Setting up a risk prediction model on metabolic syndrome among 35-74 year-olds based on the Taiwan MJ Health-checkup Database / 中华流行病学杂志

Objective This study aimed to provide an epidemiological modeling method to evaluate the risk of metabolic syndrome (MS) development in the coming 5 years among 35-74 year-olds from Taiwan.Methods A cohort of 13 973 subjects aged 35-74 years who did not have metabolic syndrome but took the initial testing during 1997-2006 was formed to derive a risk score which tended to predict the incidence of MS.Multivariate logistic regression was used to derive the risk functions and using the ‘check-up center' (Taipei training cohort) as the overall cohort.Rules based on these risk functions were evaluated in the remaining three centers (as testing cohort).Risk functions were produced to detect the MS on a training sample using the multivariate logistic regression models.Started with those variables that could predict the MS through univariate models,we then constructed multivariable logistic regression models in a stepwise manner which eventually could include all the variables.The predictability of the model was evaluated by areas under curve (AUC) the receiver-operating characteristic (ROC) followed by the testification of its diagnostic property on the testing sample.Once the final model was defined,the next step was to establish rules to characterize 4 different degrees of risks based on the cut points of these probabilities,after being transformed into normal distribution by log-transformation.Results At baseline,the range of the proportion of MS was 23.9％ and the incidence of MS in 5-years was 11.7％ in the non-MS cohort.The final multivariable logistic regression model would include ten risk factors as:age,history of diabetes,contractive pressure,fasting blood-glucose,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,body mass index and blood uric acid.AUC was 0.827 (95％ CI:0.814-0.839) that could predict the development of MS within the next 5 years.The curve also showed adequate performance in the three tested samples,with the AUC and 95％ CI as 0.813 (0.789-0.837),0.826(0.800-0.852) and 0.794(0.768-0.820),respectively.After labeling the degrees of the four risks,it was showed that over 17.6％ of the incidence probability was in the population under mediate risk while over 59.0％ of them was in the high risk group,respectively.Conclusion Both predictability and reliability of our Metabolic Syndrome Risk Score Model,derived based on Taiwan MJ Longitudinal Health-checkup-based Population Database,were relatively satisfactory in the testing cohort.This model was simple,with practicable predictive variables and feasible form on degrees of risk.This model not only could help individuals to assess the situation of their own risk on MS but could also provide guidance on the group surveillance programs in the community regarding the development of MS.

Estimation on the risk of 5-years obesity development among adults aged 30-59, based on the Taiwan MJ Health-checkup Database / 中华流行病学杂志

Objective This study aimed to provide an epidemiological modeling in evaluating the risk of developing obesity within 5 years in Taiwan population aged 30-59 years.Methods After excluding 918 individuals who were obesitive at baseline,a cohort of 14 167 non-obesity subjects aged 30-59 years in the initial year during 1998-2006,was formed to derive a Risk Score which could predict the incident obesity (IO).Multivariate logistic regression was used to derive the risk functions,using the check-up center (Taipei training cohort,n=8104) of the overall cohort.Rules based on these risk functions were evaluated in the left three centers (testing cohort,n=6063).Risk functions were produced to detect the IO on a training sample using the multivariate logistic regression models.Starting with variables that could predict the IO through univariate models,we constructed multivariable logistic regression models in a stepwise manner which eventually could include all the variables.We evaluated the predictability of the model by the area under the receiver-operating characteristic (ROC) curve (AUC) and to testify its diagnostic property on the testing sample.Once the final model was defined,the next step was to establish rules to characterize 4different degrees of risk based on the cut points of these probabilities after transforming into normal distribution by log-transformation.Results At baseline,the range of the proportion of normal weight,overweight and obesity were 50.00％ 60.00％,26.47％-31.11％ and 5.76％-7.24％ respectively in tour check-up centers of Taiwan.After excluding 918 obesity individuals at baseline,we ascertained 386 (2.73％,386/14 167) cases having IO and 2.66％-2.91％ of them having centered obesity in the four check-up centers respectivcly.Final multivariable logistic regression model would include five risk lactors:sex,age,history of diabetes,weight deduction ≥4 kg within 3 months and waist circumference.The area under the ROC curve (AUC) was 0.898 (95％CI,0.884-0.912) that could predict the development of obesity within 5 years.The curve also had adequate performance in testing the sample [AUC=0.881 (95％CI,0.862 0.900) ].After labeling the four risk degrees,16.0％ and 2.9％ of the total subjects were in the mediate and high risk populations respectively and were 7.8 and 16.6 times higher,when comparing with the population at risk in general.Conclusion The predictability and reliability of our obesity risk score model,derived based on Taiwan MJ Longitudinal Health-checkup-based Population Database,were relatively satisfactory,with its simple and practicable predictive variables and the risk degree form.This model could help individuals to self assess the situation of risk on obesity and could also guide the community caretakers to monitor the trend of obesity development.

Comparison of two diagnostic criteria for metabolic syndrome applied in health check-up population aged 12-19 years in Taiwan / 中华儿科杂志

<p><b>OBJECTIVE</b>To compare the differences of two recommended diagnostic criteria for metabolic syndrome (MS) in a health check-up population aged 12-19 years in Taiwan province.</p><p><b>METHOD</b>The study data were supplied by the MJ Health Screening Center, which is a private membership chain clinic with 4 health screening centers around the Taiwan Island and provides periodic health examination to its members. The database included a self-administered questionnaire for health history, asking about demographic, socioeconomic, medical, and lifestyle information, and clinical and laboratory measures for every member. A total of 1629 members (873 boys and 756 girls, respectively) received a health check-up first time at MJ centers were recruited from 2005 to 2006. MS detection rate and agreement rate was calculated according to two definitions, respectively. The distributions of MS components and the aggregation of risk factors were further analyzed.</p><p><b>RESULT</b>(1) The range of age-adjusted detection rate of MS for two definitions were 4.05% (5.84% for boys, 1.98% for girls) and 8.35% (10.42% for boys, 5.95% for girls), respectively. It was 0.94% , 14.20% and 36.59% for criterion I among adolescents who were overweight (BMI over 95th percentile), at risk of overweight (BMI between 85th and 95th percentile) and normal weight (BMI below the 85th percentile), respectively; while 3.61%, 25.93% and 53.66% for criterion II. (2) The range of five MS components were 9.09% (low-HDL-C)-16.39% (high blood pressure) for definition I, while 0.98% (high FBG)-27.13% (high WC) for definition II. (3) Of the total subjects, 2.76%, 1.04% and 0.25% were presented with three, four and five MS risk factors for definition I; while 6.69%, 1.60% and 0.34% for definition II, separately. (4) The most common clinical symptom complex of MS was "obesity, hypertension and low-HDL-C" for criterion I, "high TG, obesity and low-HDL-C" for criterion II. (5) The MS diagnostic criterions of I and II were in moderate accordance with agreement rate of 94.35%, Kappa index was 0.518.</p><p><b>CONCLUSION</b>Our findings reveal that there were relatively large differences in detection and aggregation of risk components on MS when using two recommended definitions, the detection rate of MS in adolescents depends strongly on the parameters chosen and their respective cut-off points. In order to avoid possible relevant under- or over-estimation of the prevalence, it seems advisable that the use of unversally specific cut-off values seems to be more appropriate to give more reliable results.</p>

Study on the long-term efficacy and safety of medicine named 'Beijing Hypertensive No. 0' in patients with primary hypertension / 中华流行病学杂志

<p><b>OBJECTIVE</b>To assess the antihypertensive effect and safety on medicine named 'Beijing Hypertensive No. 0' in a three-year treatment of primary hypertension.</p><p><b>METHODS</b>A community-based intervention study was conducted. The antihypertensive effects and adverse events were observed.</p><p><b>RESULTS</b>4000 patients with primary hypertension were randomly divided into two groups with 1529 patients treated with 'Beijing Hypertensive No. 0' and 976 patients treated with other antihypertensive drugs, among which 946 and 853 patients in the two groups completed the three-year study. After treatment, the systolic blood pressure decreased 13 mm Hg and 7 mm Hg while diastolic blood pressure decreased 8 mm Hg and 4 mm Hg in the 'No. 0' group and controlled group respectively. After three years of treatment, 90.0% and 79.5% in the 'No.0' group and in the control group had reached the BP 'fulfillment criteria', which were much higher than the baseline data. Side effects occurred in 33/1274 (2.6%) cases during three years' treatment with most commonly seen as dizziness, headache, palpitation and weakness. No serious adverse reactions occurred. There were some positive effects after treated by 'No. 0', including 0.13 mmol/L decrease of TC, 0.70 mmol/L decrease of LDL-C and an average 0.12 mmol/L increase of HDL-C. All of these changes were statistically significant. There were also opposite effects as 0.13 mmol/L increase of TG, 0.24 mmol/L increase of K+, and 0.88 mmol/L increase of Na+ on average, which were also statistically significant.</p><p><b>CONCLUSION</b>Compared with the conventional treatment, this treatment of 'Beijing Hypertensive No.0' was more convenient, safe and effective in treating mild to moderate primary hypertension in the community.</p>

Cost-effectiveness analysis on compound anti-hypertensive tablets for primary hypertension / 中华流行病学杂志

Objective To compare the cost-effectiveness of two anti-hypertensive therapy regimens,Compound anti-hypertensive tablets and other common anti-hypertensive agents,in the treatment program of Primary Hypertension.Methods We conducted a cost-effectiveness analysis based on a community trial.Two communities'primary hypertensive patients were enrolled to receive different therapy drugs:Compound anti-hypertensive tablets(Group A)or other common anti-hypertensive agents(Group B).Blood pressure,medicine used,and adverse drug reactions were observed and recorded for one year,and then costeffectiveness ratio of the two groups and incremental ratio were calculated.We considered a 30%drug price fluctuating load to make the sensitivity analysis.Results 2505 cases were enrolled with 1529 cases in group A and 976 cases in group B.The cost-effectiveness ratios were 418.1 and 1057.7 for Group A and B respectively while the incremental cost-effectiveness of Group B vs.Group A was 19 202.2.The results were insensitive to variation in the costs of drugs over clinically reasonable ranges.Conclusion Compound anti-hypertensive tablets appeared to be relatively cost-effective when compared to common drugs for the treatment of primary hypertension.

Comparison of five different diagnostic criteria on metabolic syndrome applied during physical check-up programs among population aged 35-74,in Taiwan / 中华流行病学杂志

Objective To compare the differences of five diagnostic criteria used for metabolic syndrome (MS),issued by International Diabetes Federation (IDF),the National Cholesterol Education Program (ATPIII),America-Heart-Associatien (AHA),Chinese Medical Association Diabetes Branch (CDS) and The Taiwan Health Bureau (TAIWAN),during a physical check-up program among population aged 35-74 years,in Taiwan.Methods A total number of 28 408 people who had received physical checkup program first time at the MJ centers,were recruited from 2005 to 2007.The prevalence of MS and the degree of agreement were both calculated according to the five definitions and the results of MS components.Distributions and risk factor aggregation of the results were also analyzed.Results According to the five definitions (1)The range of age-adjusted prevalence of MS appeared to be 10.6%(CDS)23.6%(AHA),and were 13.4%(CDS)-27.6%(AliA)and 8.0%(CDS)-20.5%(IDF) for men and women respectively.(2) The range of five MS components were 22.5%(low-HDL-C)-39.7%(high FPG),with 22.3%of the total subjects presented at least 3 risk factors.In addition,0%(AHA),6.7%(TAIWAN),6.9%(ATP III),8.9%(IDF) and 14.9%(CDS) of the subjects diagnosed as MS-free,by the five criterions,also appeared of having≥3 risk factors.(3) Among all the MS subjects,the proportions of clinical symptom complex,having 5,4 and 3 MS components were 8.0%,29.5%and 62.5%respectively.The most common clinical symptoms complex of MS were obesity,hypertension and high FPG.(4) The MS diagnostic criteria of ATPIII,AHA and TAIWAN were in good accordance with Kappa index,showing 0.81-0.98 for the three criteria.CDS and IDF were in relatively weak agreementwhen comparing with other definitions with Kappa index showed as 0.35 and 0.62.Conclusion Our findings revealed big differences in the prevalence and aggregation of risk components on MS,when using the five definitions.We suggested that prospective cohort studies be planned to investigate the impact on cardiovascular disease morbidity and mortality so as to verify whies criterion might be suitable to the population in Taiwan,considering the possible bias.