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ABSTRACT: OBJECTIVE: The primary aim of this article was to evaluate measurement equivalence of the English and Chinese versions of the Short Form 36 version 2 (SF-36v2) and Short Form 6D (SF-6D). STUDY DESIGN AND SETTING: In this cross-sectional study, health-related quality of life (HRQoL) was measured from 4,973 ethnic Chinese subjects using the SF-36v2 questionnaire. Measurement equivalence of domain and utility scores for the English- and Chinese-language SF-36v2 and SF-6D were assessed by examining the score differences between the two languages using linear regression models, with and without adjustment for known determinants of HRQoL. Equivalence was achieved if the 90% confidence interval (CI) of the differences in scores, due to language, fell within a predefined equivalence margin. RESULTS: Compared with English-speaking Chinese, Chinese-speaking Chinese were significantly older (47.6 vs. 55.5 years). All SF-36v2 domains were equivalent after adjusting for known HRQoL. SF-6D utility/items had the 90% CI either fully or partially overlap their predefined equivalence margin. CONCLUSION: The English- and Chinese-language versions of the SF-36v2 and SF-6D demonstrated equivalence.
Journal of clinical epidemiology 03/2013; · 2.96 Impact Factor
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ABSTRACT: PURPOSE: We aimed to evaluate the measurement properties of the Singapore English and Chinese versions of the Short-Form 36 version 2 (SF-36v2) Questionnaire, an improved version of the widely used SF-36, for assessing health-related quality of life (HRQoL) in a multi-ethnic urban Asian population in Singapore. METHODS: SF-36v2 scores and data on medical history, demographic and lifestyle factors from the Singapore Prospective Study Programme were analyzed. Convergent and divergent validity, internal consistency, floor and ceiling effects, known group validity and factor structure of the SF-36v2 were assessed for the English and Chinese versions, respectively. RESULTS: Complete data for 4,917 participants (45.8 %) out of 10,747 eligible individuals were analyzed (survey language: 4,115 English and 802 Chinese). Item-scale correlations exceeded 0.4 for all items of the English SF-36v2 and for all except one item of the Chinese SF-36v2 (bathe and dress: item-scale correlation: 0.36). In the English SF-36v2, Cronbach's alpha exceeded 0.70 for all scales. In the Chinese SF-36v2, Cronbach's alpha exceeded 0.7 on all scales except social functioning (Cronbach's alpha: 0.68). For known groups validity, respondents with chronic medical conditions expectedly reported lower SF-36v2 score on most English and Chinese SF-36v2 scales. In confirmatory factor analysis, the Singapore three-component model was favored over the United States two-component and Japan three-component models. CONCLUSIONS: The English and Chinese SF-36v2 are valid and reliable for assessing HRQoL among English and Chinese-speaking Singaporeans. Test-retest reliability and responsiveness of the English and Chinese SF-36v2 in Singapore remain to be evaluated.
Quality of Life Research 03/2013; · 2.30 Impact Factor
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ABSTRACT: PURPOSE: Obesity adversely affects health-related quality of life (HRQoL). Most studies have used body mass index (BMI) to measure obesity. Other measures of obesity, such as waist circumference (WC) or waist-to-hip ratio (WHR), may be better predictors of cardiovascular disease and mortality. We, therefore, examined the associations between other anthropometric measures and HRQoL in a multi-ethnic Asian population. METHODS: In this follow-up study from four previous cross-sectional surveys, HRQoL was measured, at follow-up, using the Short-Form 36 version 2 (SF-36v2) questionnaire. Linear regression was used to assess the relationship between anthropometric measures [BMI, WC, waist residuals (WR) (generated by regressing WC on BMI), WHR, waist-to-height ratio (WHtR) and height (Ht)] and HRQoL. We compared the models' R (2), Akaike's information criteria (AIC), and Schwarz Bayesian information criteria (BIC) from the different models. RESULTS: Among 4,981 subjects, 47.6 % were men aged 50.6 ± 12.2 and women aged 49.3 ± 11.6 years. All gender-specific anthropometric measures were significantly correlated with BMI, except WR. After adjusting for known determinants of HRQoL, we found significant associations between BMI, WC and WHtR with SF-36v2 Physical Component Summary (PCS) scores in women but not men. In contrast, after adjusting for known determinants of HRQoL, WR and WHR were significantly associated with SF-36v2 Mental Component Summary (MCS) scores in men, but not women. R², AIC and BIC were similar for all anthropometric measures in the final model. CONCLUSIONS: The associations between measures of central obesity and HRQoL differed between men and women. In women, associations were seen with SF-36v2 PCS, but measures of central obesity did not have significant associations with HRQoL after controlling for BMI. In men, an association between WC and SF-36v2 MCS was statistically significant independent of BMI. These gender differences require further investigation.
Quality of Life Research 05/2012; · 2.30 Impact Factor
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ABSTRACT: To compare the prevalence and risk factors of diabetes (DM) and diabetic retinopathy (DR) in a multi-ethnic Asian population of Chinese, Malays, and Indians in Singapore.
A total of 2919 individuals participated in a population-based, cross-sectional study in Singapore of Chinese (n = 1633), Malays (n = 658), and Indians (n = 628) aged 40 to 95 years, with retinal photographs, graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. DM was defined as fasting plasma glucose ≥ 7 mmol/L, self-reported physician-diagnosed diabetes, and use of glucose-lowering medication.
The overall age-standardized prevalence of diabetes was 13.8% (Chinese, 11.5%; Malays, 17.1%; and Indians, 21.6%; P < 0.0001). Among persons with diabetes (n = 401), the overall age-standardized prevalence of DR was 25.4% (20.1%, 24.8%, and 28.9% in Chinese, Malays, and Indians, respectively; P = 0.290). In multivariate analysis, longer diabetes duration (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.09, per year increase), higher glycated hemoglobin (OR 1.25; 95% CI, 1.01-1.54, per 1% increase), and serum creatinine levels (OR, 1.01; 95% CI, 1.00-1.03, per mg/dL increase) were the independent risk factors of DR in the whole population. Race was not found to be associated with DR (OR, 1.35; CI, 1.00-1.83). The associations of major risk factors with DR were similar among the three ethnic groups.
There was a significant difference in the prevalence of diabetes between Chinese, Malays, and Indians. The main risk factors of DR, similar among the three ethnic groups, are longer diabetes duration, higher hbA1c, and higher creatinine levels. No significant racial differences were found in the prevalence of DR among persons with diabetes.
Investigative ophthalmology & visual science 08/2011; 52(10):7586-92. · 3.43 Impact Factor
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ABSTRACT: PURPOSE. The aim of this study was to examine the relationship of physical activity and television (TV) viewing time with retinal vascular caliber in a multiethnic Asian population. METHODS. Chinese, Indian, and Malay participants (n = 3866) were examined cross-sectionally in the Singapore Prospective Study Program (2004-2007). Leisure-time physical activity and TV viewing time were assessed by the use of an interviewer-administered questionnaire. Retinal arteriolar and venular calibers were measured from digital retinal photographs. RESULTS. After adjusting for demographic, behavioral, and medical factors, those in the lowest quartile of leisure-time physical activity had a wider venular caliber (by 1.51 μm; 95% confidence interval [CI], 0.01-2.92) compared with those in the highest quartile. Using sex- and ethnicity-specific quartiles, stronger associations were noted in males (2.23 μm; 95% CI, 0.10-4.38) and Chinese (2.52 μm; 95% CI, 0.44-4.59) participants. Females who watched >2 hours of TV per day had a narrow arteriolar caliber (by 1.28 μm; 95% CI, -2.56--0.03), compared with the arteriolar caliber of those who watched less TV. CONCLUSIONS. Lower physical activity and higher TV viewing time (in females) were adversely associated with retinal microvascular caliber among Asian adults. Additional cross-sectional and longitudinal studies are needed to further clarify the potential mediating role of the microvasculature in the relationship between these behavioral risk factors and poor cardiometabolic health outcomes.
Investigative ophthalmology & visual science 07/2011; 52(9):6522-8. · 3.43 Impact Factor
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ABSTRACT: Higher coffee consumption has been associated with a lower risk of type 2 diabetes in cohort studies, but the physiological pathways through which coffee affects glucose metabolism are not fully understood. The aim of this study was to evaluate the associations between habitual coffee and tea consumption and glucose metabolism in a multi-ethnic Asian population and possible mediation by inflammation.
We cross-sectionally examined the association between coffee, green tea, black tea and Oolong tea consumption and glycemic (fasting plasma glucose, HOMA-IR, HOMA-beta, plasma HbA1c) and inflammatory (plasma adiponectin and C-reactive protein) markers in a multi-ethnic Asian population (N = 4139).
After adjusting for multiple confounders, we observed inverse associations between coffee and HOMA-IR (percent difference: - 8.8% for ≥ 3 cups/day versus rarely or never; Ptrend = 0.007), but no significant associations between coffee and inflammatory markers. Tea consumption was not associated with glycemic markers, but green tea was inversely associated with plasma C-reactive protein concentrations (percent difference: - 12.2% for ≥ 1 cup/day versus < 1 cup/week; Ptrend = 0.042).
These data provide additional evidence for a beneficial effect of habitual caffeinated coffee consumption on insulin sensitivity, and suggest that this effect is unlikely to be mediated by anti-inflammatory mechanisms.
Nutrition Journal 06/2011; 10:61. · 2.48 Impact Factor
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ABSTRACT: The development of obesity-related metabolic disorders varies with ethnicity. We examined whether ethnicity modifies the relationship between BMI and three metabolic pathways (insulin resistance, inflammation, and adiponectin) that are involved in the pathogenesis of diabetes and cardiovascular disease (CVD).
We analyzed data from 4,804 Chinese, Malay, and Asian-Indian residents of Singapore with complete data on insulin resistance (IR), C-reactive protein (CRP), and total adiponectin levels. Linear regression models with an interaction term ethnicity*BMI were used to evaluate whether ethnicity modifies the association between BMI and IR, CRP, and adiponectin.
In both uni- and multivariate analyses, BMI was directly associated with IR and CRP and inversely with adiponectin across all ethnic groups. When compared with Chinese and Malays, Asian-Indians had higher IR and CRP and lower adiponectin levels. The associations between BMI and its metabolic pathways were significantly stronger in Chinese than in other ethnic groups. The increase in IR and CRP and the decrease in adiponectin for each unit increase in BMI were greater in Chinese than in other ethnic groups. The findings were similar when waist circumference was used in the analyses instead of BMI.
The impact of BMI on IR, CRP, and adiponectin appears greater in Chinese as compared with other major Asian ethnic groups. This may partly explain the rapid increase in the prevalence of diabetes and CVD in Chinese populations and highlights the importance of weight management in Asian ethnic groups despite the apparently low levels of obesity.
Diabetes care 04/2011; 34(5):1120-6. · 8.09 Impact Factor
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ABSTRACT: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis and is associated with increased cardiovascular morbidity and mortality. We describe the prevalence and risk factors of PAD in a multi-ethnic Asian population (Chinese, Malays and Indians) in Singapore. The Singapore Prospective Study Program recruited 4132 individuals between 2004 and 2006 in which the ankle-brachial index (ABI) was measured using the Smartdop™ 20EX bi-directional blood flow detector. PAD was defined as ≤ 0.9 and a high ABI > 1.4, with ABI 1.11-1.20 as reference. The mean age (SD) of individuals in the study was 49.9 (11.8) years, with 51.8% females. PAD was present in 4.3% of the population and a high ABI (> 1.4) was rare. Malays and Indians had a higher risk (especially in females). Compared to those with an ABI between 1.11 and 1.20, those with PAD were more likely to be of Malay and Indian ethnicity, female sex, with higher systolic blood pressure and pulse pressure, with increased prevalence of diabetes mellitus, hypertension, albuminuria and renal impairment, and with a past history of stroke. In conclusion, in this large multi-ethnic Asian population, we document the distribution and risk factor associations for PAD. PAD shows an ethnic distribution similar to that of coronary artery disease in Singapore, with differences in sex distribution. Apart from traditional vascular risk factors, pulse pressure, renal impairment and a past history of stroke are important determinants of PAD.
Vascular Medicine 03/2011; 16(2):87-95. · 1.46 Impact Factor
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ABSTRACT: Physical activity patterns of a population remain mostly assessed by the questionnaires. However, few physical activity questionnaires have been validated in Asian populations. We previously utilized a combination of different questionnaires to assess leisure time, transportation, occupational and household physical activity in the Singapore Prospective Study Program (SP2). The International Physical Activity Questionnaire (IPAQ) has been developed for a similar purpose. In this study, we compared estimates from these two questionnaires with an objective measure of physical activity in a multi-ethnic Asian population.
Physical activity was measured in 152 Chinese, Malay and Asian Indian adults using an accelerometer over five consecutive days, including a weekend. Participants completed both the physical activity questionnaire in SP2 (SP2PAQ) and IPAQ long form. 43 subjects underwent a second set of measurements on average 6 months later to assess reproducibility of the questionnaires and the accelerometer measurements. Spearman correlations were used to evaluate validity and reproducibility and correlations for validity were corrected for within-person variation of accelerometer measurements. Agreement between the questionnaires and the accelerometer measurements was also evaluated using Bland Altman plots.
The corrected correlation with accelerometer estimates of energy expenditure from physical activity was better for the SP2PAQ (vigorous activity: r = 0.73; moderate activity: r = 0.27) than for the IPAQ (vigorous activity: r = 0.31; moderate activity: r = 0.15). For moderate activity, the corrected correlation between SP2PAQ and the accelerometer was higher for Chinese (r = 0.38) and Malays (r = 0.57) than for Indians (r = -0.09). Both questionnaires overestimated energy expenditure from physical activity to a greater extent at higher levels of physical activity than at lower levels of physical activity. The reproducibility for moderate activity (accelerometer: r = 0.68; IPAQ: r = 0.58; SP2PAQ: r = 0.55) and vigorous activity (accelerometer: 0.52; IPAQ: r = 0.38; SP2PAQ: r = 0.75) was moderate to high for all instruments.
The agreement between IPAQ and accelerometer measurements of energy expenditure from physical activity was poor in our Asian study population. The SP2PAQ showed good validity and reproducibility for vigorous activity, but performed less well for moderate activity particularly in Indians. Further effort is needed to develop questionnaires that better capture moderate activity in Asian populations.
BMC Medical Research Methodology 01/2011; 11:141. · 2.67 Impact Factor
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ABSTRACT: The benefits of regular physical activity for quality of life and disease prevention have been well documented. Identification of low activity groups would facilitate interventional programs. Many studies have focussed on leisure time activity, which may not capture the spectrum of physical activity relevant to disease prevention. Furthermore, few studies have been conducted in urban Asian settings.
We evaluated physical activity in different domains (leisure time, occupational, household and transportation) and its sociodemographic determinants in 4750 adult Chinese, Malay, and Asian Indian Singaporeans. Physical activity was assessed using locally validated questionnaires.
Occupational and household activity contributed substantially more to total physical activity than leisure time or transportation activity. However, when only activity of at least moderate intensity was considered leisure time activity contributed most to total physical activity. Higher socio-economic status was associated with more leisure time activity, but less total physical activity due to reduced activity in the other domains. Chinese ethnicity was also associated with less total physical activity as a result of less activity in non-leisure time domains.
In assessing levels of physical activity and recommending changes, it is important to consider physical activity in different domains. Focus on leisure-time physical activity alone could identify the wrong groups for intervention and miss opportunities for increasing physical activity in populations.
BMC Public Health 10/2010; 10:644. · 2.00 Impact Factor
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ABSTRACT: BACKGROUND. Fractal analysis provides a global index of the geometric complexity and optimality of vascular networks. In this study, we investigated the relationship between fractal measurements of the retinal vasculature and chronic kidney disease (CKD). METHODS. This was a population-based case-control study which included participants from the Singapore Prospective Study Program. We identified 261 participants with CKD, defined as estimated glomerular filtration rate of <60 mL/min/1.73 m(2), and 651 controls. The retinal fractal dimension (D(f)) was quantified from digitized fundus photographs using a computer-based programme. RESULTS. The mean D(f) was 1.43 +/- 0.048 in the participants with CKD and 1.44 +/- 0.042 in controls (P = 0.013). Suboptimal D(f) in the lowest (first) and highest (fifth) quintiles were associated with an increased prevalence of CKD after adjusting for age, systolic blood pressure, diabetes and other risk factors [odds ratio (OR) 2.10, 95% confidence interval (CI) 1.15, 3.83 and OR 1.84, 95% CI 1.06, 3.17; compared to the fourth quintile, respectively). This association was present even in participants without diabetes or hypertension. CONCLUSIONS. Our study found that an abnormal retinal vascular network is associated with an increased risk of CKD, supporting the hypothesis that deviations from optimal microvascular architecture may be related to kidney damage.
Nephrology Dialysis Transplantation 07/2010; 25(7):2252-8. · 3.40 Impact Factor
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ABSTRACT: Retinal vascular caliber changes predict diabetic microvascular complications such as retinopathy, and nephropathy. However, the association between retinal vasculature and peripheral neuropathy is not well studied.
We evaluated the association between retinal vascular caliber and peripheral neuropathy in a multi-ethnic Asian population with diabetes (n = 423) in Singapore. Retinal arteriolar and venular caliber was measured from digital retinal photographs and summarized as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent. Peripheral neuropathy was defined from neurothesiometer or monofilament sensory testing.
Larger CRAE was positively associated with peripheral neuropathy independent of age, sex, ethnicity, current smoking, alcohol consumption, body mass index, total cholesterol, systolic blood pressure, and duration of diabetes. The multivariable odds ratio (OR) [95% confidence interval (CI)] of peripheral neuropathy was 2.81 (1.38-5.73) comparing highest vs. lower three quartiles of CRAE. This association was consistently present in analyses stratified by age, sex and ethnicity. Retinal venular caliber was not associated with peripheral neuropathy.
These data suggest that larger retinal arteriolar diameters are associated with peripheral neuropathy independent of major risk factors.
Microcirculation (New York, N.Y.: 1994) 05/2010; 17(4):297-302. · 2.37 Impact Factor
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ABSTRACT: There is substantial heterogeneity in literature regarding the epidemiology for chronic kidney disease (CKD) in different Asian populations. We aimed to assess the prevalence and risk factors of CKD in a multi-ethnic Asian population in Singapore.
We examined 4499 participants of Chinese, Malay and Indian ethnicity, aged 24-95 years, who participated in the Singapore Prospective Study Program. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m(2) or the presence of micro/macroalbuminuria.
The age, sex-standardized prevalence of CKD was 12.8% (11.4%, 18.6% and 17.6% in Chinese, Malays and Indians). Older age and the presence of diabetes, hypertension and dyslipidaemia were significantly associated with CKD in all ethnic groups. Clinical, metabolic, socioeconomic and behavioral factors accounted for 68% and 78% of excess risk of CKD in Malays and in Indians, respectively. Diabetes (45%) and dyslipidaemia (16%) among Malays and hypertension among Indians (23%) had greater population-attributable risk of CKD.
The prevalence of CKD is high in all three major Asian ethnic groups, in particular Malays and Indians, but risk factors are similar to those reported from previous studies in Western populations. The association of modifiable risk factors with CKD emphasizes the need to screen and treat high-risk populations for early detection and prevention of CKD.
Nephrology Dialysis Transplantation 02/2010; 25(8):2564-70. · 3.40 Impact Factor
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ABSTRACT: Abstract Background The benefits of regular physical activity for quality of life and disease prevention have been well documented. Identification of low activity groups would facilitate interventional programs. Many studies have focussed on leisure time activity, which may not capture the spectrum of physical activity relevant to disease prevention. Furthermore, few studies have been conducted in urban Asian settings. Methods We evaluated physical activity in different domains (leisure time, occupational, household and transportation) and its sociodemographic determinants in 4750 adult Chinese, Malay, and Asian Indian Singaporeans. Physical activity was assessed using locally validated questionnaires. Results Occupational and household activity contributed substantially more to total physical activity than leisure time or transportation activity. However, when only activity of at least moderate intensity was considered leisure time activity contributed most to total physical activity. Higher socio-economic status was associated with more leisure time activity, but less total physical activity due to reduced activity in the other domains. Chinese ethnicity was also associated with less total physical activity as a result of less activity in non-leisure time domains. Conclusions In assessing levels of physical activity and recommending changes, it is important to consider physical activity in different domains. Focus on leisure-time physical activity alone could identify the wrong groups for intervention and miss opportunities for increasing physical activity in populations.
BMC Public Health. 01/2010;
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Jonathan T Tan,
Daniel P K Ng,
Siti Nurbaya,
Sandra Ye,
Xiu Li Lim,
Helen Leong,
Lin Tze Seet,
Wei Fong Siew,
Winston Kon,
Tien Yin Wong,
Seang Mei Saw,
Tin Aung,
Kee Seng Chia, Jeannette Lee,
Suok Kai Chew,
Mark Seielstad,
E Shyong Tai
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ABSTRACT: Novel type 2 diabetes mellitus (T2DM) susceptibility loci, identified through genome-wide association studies (GWAS), have been replicated in many European and Japanese populations. However, the association in other East Asian populations is less well characterized.
To examine the effects of SNPs in CDKAL1, CDKN2A/B, IGF2BP2, HHEX, SLC30A8, PKN2, LOC387761, and KCNQ1 on risk of T2DM in Chinese, Malays, and Asian-Indians in Singapore. Design: We genotyped these candidate single-nucleotide polymorphisms (SNPs) in subjects from three major ethnic groups in Asia, namely, the Chinese (2196 controls and 1541 cases), Malays (2257 controls and 1076 cases), and Asian-Indians (364 controls and 246 cases). We also performed a metaanalysis of our results with published studies in East Asians.
In Chinese, SNPs in CDKAL1 [odds ratio (OR) = 1.19; P = 2 x 10(-4)], HHEX (OR = 1.15; P = 0.013), and KCNQ1 (OR = 1.21; P = 3 x 10(-4)) were significantly associated with T2DM. Among Malays, SNPs in CDKN2A/B (OR = 1.22; P = 3.7 x 10(-4)), HHEX (OR = 1.12; P = 0.044), SLC30A8 (OR = 1.12; P = 0.037), and KCNQ1 (OR = 1.19-1.25; P = 0.003-2.5 x 10(-4)) showed significant association with T2DM. The combined analysis of the three ethnic groups revealed significant associations between SNPs in CDKAL1 (OR = 1.13; P = 3 x 10(-4)), CDKN2A/B (OR = 1.16; P = 9 x 10(-5)), HHEX (OR = 1.14; P = 6 x 10(-4)), and KCNQ1 (OR = 1.16-1.20; P = 3 x 10(-4) to 3 x 10(-6)) with T2DM. SLC30A8 (OR = 1.06; P = 0.039) showed association only after adjustment for gender and body mass index. Metaanalysis with data from other East Asian populations showed similar effect sizes to those observed in populations of European ancestry.
SNPs at T2DM susceptibility loci identified through GWAS in populations of European ancestry show similar effects in Asian populations. Failure to detect these effects across different populations may be due to issues of power owing to limited sample size, lower minor allele frequency, or differences in genetic effect sizes.
The Journal of clinical endocrinology and metabolism 11/2009; 95(1):390-7. · 6.50 Impact Factor
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ABSTRACT: BACKGROUND: C-reactive protein (CRP), a marker for inflammation, has been recently associated with early kidney damage. We examined the association between CRP and micro/macroalbuminuria in a multi-ethnic Asian population using data from two population-based studies in Singapore. Methods. We studied 5127 individuals, who participated in two separate, cross-sectional studies, the Singapore Prospective Study Program [SP2]/Singapore Cardiovascular Cohort Study 2 (SCCS2), involving 4233 participants of Chinese, Malay and Indian ethnicity, aged 24-95 years in Singapore, and the Singapore Malay Eye Study (SiMES), involving 894 participants of Malay ethnicity, aged 40-80 years. Micro/macroalbuminuria was defined as urinary albumin-to-creatinine ratio of > or =17 mg/g for men and > or =25 g/g for women. CRP was analyzed as a continuous variable and as categories (<1, 1-3, >3 mg/L). Results. The prevalence of micro/macroalbuminuria in the whole population was 21.1%. The prevalence increased with increasing categories of CRP. Compared with persons with CRP concentrations <1 mg/L, the multivariable odds ratio (OR) (95% confidence interval [CI]) was 1.33 (1.11-1.60) in persons with CRP concentrations 1-3 mg/L and 1.60 (1.30-1.96) in persons with CRP concentrations >3 mg/L; P trend <0.0001. In continuous analysis, each unit increase in log CRP was associated with an OR (95% CI) of 1.20 (1.11-1.28) of having micro/macroalbuminuria (P < 0.0001). This association was independent of potential confounders and was consistent across the two study cohorts with similar effect estimates (OR = 1.6) for micro/macroalbuminuria. Conclusions. Elevated CRP levels are associated with micro/macroalbuminuria independent of diabetes, hypertension and other potential confounders. This suggests that inflammation may play a role in early kidney damage.
Nephrology Dialysis Transplantation 11/2009; 25(4):1167-72. · 3.40 Impact Factor
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ABSTRACT: Blood pressure has a significant effect on retinal arterioles. There are few data on whether this effect varies by race/ethnicity. We examined the relationship of blood pressure and retinal vascular caliber in a multi-ethnic Asian population. The study is population-based and cross sectional in design. A total of 3749 Chinese, Malay and Indian participants aged > or =24 years residing in Singapore were included in the study. Retinal vascular caliber was measured using a computer program from digital retinal photographs. The associations of retinal vascular caliber with blood pressure and hypertension in each racial/ethnic group were analyzed. The main outcome measures are retinal arteriolar caliber and venular caliber. The results show that retinal arterioles were narrower in persons with uncontrolled/untreated hypertension (140.0 microm) as compared with persons with controlled hypertension (142.1 microm, P=0.0001) and those with no hypertension (146.0 microm, P<0.0001). On controlling for age, gender, body mass index, lipids and smoking, each 10 mm Hg increase in mean arterial blood pressure was associated with a 3.1 microm decrease in arteriolar caliber (P<0.0001), with a similar magnitude seen in all three racial/ethnic groups: 3.1 microm in Chinese, 2.8 microm in Malays and 3.2 microm in Indians (P<0.0001 for all). Each 10 mm Hg increase in mean arterial blood pressure was associated with a 1.8 microm increase in venular caliber (P<0.0001); furthermore, the magnitude of this effect was similar across the three racial/ethnic groups. The effect of blood pressure on the retinal vasculature was similar across three major racial/ethnic groups in Asia.
Hypertension Research 09/2009; 32(11):975-82. · 2.58 Impact Factor
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ABSTRACT: Retinal arteriolar narrowing is a marker of chronic microvascular damage from hypertension. We hypothesized that the presence of retinal arteriolar narrowing increases the likelihood of chronic kidney disease (CKD) associated with hypertension.
We examined 3602 persons of Chinese, Malay and Indian ethnicities, aged at least 24 years residing in Singapore. CKD was defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m(2). Hypertension was defined as SBP of at least 140 mmHg or DBP of at least 90 mmHg or self-reported physician-diagnosed hypertension. Retinal arteriolar caliber was measured from retinal photographs and summarized. The lowest arteriolar caliber quartile was defined as retinal arteriolar narrowing.
Both hypertension and retinal arteriolar narrowing were associated with CKD (n = 185), independent of major confounders, with multivariable odds ratio of 2.10 (95% confidence interval 1.46-3.02) for CKD associated with hypertension and odds ratio of 1.68 (95% confidence interval 1.04-2.71) for retinal arteriolar narrowing. The association between hypertension and CKD was stronger in the presence of retinal arteriolar narrowing (P for interaction 0.09), and joint exposure to both hypertension and retinal arteriolar narrowing was associated with a three-fold odds of having CKD (multivariable odds ratio 3.61, 95% confidence interval 1.88-6.93) compared with absence of hypertension and arteriolar caliber in the highest quartile (quartile 4).
These findings show that the presence of microvascular disease in the retina increases the likelihood of CKD associated with hypertension and suggest that examination of the retinal vasculature may aid in stratification of CKD risk in hypertensive patients.
Journal of hypertension 08/2009; 27(11):2209-17. · 4.02 Impact Factor
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ABSTRACT: The aim of this study was to examine the relationship of retinal vascular caliber with diabetes and impaired fasting glucose (IFG) in a multiethnic Asian population.
This work was a population-based cross-sectional study comprising 3,404 Singaporean Chinese, Indian, and Malay participants. Retinal arteriolar and venular diameters, CRAE and CRVE, respectively were measured from digital retinal photographs. Diabetes was defined as physician-diagnosis of diabetes, self-reported use of diabetic medication, or fasting plasma glucose (FPG) > or = 7 mmol/L; IFG as FPG 6.1-6.9 mmol/L.
After adjusting for age, gender, ethnicity, systolic blood pressure, body mass index, total cholesterol, triglycerides, smoking, and vascular caliber (Model 3), participants with diabetes had both larger CRAE and CRVE, compared to those with normal fasting glucose (NFG) or IFG. In a multivariate analysis, including clinical risk factors and CRVE, mean CRAE increased from 143.6 microm in NFG to 145.3 microm with diabetes (P for trend = 0.01). On the other hand, each mmol/L increase in FPG was associated with a 0.51-microm increase in CRVE (P=0.006). In a subgroup analysis stratified by ethnicity, the association between FPG and larger CRVE was predominantly present among ethnic Indians (0.9-microm increase in CRVE per mmol/L increase in FPG).
Diabetes was associated with larger retinal arteriolar diameters and glucose level was associated with larger retinal venular diameters in this multiethnic Asian population. The magnitude of association between glucose level and venular widening was stronger among ethnic Indians.
Microcirculation (New York, N.Y.: 1994) 06/2009; 16(6):534-43. · 2.37 Impact Factor
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ABSTRACT: Recent studies suggest that no distinct glycemic threshold consistently differentiates individuals with or without retinopathy. The authors sought to determine whether the same was true for other microvascular complications. They studied 5,094 participants with fasting plasma glucose values and concurrent microvascular complications from 4 previous cross-sectional surveys carried out in Singapore (1982-1998) who attended a follow-up examination in 2004-2007. Peripheral neuropathy was diagnosed based on abnormal responses to a 10-g monofilament or neurothesiometer test. Chronic kidney disease was defined in various ways by using albuminuria (urine albumin:creatinine ratio >30 microg/mg) and estimated glomerular filtration rate, alone and in combination. Prevalence of peripheral neuropathy was 7.5%. For chronic kidney disease, prevalence of albuminuria only was 10.5%, estimated glomerular filtration rate of <60 mL/minute per 1.73 m(2) only was 4.1%, and both was 2.1%. Prevalence of peripheral neuropathy and chronic kidney disease gradually increased in relation to fasting plasma glucose, beginning at levels below the existing diagnostic threshold for diabetes mellitus of 7.0 mmol/L (126 mg/dL). For chronic kidney disease, these associations persisted after adjustment for age, gender, ethnic group, and hypertension. Current diagnostic thresholds for diabetes mellitus have limited sensitivity for identifying individuals with these microvascular complications. Ascertaining these individuals may require development and application of novel screening strategies.
American journal of epidemiology 04/2009; 169(12):1454-62. · 5.59 Impact Factor
