Learning through connections: clinical participation and interpersonal relationships in longitudinal integrated clerkships and traditional block rotations in Taiwan.

BACKGROUND: Longitudinal integrated clerkships (LICs) and traditional block rotations (TBRs) employ different designs that provide various learning experiences for students. In this study, we explored students' clinical participation and interpersonal interactions in LICs and TBRs at 2 metropolitan hospitals in Taiwan. METHODS: In April 2018, we enrolled 15 LIC and 29 TBR students. We conducted a cross-sectional survey which required the students to outline a typical daily schedule during their internal medicine rotations and draw an ecomap of the clinical team members. With the patient in the center as a reference, the size of each circle in an ecomap indicated the importance of the member; the distances and number of connecting lines between two circles represented the relationship and frequency of interaction, respectively, between the corresponding members. We analyzed the results and compared the responses of the LIC and TBR students. RESULTS: The LIC students spent more time on direct patient care and in the outpatient clinic/operation room, whereas the TBR students participated more in educational activities and in observation behind their seniors. In the ecomap analysis, the LIC students had a closer relationship with attending physicians and had better interactions with patients and preceptors than did the TBR students. Conversely, the TBR students felt closer to and interacted more frequently with interns and residents. CONCLUSIONS: The LIC students had more opportunities to care for patients directly and engaged in interactions with patients and attending physicians more frequently than did the TBR students. TRIAL REGISTRATION: Ethical approval for the study was obtained from the Institutional Review Board of Tri-Service General Hospital (TSGHIRB 2-106-05-018).

Using cultural historical activity theory to understand how post-graduate residents perform discharge planning at a medical center in Taiwan.

BACKGROUND: Despite the importance of discharge planning in physicians' education, currently in most countries, no identical training is provided. Difficulties in promoting physician discharge planning education in Taiwan are still noted. This study aims to find the physicians' role of discharge planning training in educating post graduate year residents (PGY) in Taiwan. MATERIALS AND METHODS: We took advantage of government and hospital policies that promote the discharge planning program to teach and implement it, beginning with PGY residents by incorporating it into their training program. We recruited 30 PGY residents who were attending their three-month general internal medicine training from 2018 to 2019. They were interviewed at the end of the program using cultural-historical activity theory (CHAT). Qualitative research methods were used to further understand how discharge planning and care was implemented. RESULTS: Trainees initially believed that they did not have any role in discharge planning. Using the cycle of expansive learning, we found that the role of physicians in discharge planning was unclear. There were still some inconsistencies in the teaching and implementation of the discharge planning program for PGY residents that needed to be resolved, but this study also let participants learn through practice to improve their identification of discharge planning. CONCLUSIONS: This study analyzed the impact of a discharge planning program for PGY physicians in Taiwan. It showed that the program affected physicians' practice and medical education, although some contradictions remain.

Interdisciplinary Shadowing and Case Discussion Improve Medical Students' Self-Efficacy and Attitude Toward Discharge Planning.

Background: The Discharge Planning Curriculum (DPC) is a 4-hour course for penultimate-year medical students at a tertiary teaching hospital in Taiwan. The course begins with a 30-minute introduction, followed by the students shadowing discharge planning case managers as they visit patients on the wards. After patient visits, the students engaged in a 1-hour case discussion. Our research assessed the effectiveness of the DPC for medical students. Methods: This mixed methods study recruited medical students participating in family medicine rotations between October 2017 and May 2018. To determine the impact of the DPC, we quantitatively analyzed questionnaire responses to measure changes in self-efficacy, attitude toward discharge planning, and course satisfaction before and after completing the DPC. Additionally, we conducted qualitative focus group interviews to gain insight into the students' learning experiences and applied thematic analysis to the interview data. Results: Our study found two quantitative results: 1) The DPC significantly improved self-efficacy and attitude toward discharge planning (p < 0.001). 2) The medical students acquired knowledge about home care, assistive device application, long-term care facility referral, home rehabilitation, and home care services, and more than 95% of the students reported being satisfied with the course. In addition, the focus group interviews revealed that medical students learned several aspects of discharge planning through the curriculum, including an understanding of various aspects of discharge planning through the curriculum, the importance of early discharge planning, the roles of doctors and case managers, and the challenges faced in the process. Conclusion: The DPC helped medical students understand different team members' roles in discharge planning and appreciate the challenges that case managers face in this process. The DPC improved medical students' attitudes toward discharge planning. The curriculum can be a valuable tool in training future healthcare providers in effective transitional care.

A novel curriculum for the Same-Sex Marriage Act and Patient Right to Autonomy Act (SMPRA) module based on two new laws in Taiwan: a mixed-methods study.

BACKGROUND: The establishment of laws has had a tremendous impact on holistic medical care. The Patient Right to Autonomy (PRA) Act and the Same-Sex Marriage Act have been passed in Taiwan, and both have sparked intense societal debate. The Same-Sex Marriage Act and PRA Act (SMPRA) teaching module was created for the Gender, Medicine, and Law (GML) course of the medical curriculum. This video trigger-assisted problem-based learning (VTA-PBL) software has integrated content on the aforementioned legislative proclamations. It upends conventional beliefs and fosters reflective practices on sexual rights and the right to representation among medical students. This study examined how the SMPRA module affected the knowledge and attitudes of medical students taking up the GML course. METHODS: A simple pre-/post-test design evaluated the outcomes of the PBL module to examine the changes in knowledge and attitudes of medical students toward same-sex marriage rights. In 2019 and 2020, 126 and 49 5th-year medical students took up the GML course, respectively. The GML components included a video scenario representing advanced decision-making and a healthcare agency with a same-sex couple, a PBL discussion, and student feedback presentations. The mechanisms of feedback collection and measuring student knowledge and attitudes toward sexual rights differed between one cohort in 2019 and the other in 2020. Pre- and post-lecture tests were used in the first school year, whereas a post-lecture open-ended questionnaire survey was used in the second school year. RESULTS: In total, 90 and 39 eligible questionnaires were received in the first and second school years, respectively, which corresponded to response rates of 71% and 80%. Students showed a better understanding of and positive enhancement of proficiency in legal and ethical content and relevant clinical practice. Qualitative analysis revealed that students viewed healthcare providers as checkpoints for conflicts of interest; medical ethics as the cornerstone of clinical practice; cultural background as a significant influence on decision-making; and empathetic communication as the cornerstone of relationships between patients, family members, and doctors. CONCLUSION: The GML course of the SMPRA module fosters reflective practices on ethical and legal sexual rights issues.

Using drawing and situated learning to teach transitional care to post-graduate residents.

BACKGROUND: The "draw-and-talk" technique has become popular in medical training, as it can help healthcare practitioners develop empathic understanding of patients and contribute to personal transformation. We adopted this method to make the teaching of transitional care planning more relevant to post-graduate residents undergoing their internal medicine training at a medical center in Taiwan. METHODS: Before the conventional lecture on discharge planning, trainees were invited to draw their "home" and "life as older adults" and share their drawings with others. Subsequently, they were guided to consider whether their home would be livable if they either had a disability or were old. The drawings and narratives were analyzed thematically, and feedback on the session was collected. RESULTS: Trainees were initially of the opinion that they did not have any role in discharge planning. However, the emphasis on the self-experience of drawing and the thematic use of "home" and "elderly life" led to reflective discussions about post-discharge care. The session provoked constructive self-reflection and meta-cognitive awareness and encouraged residents to actively participate in transition care plans. Response to the draw-and-talk session was overwhelmingly favorable. CONCLUSIONS: Post-graduate residents in Taiwan conventionally do not have much interest or autonomy regarding their patients' lives outside the hospital. The use of drawing and reflection is a simple and inexpensive method to contextualize discharge planning in participants' real lives, engage them in actively visualizing the healthcare needs of older adults and patients with disability, and initiate thinking about the impact of discharge preparations, follow-up care, and barriers to care at home. Draw-and-talk might be helpful in improving residents' knowledge and empathy toward patients preparing for discharge, which is crucial for the quality of transitional care.

Favorable self­rated health is associated with ideal cardiovascular health: a cohort study.

INTRODUCTION: Both self­rated health (SRH) and the cardiovascular health (CVH) metrics of the American Heart Association have been reported as predictors of cardiovascular events. However, a longitudinal study of the relationships between these metrics has not been conducted before. OBJECTIVES: We investigated the association between SRH and CVH metrics in a longitudinal study involving an Asian population. PATIENTS AND METHODS: Eligible participants were enrolled between 2009 and 2014. Multivariable logistic regression models were used to examine the association between SRH and overall ideal CVH metrics as well as each ideal CVH metric at baseline and during follow­up. Additionally, we classified participants into 3 groups according to the change in SRH after 3 years of follow­up and analyzed the changes in ideal CVH metrics in these groups. RESULTS: Our study group consisted of 15 608 participants. After a mean follow­up of 2.69 years, participants who classified their health as "Poor" or "Very Poor" had reduced odds ratios (ORs) for ideal CVH metrics, with ORs of 0.68 (95% CI, 0.54-0.85; P = 0.001) and 0.59 (95% CI, 0.37-0.96; P = 0.03) for "Poor" and "Very Poor" SRH, respectively. In contrast, the odds for increased ideal CVH metrics rose as SRH improved (OR, 1.20; 95% CI, 1.07-1.36; P = 0.002). CONCLUSIONS: Changes in SRH ratings might accurately reflect changes in CVH metrics. Our longitudinal study demonstrated that SRH was significantly associated with the number of ideal CVH metrics. Our findings provide epidemiological evidence for future public health strategies targeting cardiovascular disease.

Patient perceptions of students in a longitudinal integrated clerkship in Taiwan: a qualitative study.

BACKGROUND: Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students' clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, education leaders in Taiwan restructured clinical education and implemented the first longitudinal integrated clerkship in East Asia. We aimed to investigate patients' perceptions of longitudinal relationships with the LIC students within Taiwan's Confucian cultural and social context. METHODS: We invited patients or their family members who were cared for longitudinally by a LIC student to participate in the study. Participating patients or their family members undertook semi-structured interviews. We analyzed data qualitatively using a general inductive approach to identify themes in the patients' descriptions of their experiences interacting with the LIC students. RESULTS: Twenty-five patients and family members participated in interviews: 16 patients and 9 family members. Qualitative analysis of interview transcripts identified three themes from patients' experience receiving care from their LIC students: care facilitation, companionship, and empathy. To provide care facilitation, LIC students served as a bridge between the physicians and patients. Students served patients by reminding, consulting, tracking disease progression, and researching solutions for problems. To provide companionship, students accompanied patients interpersonally like a friend or confidant who listens and provides a presence for patients. To provide empathy, patients reported that students showed sincere concern for patients' experience, feelings, and mood. CONCLUSION: In our study, Taiwanese patients' perspectives of LIC students suggested the value of care facilitation, companionship, and empathy. We discuss these themes within the context of Confucian culture and the Taiwanese context of care.

Gender differences in the association between physical activity and health-related quality of life among community-dwelling elders.

BACKGROUND: Physical activity can improve health-related quality of life (HRQoL) in older adults. However, the differential effects of gender on quality of life are unclear. AIMS: To determine the association between physical activity and HRQoL in men and women. METHODS: This was a cross-sectional study conducted from March to August 2011. Community-dwelling older people aged 65 years or older were eligible. Physical activity in kcal per week was measured with the International Physical Activity Questionnaire (IPAQ)-Taiwan version. HRQoL was measured with the 36-Item Short Form Survey (SF-36) questionnaire. Cognitive function and depression were assessed using the Mini-Mental State Examination (MMSE) and Patient Health Questionnaire-9 (PHQ-9). The relationship between physical activity and HRQoL in men and women was investigated by a multiple linear regression model. RESULTS: A total of 188 older people (M: 50.5%) participated in this study. The mean ages of men and women were 71.9 ± 5.3 and 77.1 ± 6.4 years, respectively (p < 0.001). Older women had higher physical activity levels than men (4786.1 ± 1065.6 vs 4422.2 ± 1114.3 kcal/week, p = 0.023). After adjusting for covariates, multiple linear regression analysis showed that older men with higher physical activity levels had better scores on both the physical component summary (PCS) (p = 0.031) and mental component summary (MCS) (p = 0.007) than men with lower levels. Furthermore, older men with higher moderate-vigorous physical activity levels had better scores on the PCS than older men with lower activity levels, and older men with higher walking physical activity levels had better scores on the MCS than older men with lower activity levels. CONCLUSIONS: In this study, older women were more physically active than older men. However, older men (but not older women) with higher physical activity had better HRQoL. The association between physical activity and HRQoL differed between men and women.

Sarcopenia and cognitive impairment: A systematic review and meta-analysis.

BACKGROUND: Sarcopenia and cognitive impairment are two of the most prevalent causes of disability in the aging population. Despite the vast amount of research that has been done to quantify the association between these two conditions, extensive systematic reviews and meta-analyses remain limited. METHODS: We performed a systematic review using the PubMed, EMBASE, Scopus, and Google Scholar databases. Sarcopenia was defined as the loss of skeletal muscle mass and muscle function, as measured by muscle strength or performance. Cognitive impairment was diagnosed by validated cognitive or neuropsychological tests. RESULTS: We identified 303 potentially relevant articles in the initial search. Observational studies quantifying a relationship between sarcopenia and cognitive impairment were selected. Information was extracted from 15 studies, and random-effects models were used for the meta-analysis. The pooled odds ratios for cognitive impairment for patients with sarcopenia compared with patients without sarcopenia were 2.85 (95% confidence interval: 2.19-3.72) in the unadjusted analysis and 2.25 (95% confidence interval: 1.70-2.97) in the adjusted meta-analysis. These results remained constant in subgroup analyses by study population, study region, the definition of sarcopenia, and cognitive impairment. Although half of the studies (8 out of 15) were of fair quality, we conducted a sensitivity analysis to exclude studies with fair quality and obtained similar results. CONCLUSIONS: Sarcopenia is associated with an increased risk of cognitive impairment independent of study population, the definition of sarcopenia, and cognitive impairment. This suggests the importance of the early recognition of sarcopenia for the prevention of cognitive impairment in clinical practice.

Utilization of anthropometric parameters as a novel tool for detection of insulin resistance.

BACKGROUND: Anthropometric parameters have been widely applied in evaluating muscle mass, insulin resistance (IR), and cardiometabolic diseases. Arm circumference (AC) and calf circumference (CC) are used as informative markers for sarcopenia. However, few studies concern the correlation between AC, CC and IR. The aim of the present survey is to investigate the relationship between AC, CC and homeostatic model assessment of insulin resistance (HOMA-IR). METHODS: This cross-sectional observational study included 11,527 participants aged 40-85 years from the National Health and Nutrition Examination Survey (NHANES), 1999 to 2006. We divided the participants into male and female groups. Each group was then divided into four subgroups depending on their AC and CC levels. RESULTS: After adjustment for multiple covariates, we observed a significant negative correlation between the CC and HOMA-IR. This study showed a significant positive correlation between the AC and HOMA-IR after multiple adjustments. Subjects in the highest CC quartiles tended to have the lowest HOMA-IR in both male and female group (P for trend <0.001 in all models). CONCLUSIONS: CC may be a novel tool to guide public health policy and clinical predictor of IR in middle-aged and older people.

Characterization of Cardiometabolic Risks in Different Combination of Anthropometric Parameters and Percentage Body Fat.

The prevalence of obesity was increasing and became a growing problem worldwide. Obesity increased the risk of developing metabolic abnormalities and was associated adverse health outcomes. Our aim was to examine the associations among different combinations of obesity phenotypes (high body mass index > 27 kg/m2 (O), high waist circumference (male > 90 cm, female > 80 cm) (W), fatty liver (F) and percentage body fat in top 40% (P)) and cardiometabolic diseases (type 2 diabetes mellitus (DM), hypertension (HTN), metabolic syndrome (MetS)). A total of 48426 eligible subjects were categorized based on the different definitions. After adjusting for all covariables, participants with O + F + P combination were more likely associated with the presence of DM. Participants with O + W combination were more associated with the presence of HTN than others. Participants with O + W + F + P had higher risk for the presence of MetS than others. The study addressed the associations between different obesity phenotypes and DM and HTN in the adult population. Better understanding the pathophysiological mechanisms underlined individual vulnerability and progression of cardiometabolic insults.

Hypertension control and risk of colonic diverticulosis.

BACKGROUND: The prevalence of diverticulosis has increased in our aging population, but the risk factors for diverticulosis are not fully understood. The role of hypertension in the risk of diverticulosis remains uncertain. This study investigated whether hypertension is associated with asymptomatic colorectal diverticulosis. METHODS: This study enrolled asymptomatic patients who received a colonoscopy as part of a health check. Hypertension was defined by actual measured blood pressure. Logistic regression models were used to examine the relationship between hypertension and diverticulosis. In addition, we established three logistic regression models for covariate adjustment, and further stratified patients with hypertension into three subgroups based on their type of hypertension. RESULTS: The study group consisted of 2748 participants, including 141 participants with diverticulosis and 2607 participants without diverticulosis. After adjustments for potential covariates, the odds ratio (OR) for having diverticulosis was 1.83 (95% confidence interval, 1.21-2.75, p = 0.004) in the hypertension group compared with the group without hypertension. In subgroup analyses, hypertension without antihypertensive medication use, and hypertension despite the use of antihypertensive medication were also significantly associated with the occurrence of asymptomatic diverticulosis (OR = 1.73, p = 0.028; OR = 2.07, p = 0.013, respectively). Current normal blood pressure under antihypertensive drug therapy was not associated with diverticulosis (OR = 1.74, p = 0.092). CONCLUSIONS: Our findings suggest a positive association between hypertension and diverticulosis. Participants with poorly controlled blood pressure were found to have a higher risk of asymptomatic diverticulosis. Our study presents epidemiologic evidence for future prevention strategies against diverticulosis.

Body Fat Percentage in Relation to Lung Function in Individuals with Normal Weight Obesity.

Accumulating evidence indicates the association between obesity and lung function. However, no previous study has examined whether obesity affects lung function in normal weight participants with high body fat. We hypothesized that subjects with normal weight obesity (NWO) were inversely associated with lung function in Taiwan. The study sample was composed of participants who attended health examinations at the Tri-Service General Hospital from 2010 to 2016. A total of 7801 eligible participants who were classified as NWO were divided into quartiles by percentage body fat (PBF), which was measured by bioelectrical impedance analysis (BIA). A multivariable linear regression was performed to assess the association between PBF quartiles and pulmonary function. The relationship between PBF and the presence of obstructive and restrictive lung diseases was analyzed by a logistic regression. PBF quartiles were closely associated with reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in all adjusted models. This relationship remained significant in the male population, and a dose-dependent effect was observed. Increased PBF was associated with increased risks for the presence of restrictive lung diseases. These results presented a novel finding that body fat exhibited an inverse association with pulmonary function in NWO subjects. More comprehensive management of subjects with normal weight but high body fat, which might contribute to metabolic dysfunction and impaired pulmonary function, is needed.

Using an extended theory of planned behaviour to predict smoking cessation counsellors' intentions to offer smoking cessation support in the Taiwanese military: a cross-sectional study.

OBJECTIVES: To use the extended theory of planned behaviour (TPB) to predict smoking cessation counsellors' intentions to offer smoking cessation support. DESIGN: Cross-sectional study SETTING: Taiwanese military PARTICIPANTS: A survey of 432 smoking cessation counsellors was conducted in 2017. PRIMARY AND SECONDARY OUTCOME MEASURES: All participants completed a self-administered questionnaire that solicited information concerning demographics, smoking behaviour, self-rated suitability for being a counsellor, the knowledge and skills learnt from training courses and the TPB construct. RESULTS: The factors of perceived behavioural control (ß=0.590, p<0.001), self-rated suitability for being a counsellor (acceptable vs not suitable, ß=0.436, p=0.001; suitable vs not suitable, ß=0.510, p<0.001), knowledge (ß=0.298, p=0.020) and professional specialty (military doctor vs non-military doctor, ß=0.198, p=0.034) were found to be correlated with intention. However, attitude, subjective norms and descriptive norms were determined to be non-significant correlates. The model explained 59.7% of the variance for the intention to offer smoking cessation support (F[12,343]=44.864, p<0.001). CONCLUSIONS: To encourage smoking cessation counsellors to offer cessation support to smokers, policies should aim to increase their perceived behavioural control, knowledge and self-rated suitability for being a counsellor.

Crosssectional Assessment of Bone Mass Density in Adults with Hepatitis B Virus and Hepatitis C Virus Infection.

Osteoporosis is one of the major complications in chronic hepatitis B virus (HBV) and hepatitis C (HCV) infection. However, few studies had examined the relationship between hepatic viral infection with bone loss. Our aim was to investigate the association between hepatic viral infection with bone mineral density (BMD) in a cross-sectional study. Participants who attended the health examinations at the Tri-Service General Hospital (TSGH), Taiwan, were enrolled in the study. Diagnosis of viral hepatitis was confirmed by the serum viral markers of hepatitis B surface antigen (HBsAg) and anti-HCV, and BMD measurement was performed by the bone densitometry. Subjects were divided into four groups by the presence of viral markers. The association between hepatic viral infection and BMD was examined by a multivariate linear regression model. HBV infection was inversely associated with BMD after full adjusting with ß values of -0.17 (95% CI: -0.29, -0.05) (p < 0.05). The relationship remained significant in males (ß = -0.16, 95% CI = -0.31, -0.01) (p < 0.05). In subjects with body mass index less than 30 HBV infection was associated with reduced BMD (ß = -0.16, 95% CI = -0.29, -0.02) (p < 0.05). However, HCV infection was only associated with an increase in BMD in patients with BMI less than 30 (ß = 0.17, 95% CI = 0.21, 0.32) (p < 0.05). Chronic HBV infection was significantly associated with reduced BMD in males. The impact of viral hepatitis on bone health deserves further investigation for the potential pathophysiological mechanisms.

Helicobacter pylori infection increases risk of incident metabolic syndrome and diabetes: A cohort study.

Emerging studies have shed light on the association between Helicobacter pylori (HP) infection and cardiometabolic risk. However, there is no evidence to support a causal link for the relationship in the general population. Our aim was to determine whether HP infection is associated with the risks of incident type II diabetes mellitus (DM) in a population-based cohort consisting of adults from the general population. A total of 69235 adults enrolled in the study obtained health examinations at the Tri-Service General Hospital in Taiwan from 2010 to 2016. HP infection detection was performed by rapid urease tests (RUTs), and endoscopic examinations were used to diagnose gastroesophageal reflux disease (GERD), gastric ulcers (GUs) and duodenal ulcers (DUs). Cross-sectional and longitudinal analyses were performed to examine the association between HP infection and cardiometabolic diseases using logistic regression and Cox regression in a large population-based study. HP infection was significantly associated with the presence of metabolic syndrome (MetS) (OR = 1.26, 95%CI: 1.00-1.57) and DM (OR = 1.59, 95%CI: 1.17-2.17) only in male subjects, and abnormal endoscopic findings were also correlated with cardiometabolic diseases. Our findings demonstrated that participants with HP infection had an elevated risk of developing incident DM (HR = 1.54, 95%CI: 1.11-2.13). In addition, endoscopic findings of a DU (HR = 1.63, 95%CI: 1.02-2.63), rather than GERD or a GU, were also predictive of incident DM. In this cohort, HP infection was a statistically significant predictor of incident DM among male population.

Nonalcoholic fatty liver disease and sarcopenia in a Western population (NHANES III): The importance of sarcopenia definition.

BACKGROUND: Recent epidemiological studies have shown that sarcopenia is associated with non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis in an Asian population. We investigated whether NAFLD is associated with a higher risk of sarcopenia using a different definition in elderly patients. METHODS: A population-based cross-sectional survey of US patients was conducted, involving 2551 participants aged 60-75 years. NAFLD was measured by ultrasound. Sarcopenia was defined by both a low muscle mass and poor muscle function. In addition, the skeletal muscle index (SMI) was calculated as the absolute muscle mass (kilograms) divided by height2 (meters) or total body mass (kilograms). A multivariable logistic regression was conducted to estimate the relationship between sarcopenia and NAFLD in the elderly. RESULTS: After adjusting for age, sex, and race/ethnicity, severe hepatic steatosis was associated with a decreased risk of sarcopenia as defined by the height-adjusted SMI (odds ratio (OR) 0.63; 95% confidence interval (CI) 0.46-0.87). In contrast, severe hepatic steatosis was associated with an increased risk of sarcopenia as defined by the weight-adjusted SMI (OR 1.73; 95% CI 1.31-2.28). These significant associations remained after further adjustments for other potential confounding variables. CONCLUSIONS: NAFLD is associated with a lower risk of sarcopenia when using the height-adjusted SMI. In contrast, it showed the opposite result when using the weight-adjusted SMI. The definition of sarcopenia may be an important factor when examining its relationship with NAFLD.

Changes of Percent Body Fat as a Useful Surrogate for Risk of Declined Renal Function.

The association between anthropometric indices with chronic kidney disease (CKD) was examined previously. However, the effect of body fat on renal function was not determined clearly. Our aim was to investigate the association of percent body fat (PBF) and renal function in adult population from health examination in Tri-Service General Hospital (2010-2016). 35087 participants aged 20 years and older were enrolled in the study. PBF was measured by bioelectrical impedance analysis (BIA). Estimation of renal function was performed by Taiwanese MDRD equation. Optimal cut-off values of PBF was accessed by a receiver-operator characteristic (ROC) curve analysis. Multivariate regression models were used in the relationship among changes of PBF, renal function, and future CKD. In terms of baseline PBF for CKD, optimal cut-off values of PBF in males and females were 21.55 and 40.75. The changes of PBF were more closely associated with renal function decline than waist circumference (WC) with ß values of -0.173 (95% CI: -0.233, -0.112) and -0.077 (95% CI: -0.104, -0.049), respectively. After stratified by gender, this relationship remained significant in male population with ß values of -0.276 (95% CI: -0.371, -0.181) and -0.159 (95% CI: -0.207, -0.112), respectively. Female subjects with increased baseline PBF over cut-off values had increased risk for predicting the future CKD with odd ratios (ORs) of 2.298 (95% CI: 1.006-5.252). Body fat had detrimental impact on renal function and development of CKD in adult population. Measurement of PBF for surveillance of renal function impairment was warranted.

Body fat has stronger associations with bone mass density than body mass index in metabolically healthy obesity.

OBJECTIVE: The effect of obesity-induced metabolic abnormalities on bone mineral density (BMD) and osteoporosis are well established. However, the association between metabolically healthy obesity (MHO) and BMD remains unclear. Our aim was to investigate whether different obesity phenotypes in MHO were associated with BMD in a cross-sectional study. METHODS: All eligible adults receiving a health examination at the Tri-Service General Hospital from 2010 to 2016 were included. They were categorized based on body mass index (BMI) or percentage body fat (PBF). The associations between BMI or PBF and BMD were analyzed by adjusting for pertinent covariables. RESULTS: Males with normal weight and overweight and females with underweight and normal weight were associated with reduced BMD (ß = 0.221, 95%CI = -0.354, -0.088; ß = -0.155, 95%CI = -0.286, -0.023) (ß = -0.736, 95%CI = -1.043, 0.429; ß = -0.340, 95%CI = -0.567, -0.112), respectively. Females in Q1 had close to significant associations with reduced BMD (ß = -0.253, 95%CI = -0.465, -0.041). Normal weight, overweight, Q2, and Q3 had stronger prediction of low BMD with ORs of 0.402 (95%CI = 0.204-0.791), 0.539 (95%CI = 0.321-0.905), 0.694 (95%CI = 0.490-0.982), and 0.466 (95%CI = 0.342-0.636), respectively. The relationship remained significant in male population that PBF was associated with reduced BMD with ORs of 0.435 (95%CI = 0.203, 0.935), 0.494 (95%CI = 0.247, 0.991), 0.268 (95%CI = 0.120, 0.597) in Q1, Q2, Q3 respectively. CONCLUSION: Increased PBF had a significant association with low BMD in the MHO population. Obesity defined by PBF might be a useful indicator for low BMD. The association between body fat and bone health deserves further investigation regarding the potential pathophysiological mechanisms.