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ABSTRACT: OBJECTIVE: Sleep quality and obesity are associated with type 2 diabetes, hypertension, and metabolic syndrome. However, there is limited research on the association between sleep quality and obesity, and thus the aim of this study is to investigate this relationship in a Chinese population. DESIGN AND METHODS: Subjects were recruited from the Prevention Health Center of National Cheng Kung University Hospital. Anthropometric data and metabolic parameters were measured. Being overweight or obese was defined according to the recommendations of the Department of Health in Taiwan. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). RESULTS: Of the total 2,803 subjects, 1,059 were classified as normal weight, 1,127 were overweight, and 617 were obese. The global PSQI score were 6.30 ± 2.56, 6.61 ± 2.96, and 7.02 ± 2.95 in subjects who were normal weight, overweight, and obese, respectively (test for trend, P < 0.001). Of the variables tested in the multivariate linear regression model, female gender, being overweight, obesity, sleep duration, and alcohol drinking were significantly associated with global PSQI scores, and in the multivariate logistic regression model, female gender, being overweight, obesity, and sleep duration were independent predictors of poor sleepers after controlling for age, gender, BMI or different weight statuses, sleep duration, alcohol drinking, smoking, habitual exercise, hypertension, newly diagnosed diabetes, total cholesterol, high-density lipoprotein, triglyceride, estimated glomerular filtration rate, and alanine aminotransferase. CONCLUSIONS: In conclusion, female gender, being overweight, obesity, and sleep duration were associated with poor sleep quality independent of cardiometabolic risk factors. In clinical practice, subjects who are obese, or even only overweight, should be evaluated for the presence of sleep disturbance.
Obesity 03/2013; 21(3):486-492. · 4.28 Impact Factor
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ABSTRACT: Although simple renal cysts are thought to be related to hypertension, no reports have examined the relationship between simple renal cysts and prehypertension. Here, we evaluated the effects of simple renal cysts on prehypertension and hypertension and the role of serum renin levels in the cyst-related prehypertension/hypertension in adults. A total of 14,995 patients were enrolled and divided into normotension, prehypertension, and hypertension groups. Simple renal cysts were classified into different categories based on number (1 vs. 2 cm) and size (<2 vs. 2 cm). In multivariate analysis, simple renal cysts were independently related to prehypertension/hypertension. Two or more simple renal cysts or cyst of 2 cm were independently associated with prehypertension/hypertension. However, the association between cyst of 2 cm and prehypertension/hypertension disappeared after further adjusting for serum renin level in an exposure-matched subgroup analysis. Thus, the presence of two or more simple renal cysts and cyst of 2 cm were the important determinants of prehypertension and hypertension in adults. One possible mechanism of cyst-related prehypertension/hypertension may be related to an increased serum renin level. We recommend close monitoring of blood pressure routinely among patients with two or more simple renal cysts.Kidney International advance online publication, 6 February 2013; doi:10.1038/ki.2012.481.
Kidney International 02/2013; · 6.61 Impact Factor
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ABSTRACT: Activation of G protein-coupled receptor 40 (GPR40) by agonists increases insulin release in isolated islets, whereas it is inconclusive as to whether GPR40 antagonists decrease blood glucose and increases insulin sensitivity. Although some clinical trials indicated that administration of a GPR40 agonist shows benefits in the regulation of blood glucose homeostasis, the pharmacological mechanisms of this receptor in the improvement of glycemic control remain unclear. Therefore, we used a selective GPR40 agonist, GW9508, to clarify the role of GPR40 in the regulation of blood glucose. Bolus intraperitoneal injection of GW9508 in mice showed a slight decrease in blood glucose, with an increase in plasma insulin levels under glucose stimuli. However, long-term treatment with low doses of GW9508 in high fat diet-induced diabetic mice (HFD) significantly decreased blood glucose with decreased plasma insulin and improved glucose intolerance and insulin resistance. Using small interfering ribonucleic acid to delete GPR40 in HepG2 cells, we demonstrated that GW9508 reversed palmitate-induced insulin signaling impairment through a GPR40-dependent pathway. We also found that GW9508 activates the Akt-GSK3β pathway to increase glycogen levels in HepG2 cells. Furthermore, administration of GW9508 significantly decreased the hepatic expression of fetuin-A in HFD mice, and regulated high glucose- or palmitate-induced fetuin-A expression to increase insulin sensitivity through a GPR40-PLC-PKC pathway in HepG2 cells. Taken together, GW9508 exerts a partial agonist effect to regulate blood glucose through multiple mechanisms. Investigation of chemicals that act on GPR40 might be a new strategy for the treatment of diabetes.
AJP Endocrinology and Metabolism 01/2013; · 4.75 Impact Factor
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ABSTRACT: Short and long sleep duration are associated with metabolic syndrome. However, there is limited research on the association between sleep quality and metabolic syndrome, and thus the aim of this study is to investigate this relationship.
The cross-sectional baseline data were collected from the decoded database of the Prevention Health Center of National Cheng Kung University Hospital from 2002 to 2006. The diagnosis of metabolic syndrome was according to the statement of the American Heart Association/National Heart, Lung, and Blood Institute. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates poorer sleep quality, and a global PSQI score greater than five differentiates poor from good sleepers.
Of the 3,435 subjects recruited, 899 (26.2%) had metabolic syndrome. Subjects with metabolic syndrome had higher PSQI and prevalence of poor sleepers than those without metabolic syndrome. The multivariate lineal regression analysis showed that female gender, metabolic syndrome, sleep duration, snoring, alcohol drinking, and habitual exercise were independent predictors of PSQI. When substituting metabolic syndrome with the five components, hyperglycemia and low high-density lipoprotein cholesterol (HDL-C) were positively associated with PSQI. The multivariate logistic regression analyses showed that female gender, metabolic syndrome, sleep duration, and snoring were independently associated with being poor sleepers. Of the five components, only low HDL-C was an independent predictor of being poor sleepers.
Subjects with metabolic syndrome have higher global PSQI scores and a higher risk of being poor sleepers. Of the five components of metabolic syndrome, hyperglycemia and low HDL-C are independently associated with the global PSQI scores, while low HDL-C is an independent predictor of being poor sleepers.
PLoS ONE 01/2013; 8(1):e54304. · 4.09 Impact Factor
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ABSTRACT: Context:Fetuin-A, a liver-derived glycoprotein that impairs insulin signaling, is associated with nonalcoholic fatty liver disease (NAFLD), diabetes, and the risk of cardiovascular diseases. Both prediabetes and NAFLD are associated with increased cardiovascular risk, and their concurrence significantly impairs hepatic and adipose tissue insulin sensitivity.Objective:Our objective was to investigate the relationship between serum fetuin-A levels and prediabetes in subjects with or without NAFLD.Design:This was a cross-sectional case-control study.Patients:A total of 510 age- and sex-matched subjects with normal glucose tolerance (NGT), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT) with or without NAFLD were recruited. Each subject was assessed by abdominal ultrasound to diagnose NAFLD.Main Outcome Measures:Serum fetuin-A concentrations were compared between groups. The association with clinico-metabolic parameters was examined.Results:The presence of NAFLD significantly increases fetuin-A levels in subjects with NGT and prediabetes. As compared with NGT, IGT, but not IFG, significantly increases fetuin-A levels in subjects with or without NAFLD. Serum fetuin-A concentrations were positively related to postload 2-h glucose, body mass index, triglyceride, and homeostasis model assessment of insulin resistance but negatively associated with age, high-density lipoprotein cholesterol, and adiponectin. In multiple regression analysis, age, IGT vs. NGT, and IGT with NAFLD vs. NGT were independently associated with fetuin-A levels after adjustment for cardiovascular risk factors and adiponectin.Conclusions:IGT with or without NAFLD was independently associated with fetuin-A levels after adjustment for cardiometabolic risk factors. The elevated fetuin-A levels could have a clinical implication in the increased cardiovascular risk and insulin resistance associated with NAFLD and IGT.
The Journal of clinical endocrinology and metabolism 10/2012; · 6.50 Impact Factor
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ABSTRACT: SummaryBackground Obesity is related to social disparity. The objective of the study was to evaluate different indicators of parental SES with the association of central obesity in young adult Taiwanese students. Methods This study was cross-sectionally designed and a total of 4552 subjects were recruited. Each subject completed a self-administrated questionnaire and received anthropometric and laboratory measurements. The indicators of SES in study subjects included parental education, occupation, household incomes, childhood and current index of social position (ISP), measured according to the modified Hollingshead's ISP. Central obesity was defined as waist circumference ≥90 cm in men and ≥80 cm in women. Results The prevalence of central obesity was 10.7% in this study. When compared to subjects with normal waist circumferences, subjects with central obesity were older, had a higher BMI, both systolic and diastolic blood pressure, a higher proportion of male gender, family history of diabetes and hypertension, alcohol consumption habit, and a higher proportion of low current household income, current parental blue collar occupational level, and lower current and childhood parental ISP level. Multivariate analysis showed the current parental household income and ISP were significantly higher indicators of risk of central obesity after adjustment for possible confounding factors. The odds ratios were 1.26 and 1.30, respectively. Conclusions Our results showed that low household income and current ISP were independently associated with the risk of central obesity. Therefore, young adults with low SES should be an important target group for prevention and management of central obesity in school health promotion programs.
Obesity Research & Clinical Practice 09/2012; · 0.38 Impact Factor
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ABSTRACT: To examine the association between sleep duration and metabolic syndrome in an apparently healthy Chinese population.
The baseline data were collected from a health examination center in Tainan, Taiwan, from October 1, 2006, to August 31, 2009. A total of 7100 adults were recruited. Subjects were classified into three groups according to their sleep duration: short (<6h), normal (6-8h), and long sleepers (>8h).
There were significant differences in age, gender, education level, fasting plasma glucose, and the proportion of smoking status and exercise frequency among different sleep groups. Based on multiple logistic regression, short sleepers were positively associated with metabolic syndrome (OR=1.28, 95% CI: 1.01-1.63) in males but not in females (OR=1.04, 95% CI: 0.72-1.51). Long sleepers were not related with metabolic syndrome in both genders. Short sleep duration was independently related to hyperglycemia (OR=1.39, 95% CI: 1.10-1.74) also in males only. Other components such as hypertriglyceridemia, low high density lipoprotein cholesterol, high blood pressure and central obesity were not associated with short sleep duration.
Males with short sleep duration are positively associated with metabolic syndrome and they also exhibited a higher prevalence of hyperglycemia.
Preventive Medicine 07/2012; 55(4):305-9. · 3.22 Impact Factor
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ABSTRACT: Fetuin-A is a biomarker reported to be important in many metabolic disorders, including obesity, diabetes, and hepatic steatosis. Although it is well known that fetuin-A is increased in diabetes and nonalcoholic fatty liver disease (NAFLD), the levels of fetuin-A in diabetic patients with NAFLD are unknown. Furthermore, the regulation of fetuin-A expression is still obscure. In this study, a total of 180 age- and sex-matched subjects with normal glucose tolerance, NAFLD, newly diagnosed diabetes (NDD), and NDD with NAFLD were recruited. We found that the levels of fetuin-A were significantly increased in NDD with NAFLD as compared with NDD or NAFLD subjects. We further used HepG2 cells to investigate the regulation of fetuin-A. Treatment with endoplasmic reticulum (ER) stress activator, thapsigargin, increased the expression of fetuin-A mRNA and protein in a time- and dose-dependent manner. Pretreatment with ER stress inhibitor, 4-phenylbutyrate, reversed high glucose or palmitate-induced fetuin-A expression. Moreover, treatment with 4-phenylbutyrate in both streptozotocin-induced and high-fat diet-induced diabetic mice not only decreased hepatic fetuin-A levels but also improved hyperglycemia. Taken together, we found that fetuin-A levels were increased in diabetes patients with NAFLD. Moreover, ER stress induced by high glucose and palmitate increased the expression of fetuin-A and further contributed to the development of insulin resistance.
Endocrinology 05/2012; 153(7):2974-84. · 4.46 Impact Factor
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ABSTRACT: With the exception of depression and anxiety, there has been no study designed to evaluate the association between other psychiatric symptoms and Type 2 diabetes. The aim of this study was to investigate the relationship between different psychiatric symptoms and diabetes as well as pre-diabetes (Pre-DM) in a Chinese population. Totally, 9561 participants without a history of diabetes, depression, psychosis, use of hypnotics, and abnormal thyroid function were enrolled. Psychiatric symptoms were measured by Brief Symptoms Rating Scale questionnaire, which consists of three global indices [General Severity Index (GSI), Total Number of Positive Symptoms (PST), and Positive Symptom Distress Index (PSDI)] and ten subscales, including somatization, obsession, interpersonal sensitivity, depression, anxiety, hostility, phobia, paranoid ideation, psychoticism and additional symptoms. Different glycemic statuses included normal glucose tolerance (NGT), Pre-DM, and newly-diagnosed diabetes (NDD) group. GSI, somatization, hostility, phobia, psychoticism, and additional symptoms were the factors positively associated with NDD as well as pre-DM in an age-adjusted model. After adjustments for age, gender, body mass index, educational level, hypertension, plasma triglycerides and creatinine, smoking, alcohol use, regular exercise, marital status, and family history of diabetes mellitus, the following psychiatric symptoms were independently related to both NDD and pre-DM: GSI, PST, somatization, obsession, interpersonal sensitivity, depression, anxiety, hostility, phobia, psychoticism, and additional symptoms. In addition to depression and anxiety, global indices of psychiatric symptoms and other subscales, including somatization, obsession, interpersonal sensitivity, hostility, phobia, psychoticism and additional symptoms, may have an impact on both diabetes and Pre-DM.
Journal of psychiatric research 05/2012; 46(7):927-32. · 3.72 Impact Factor
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ABSTRACT: OBJECTIVE: Decreased sleep quality and duration predicts the development of type 2 diabetes. Prediabetes is an established risk factor for type 2 diabetes and cardiovascular disease. However, there is limited research on the association between prediabetes and sleep quality. The aim of this study is to investigate this relationship in a Chinese population. METHODS: Subjects were recruited from the Prevention Health Center of National Cheng Kung University Hospital. Anthropometric data and metabolic parameters were measured. The diagnoses of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes followed the recommendations of the American Diabetes Association. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). RESULTS: A total of 1,805 subjects with normal glucose tolerance (NGT, n=1,217), IFG (n=118), IGT (n=287), IFG+IGT (n=80), and newly diagnosed diabetes (NDD, n=103) were recruited. The global PSQI scores were 6.07 ± 2.44, 6.74 ± 3.23, 6.91 ± 3.51, 6.74 ± 2.26, and 7.16 ± 3.49 in subjects with NGT, IFG, IGT, IFG+IGT, and NDD, respectively. Multivariate linear regression analysis showed that female gender, smoking, IGT, IFG+IGT, and NDD, but not IFG, were independent determinants of global PSQI score. Multivariate logistic regression analysis showed that female gender, IGT, IFG+IGT, and NDD, but not IFG, were predictors of poor sleep. CONCLUSIONS: Subjects with prediabetes and NDD had a significantly higher global PSQI score than those with NGT. Furthermore, female gender, smoking, IGT, IFG+IGT, and NDD, but not IFG, were significantly associated with poor sleep quality independent of cardiometabolic risk factors in a Chinese population. © 2012 Blackwell Publishing Ltd.
Clinical Endocrinology 05/2012; · 3.17 Impact Factor
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ABSTRACT: Studies have shown that diabetes mellitus increased brachial-ankle pulse-wave velocity (baPWV), but the impact of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) remains controversial.
Our objective was to investigate the impact of the different glycemic states on baPWV in a relatively healthy Chinese population.
We enrolled 4938 subjects in the health examination center of the National Cheng Kung University Hospital from October 2006 to August 2009 after excluding those who were under medications for diabetes, hypertension, or hyperlipidemia or had a history of cardiovascular disease.
The baPWV values to assess arterial stiffness were calculated as the distance traveled by the pulse wave divided by the time taken to travel the distance. The participants were classified into normal glucose tolerance (NGT; n = 3777), isolated IFG (n = 221), IGT (n = 726), and newly diagnosed diabetes (NDD; n = 214) groups.
The mean values of baPWV were 1284.9 ± 205.2, 1379.6 ± 226.8, 1408.1 ± 251.7, and 1500.8 ± 282.5 cm/sec in NGT, isolated IFG, IGT, and NDD groups, respectively. The isolated IFG, IGT, and NDD groups had a higher baPWV value as compared with the NGT group. In a multiple linear regression test, both IGT and NDD groups, but not the isolated IFG group, had significantly higher baPWV values after adjustment for age, sex, body mass index, waist to hip ratio, smoking, alcohol consumption, habitual exercise, systolic blood pressure, and lipid profiles.
Subjects with IGT and NDD, but not isolated IFG, exhibit a greater arterial stiffness.
The Journal of clinical endocrinology and metabolism 02/2012; 97(4):E658-62. · 6.50 Impact Factor
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ABSTRACT: The aim of this study is to determine the relationship between leisure time physical activity (LTPA) and non-leisure time physical activity (NLTPA) on mortality among the elderly in Taiwan.
This is a prospective observational cohort study. We analyzed the mortality data from a cohort of 876 non-institutionalized community-dwelling men and women aged 65 years or over, who were recruited by stratified clustering random sampling from Tainan city and participated in the 1996 Elderly Medication Survey. Information about activities and other variables were collected by structured interviews at baseline in the participants' home. The Cox proportional hazards model and crude death rate were applied to estimate mortality risk.
Among the 876 participants, 312 died during the follow-up period (1996-2004). In the unadjusted Cox regression model, subjects aged over 75, having difficulty in carrying out activities of daily living (ADLs), a BMI less than 18.5, a history of diabetes mellitus or stroke, without LTPA or being inactive in NLTPA, were found to have a higher risk of eight-year mortality. With the adjustment for age, gender, education level, habitual smoking and drinking, living status, BMI and medical history, the mortality was found to be higher among the sedentary subjects, either defined by lack of LTPA or NLTPA, with the hazard ratio of 1.27 (95% confidence interval [CI] = 0.97-1.66) and 1.45 (95% CI = 1.07-1.97), respectively. Furthermore, when both LTPA and NLTPA were put into the model simultaneously, NLTPA (HR = 1.40; 95% CI = 1.03-1.91) but not LTPA (HR = 1.21, 95% CI = 0.92-1.59) significantly predicted mortality during eight-year follow-up. In addition, subjects who were actively engaged in NLTPA had a lower mortality risk especially in subjects without performing LTPA.
NLTPA is an independent predictor of longevity among older people in Taiwan. A physically active lifestyle, especially engaged in NLTPA, is associated with lower mortality risk in the elderly population. We thus suggest that encouraging older people to keep on engaging in customary NLTPA is good for their health.
BMC Public Health 06/2011; 11:428. · 2.00 Impact Factor
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ABSTRACT: Assessing the correlates of practicing physical activity during leisure time is important with regard to planning and designing public health strategies to increase beneficial behaviors among adult populations. Although the importance of leisure time physical activity (LTPA) is highlighted in many Western countries, there are not many publications on physical activity patterns, and even less on their correlates, in non-Western societies. The goal of this study was thus to explore the determinants influencing adults' leisure time physical activity (LTPA) in a city in southern Taiwan.
A cross-sectional population-based study was conducted in 2007, using a standardized questionnaire. Energy expenditure was dichotomized into two groups based on the recommended levels of moderate physical activity from LTPA: ≥10 or < 10 MET·hr·wk(-1). Logistic regression analyses were applied to the results.
A total of 762 subjects with valid data took part in the study (mean age 53.8 ± 13.8 years). In multivariate logistic regression analysis, we found the following results: Age was positively associated with LTPA. Adults with stronger perceived convenience of exercise facilities (OR = 2.04; 95%CI = 1.28-3.24) and past exercise experience in school (OR = 1.86; 95%CI= 1.19-2.91) participated in more LTPA. Subjects with more general social support (OR = 1.66;95%CI = 1.13-2.44), greater knowledge about the health benefits of exercise (OR = 1.85;95%CI = 1.25-2.74), more sports media consumption (OR = 1.94;95%CI = 1.26-2.98), and higher self-efficacy (OR = 3.99;95%CI = 2.67-5.97) were more likely to engage in LTPA. Further analysis comparing different sources of social support showed only social support from friends had a significant positive association (OR = 1.73;95%CI = 1.14-2.63) with increased LTPA.
LTPA in southern city of Taiwan showed some unique associations with age, socioeconomic status and media consumption that are not commonly reported in the Western World and similar associations with regards to psychosocial correlates of LTPA participation. Further studies from developing countries are warranted to highlight culture-specific differences in physical activity participation.
BMC Public Health 06/2011; 11:427. · 2.00 Impact Factor
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ABSTRACT: U-shaped patterns have been observed for the relationship between sleep duration and diabetes. In addition, prediabetes is associated with the risk of cardiovascular diseases and diabetes. However, there are few studies investigating the relationship between sleep duration and prediabetes/newly diagnosed diabetes. The aim of this study is to examine the relationship between sleep duration and prediabetes/newly diagnosed diabetes in a Taiwanese population. After excluding the subjects with a high risk of obstructive sleep apnea, those with a positive history of diabetes, or those taking hypnotic drugs, a total of 3470 adults were recruited from a health checkup center. Each subject completed a self-administrated structured questionnaire on sleep duration and lifestyle factors. Prediabetes/diabetes was defined following the definition of the American Diabetes Association. Subjects with different sleep durations were classified into short (<6.0 hours), normal (6.0∼8.49 hours), and long sleepers (≥8.5 hours). The proportion of subjects with normal glucose tolerance, prediabetes, and newly diagnosed diabetes was 71.9%, 22.9%, and 5.2%, respectively. There were significant differences in age, sex, weight, education level, body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, alcohol and coffee drinking habits, family history of diabetes, and sleep duration among the 3 glycemic groups. In multinomial regression, both short and long sleepers had a higher risk of newly diagnosed diabetes; and the odds ratio were 1.55 (95% confidence interval, 1.07-2.24) and 2.83 (1.19-6.73), respectively. However, sleep duration was not found to relate to prediabetes. In conclusion, both short and long sleep durations were independently associated with newly diagnosed diabetes, but not with prediabetes.
Metabolism: clinical and experimental 06/2011; 60(6):799-804. · 2.59 Impact Factor
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ABSTRACT: Hepatic steatosis is associated with an increased risk of diabetes. Although the levels of serum fetuin-A, a liver-derived glycoprotein that impairs insulin signalling, are positively correlated with hepatic steatosis, the levels of fetuin-A in subjects with impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and newly diagnosed type 2 diabetes (NDD) have not been established. The aim of this study is to investigate the relationship among serum fetuin-A concentrations, IFG, IGT and NDD in Chinese subjects without nonalcoholic fatty liver disease (NAFLD).
A total of 360 age- and sex-matched subjects with normal glucose tolerance (NGT), IFG, IGT and NDD were recruited in this case-control study.
Each subject was assessed by abdominal ultrasound to exclude the presence of NAFLD. Serum fetuin-A concentrations were measured by enzyme-linked immunosorbent assay and compared between NGT, IFG, IGT and NDD groups. The association with clinical and metabolic parameters was also examined.
Serum fetuin-A concentrations were higher in NDD and IGT groups than NGT groups (341 ± 88, 335 ± 90, and 300 ± 75 μg/ml). In multiple linear regression analysis, IGT (P < 0·01) and NDD (P < 0·05) were the positively associated factors of serum fetuin-A concentrations, but age (P < 0·05) was a negatively associated factor after adjusting for age, anthropometric indices, lipid profile, estimated glomerular filtration rate (eGFR), adiponectin, C-reactive protein (CRP) and homeostasis model assessment (HOMA-IR).
IGT and NDD are positively associated with serum fetuin-A concentrations in subjects without NAFLD independent of cardiometabolic risk factors.
Clinical Endocrinology 04/2011; 75(4):450-5. · 3.17 Impact Factor
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Chih-Cheng Hsu,
Hsing-Yi Chang,
Meng-Chuan Huang,
Shang-Jyh Hwang,
Yi-Ching Yang,
Tong-Yuan Tai,
Hung-Jen Yang,
Chwen-Tzuei Chang, Chih-Jen Chang,
Yu-Sheng Li,
Shyi-Jang Shin,
Ken N Kuo
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ABSTRACT: An association between insulin resistance and microalbuminuria in type 2 diabetes has often been found in cross-sectional studies. We aimed to reassess this relationship in a prospective Taiwanese cohort of type 2 diabetic subjects.
We enrolled 738 normoalbuminuric type 2 diabetic subjects, aged 56.6 ± 9.0 years, between 2003 and 2005 and followed them through the end of 2009. Average follow-up time was 5.2 ± 0.8 years. We used urine albumin-to-creatinine ratio to define microalbuminuria and the homeostasis model assessment of insulin resistance (HOMA-IR) to assess insulin resistance. The incidence rate ratio and Cox proportional hazards model were used to evaluate the association between HOMA-IR and development of microalbuminuria.
We found incidences of microalbuminuria of 64.8, 83.5, 93.3, and 99.0 per 1,000 person-years for the lowest to highest quartiles of HOMA-IR. Compared with those in the lowest quartile of HOMA-IR, the incidence rate ratios for those in the 2nd, 3rd, and highest quartiles were 1.28 (95% CI 0.88-1.87), 1.44 (0.99-2.08), and 1.52 (1.06-2.20), respectively (trend test: P < 0.001). By comparison with those in the lowest quartile, the adjusted hazard ratios were 1.37 (0.93-2.02), 1.66 (1.12-2.47), and 1.76 (1.20-2.59) for those in the 2nd, 3rd, and highest HOMA-IR quartiles, respectively.
According to the dose-response effects of HOMA-IR shown in this prospective study, we conclude that insulin resistance could significantly predict development of microalbuminuria in type 2 diabetic patients.
Diabetes care 02/2011; 34(4):982-7. · 8.09 Impact Factor
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ABSTRACT: The mortality rate of colorectal cancer ranks third behind lung and hepatic cancer in Taiwan. Colorectal cancer mostly arises from adenomatous polyps of left colon. The aim of our study was to examine the association of serum lipids with the histological pattern of rectosigmoid adenoma.
There were 2,506 eligible examinees aged 20 and above who underwent sigmoidoscopy as a screening examination in National Cheng Kung University Hospital between January 2003 and October 2006. They were classified into three groups: tubular adenoma (333 subjects), villous-rich (tubulovillous/villous) adenoma (53 subjects) and normal (2,120 subjects). We defined high total cholesterol (TC) as a level ≧200 mg/dl, low high-density lipoprotein cholesterol (HDL-C) as a level <40 mg/dL, and high triglyceride (TG) as a level ≧200 mg/dl according to the third report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Adenoma histology was classified as tubular, tubulovillous and villous according to the proportion of villous part.
Among the study population, 333 subjects (13.3%) had tubular adenomas and 53 subjects (2.1%) had villous-rich adenomas. The odds ratio (OR) for villous-rich adenoma in subjects with TG≧200 mg/dL compared to those with TG < 200 mg/dL was 3.20 (95% confidence interval [CI]:1.71-6.01), after adjusting for age, gender, general obesity, central obesity, diabetes, hypertension, smoking, and alcohol consumption. If further taking high TC and low HDL-C into consideration, the OR was 4.42 (95% CI:2.03-9.63).
Our study showed that subjects with high serum TG tended to have a higher risk of tubulovillous/villous adenoma in rectosigmoid colon. Therefore, reducing the serum TG level might be one method to prevent the incidence of colorectal cancer.
BMC Gastroenterology 01/2011; 11:54. · 2.42 Impact Factor
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ABSTRACT: Previous studies on the change of cardiac autonomic function and insulin resistance in metabolic syndrome recruited subjects with cardiovascular-related disease and defined metabolic abnormality with a more severe cutoff. We explored the alteration of cardiac autonomic function and insulin resistance in predisease community dwellers with different numbers of metabolic abnormalities.
A total of 1298 subjects were classified as none (n=539), one (n=378), 2 (n=218), and 3 or more metabolic abnormalities (n=154). Insulin resistance was calculated by homeostatic model assessment. Cardiac autonomic function included 5-minute standard deviation of R-R interval, low- and high-frequency power spectrum, and low-/high-frequency power spectrum ratio, the ratio of the longest R-R interval around the 30th beat and the shortest R-R interval around the 15th beat after standing, and the ratio of the longest expiratory R-R interval to the shortest inspiratory R-R interval during deep breathing.
Subjects with a single metabolic abnormality or more had a lower standard deviation of R-R interval and expiratory/inspiratory ratio than subjects without metabolic abnormality in multivariate analysis. Subjects with 3 or more metabolic abnormalities had a higher low-/high-frequency power spectrum ratio, but a lower high-frequency power. Insulin resistance was higher in groups with 2 metabolic abnormalities or more, but not in the group with one metabolic abnormality, than those without metabolic abnormality.
Cardiac autonomic function altered in predisease subjects with one or more metabolic abnormalities, while insulin resistance existed in subjects with 2 or more metabolic abnormalities. Thus, autonomic function change may precede insulin resistance in the initiation of metabolic syndrome.
The American journal of medicine 05/2010; 123(5):432-8. · 4.47 Impact Factor
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ABSTRACT: Very-low-calorie diets (VLCDs) are an effective method for weight reduction in Caucasians. This study investigated the efficacy and safety of two different VLCDs (450 or 800kcal/d) in obese Taiwanese.
132 participants with BMI > or =30kg/m(2) were randomized to two VLCD groups for body weight reduction for 12 weeks. Each group had 66 participants. Anthropometric and metabolic parameters were measured.
The intention-to-treat analysis revealed that the percentage change in body weight over the 12-week treatment period was -9.14% in the VLCD-450 group and -8.98% in the VLCD-800 group. A total of 27 (40.9%) participants in the VLCD-450 group and 29 (43.9%) participants in the VLCD-800 group achieved 10% or more weight loss at the end of treatment. The body weight, waist circumference, hip circumference, fat mass, blood pressure, triglycerides, and blood glucose were statistically improved from baseline but not between the two groups. The improvement rate of nonalcoholic fatty liver disease (NAFLD) was 41.5% in the VLCD-450 group and 50.0% in the VLCD-800 group. The incidence of adverse events did not differ significantly between the groups and no serious adverse events were reported in either group.
Both the VLCD-450 and 800kcal/d can effectively and safely reduce body weight and improve NAFLD in 12 weeks in obese Taiwanese participants. However, there is no additional benefit in prescribing the more restrictive diet intervention in Taiwanese.
Nutrition 07/2009; 25(11-12):1129-36. · 3.03 Impact Factor
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ABSTRACT: Background: There is limited information about the quality of sleep in patients with chronic kidney disease (CKD) and of the association between quality of sleep and severity of renal dysfunction. In this study, we investigated the relationship between renal function and quality of sleep in Taiwanese patients with CKD. Methods: We enrolled patients who underwent health checkups at the National Cheng Kung University Hospital medical center from July 1997 to October 2007. Based on guidelines of the National Kidney Foundation, 393 subjects had CKD. Renal function, estimated from glomerular filtration rate, was calculated with the Modification of Diet in Renal Disease equation. Patients were classified as having CKD stage 1-2 or CKD stage 3-5. Sleep quality was assessed with the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). We classified patients with global PSQI scores≤6 as having good sleep quality (GSQ), and patients with global PSQI scores>6 as having poor sleep quality (PSQ). Results: Among our 393 patients, 251 (63.9%) were male and 142 (46.1%) were female. A total of 194 patients (49.4%) had PSQ. In patients with CKD stage 1-2, 162 (47.2%) had PSQ while in patients with CKD stage 3-5, 32 (64%) had PSQ. Patients with GSQ group were more likely to be male, and to have high diastolic blood pressure, cholesterol, albumin, fasting glucose, and hemoglobin. In addition, GSQ patients tended to perform regular exercise and to have stage 1-2 CKD. CKD stage 3-5, female gender, lower fasting plasma glucose and high body mass index were independently associated with PSQ. Conclusion: About half of our CKD subjects had PSQ. Patients with stage 3-5 CKD, of female gender, lower fasting plasma glucose and with high body mass index were more likely to suffer from PSQ. We suggest that clinicians devote more attention to the sleep quality of subjects with CKD, especially patients with stage 3-5 CKD.
Asia Pacific Family Medicine 03/2009; 19(1):49-61.
