Association between haemoglobin A1c and all-cause and cause-specific mortality in middle-aged and older Koreans: a prospective cohort study.

BACKGROUND: This study aimed to examine associations between haemoglobin A1c (HbA1c) levels over time and all-cause and cause-specific mortality in middle-aged and older Koreans. METHODS: Using 16 years of follow-up data from the Korean Genome and Epidemiology Study, we analysed 9294 individuals aged 40-69 years with no history of cardiovascular disease (CVD) or cancer. Participants were divided into a known diabetes group and five groups categorized by HbA1c levels (< 5.0%, 5.0-5.4%, 5.5-5.9%, 6.0-6.4%, and ≥ 6.5%). Hazard ratios (HRs) for all-cause and cause-specific mortality associated with HbA1c levels were calculated using a conventional and a time-dependent Cox proportional hazards model. Restricted cubic spline models were fitted to investigate the relationship between continuous HbA1c levels and mortality among people without known diabetes. Subgroup analyses were performed for age, sex, smoking, hypertension, liver diseases, and red blood cell counts. RESULTS: During a median follow-up period of 15.7 years, there were 944 deaths, including 185 deaths from CVD, 359 from cancer, and 125 from all external causes. Compared with participants with HbA1c levels of 5.5-5.9%, multivariate-adjusted HRs and 95% confidence intervals for all-cause death of participants with levels < 5.0%, 5.0-5.4%, 6.0-6.4%, and ≥ 6.5% and participants with known diabetes were 1.84 (1.35-2.51), 1.13 (0.95-1.34), 1.30 (1.04-1.62), 1.37 (0.97-1.93), and 2.03 (1.70-2.44), respectively. The risk of cancer mortality was significantly increased in HbA1c < 5.0% (HR, 2.21; 95% CI 1.42-3.44) and known diabetes (HR, 1.60; 95% CI 1.18-2.15). When we performed diverse subgroup analyses, low HbA1c levels at baseline were strongly associated with mortality in participants with liver diseases. CONCLUSIONS: We found U-shaped associations between HbA1c levels at baseline and over time and all-cause mortality in middle-aged and older Koreans. Additionally, the risk of cancer mortality increased both in low and high HbA1c groups, but CVD mortality increased only in high HbA1c group. In particular, people with liver diseases and low HbA1c levels had a high risk of all-cause mortality. Therefore, more careful management of these groups is suggested to identify any deteriorating health conditions.

Identification of Dietary Patterns Associated with Incidence of Hyperglycemia in Middle-Aged and Older Korean Adults.

Little is known about the association between dietary patterns and hyperglycemia incidence among Korean adults. Hence, we aimed to prospectively investigate the major dietary patterns associated with hyperglycemia among middle-aged and older Korean adults. In total, 55,457 adults (18,292 men and 37,165 women) aged 40 to 79 years, who were previously enrolled in the Health Examinee Study of the Korean Genome and Epidemiology Study and had no history of type 2 diabetes mellitus (T2DM) or cancer at baseline, were included. Dietary patterns were identified by a factor analysis based on dietary data, which were assessed at baseline using a validated food-frequency questionnaire. Participants were classified as having hyperglycemia if fasting blood glucose levels were ≥126 mg/dL or physician diagnosed T2DM during follow-up. Multivariable Cox proportional hazard models were used to examine the associations between each dietary pattern and future hyperglycemia risk after adjusting for potential confounders. After a mean follow-up of 4.9 years, 2574 new cases of hyperglycemia were identified. Using a factor analysis, four distinct dietary patterns were identified: "prudent;" "fatty fish, meat, and flour-based food;" "coffee and sweets;" and "whole grain (men)" or "white rice (women)." The "prudent" pattern was inversely associated with hyperglycemia risk only in women (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.63-0.89; p for trend = 0.0003). Conversely, women in the highest quintile of the "fatty fish, meat, and flour-based food" pattern showed an increased risk of hyperglycemia (HR, 1.22; 95% CI, 1.03-1.44; p for trend = 0.0210) compared with those in the lowest quintile. The "coffee and sweets" and "white rice" patterns were not associated with hyperglycemia risk in women. The dietary patterns observed in men had no associations with hyperglycemia incidence. Our findings suggest that a diet rich in vegetables, mushrooms, seaweeds, fruits, and soy products and low in fatty fish and high-fat meat may potentially play a protective role in T2DM development with sex differences in middle-aged and older Korean adults.

Potential role of native pickling cucumber polygalacturonase in softening of fresh pack pickles.

UNLABELLED: This study examined the potential involvement of polygalacturonase (PG) in commercial pickling cucumbers on gradual softening of refrigerated and pasteurized fresh pack pickle products that adversely affects their market-life. PG activity was detected in all sources of commercial pickling cucumbers and refrigerated pickle spears, and activity was detected in some sources of pasteurized spears. Polygalacturonic acid hydrolysis determined from changes in fluidity, reducing groups and oligogalacturonides indicated involvement of both exo- and endo-PG. Treatment of pasteurized pickle mesocarp tissues with concentrated extracts from pickling cucumbers resulted in rapid softening and alteration of pectic substances. D-values for thermal inactivation of pickling cucumber PG at 75, 80, 85, and 90 °C were 22.0, 19.5, 14.5, and 4.2 min, respectively, indicating that residual activity would be expected in commercially pasteurized pickle products. It is concluded that residual cucumber PG could be responsible for softening of processed pickle products, and it is suspected that variations in textural quality of given products are caused by differences in residual types and levels of native PG. PRACTICAL APPLICATION: Since enzyme extracts from commercial pickling cucumbers were demonstrated to be capable of softening pickle tissues and that PG activity was present in some processed fresh pack products, methods that inactivate or eliminate the enzyme(s) should reduce softening of products during storage and marketing.

Transcatheter closure of multiple atrial septal defects with the amplatzer device.

Percutaneous device occlusion of secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. A variety of devices have been used successfully. However, all of them have limitations. We report our experience with two devices used to close multiple ASDs.

Production of bioactive rockfish (Sebastes schlegeli) myostatin-1 prodomain in an Escherichia coli system.

Myostatin (MSTN) is a potent negative regulator of skeletal muscle growth in mammalian species, and its activity is inhibited by MSTN prodomain, the N-terminal part of proMSTN cleaved during post-translational MSTN processing. In fish, MSTN also appears to suppress fish muscle growth with its activity being inhibited by prodomain. The objective of this study was to produce bioactive MSTN-1 prodomain of rockfish (S. schlegeli), a commercial aquaculture species in East Asia, in E. coli using maltose binding protein (MBP) as a fusion partner. Rockfish MSTN-1 prodomain (sMSTN1pro) cDNA was cloned into the pMALc2x vector, and proteins (MBP-sMSTN1pro) were expressed in Rosetta-gami 2(DE3)pLysS cells by IPTG induction. The MBP-sMSTN1pro was expressed in soluble forms, and affinity purified using amylose resin. The affinity purified MBP-sMSTN1pro suppressed MSTN activity in vitro. The results suggest that MBP is probably a useful fusion partner in producing bioactive MSTN prodomains of various animal species in E. coli.