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Bríain Omicron Hartaigh, G Neil Thomas,
Jos A Bosch,
Karla Hemming,
Stefan Pilz,
Adrian Loerbroks,
Marcus E Kleber,
Tanja B Grammer,
Joachim E Fischer,
Guenther Silbernagel,
Andreas Tomaschitz,
Winfried März
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ABSTRACT: BACKGROUND: Conventional factors do not fully explain the distribution of cardiovascular outcomes. Biomarkers are known to participate in well-established pathways associated with cardiovascular disease, and may therefore provide further information over and above conventional risk factors. This study sought to determine whether individual and/or combined assessment of 9 biomarkers improved discrimination, calibration and reclassification of cardiovascular mortality. METHODS: 3267 patients (2283 men), aged 18-95years, at intermediate-to-high-risk of cardiovascular disease were followed in this prospective cohort study. Conventional risk factors and biomarkers were included based on forward and backward Cox proportional stepwise selection models. RESULTS: During 10-years of follow-up, 546 fatal cardiovascular events occurred. Four biomarkers (interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D) were retained during stepwise selection procedures for subsequent analyses. Simultaneous inclusion of these biomarkers significantly improved discrimination as measured by the C-index (0.78, P=0.0001), and integrated discrimination improvement (0.0219, P<0.0001). Collectively, these biomarkers improved net reclassification for cardiovascular death by 10.6% (P<0.0001) when added to the conventional risk model. CONCLUSIONS: In terms of adverse cardiovascular prognosis, a biomarker panel consisting of interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D offered significant incremental value beyond that conveyed by simple conventional risk factors.
International journal of cardiology 04/2013; · 7.08 Impact Factor
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Ya Li Jin,
Tong Zhu,
Lin Xu,
Wei Sen Zhang,
Bin Liu,
Chao Qiang Jiang,
Hong Yu,
Li Ming Huang,
Kar Keung Cheng, G Neil Thomas,
Tai Hing Lam
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ABSTRACT: OBJECTIVE: To examine the association between serum uric acid (UA) levels and cardiovascular risk factors in subjects without diabetes or hyperuricemia. METHODS: 6172 women and 2662 men aged 50+ years without diabetes from Phase 1 of the Guangzhou Biobank Cohort Study were included. Data on personal history, physical examination and biochemical parameters were collected. Subjects were categorized by serum UA concentration, and the association between UA levels and cardiovascular risk factors was examined using generalized linear models. RESULTS: In both men and women with normouricemia (UA<420μmol/l in men and <360μmol/l in women), tertiles of UA levels were adversely associated with body mass index, waist circumference, waist-to-hip ratio, total- and HDL-cholesterol, apolipoprotein A1, systolic and diastolic blood pressures, pulse pressure, fasting plasma glucose and white blood cell count (P value for trend ranged from 0.04 to <0.001), and also consistently associated with metabolic disorders including obesity, hypertension, hypertension treatment, dyslipidemia, waist circumference increased since the age of 18years and the metabolic syndrome (P value for trend ranged from 0.02 to <0.001). CONCLUSION: Increasing UA levels, even in subjects with normouricemia and without diabetes, were associated with increasing prevalence of cardiovascular risk factors, suggesting that clinically dichotomous definition of hyperuricemia may be inadequate and high-normal value of UA may warn of metabolic disorders.
International journal of cardiology 02/2013; · 7.08 Impact Factor
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Xin Yi Leng,
Xiang Yan Chen,
Ping Chook,
Li Xiong,
Wen Hua Lin,
Jing Yi Liu,
Brian Tomlinson, G Neil Thomas,
Tai Hing Lam,
Karen S L Lam,
Bernard M Y Cheung,
Ka Sing Wong
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ABSTRACT: Abstract Background: Carotid atherosclerosis should not be neglected as a cause for stroke in China, despite its low prevalence. This study was performed to evaluate the association between ultrasonographic markers for different stages of carotid atherosclerosis and metabolic syndrome. Methods: This was a community-based study in Hong Kong. Metabolic syndrome was defined as having three or more of the following conditions or receiving specific treatment for these conditions: Abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol, hypertension, and impaired fasting blood glucose. All subjects underwent carotid duplex ultrasonography. Mean carotid intima media thickness (CIMT) of bilateral common carotid arteries was used as the CIMT value for a single subject. CIMT within the 4(th) quartile was regarded as increased CIMT. Carotid plaque was defined as a focal CIMT of >1.5 mm. A carotid plaque obstructing ≥50% of vessel lumen was considered as carotid stenosis. Results: A total of 653 subjects (mean age 55.1±10.4; 47.2% male) were recruited. Metabolic syndrome was found in 188 (28.8%) subjects (30.8% in males and 27.0% in females). Mean CIMT was 0.74±0.12 mm. Increased CIMT, carotid plaque, and carotid stenosis were detected in 163 (25.0%), 95 (14.5%), and 6 (1.4%) subjects, respectively. In multivariate linear regression, CIMT significantly increased with increasing numbers of metabolic syndrome components (P<0.001). In multivariate logistic regression analysis, metabolic syndrome was independently associated with increased CIMT [odds ratio (OR) 1.17; 95% confidence interval (CI) 1.11-2.64; P=0.014), but not presence of carotid plaque (OR 1.50; 95% CI 0.92-2.46; P=0.108). Conclusions: Metabolic syndrome may be independently associated with the early stage but not the later and advanced stages of carotid atherosclerosis in community residents in China.
Metabolic syndrome and related disorders 01/2013;
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Bríain O Hartaigh,
Jos A Bosch,
Douglas Carroll,
Karla Hemming,
Stefan Pilz,
Adrian Loerbroks,
Marcus E Kleber,
Tanja B Grammer,
Joachim E Fischer,
Bernhard O Boehm,
Winfried März, G Neil Thomas
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ABSTRACT: AimsBoth elevated inflammatory activity and sustained tachycardia reflect unfavourable cardiovascular risk profiles, and there is evidence to suggest the deleterious effects of inflammation are amplified by increased heart rate. The purpose of this study was to assess the interaction between resting heart rate and inflammation in cardiovascular mortality.Methods and resultsA total of 3267 patients (2283 men), aged 18-95 years, scheduled for coronary angiography, were followed prospectively. By principle component analysis, we developed an overall multi-marker index of inflammation weighting the respective coefficients of five inflammatory markers including: interleukin-6, C-reactive protein, serum amyloid A, neutrophils, and fibrinogen. Cox proportional hazard regression models were employed to evaluate the relationship between inflammation and heart rate with cardiovascular mortality. Across 29 940 person years of follow-up, there were 546 (17%) deaths due to cardiovascular disease (CVD). Significantly, we observed a strong synergistic effect of inflammatory activity and concurrent elevated heart rate. For CVD mortality, patients in the highest quartile of inflammation had an adjusted hazard ratio (95% confidence interval) of 1.84 (1.31-2.57), P < 0.0001 if their resting heart rate was <75 b.p.m. Substantially, patients had a greater adjusted HR of 7.50 (3.21-17.50), P < 0.0001 if their resting heart rate was ≥75 b.p.m.Conclusion
The present analyses underline elevated inflammation as a risk factor for cardiovascular mortality. The effects of inflammation appeared to be strongly amplified by a faster resting heart rate. If confirmed by additional studies, this association may prove a useful adjunct for therapeutic approaches to alleviate symptoms and prolong survival.
European Heart Journal 11/2012; · 10.48 Impact Factor
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Xin Yi Leng,
Xiang Yan Chen,
Ping Chook,
Li Xiong,
Wen Hua Lin,
Jing Yi Liu,
Brian Tomlinson, G Neil Thomas,
Tai Hing Lam,
Karen S L Lam,
Bernard M Y Cheung,
Ka Sing Wong
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ABSTRACT: BACKGROUND AND PURPOSE: Large artery intracranial occlusive disease (LAICOD) is a predominant cause of ischemic stroke in China. Carotid intima-media thickness (CIMT) and presence of carotid plaque are also related to subsequent ischemic stroke. However, the correlation between these and LAICOD is less clear. METHODS: This was a community-based cross-sectional study. All subjects underwent carotid duplex ultrasonography and transcranial Doppler. Mean CIMT value of bilateral common carotid arteries was used. Plaque was defined as a focal CIMT of >1.5 mm. LAICOD in transcranial Doppler was defined by peak systolic velocity and age, and presence of turbulence or musical sound was also considered. RESULTS: For the 537 subjects studied (mean age, 54.7±10.1 years; 46.9% males), mean CIMT was 0.74±0.12 mm, with the 75th percentile of 0.80 mm. CIMT ≥1.0 mm was identified in 13 subjects (2.4%). Plaques were detected in 79 subjects (14.7%). Compared with those without LAICOD, the 48 subjects (8.9%) with LAICOD had greater CIMTs (0.77±0.09 versus 0.73±0.12 mm; P=0.044), more with CIMT of higher quartiles (P=0.007), and more with carotid plaques (25.0% versus 13.7%; P=0.035). However, after adjusting for confounding factors, CIMT and presence of carotid plaque were not significantly associated with LAICOD. CONCLUSIONS: The results suggest that CIMT and presence of carotid plaque probably are not independently correlated with LAICOD in Chinese community residents, which supported the existence of pathologic and pathophysiologic differences in atherogenesis of intra- and extracranial arteries.
Stroke 11/2012; · 5.73 Impact Factor
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ABSTRACT: High blood pressure (BP) is becoming increasingly common during childhood. Regular physical activity (PA) reduces BP in adults, but limited studies have reported inconsistent results among children. The aim of this study is to examine, for the first time, the cross-sectional and longitudinal associations between BP and objectively measured PA in young children of predominantly South Asian background. Data from the Birmingham healthy Eating and Active lifestyle for CHildren Study were analyzed. Five hundred seventy-four children, aged 5 to 7 years, underwent a series of measures at baseline and were followed up 2 years later. PA was objectively measured using accelerometry and converted to counts per minute (total PA, cpm), and time spent in moderate-vigorous PA (minutes per day). BP was measured by trained staff using standard protocols. Data were available for 512 children at baseline (mean age 6.5 years, range 5.4-7.8 years), and 427 of these children were followed up. Baseline total PA was inversely associated with diastolic BP at both baseline (adjusted regression coefficient: -0.75 mm Hg [95% CI -1.33 to -0.18] per 20 cpm) and follow-up (-0.74 mm Hg [95% CI -1.40 to -0.08]). All associations remained unchanged after further adjustment for weight status. This study strengthens evidence of a causal association between higher PA and lower BP in children as young as 5, independent of weight status. The results provide support for development of interventions to increase PA in young children.
Hypertension 11/2012; · 6.21 Impact Factor
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ABSTRACT: OBJECTIVE: Evidence suggests that vitamin D may protect against the onset of diabetes. However, the mechanisms underlying the role of vitamin D on glycaemic status are unclear, and warrant further investigation. We sought to determine the relationship between serum 25-hydroxyvitamin D (25[OH]D) and glycaemic status among intermediate-to-high risk patients scheduled for coronary angiography. METHODS: Participants were 3,316 male and female patients (mean [SD] age, 62.7 [±10.6] years). Four categories were formed according to serum 25[OH]D levels. The association between serum 25[OH]D and diabetes was assessed using multivariable logistic regression. RESULTS: Fasting and 2h post-load glucose, HbA1c and the HOMA-IR indices diminished with increasing serum 25[OH]D levels (P <0.001). However, no associations were observed between insulin, pro-insulin or C-peptide and serum 25[OH]D concentrations. The pro-inflammatory markers IL-6 and hs-CRP also decreased considerably with higher vitamin D levels (P <0.001). After full adjustment, those with optimal serum 25[OH]D levels had a reduced odds for fasting diabetes (OR = 0.63, 95% CI 0.46 - 0.86, P(trend) =0.01), 2h post-load diabetes (OR = 0.46, 95% CI 0.29 - 0.74, P(trend) =0.004), both fasting/2h post-load diabetes (OR = 0.61, 95% CI 0.42 - 0.87, P(trend) =0.001) and all of the combined hyperglycaemic states (OR = 0.68, 95% CI 0.52 - 0.80, P(trend) =0.01). CONCLUSIONS: Higher serum 25[OH]D levels were associated with better glycaemic status and lower inflammation. Should these observations be confirmed in future studies, vitamin D supplementation may prove a useful adjunct in attenuating the onset of diabetes. © 2012 Blackwell Publishing Ltd.
Clinical Endocrinology 08/2012; · 3.17 Impact Factor
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ABSTRACT: The impact of occupational dust and gas/fume exposure on chronic obstructive pulmonary disease (COPD) in developing countries has not been quantified. We examined the relationship between past dust and fume exposure and prevalence of COPD and respiratory symptoms in a cross-sectional analysis of a large Chinese population sample. Participants in the Guangzhou Biobank Cohort Study (n = 8216; 27.3% men, mean age 61.9 ± 6.8 years) had spirometry and a structured interview including exposures, symptoms, and lifestyle. Self-reported intensity and duration of dust and gas/fume exposure was used to derive cumulative exposure. COPD was diagnosed from spirometry using lower limit of normal based on prediction equations. COPD was associated with high exposure to dust or gas/fume (exposed: 87/1206 v non-exposed: 191/3853; adjusted odds ratio: 1.41; 95% confidence interval (CI) 1.06, 1.87) with no evidence of effect modification by smoking. Respiratory symptoms were associated with exposures to dust and gas/fume, with adjusted odds ratios for chronic cough/phlegm of 1.57 (1.13, 2.17) and 1.39 (1.20, 1.60) for dyspnoea. The overall population attributable fraction for COPD due to occupational exposure was 10.4% (95% CI -0.9%, 19.5%). Occupational dust and gas/fume exposure is associated with an increased prevalence of COPD in this Chinese sample, independent of smoking. The population attributable fraction in Chinese is similar to that in Western populations.
Respiratory medicine 07/2012; 106(10):1421-8. · 2.33 Impact Factor
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ABSTRACT: BACKGROUND: Chronic obstructive pulmonary disease (COPD) co-exists with depression, but important questions remain about the determinants of this association. PURPOSE: We examined the association of depressive symptoms with three aspects of COPD: self-reports of physician-diagnosed COPD, chronic respiratory symptoms, and airway obstruction. METHODS: We used data from the Guangzhou Biobank Cohort Study (n = 7,995). Airway obstruction was assessed by spirometry. A score ≥4 on the 15-item Geriatric Depression Scale was used as a cutoff for depressive symptoms. RESULTS: Self-reported COPD was positively associated with depressive symptoms but airway obstruction was not. Compared to those free of both respiratory symptoms and airway obstruction those reporting respiratory symptoms were more likely to have depressive symptoms regardless of whether they had obstruction or not. CONCLUSIONS: In this Chinese population, a self-reported physician diagnosis of COPD and symptom perception, but not airway obstruction, appeared as main determinants of depressive symptoms.
Annals of Behavioral Medicine 07/2012; · 4.20 Impact Factor
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Bríain ó Hartaigh,
Jos A Bosch, G Neil Thomas,
Janet M Lord,
Stefan Pilz,
Adrian Loerbroks,
Marcus E Kleber,
Tanja B Grammer,
Joachim E Fischer,
Bernhard O Boehm,
Winfried März
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ABSTRACT: White blood cells are known to predict cardiovascular mortality, but form a highly heterogeneous population. It is therefore possible that specific subtypes disproportionally contribute to the prediction of cardiovascular outcomes. Therefore, we compared leukocyte subsets alone and in conjunction with an established inflammatory marker, C-reactive protein, for predicting death due to cardiovascular disease in a high-risk population.
Patients, 3316, (mean [SD] age, 62 [10] years) scheduled for coronary angiography were prospectively followed up. Neutrophil, monocyte and lymphocyte counts were determined. Neutrophil and monocyte subsets were further analysed on the basis of surface expression of CD11b, CD18, CD31, CD40 and CD58. Lymphocytes were further subdivided into CD3, CD4, CD8, and CD19 subsets. The association between each marker and subsequent cardiovascular mortality was assessed using multivariable Cox regression models.
During a median follow-up period of 7.8 years, 745 (22.5%) patients died, of which 484 were due to cardiovascular events. After entering conventional risk factors and removing patients with a current infection, neutrophil count (HR [95% CI]=1.90 [1.39, 2.60], P<0.001) and the neutrophil/lymphocyte ratio (HR [95% CI]=1.68 [1.24, 2.27], P=0.003) emerged as independent predictors of cardiovascular mortality. After mutual adjustment, neutrophil count (HR [95% CI]=1.87 [1.35, 2.50], P<0.001) out-performed C-reactive protein (HR [95% CI] 1.32 [0.99, 1.78], P=0.06) as a predictor of cardiovascular mortality.
Due to its predictive potential and inexpensive determination, assessment of high neutrophil counts may represent an important marker, possibly improving cardiovascular mortality risk prediction.
Atherosclerosis 06/2012; 224(1):161-9. · 3.79 Impact Factor
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ABSTRACT: Several epidemiologic studies have reported an association between elevated heart rate (HR) at rest and reduced survival. The usefulness of HR at rest in predicting end points in high-risk patients is yet to be definitively established. The purpose of this study was to clarify the relation between HR at rest with total and cardiovascular mortality in patients who underwent coronary angiography. A total of 3,316 Caucasian patients with available coronary angiograms were prospectively followed from 2001 to 2011 (median 9.9 years). The effect of HR at rest on total and cardiovascular mortality was explored, while correcting for a number of confounders. Patients in the highest quartile (HR at rest ≥ 84 beats/min) had survival times reduced by 1.2 and 1.4 years for overall and cardiovascular mortality, respectively. Likewise, these patients had significantly elevated adjusted risk for total (hazard ratio 1.39, 95% confidence interval 1.17 to 1.67, p for trend <0.001) and cardiovascular mortality (hazard ratio 1.38, 95% confidence interval 1.08 to 1.78, p for trend = 0.004). In conclusion, HR at rest is an inexpensive, easily measured, and modifiable predictor of mortality.
The American journal of cardiology 05/2012; 110(4):515-20. · 3.58 Impact Factor
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ABSTRACT: The aim of this study was to examine the relationship between seated resting heart rate and the metabolic syndrome (MetS) among older residents of Guangzhou, South China. A total of 30,519 older participants (≥50 years) from the Guangzhou Biobank Cohort Study were stratified into quartiles based on seated resting heart rate. The associations between each quartile and the MetS were assessed using multivariable logistic regression. A total of 6,907 (22.8 %) individuals were diagnosed as having the MetS, which was significantly associated with increasing heart rate quartiles (P < 0.001). Participants in the uppermost quartile (mean resting heart rate 91 ± 8 beats/min) of this cardiovascular proxy had an almost twofold increased adjusted risk (odds ratio (95 % CI) = 1.94 (1.79, 2.11), P < 0.001) for the MetS, as compared to those in the lowest quartile (mean resting heart rate, 63 ± 4 beats/min). Heart rate, which is an inexpensive and simple clinical measure, was independently associated with the MetS in older Chinese adults. We hope these observations will spur further studies to examine the usefulness of resting heart rate as a means of risk stratification in such populations, for which targeted interventions should be implemented.
Acta Diabetologica 04/2012; · 2.78 Impact Factor
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Nadeem Sarwar,
Adam S Butterworth,
Daniel F Freitag,
John Gregson,
Peter Willeit,
Donal N Gorman,
Pei Gao,
Danish Saleheen,
Augusto Rendon,
Christopher P Nelson, [......],
Alison H Goodall,
Paul M Ridker,
Hilma Hólm,
Hugh Watkins,
Willem H Ouwehand,
Nilesh J Samani,
Stephen Kaptoge,
Emanuele Di Angelantonio,
Olivier Harari,
John Danesh
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ABSTRACT: Persistent inflammation has been proposed to contribute to various stages in the pathogenesis of cardiovascular disease. Interleukin-6 receptor (IL6R) signalling propagates downstream inflammation cascades. To assess whether this pathway is causally relevant to coronary heart disease, we studied a functional genetic variant known to affect IL6R signalling.
In a collaborative meta-analysis, we studied Asp358Ala (rs2228145) in IL6R in relation to a panel of conventional risk factors and inflammation biomarkers in 125,222 participants. We also compared the frequency of Asp358Ala in 51,441 patients with coronary heart disease and in 136,226 controls. To gain insight into possible mechanisms, we assessed Asp358Ala in relation to localised gene expression and to postlipopolysaccharide stimulation of interleukin 6.
The minor allele frequency of Asp358Ala was 39%. Asp358Ala was not associated with lipid concentrations, blood pressure, adiposity, dysglycaemia, or smoking (p value for association per minor allele ≥0·04 for each). By contrast, for every copy of 358Ala inherited, mean concentration of IL6R increased by 34·3% (95% CI 30·4-38·2) and of interleukin 6 by 14·6% (10·7-18·4), and mean concentration of C-reactive protein was reduced by 7·5% (5·9-9·1) and of fibrinogen by 1·0% (0·7-1·3). For every copy of 358Ala inherited, risk of coronary heart disease was reduced by 3·4% (1·8-5·0). Asp358Ala was not related to IL6R mRNA levels or interleukin-6 production in monocytes.
Large-scale human genetic and biomarker data are consistent with a causal association between IL6R-related pathways and coronary heart disease.
British Heart Foundation; UK Medical Research Council; UK National Institute of Health Research, Cambridge Biomedical Research Centre; BUPA Foundation.
The Lancet 03/2012; 379(9822):1205-13. · 38.28 Impact Factor
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ABSTRACT: Optimal vitamin D levels are associated with reduced cardiovascular and all-cause mortality. We investigated whether optimal 25-hydroxyvitamin D (25[OH]D) is protective in individuals with the metabolic syndrome.
The Ludwigshafen Risk and Cardiovascular Health (LURIC) study is a cohort study of subjects referred for coronary angiography between 1997 and 2000, from which 1,801 with the metabolic syndrome were investigated. Mortality was tracked for a median of 7.7 years. Multivariable survival analysis was used to estimate the association between 25(OH)D levels and mortality.
Most subjects (92%) had suboptimal levels of 25(OH)D (<75 nmol/L), with 22.2% being severely deficient (<25 nmol/L). During follow-up, 462 deaths were recorded, 267 (57.8%) of which were cardiovascular in origin. After full adjustment, including the metabolic syndrome components, those with optimal 25(OH)D levels showed a substantial reduction in all-cause (hazard ratio [HR] 0.25 [95% CI 0.13-0.46]) and cardiovascular disease mortality (0.33 [0.16-0.66]) compared with those with severe vitamin D deficiency. For specific cardiovascular disease mortality, there was a strong reduction for sudden death (0.15 [0.04-0.63]) and congestive heart failure (0.24 [0.06-1.04]), but not for myocardial infarction. The reduction in mortality was dose-dependent for each of these causes.
Optimal 25(OH)D levels substantially lowered all-cause and cardiovascular disease mortality in subjects with the metabolic syndrome. These observations call for interventional studies that test whether vitamin D supplementation provides a useful adjunct in reducing mortality in these subjects.
Diabetes care 03/2012; 35(5):1158-64. · 8.09 Impact Factor
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ABSTRACT: BACKGROUND: There is consistent evidence of the co-occurrence of poor mental health and asthma in Western populations. Since the experience and expression of mental health is partly culturally determined, it is of interest to examine if similar associations are found in other cultural settings. In that regard, very little is known about the association between mental health and asthma in Asian countries, such as China. PURPOSE: The aim of this study was to investigate the relationship between mental health and asthma in a large sample from China. METHOD: We used data from the Guangzhou Biobank Cohort Study phase 3 (n = 9,280). Participants reported physician-diagnosed asthma. Mental health measures included the 15-item Chinese version of the Geriatric Depression Scale (GDS-C) and the SF-12 Mental Component Summary (MCS) score. We compared the prevalence of asthma by GDS-C and MCS scores by estimating prevalence ratios (PRs) and their corresponding 95% confidence intervals (95% CI), using Poisson regression. RESULTS: Compared to those without depression, the prevalence of asthma was higher in those with moderate or severe depression levels (PR = 2.63, 95% CI = 1.58-4.40 and PR = 4.43, 95% CI = 1.62-12.09, p for trend ≤0.0001). The prevalence of asthma increased by 46% with every 1 standard deviation increase of the GDS-C score (PR = 1.46, 95% CI = 1.24-1.73). The MCS score was not associated with asthma. CONCLUSION: Depressive symptoms were associated with asthma prevalence in a Chinese population. Further research into the mechanism and potential directions of causality is warranted.
International Journal of Behavioral Medicine 02/2012; · 2.63 Impact Factor
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G Neil Thomas,
R Scragg,
Chao Q Jiang,
Will Chan,
Winfried Marz,
Stefan Pilz,
Hyeon C Kim,
Brian Tomlinson,
Jos Bosch,
Tai H Lam,
Bernard M Y Cheung,
Kar K Cheng
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ABSTRACT: Vitamin D plays a role in a range of functions that may impact on glycaemic control. In this study we systematically report on clinical studies evaluating the impact of vitamin D on aspects of hyperglycaemia in non-pregnant adults. A total of 1,294 articles, of which 417 were reviews, were identified. No well-designed randomised, controlled trials were identified that specifically investigated the effects of vitamin D supplementation on glucose and insulin concentrations. The majority of the studies that are available were poorly designed, having limited numbers, short study duration, or were conducted in volunteers with normal baseline, as measured by 25-hydroxyvitamin D (25(OH)D), concentrations or used inadequate doses of the supplements to normalise vitamin D concentrations, or used inappropriate analyses. Most studies did not observe improvements in glycaemia, with few exceptions. The results were more equivocal for aspects of insulin resistance. Most found no benefit on measures of insulin resistance, although some did. However, more studies described improved insulin release, although data from the studies to date are really inadequate to provide any reliable conclusions. Well-conducted randomised, controlled trials with adequate vitamin D doses are required to effectively assess whether this vitamin can reduce the incidence of diabetes.
Current diabetes reviews 01/2012; 8(1):18-31.
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ABSTRACT: Aging, in conjunction with decreasing physical activity, is associated with a range of health problems. Simple, low-maintenance, population-based means of promoting activity to counteract the age-associated decline are required. We therefore assessed the effect of pedometry and buddy support to increase physical activity.
We undertook a clustered randomized trial (HKCTR-346) of 24 community centers involving 399 older Chinese participants (≥ 60 yr). Centers were randomly allocated to 1) pedometry and buddy, 2) pedometry and no buddy, 3) no pedometry and buddy, and 4) no pedometry and no buddy with a 2 × 2 factorial design. The trial simultaneously tested the individual and combined effects of the interventions. The intervention groups also received monthly organized group activities to provide encouragement and support. Outcome measures were assessed at 6 and 12 months, including physical fitness and activity and cardiovascular disease risk factors (anthropometry and blood pressure).
From the 24 centers, 356 volunteers (89.2%) completed the study. Those receiving the interventions had higher mean physical activity levels at 12 months of 1820 (95% confidence interval (CI) = 1360-2290) and 1260 (95% CI = 780-1740) MET·min·wk(-1), respectively relative to the decrease in the control groups. The buddy peer support intervention significantly improved mean aerobic fitness (12% [95% CI = 4%-21%]) and reduced both body fat (-0.6% [95% CI = -1.1% to 0.0%]) and time to complete the 2.5-m get-up-and-go test (-0.27 [95% CI = -0.53 to -0.01] s). No other improvements in the cardiovascular disease risk factors were observed. The combination of motivational tools was no better than the individual interventions.
Both motivational interventions increased physical activity levels, and the buddy style improved fitness. These tools could be useful adjuncts in the prevention of obesity and age-related complications.
Medicine and science in sports and exercise 12/2011; 44(6):1157-66. · 3.71 Impact Factor
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ABSTRACT: There is a well-established link between dysphoric mood and endocrine dysregulation, but the strength of this association may vary with age. In order to investigate this possibility we assessed anxiety and depression with overnight urinary cortisol and plasma dehydroepiandrosterone-sulphate (DHEAS) in 608 factory employees ranging between 21 and 62 years. As expected, DHEAS declined with age (r=-0.54, P<0.001) while there was a modest age-related increase in nocturnal cortisol (r=0.17, P<0.001). Depressive symptoms were associated with higher nocturnal cortisol (β=0.19, P<0.001), independent of age. While the association between anxiety and cortisol (age by anxiety interaction: β=0.11, P<0.05) became stronger with age, there was a similar decline in the DHEAS/cortisol ratio in high-anxious middle-aged adults (β=-0.10, P=0.018). The current findings suggest that dysphoric mood, and in particular anxiety, may exacerbate the effects of aging on cortisol release. Prospective studies are needed to determine the causal relations between dysphoric mood, cortisol and DHEAS across the lifespan.
Psychoneuroendocrinology 11/2011; 37(7):929-36. · 5.81 Impact Factor
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Youling Guo,
Larry W Baum,
Pak Chung Sham,
Virginia Wong,
Ping Wing Ng,
Colin Hiu Tung Lui,
Ngai Chuen Sin,
Tak Hong Tsoi,
Clara S M Tang,
Johnny S H Kwan,
Benjamin H K Yip,
Su-Mei Xiao, G Neil Thomas,
Yu Lung Lau,
Wanling Yang,
Stacey S Cherny,
Patrick Kwan
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ABSTRACT: In the majority of patients, epilepsy is a complex disorder with multiple susceptibility genes interacting with environmental factors. However, we understand little about its genetic risks. Here, we report the first genome-wide association study (GWAS) to identify common susceptibility variants of epilepsy in Chinese. This two-stage GWAS included a total of 1087 patients and 3444 matched controls. In the combined analysis of the two stages, the strongest signals were observed with two highly correlated variants, rs2292096 [G] [P= 1.0 × 10(-8), odds ratio (OR) = 0.63] and rs6660197 [T] (P= 9.9 × 10(-7), OR = 0.69), with the former reaching genome-wide significance, on 1q32.1 in the CAMSAP1L1 gene, which encodes a cytoskeletal protein. We also refined a previously reported association with rs9390754 (P= 1.7 × 10(-5)) on 6q21 in the GRIK2 gene, which encodes a glutamate receptor, and identified several other loci in genes involved in neurotransmission or neuronal networking that warrant further investigation. Our results suggest that common genetic variants may increase the susceptibility to epilepsy in Chinese.
Human Molecular Genetics 11/2011; 21(5):1184-9. · 7.64 Impact Factor
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ABSTRACT: To examine the association between total sleep duration and the prevalence of metabolic syndrome (MetSyn) in older Chinese.
Cross-sectional analysis of baseline data from the Guangzhou Biobank Cohort Study (GBCS) was performed. Participants (n = 29,333) were aged ≥50 years. Risk of MetSyn and its components were identified for self-reported total sleep duration.
Participants reporting long (≥9 h) and short (<6 h) total sleep duration had increased odds ratio (OR) of 1.18 (95% CI 1.07-1.30) and 1.14 (1.05-1.24) for the presence of MetSyn, respectively. The relationship remained in long sleepers (OR 1.21 [1.10-1.34]) but diminished in short sleepers (0.97 [0.88-1.06]) after full adjustment.
Long sleep duration was associated with greater risk of MetSyn in older Chinese. Confirmation through longitudinal studies is needed. The mechanisms mediating the link between long sleep duration and MetSyn require further investigation.
Diabetes care 08/2011; 34(10):2317-9. · 8.09 Impact Factor
