus longan Lour.) flowers on nitric oxide production in LPS-stimulated macrophage cells

Anthocyanidins found in certain flowers have been shown to act as strong antioxidants in various systems, exhibiting multiple biological actions. The antioxidative effects of water extract and ethanolic extract of longan (Dimocarpus longan Lour.) flowers were evaluated by radical scavenging activity and compared to those of gallic acid, myricetin, and epigallocatechin gallate. In this study, the suppressive effects of longan flower extracts on nitric oxide and prostaglandin E2 production were investigated using a lipopolysaccharide-stimulated RAW 264.7 cell model. Abundant levels of phenolic compounds including flavonoids, condensed tannins, and proanthocyanidins were found in water or ethanolic extracts prepared from dried longan flowers. The antioxidative effect of longan flower extract was similar to the effect exhibited by pure antioxidants. Moreover, longan flower extract showed prominent inhibitory effects on prostaglandin E2 production. Significant concentration-dependent inhibition of nitric oxide production was detected when cells were cotreated with lipopolysaccharide and various concentrations of longan flower extracts. These inhibitory effects were further attributed to suppression of inducible nitric oxide synthase protein expression and not to reduced enzymatic activity. These results suggest that longan flower crude extracts, especially ethanolic extract, have antioxidant and anti-inflammatory effects, and the probable mechanism involves inhibition of inflammation by proanthocyanidins. Preliminary observations suggest that longan flower extract, especially alcoholic extract, could be another potential source of natural dietary antioxidant and anti-inflammatory agent.

Heat treatment enhances the NO-suppressing and peroxynitrite-intercepting activities of kumquat (Fortunella margarita Swingle) peel

In Taiwan, folk remedies containing dried kumquats (Fortunella margarita Swingle) are used to cure inflammatory respiratory disorders. The induction of inducible nitric oxide (NO) synthase in inflammatory cells and increased airway production of NO and peroxynitrite, its derivative, are key events in such disorders. Although heat is known to affect the antioxidant activity of citrus peels, the effects of dehydration and heating on NO suppression and on the interception of peroxynitrite are unclear. We determined the NO-suppressing activities of freeze-dried, oven-dried, and heat-treated kumquat extracts by measuring their inhibition of NO production in lipopolysaccharide-activated RAW 264.7 macrophages. Furthermore, we evaluated the attenuation of peroxynitrite-mediated nitrotyrosine formation in albumin. Heating, but not oven drying, enhanced the ability of kumquat peels to suppress NO and intercept peroxynitrite, as compared with freeze drying. However, heat treatment and oven drying of kumquat flesh attenuated these activities; these effects were at least partially attributed to heat-susceptible ascorbate.

Protective capacities of certain spices against peroxynitrite-mediated biomolecular damage

Peroxynitrite, a potent cytotoxic agent, can damage a variety of biomolecules such as proteins, lipids, and DNA, and is considered as one of the major pathological causes of several diseases. Therefore, it would appear likely that interception of peroxynitrite by certain dietary compounds may represent one mechanism by which such foods may exert their beneficial action in vivo. A number of researchers have speculated that certain spices, rich in phenolics, may, conceivably, act as potential protectors against the actions of peroxynitrite. Eight culinary spices including cardamom, cinnamon, cloves, cumin, nutmeg, paprika, rosemary and turmeric were selected for study purposes. Further, the protective effects of methanol extracts of such spices against peroxynitrite-mediated damage to proteins, lipids and DNA were evaluated as determined by these extracts' ability to attenuate the formation of, respectively, nitrotyrosine in albumin, thiobarbiturate acid-reactive substances (TBARS) in liposome and strand breakages for plasmid DNA. All of the tested spices exerted some level of protective ability against peroxynitrite-mediated biomolecular damage. Amongst them, cloves deserve special attention due to their outstanding protective abilities against two of three forms of peroxynitrite-mediated biomolecular damage. Additionally, the phenolic content of certain spices appears to correlate well with such spices' protective effect against peroxynitrite-mediated tyrosine nitration and lipid peroxidation. Such an observation indicates that phenolics present in the spices contributed to such spice-elicited protection against peroxynitrite toxicity.

Evaluation of NO-suppressing activity of several Mediterranean culinary spices

Excess nitric oxide (NO) produced by inducible nitric oxide synthase (iNOS) is implicated in the development of a number of diseases. Due to the absence of any natural specific enzymatic defense system in vivo, the consumption of certain foods which exhibit selective suppressive ability as regards NO overproduction might boost the host's protective effects against NO-mediated toxicity. Spices, rich in phenolics, are speculated conceivably to act as potential NO-scavengers or iNOS suppressors. The relative NO-suppressing activity of methanol extracts deriving from nine Mediterranean culinary spices was determined by measuring their inhibitory effect upon NO production for lipopolysaccharide (LPS)-activated RAW 264.7 macrophages. In addition, the specifics of the suppressing mechanism were further explored. All of the spices tested, with the exception of clove, displayed a rather linear dose-dependent NO-suppressing effect without there appearing to exist any effect upon cell viability. Furthermore, the NO-suppressing capacity of certain spices was able to be ranked based upon their IC(50) (the concentration of spice extracts is required to cause 50% inhibition of NO production by LPS-activated RAW 264.7 cells), the ranking appearing as: rosemary (0.031%)>tarragon (0.052%)>cinnamon (0.059%)>oregano (0.106%)>basil (0.162%)>marjoram (0.236%)>allspice (0.269%)>and thyme (0.270%). Only cinnamon displayed excellent NO-scavenging ability, whereas all of the other spices demonstrated moderate to poor activities in this regard. Moreover, the inhibitory effect of tested spices upon the iNOS protein level was almost equivalent to their suppressive effect upon NO production. It would appear that inhibition of iNOS expression was the primary mechanism of action of spices as regards their exerting NO-suppressing activity.

Social determinants of frailty

BACKGROUND

Frailty represents a body-wide set of a linked deterioration that occurs with ageing, but is susceptible to active intervention and is reversible. The concept of frailty should include broader environmental factors. A quantitative measure of frailty, the frailty index (FI), developed for elderly Canadians and shown to be valid for an elderly Chinese population, was examined for its association with socioeconomic, lifestyle, and social support network factors in an elderly Chinese cohort.

OBJECTIVE

2,032 people aged 70 years and over recruited by stratified random sampling of the population were surveyed in 1990-1991, and information obtained regarding physical and functional health, psychological factors, lifestyle, socioeconomic and social support factors. The FI was constructed from 62 variables covering cognitive, psychological and physical health, and tested for association with socioeconomic, lifestyle and social support factors using ANOVA and t test.

RESULTS

The mean FI for women was higher than for men (0.16 +/- 0.08, n = 1,033 vs. 0.13 +/- 0.08, n = 999, p < 0.001, t test). For men, increasing frailty was observed with non-white collar occupations, inadequate expenses, no or little exercise, abstinence from alcohol, few relatives or neighbours and no or infrequent participation in helping others. For women, little contact with relatives (rather than number of relatives), and absence of participation in community/religious activities were additional factors.

CONCLUSION

FI is influenced by social and environmental factors in keeping with the concept of frailty being multi-dimensional. Such a quantitative measure may be a useful indicator of the health of elderly populations as well as for public health measures to combat frailty.

Validity of body mass index and waist circumference in the classification of obesity as compared to percent body fat in Chinese middle-aged women

OBJECTIVE

To evaluate the validity of currently recommended obesity cutoffs of body mass index (BMI, in kg/m(2)) and waist circumference (WC, in cm) for Asians by the WHO/IASO/IOTF and for Chinese by the Working Group on Obesity in China (WGOC) using the percentage body fat (%BF)-obesity criteria.

DESIGN

A cross-sectional study.

SUBJECTS

A total of 1122 community-based Hong Kong Chinese women aged between 41 and 63 years.

MEASUREMENTS

Total %BF and percent truncal fat (%TF) were measured using dual-energy X-ray absorptiometry. Anthropometric indices were measured using standard methods.

RESULTS

Regression analyses showed that the BMI cutoffs of 23, 24, 25, and 28 kg/m(2) corresponded to the %BF of 34.8, 35.9, 36.9 and 39.5%, and the 80 cm WC corresponded to 34% TF, respectively. Compared with the %BF obesity cutoff (>/=40%), the WHO/IASO/IOTF BMI-obesity criterion (>/=25) shows a good sensitivity (75%) and specificity (71%); and the WGOC criterion (BMI>/=28) had a low sensitivity (41%) but an excellent specificity (93%), respectively. Corresponding to the BMI cutoffs of 23, 24, 25 and 28 kg/m(2), the %BF cutoffs associated with peak kappa statistic were 33, 34, 35 and 40%, and the relevant %TF linked with 80 cm WC was 33%, respectively.

CONCLUSION

BMI and WC have a good accuracy in the prediction of obesity. Our findings suggest that the WGOC BMI cutoffs are appropriate, but 80 cm of WC is a very rigorous cutoff for this population when using the criteria of 34 and 40% of body fat or truncal fat for overweight and obesity.

Depression is the predominant factor contributing to morale as measured by the Philadelphia Geriatric Morale Scale in elderly Chinese aged 70 years and over

OBJECTIVE

To examine factors contributing to the total Philadelphia Geriatric Morale Scale (PGMS) and its two subscales: reconciled ageing and unstrained affect.

METHOD

The PGMS was administered to 759 community-living subjects aged 70 years and over. Information regarding socioeconomic status, health conditions, sensory impairment, physical symptoms, social support, activities of daily living as measured by the Barthel Index, life satisfaction, and the Geriatric Depression Score, was collected. Associations between these factors and PGMS and its subscale were examined using univariate analysis (Mann-Whitney; Kruskal-Wallis tests), and multivariate analysis using the classification and regression tree (CART) method.

RESULTS

Gender, old age, physical, socioeconomic and social factors were significantly associated with PGMS. There was a strong correlation with GDS (r = 0.77, p < 0.001). In the CART analysis, for both subscales and the total score, GDS was the predominant factor contributing to the score. Other factors include self perception of health, enough expenses, overall satisfaction with life, gender, and constipation.

DISCUSSION

The PGMS and GDS are closely related. In addition to the GDS, health perception, life satisfaction, and adequate finance were factors contributing to quality of life in elderly Hong Kong Chinese.

Maternal plasma adiponectin concentrations at 24 to 31 weeks of gestation: negative association with gestational diabetes mellitus

OBJECTIVE

Adiponectin is an adipocyte-derived hormone with antidiabetic, antiatherosclerotic, and antiinflammatory properties. This study investigated the relations between maternal adiponectin concentration and gestational diabetes mellitus (GDM) and other metabolic parameters during midpregnancy.

METHODS

Two-hour 75-g oral glucose tolerance tests were performed in 253 pregnant women at 24 to 31 wk of gestation. Two hundred nineteen who had normal glucose tolerance (NGT) and 34 women who had GDM and their newborns were investigated. Fasting maternal blood samples were drawn to determine plasma concentrations of adiponectin, glucose, insulin, C-peptide, free fatty acid, and blood lipids. Blood samples at 1 and 2 h after an oral glucose load were obtained to measure plasma glucose, insulin, and C-peptide concentrations.

RESULTS

Plasma adiponectin concentrations were significantly lower in women who had GDM than in those who had NGT (P = 0.014). Maternal age, body mass index (before pregnancy and at blood collection), and plasma level of free fatty acid were significantly greater in those who had GDM than in those who had NGT. Logistic regression analysis showed that maternal adiponectin level and GDM were significantly correlated (P = 0.043), but that the correlation became weaker (P = 0.116) after adjusting for maternal body mass index and plasma level of free fatty acid before pregnancy. In the NGT group, maternal adiponectin concentrations were significantly negatively correlated with plasma fasting insulin, fasting C-peptide, fasting C-peptide/fasting glucose ratio, 2-h glucose, triacylglycerol, and maternal body mass index and positively correlated with high-density lipoprotein cholesterol concentration. In the GDM group, maternal adiponectin level was negatively correlated with neonatal birth weight.

CONCLUSIONS

Midpregnancy hypoadiponectinemia may be associated with a higher risk of GDM.

Lack of relationship between beta3-adrenergic receptor gene polymorphism and gestational diabetes mellitus in a Taiwanese population

The Trp64Arg polymorphism of beta(3)-adrenergic receptor (ADRB3) has been reported to be associated with insulin resistance and gestational diabetes mellitus (GDM). The objective of this study is to investigate whether the ADRB3 Arg variant confers susceptibility to GDM in a Taiwanese population. A total of 299 pregnant women (mean +/- SD, 31.1 +/- 4.2 years) was recruited. Two-hour, 75-g oral glucose tolerance tests (OGTT) were conducted at 24 to 31 weeks gestation (28.3 +/- 1.6 weeks). Forty-one GDM subjects and 258 controls with normal glucose tolerance (NGT) level were genotyped for the ADRB3 Trp64Arg polymorphism. The genotype distribution and allele frequency of ADRB3 did not significantly differ between GDM and NGT subjects (9.8% v 14.5%). Body weight gain during pregnancy was not different between ADRB3 genotypes. However, the GDM subjects with the Arg64 variant had higher fasting (P =.04) and postload 120 minutes (P =.03) insulin levels as compared with the GDM subjects with the Trp64Trp allele. In all subjects, the women with the Arg64 allele (n = 76) had significantly higher level of insulin secretion (the ratio of Deltainsulin(60)/Deltaglucose(60)) during OGTT than those without (n = 223) (P =.03) despite similar plasma levels of glucose and insulin in both genotypes. Our results indicated that the ADRB3 Trp64Arg variant is not related to the development of GDM and has no effect on obesity during pregnancy in a Taiwanese population. However, ADRB3 polymorphism might be a possible determinant of insulin resistance.

Cord plasma concentrations of adiponectin and leptin in healthy term neonates: positive correlation with birthweight and neonatal adiposity

OBJECTIVE

Adiponectin is negatively associated with leptin, insulin and obesity in children and adults. Whereas increases in fetal insulin and leptin are associated with increased weight and adiposity at birth, the role of adiponectin in fetal growth has not yet been determined. The aims of this study were to examine the relationships between adiponectin and insulin, leptin, weight and adiposity at birth in healthy term infants.

DESIGN AND METHODS

Anthropometric parameters including weight, length, circumferences and skinfold thickness were measured, and plasma lipid profiles, insulin, leptin and adiponectin concentrations in cord blood samples from 226 singleton infants born at term after uncomplicated pregnancies were assayed.

RESULTS

Cord plasma adiponectin, leptin and insulin levels correlated significantly and positively with birthweight (P = 0.001, P < 0.001, P < 0.001, respectively) and the sum of skinfold thicknesses (P < 0.001, P < 0.001, P < 0.001, respectively). Mean cord plasma adiponectin and leptin levels, but not insulin level, were significantly higher in large-for-gestational-age (LGA) infants compared with appropriate-for-gestational-age (AGA) infants. Cord plasma leptin concentration, but not adiponectin concentration, was significantly higher in female infants than in male infants (P = 0.003 and P = 0.94, respectively). Cord plasma adiponectin concentration correlated positively with leptin level (P = 0.007) but not with insulin level (P = 0.78).

CONCLUSIONS

High adiponectin levels are present in the cord blood. Cord plasma adiponectin and leptin levels are positively correlated with birthweight and adiposity. This suggests that adiponectin may be involved in regulating fetal growth.

Thyroid autoantibody profiles in ophthalmic dominant and thyroid dominant Graves' disease differ and suggest ophthalmopathy is a multiantigenic disease

BACKGROUND

Thyroid-associated ophthalmopathy (TAO) occurs in 25-50% of patients with Graves' disease (GD) and is occasionally seen in hypothyroid Hashimoto's disease or euthyroid individuals. The link between TAO and hyperthyroidism remains unclear. We hypothesized that qualitative or quantitative differences in thyroid antibodies might determine individual predisposition to these features.

METHODS

In a prospective study over 3 years, thyroid antibody levels were measured in all patients diagnosed at the Singapore National Eye Centre to have GD. These patients had no known history of thyroid disease, presented with eye complaints and diagnosis was made by an ophthalmologist. A total of 31 patients were identified. Antibody levels were compared against 71 consecutive patients referred to a thyroid clinic (TC) for thyrotoxic symptoms in whom the diagnosis of GD was confirmed by a thyroidologist.

FINDINGS

Thyroid autoantibody profiles of patients diagnosed at the ophthalmology centre (OC) and TC differed markedly. OC patients had significantly higher TSI (P = 0.003) but lower TPOAb (P = 0.008) and TgAb levels (P < 0.001). In contrast, TC patients had higher free T4 (P = 0.048) and higher TBII levels (P < 0.001). Antibody levels were correlated with four parameters of ophthalmopathy--chronic lid retraction, lid swelling, proptosis and extraocular myopathy (EOM). On univariate logistic regression analysis, TSI was a positive predictor and TPOAb and TgAb negative predictors of all four features. In the absence of TgAb, the odds ratios for individual TAO features ranged from 2.8 to 7.9, with corresponding values of 3.9-10.2 when TPOAb was absent. In stepwise logistic regression analysis, TSI was the strongest independent predictor of all aspects studied: lid fullness P = 0.001, proptosis P = 0.001, lid retraction P = 0.008, EOM P = 0.009. Among smokers, TPOAb were significantly lower (P = 0.044) but no association between smoking and the other antibodies was observed.

INTERPRETATION

The study demonstrates markedly different thyroid autoantibody profiles in newly diagnosed GD patients with ophthalmic dominant as opposed to thyroid dominant features. It suggests differing antibody patterns are associated with predisposition to hyperthyroidism and orbitopathy. In addition, an association between smoking and low TPOAb levels was noted.

Restless legs symptoms in thyroid disorders

Dopaminergic dysfunction is associated with thyroid disorders and restless legs syndrome (RLS). In a 'face-to-face' interview, we evaluated for RLS using the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG) in patients diagnosed biochemically with either hyper- or hypothyroidism, and in controls without thyroid disorders. Amongst 146 consecutive patients with biochemically confirmed thyroid disorders, none satisfied all the IRLSSG criteria of RLS, similar to the control population (0.2%, 1/434). However, we found 8.2% (12/146) with RLS-like symptoms (satisfied the first 3 IRLSSG criteria) compared to 0.9% (4/434) in the controls (p < 0.0001). Four (33.3%) of these patients reported complete resolution of these symptoms after treatment for their thyroid condition. In conclusion, while RLS-like symptoms were observed in some patients with thyroid disorders, our study demonstrates no significant difference of RLS prevalence between patients with thyroid disorders and euthyroid controls.

Diet and glucose tolerance in a Chinese population

BACKGROUND

Associations between dietary factors and glucose tolerance observed in Caucasian populations may not be applicable to Chinese populations, since the traditional Chinese diet contains plentiful vegetables and is rice-based (which has a lower glycemic index than potatoes). To address this question, the dietary patterns in 988 Hong Kong Chinese subjects with normal and impaired glucose tolerance, and diabetes, were examined in a cross sectional survey to determine if there is any association between diet and glucose tolerance.

METHOD

A stratified random population sample of 988 subjects (488 male, 500 female) was recruited. A food frequency questionnaire was used to determine dietary intake, and glucose tolerance was examined using the glucose tolerance test and the WHO criteria used to classify subjects into the three glucose tolerance categories.

RESULTS

Using the standardized world population of Segi, the prevalence rate for DM was 6.6% for men and 5.7% for women; and for IGT 10.3% for men and 15.4% for women aged 30-64 y. Abnormal glucose tolerance is associated with female gender, older age, lower educational attainment and higher body mass index (BMI). No clear pattern of association with dietary factors was observed after adjusting for confounding factors. However, if subjects with BMI>or=25 kg/m(2) were excluded, an increase in mean consumption of rice/noodles/pasta per week was observed in the DM group, after adjusting for total energy intake and other confounding factors. No association between dietary variety, which has been linked with body fatness, and glucose tolerance, was observed.

CONCLUSION

Dietary habit may not be a strong risk factor for the development of glucose intolerance in Chinese populations, given the favorable features of the Chinese diet. The high consumption of rice in the DM subjects who are of normal BMI suggests that further studies examining glycemic indices of Chinese food items may be beneficial. Obesity still remains the most important predisposing factor.

EMG myokymia as a cause of ptosis in hypothyroidism

Ptosis is known to be associated with thyroid disorders. We describe two biochemically corrected hypothyroid patients presenting with isolated bilateral ptosis. EMG of the orbicularis oculi showed continuous grouped motor unit potentials. In the absence of obvious aetiology, it is hypothesised that focal demyelination of terminal branches to the orbicularis oculi may play a role in the generation of the discharges.

Is waist circumference a useful measure in predicting health outcomes in the elderly?

OBJECTIVE

To examine the effect of age on the relationship between body mass index (BMI) and waist circumference (WC), and the usefulness of BMI, WC and waist-hip ratio (WHR) in predicting mortality and cardiovascular risk in the elderly population.

DESIGN

Longitudinal observational study of 36 months duration.

SUBJECTS AND METHOD

A stratified random sample of 2,032 Chinese subjects (990 male, 1,033 female) mean age (s.d.) 80.1 (7.5), interviewed and examined at baseline and after 36 months. Deaths and presence of diabetes mellitus and hypertension were documented. A younger data set of 1,010 subjects (500 male, 510 female), mean age (s.d.) 45.5 (11.6), was used for comparison of the BMI-WC relationship between younger and older subjects. In predicting outcomes using different values of BMI, WC and WHR, receiver operating characteristic curve analysis was used to derive cut-off values with optimal sensitivity and specificity, and the likelihood ratios for mortality, diabetes and hypertension for different anthropometric values were plotted.

RESULTS

The waist circumference values corresponding to BMI values of 25 and 30 kg/m(2) were higher in elderly (92 and 103 cm for men; 88 and 99 cm for women) compared with younger subjects (85 and 97 cm for men; 78 and 88 cm for women). BMI and WC are inversely associated with mortality, in both men and women, positively associated with diabetes in men but not in women. WC was positively associated with hypertension in men and women. WHR was not associated with any outcome measures. The anthropometric measurement at the point of intersection of the likelihood curves for mortality and diabetes may be considered the optimum value, being BMI=21 kg/m(2) for men and 25 kg/m(2) for women, WC between 80 and 85 cm, and WHR 0.88-0.90.

CONCLUSION

Waist measurement values for predicting health outcomes in elderly people aged 70 y and over are different compared with younger subjects, and have similar predictive accuracy compared with body mass index. Waist-hip ratio is not a useful predictor.