Body mass index and albumin levels are prognostic factors for long-term survival in elders with limited performance status.

Elderly long-term care facility residents typically have musculoskeletal conditions that may lead to long-term disability and increased mortality. Our main objective was to explore the relationship between body mass index (BMI), albumin levels, and mortality in elderly individuals with limited performance status. Among 182 participants (mean age, 78.8 years; 57% women), 11%, 64%, and 25% had serum albumin levels of <2.8, 2.8-3.5, and >3.5 g/dL, respectively. After multivariate adjustments, diastolic blood pressure >90 mmHg was associated with all-cause mortality [hazard ratio (HR) = 2.08, 95% confidence interval (CI) = 1.13-3.82; P = 0.018]. In addition, BMI <18.5 kg/m2 and albumin level <2.8 g/dL associated with higher mortality than BMI = 18.5-24 kg/m2 and albumin level > 3.5 g/dL (HR = 1.80, 95% CI = 1.11-2.94 and HR = 2.54, 95% CI 1.22-5.30, respectively; P = 0.018 and 0.013, respectively). Highest mortality was noted in participants with albumin levels <2.8 g/dL and BMIs <18.5 kg/m2 (HR = 6.12, 95% CI = 1.85-20.21, P = 0.003). Combined hypoalbuminemia (albumin level < 2.8 g/dL) and low BMI (<18.5 kg/m2) may be a useful prognostic indicator of high mortality risk in elderly individuals with limited performance status.

Gender Difference in the Relationship of Albuminuria and Arterial Stiffness in Chinese Adults - a 6.6-Year Follow-Up Longitudinal Study.

BACKGROUND/AIMS: Brachial-ankle pulse wave velocity (baPWV) reflects the stiffness of muscular arteries. Albuminuria is recognized as a marker of vascular dysfunction. We assessed the association between arterial stiffness and albuminuria in a population-based longitudinal study. METHODS: 1116 adults aged ≥ 40 years in the Taichung Community Health Study (TCHS) in 2004 attended a follow-up visit in 2011. Albuminuria was defined as an urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g. Arterial stiffness was defined as BaPWV ≥ 1540 cm/sec in males and BaPWV ≥ 1480 cm/sec in females, respectively. ∆baPWV was calculated as baPWV at follow-up minus baPWV at baseline, while ∆UACR was calculated as UACR at follow-up minus UACR at baseline. Multiple linear and logistic regression analyses were used to explore the relationship between albuminuria and arterial stiffness. RESULTS: Among 652 subjects without arterial stiffness at baseline, 209 (32%) subjects developed incident arterial stiffness after an average of 6.6 years. In male subjects, baseline albuminuria was associated with development of arterial stiffness (odds ratio: 4.47, 95% confidence interval [CI]: 1.04-19.31) and ∆baPWV was modestly positively associated with ∆UACR. CONCLUSION: Our results indicated that male adults with albuminuria had an increased risk for developing arterial stiffness.

Mid-upper arm circumference, calf circumference and mortality in Chinese long-term care facility residents: a prospective cohort study.

OBJECTIVE: To investigate the association between mid-upper arm circumference (MUAC), calf circumference (CC) and all-cause mortality in a Chinese population. DESIGN: Prospective cohort study. SETTING: Eight long-term care facilities in central Taiwan. PARTICIPANTS: A total of 329 residents age 60 years and older (median 79.0 years, range 60-101; 139 men, 190 women) were enrolled. METHODS: Anthropometrics and metabolic parameters were measured at the time of enrolment to the study. Mean MUAC and CC were 24.2±3.4 cm and 27.5±4.3 cm, respectively. Mortality data were obtained from the Department of Health in Taiwan. MAIN OUTCOME MEASURE: To identify the association between all-cause mortality and MUAC or CC. RESULTS: There were 255 deaths during the 7-year follow-up period. After adjusting for age, sex, cigarette smoking, betel nut chewing, alcohol use, Karnofsky Performance Status Scale score, serum albumin level, hypertension and diabetes mellitus, subjects in the highest tertile of MUAC (27.8±2.2 cm) and CC (32.1±2.6 cm) had a significantly lower mortality rate than did subjects in the lowest tertile (MUAC 20.6±1.7 cm; CC 22.8±1.9 cm). The adjusted HR for all-cause mortality in the highest versus lowest MUAC tertile was 0.64 (95% CI 0.45 to 0.90). The adjusted HR for all-cause mortality in the highest versus lowest CC tertile was 0.51 (95% CI 0.35 to 0.74). CONCLUSIONS: MUAC and CC are negative predictors for all-cause mortality in older Chinese adults living in long-term care facilities. Participants with higher MUAC and CC had lower all-cause mortality.

Age at menarche and its association with the metabolic syndrome in Taiwan.

BACKGROUND: The average age at menarche in the Taiwanese population is falling. Contrarily, the prevalence of metabolic syndrome (MetS) showed a worldwide increase in the past two decades. The aim of this study was to examine the association between age at menarche and MetS. MATERIALS AND METHODS: A total of 3292 women aged 19-91 years old were enrolled in two databases from 2004 to 2008. MetS was defined according to American Heart Association's criteria. Age at menarche was obtained from self-reported questionnaires. Multiple logistic regression analyses were used to estimate the association between age at menarche and MetS with adjustment for potential confounding variables. RESULTS: The prevalence of MetS increased with age. After adjusting age, lifestyle status, and reproductive factors as variables, subjects who had menarche at a younger age showed significantly higher risk of MetS. The adjusted odds ratio of having MetS in <12 and 12-14 years old menarche age groups were 1.71 (1.07-2.71) and 1.22 (1.00-1.50), respectively. The significant increase in odds ratio for MetS in early age menarche also reveals a dose-response effect. CONCLUSIONS: Early onset of menarche is an important risk factor of MetS and may help identify women at risk of MetS.

Benign neoplasm of the heart increases the risk of first ischemic stroke: a population-based cohort study.

OBJECTIVE: The study aims to investigate the incidence of first ischemic stroke in patients with benign cardiac tumors who did or did not undergo operations. METHODS: We used the National Health Insurance Research Database of Taiwan to conduct the research. The exposure cohort comprised 587 adult patients with benign cardiac tumors. Each patient was randomly frequency matched by age, index month, and index year with 10 participants from the general population who exhibited no history of benign cardiac tumors before the index date (control group). Cox's proportion hazard regression analyses were conducted to determine the relation between benign cardiac tumors and the risk of ischemic stroke. RESULTS: Based on clinical diagnoses, the prevalence of benign cardiac tumors was 0.004%. Patients with benign cardiac tumors exhibited an increased risk of first ischemic stroke [adjusted hazard ratio: 1.77; (95% confidence interval, 1.20-2.63)], particularly at young ages (adjusted hazard ratio: 22.9, 95% confidence interval: 4.17-126.0). We observed no significant difference in the risk of ischemic stroke between men with and without benign cardiac tumors (adjusted hazard ratio: 1.29, 95% confidence interval: 0.63-2.63). Among patients with benign cardiac tumors, the adjusted hazard ratio of first ischemic stroke was 0.48 (95% confidence interval: 0.23-1.04) in the operation group compared with the nonoperation group. CONCLUSION: Younger patients (<50 years) with benign cardiac tumors exhibit an increased risk of first ischemic stroke.

Risks of decreased renal function and increased albuminuria for glycemic status and metabolic syndrome components: Taichung Community Health study.

BACKGROUND: The objective of this study was to assess the association of glycemic status and decreased renal function as determined by estimated glomerular filtration rate (eGFR) and albuminuria in an adult Taiwanese metropolitan population. METHODS: We did a cross-sectional survey in a representative sample of 2,350 Taiwanese adults aged 40 years and over living in a metropolitan city in Taiwan from 2004 to 2005. Glycemic status was classified as normal glycemia, hyperglycemia, and type 2 diabetes (T2D). Renal function was assessed with eGFR using modified Modification of Diet in Renal Disease Study equation for Chinese. Albuminuria was determined by the urinary albumin-creatinine ratio. Decreased renal function was defined as eGFR <60 mL/min/1.73 m(2) and albuminuria as the albumin-creatinine ratio >30 mg g(-1) creatinine. RESULTS: 593 (25.23%) had hyperglycemia and 287 (12.21%) had T2D. As glycemia level increased, the prevalence of albuminuria and decreased eGFR increased. After adjustment, T2D was associated with an OR of 2.93 (95% CI: 2.11-4.07) for albuminuria, and an OR of 2.05 (95% CI: 1.18-3.58) for decreased eGFR. CONCLUSIONS: In a representative sample from a metropolitan city in Taiwan, T2D was associated with albuminuria and decreased eGFR.

Long-term use of zolpidem increases the risk of major injury: a population-based cohort study.

OBJECTIVE: To estimate the risk of head injury or fracture requiring hospitalization in patients treated with zolpidem. PATIENTS AND METHODS: We identified 8188 patients 18 years and older who had received a first prescription for zolpidem between January 1, 2000, and December 31, 2009, and compared them with 32,752 age- and sex-matched patients who had not used sedative-hypnotic agents. Both cohorts were followed up for at least 1 year or until hospitalization for head injury or fracture (major injury). Hazard ratios (HRs) and 95% CIs were calculated by comparing the incidence of major injury requiring hospitalization between the zolpidem user and comparison cohorts, including age groups 18 to 54 and 55 years or more, using a Cox proportional hazards regression analysis. RESULTS: The adjusted HR for major injury in zolpidem users was 1.67 (95% CI, 1.19-2.34). The adjusted HR for major injury in zolpidem users in the younger cohort (aged 18-54 years) was 1.70 (95% CI, 1.15-2.51) and in the older cohort (aged ≥55 years) was 1.57 (95% CI, 0.78-3.13). The adjusted HR for major injury in zolpidem users increased when the zolpidem dosage increased (HR, 2.04; 95% CI, 1.32-3.13 for 71-800 mg/y; HR, 4.37; 95% CI, 2.12-9.01 for 801-1600 mg/y; and HR, 4.74; 95% CI, 2.38-9.42 for >1600 mg/y). CONCLUSION: The long-term use of zolpidem is associated with a significantly greater risk of head injury or fracture requiring hospitalization than in patients who do not use sedative-hypnotic agents (P<.001), particularly in the younger (aged 18-54 years) patients.

Professional development is enhanced by serving as a mini-CEX preceptor.

INTRODUCTION: The mini-clinical evaluation exercise (mini-CEX) is widely used for the evaluation of medical trainees' clinical competence. To our knowledge, no study has examined the effect of mini-CEX on the preceptors. Based on the principle of "to teach is to learn twice," we hypothesized that the act of precepting a mini-CEX would enhance preceptors' own learning and performance. METHODS: A 21-item questionnaire incorporating the 3 out of 4 levels of Kirkpatrick's model was completed by experienced mini-CEX preceptors. Data collected from the questionnaire included ratings of Kirkpatrick's level of "Reaction" (level 1) and "Behavior" (level 3) and the frequencies of relearning the clinical skills related to mini-CEX, which assessed Kirkpatrick's "Learning" (level 2). RESULTS: A majority of the respondents either strongly agreed or agreed that precepting the mini-CEX both increased reflection on their own clinical practice and had a positive impact on their clinical skills. More than 80% of preceptors reported relearning one or more of the mini-CEX clinical skills. Experienced preceptors relearned the clinical skills more frequently than the less experienced preceptors. About one-third of respondents indicated that being a preceptor of mini-CEX increased both self-confidence and health care quality in their own clinical practice. DISCUSSION: These findings provide preliminary evidence suggesting that participating as a preceptor in a mini-CEX has a positive impact on the preceptor's professional development. Further studies are needed, including analyzing mechanisms of mini-CEX on the clinical skills of preceptor, and assessing whether similar effects can be observed in other teaching hospitals in different cultural contexts.

Prospective validation of American Diabetes Association risk tool for predicting pre-diabetes and diabetes in Taiwan-Taichung community health study.

BACKGROUND: A simple diabetes risk tool that does not require laboratory tests would be beneficial in screening individuals at higher risk. Few studies have evaluated the ability of these tools to identify new cases of pre-diabetes. This study aimed to assess the ability of the American Diabetes Association Risk Tool (ADART) to predict the 3-year incidence of pre-diabetes and diabetes in Taiwanese. METHODS: This was a 3-year prospective study of 1021 residents with normoglycemia at baseline, gathered from a random sample of residents aged 40-88 years in a metropolitan city in Taiwan. The areas under the curve (AUCs) of three models were compared: ADART only, ADART plus lifestyle behaviors at baseline, and ADART plus lifestyle behaviors and biomarkers at baseline. The performance of ADART was compared with that of 16 tools that had been reported in the literature. RESULTS: The AUCs and their 95% confidence intervals (CIs) were 0.60 (0.54-0.66) for men and 0.72 (0.66-0.77) for women in model 1; 0.62 (0.56-0.68) for men and 0.74 (0.68-0.80) for women in model 2; and 0.64 (0.58-0.71) for men and 0.75 (0.69-0.80) for women in model 3. The AUCs of these three models were all above 0.7 in women, but not in men. No significant difference in either women or men (p = 0.268 and 0.156, respectively) was observed in the AUC of these three models. Compared to 16 tools published in the literature, ADART had the second largest AUC in both men and women. CONCLUSIONS: ADART is a good screening tool for predicting the three-year incidence of pre-diabetes and diabetes in females of a Taiwanese population. The performance of ADART in men was similar to the results with other tools published in the literature. Its performance was one of the best among the tools reported in the literature.

The relationship of high sensitivity C-reactive protein to percent body fat mass, body mass index, waist-to-hip ratio, and waist circumference in a Taiwanese population.

BACKGROUND: High-sensitivity C-reactive protein (hs-CRP) is an easily measured inflammatory biomarker. This study compared the association of percent body fat mass (%FM), body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with hs-CRP in a Taiwanese population. METHODS: A total of 1669 subjects aged 40-88 years were recruited in 2004 in a metropolitan city in Taiwan. The relationships between obesity indicators and a high level of hs-CRP were examined using multivariate logistic regression analysis. The upper quartile of the hs-CRP distributions was defined as the high category group. The areas under the curve (AUCs) of the receiver operating characteristic curves were calculated for all obesity indicators to compare their relative ability to correctly classify subjects with a high level of hs-CRP. RESULTS: After multivariate adjustment, the odds ratio for %FM was the only significant indicator that was associated with a high level of hs-CRP in men (1.55, 95% CI: 1.07-2.25). All indicators were associated with a high level of hs-CRP in women. In men, the AUCs for %FM were significantly higher than those for BMI, WHR, and WC, when demographic and lifestyle behaviors were considered (p < 0.001 for all comparisons), but they were not significantly different in females. CONCLUSIONS: Our study demonstrates that %FM is the only obesity indicator that is strongly associated with a high level of hs-CRP after adjusting for sociodemographic factors, lifestyle behaviors and components of metabolic syndrome in both genders in a Taiwanese population aged forty years and over. In men, %FM had the greatest ability to classify subjects with a high level of hs-CRP when only demographic and lifestyle behaviors were considered. Our study finding has important implications for the screening of obesity in community settings.

Sex difference in the association of metabolic syndrome with high sensitivity C-reactive protein in a Taiwanese population.

BACKGROUND: Although sex differences have been reported for associations between components of metabolic syndrome and inflammation, the question of whether there is an effect modification by sex in the association between inflammation and metabolic syndrome has not been investigated in detail. Therefore, the aim of this study was to compare associations of high sensitivity C-creative protein (hs-CRP) with metabolic syndrome and its components between men and women. METHODS: A total of 1,305 subjects aged 40 years and over were recruited in 2004 in a metropolitan city in Taiwan. The biochemical indices, such as hs-CRP, fasting glucose levels, lipid profiles, urinary albumin, urinary creatinine and anthropometric indices, were measured. Metabolic syndrome was defined using the American Heart Association and the National Heart, lung and Blood Institute (AHA/NHLBI) definition. The relationship between metabolic syndrome and hs-CRP was examined using multivariate logistic regression analysis. RESULTS: After adjustment for age and lifestyle factors including smoking, and alcohol intake, elevated concentrations of hs-CRP showed a stronger association with metabolic syndrome in women (odds ratio comparing tertile extremes 4.80 [95% CI: 3.31-6.97]) than in men (2.30 [1.65-3.21]). The p value for the sex interaction was 0.002. All components were more strongly associated with metabolic syndrome in women than in men, and all sex interactions were significant except for hypertension. CONCLUSIONS: Our data suggest that inflammatory processes may be of particular importance in the pathogenesis of metabolic syndrome in women.

The relation of metabolic syndrome according to five definitions to cardiovascular risk factors--a population-based study.

BACKGROUND: Although National Cholesterol Education Program (NCEP), International Diabetes Federation (IDF), American Heart Association and National Heart, Lung and Blood Institute (AHA/NHLBI), World Health Organization (WHO), and the European Group for the Study of Insulin Resistance (EGIR) definitions of metabolic syndrome (MetS) have been commonly used by studies, little is known about agreement among these five definitions. We examined the agreement among these five definitions and explored their relationship with risk factors of cardiovascular disease in a Taiwan population. METHODS: A total of 1305 subjects aged 40 years and over in Taiwan were analyzed. Biomedical markers and anthropometric indices were measured. Agreement among definitions was determined by the kappa statistic. Logistic regression models were fit to estimate the odds of a high cardiovascular risk group for five definitions of MetS. RESULTS: The agreement among the NCEP, IDF, and AHA/NHLBI definitions was from substantial to very good, and agreement between the WHO and EGIR definitions was also substantial. All MetS definitions were significantly associated prevalence of microalbuminuria, elevated highly sensitive CRP (hs-CRP), and arterial stiffness only in women. In men, MetS by NCEP and AHA/NHLBI was associated with elevated level of hs-CRP and arterial stiffness. MetS by WHO and EGIR were significantly associated with microalbuminuria. And MetS by WHO was the only MetS definition that significantly associated with prevalence of arterial stiffness (OR: 2.75, 95% CI: 1.22-6.19). CONCLUSIONS: The associations of these five definitions with cardiovascular risk factors were similar in women, and it was evident that the five definitions performed better in women than in men, with higher ORs observed in relation to arterial stiffness, elevated hs-CRP, and higher Framingham risk scores.

Relationship between serum retinol-binding protein 4 and visfatin and the metabolic syndrome.

BACKGROUND: This study investigates the relationship between serum concentration of RBP4 and visfatin and the metabolic syndrome. METHODS: Patients with metabolic syndrome were studied between October, 2004 and September, 2005. All study subjects were aged 40 and over and lived in Taichung city, Taiwan. The Third Report of the National Cholesterol Education Program's Adult Treatment Panel (ATP III, 2001) was used to define the metabolic syndrome. Serum RBP4 and visfatin levels were measured by enzyme-linked immunosorbent assay. RESULTS: Serum mean RBP4 levels in subjects who had all five abnormal components of metabolic syndrome (mean+/-SD=40.8+/-18.6) and those who had all components except hyperglycemia (43.5+/-23.5) were significantly higher than those in healthy controls (30.3+/-14.0 microg/ml) (p<0.05). Similar results were not found in serum visfatin levels. Using log-transformed serum RBP4 or visfatin levels as a dependent variable, we found that subjects with all five and four abnormal components of metabolic syndrome had significantly higher mean serum RBP4 levels (p=0.043 and 0.034, respectively), compared to healthy controls, after adjusting for other covariates. In contrast, similar results were not found in serum visfatin levels. CONCLUSION: Metabolic syndrome is significantly associated with serum RBP4, but not serum visfatin.

In addition to insulin resistance and obesity, brachial-ankle pulse wave velocity is strongly associated with metabolic syndrome in Chinese--a population-based study (Taichung Community Health Study, TCHS).

AIM: To investigate the association between arterial stiffness (present with brachial-ankle pulse wave velocity (baPWV)) and metabolic syndrome (MetS) in a population-based study of middle-aged Chinese. METHODS: MetS was defined using the AHA/NHLBI criteria. A total of 1,018 subjects aged 40 years and over were recruited in 2004. Homeostasis model assessment was applied to estimate the degree of insulin resistance (HOMA-IR). The baPWV was divided into four groups by quartiles. RESULTS: The prevalence of MetS and its individual components increased by the increase in baPWV quartiles. After adjusting for age, BMI, HOMA-IR, smoking, alcohol drinking, betel nut chewing, and physical activity status, multiple logistic regression revealed that baPWV groups were significantly associated with MetS. Compared with the lowest baPWV quartile, the adjusted odds ratio of having MetS in baPWV quartile II, III, IV was 2.10 (1.034.28), 4.48 (2.169.26), 10.4 (4.5324.0) in men, and 4.20 (1.4712.0), 14.6 (5.2240.6), 16.3 (5.4848.2) in women, respectively. The prevalence of MetS increased with the increase of age, HOMA-IR, and BMI groups. The optimal cut-off values of baPWV for MetS were 1,539 cm/sec in men and 1,482 cm/sec in women, respectively. CONCLUSIONS: In addition to insulin resistance and obesity, baPWV was strongly related to MetS in middle-aged Taiwan Chinese. The cut-off value of baPWV for cardiovascular disease differed between genders.

Association among cigarette smoking, metabolic syndrome, and its individual components: the metabolic syndrome study in Taiwan.

Insulin resistance is a common feature of metabolic syndrome. Smokers are at great risk of developing insulin resistance. Theoretically, smoking status should be associated with metabolic syndrome. This study aimed to explore the association among cigarette smoking, metabolic syndrome, and its individual components. Information of participants regarding previous and current diseases, family history of disease, smoking habits, alcohol consumption, betel nut chewing, and physical activity status were gathered from self-reported nutrition and lifestyle questionnaires. The fasting plasma glucose, triglyceride level, high-density lipoprotein cholesterol (HDL-C) level, blood pressure, and anthropometric indices in each patient were measured. Data of 1146 male subjects were analyzed. Individuals who currently smoked had a higher prevalence of metabolic syndrome than those who had never smoked and those who had quit smoking. The adjusted odds ratios of current smoking amount showed a statistically significant dose-dependent association with metabolic syndrome, high triglyceride level, and low HDL-C level. Current smokers who smoke > or =20 pack-years have a significantly increased risk of developing metabolic syndrome, high triglyceride level, and low HDL-C level. The higher risk of development of metabolic syndrome, high triglyceride level, and low HDL-C level was insignificant in former smokers. In conclusion, this community-based study supports the view that smoking is associated with metabolic syndrome and its individual components. Smoking cessation is beneficial to metabolic syndrome and its individual components.

Metabolic syndrome in a Taiwanese metropolitan adult population.

BACKGROUND: Metabolic syndrome (MS) is a combination of medical disorders that increase one's risk for cardiovascular disease and diabetes. Little information exists on the prevalence of MS in a general adult population in Taiwan. METHODS: We did a cross-sectional survey in a representative sample of 2,359 Chinese adults aged 40 years and over who lived in a metropolitan city, Taiwan in 2004-05. MS was defined by Adult Treatment Panel III criteria modified for Asians. RESULTS: The prevalence of MetS was 35.32% and 43.23% in men aged 40-64 years and 65 years and over, respectively, and 24.19% and 51.82% in women aged 40-64 years and 65 years and over. Older age, postmenopausal status, higher body mass index, current smoking, low education attainment, low household income, no alcohol consumption, lower level of occupation physical activity, and a family history of diabetes were associated with increased odds of MetS. CONCLUSION: MetS was present in more than 30% of the Taiwan adult population aged 40 years and over in a metropolitan area; there were substantial variations by age and body mass index groups.

The relationship between visfatin levels and anthropometric and metabolic parameters: association with cholesterol levels in women.

Adipose tissue has recently been identified as an endocrine organ. Visfatin is a novel adipocytokine predominantly secreted from visceral adipocytes. Visceral obesity is an important component of metabolic syndrome; however, the relationship between visfatin levels and metabolic syndrome is not clear. The purpose of this study was to explore the association between visfatin levels and anthropometry and parameters of metabolic syndrome. Anthropometric measurements included height, weight, body mass index, waist and hip circumferences, waist-to-hip ratio, and blood pressure. Metabolic parameters including fasting serum visfatin, fasting serum insulin and fasting plasma glucose, lipid profiles, and uric acid levels were measured. Data of 500 subjects (244 men and 256 women) were used for the analysis. There was no significant difference in serum visfatin levels between male and female subjects. Visfatin correlated negatively with body mass index (beta = -.011, P = .025) in male subjects; however, visfatin did not correlate with any other anthropometric or any metabolic parameters in male subjects. There was no correlation between visfatin levels and any anthropometric parameters in female subjects; however, it did correlate positively with high-density lipoprotein cholesterol levels (beta = .126, P = .006) and correlate negatively with low-density lipoprotein cholesterol levels (beta = -.039, P = .010) in female subjects. In conclusion, visfatin is not related to most anthropometric parameters and most parameters of metabolic syndrome. It may play a role in cholesterol homeostasis in women.

Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients.

BACKGROUND: Several lipid ratios may be predictors of coronary artery disease risk. We assessed the efficacy of Monascus purpureus Went rice (red yeast rice) on lowering lipid ratios. METHOD AND RESULTS: We evaluated 79 hypercholesterolemic patients (aged 23-65 years) who received a twice-daily dose of either red yeast rice or a placebo at 600 mg for 8 weeks. The 8-week treatment with red yeast rice showed significantly greater reduction than the placebo treatment in low-density lipoprotein cholesterol levels, total cholesterol/high-density lipoprotein cholesterol, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and apolipoprotein B/apolipoprotein A-I ratios. CONCLUSIONS: Red yeast rice can reduce lipid ratios in hypercholesterolemic patients.

Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia.

OBJECTIVE: The purpose of this study was to assess the lipid-lowering effect of Monascus purpureus Went rice on serum lipids in patients with hyperlipidemia, and to assess its safety by reporting adverse events and clinical laboratory measurements. DESIGN AND METHODS: This was a randomized, double-blind, placebo-controlled study. In all, 79 patients (aged 23-65 years) with a mean baseline low-density lipoprotein cholesterol (LDL-C) level of 5.28 mmol/l (203.9 mg/dl) received a twice daily dose of placebo or Monascus purpureus Went rice (600 mg) for 8 weeks. RESULTS: At week 8, Monascus purpureus Went rice therapy reduced LDL-C by 27.7%, total cholesterol by 21.5%, triglycerides by 15.8% and apolipoprotein B by 26.0%. High-density lipoprotein cholesterol and apolipoprotein A-I levels were increased by 0.9 and 3.4% respectively (not significant). No patient in the Monascus purpureus Went rice treatment group had an alanine aminotransferase (ALT), aspartate aminotransferase (AST) or creatine phosphokinase (CPK) measurement that was > or = 3 times the upper limit of normal at week 4 and week 8. CONCLUSION: Monascus purpureus Went rice significantly reduced LDL-C, total cholesterol, triglycerides and apolipoprotein B levels, and was well tolerated in patients with hyperlipidemia. However, this study only provides data from an 8-week trial and long-term safety and efficacy data are needed.

Using Tc-99m DMSA renal cortex scan to detect renal damage in women with type 2 diabetes.

Women with diabetes mellitus (DM) have urinary tract infection (UTI) more often than women without DM. It is unknown, however, what the prevalence and type of renal damage due to UTI is in these women. Therefore, in this study, we compared type 2 DM women with or without UTI history for the prevalence and type of renal damage by technetium-99m dimercapto-succinic acid (Tc-99m DMSA) renal scan. A total of 128 type 2 DM women with or without UTI history received Tc-99m DMSA renal scan were included in this study. The patients were separated into three groups: (1) 43 patients without UTI history, (2) 42 patients with only lower UTI (cystitis) history and (3) 43 patients with upper UTI (pyelonephritis) history. The renal scan findings were separated into three types: (A) normal, (B) inflammation and (C) scar. The 31.9% (50/128) of type 2 DM patients had renal damages. Group 1 patients had a significantly lower prevalence of renal damages including inflammation and scar as compared to Groups 2 and 3 patients. In addition, the prevalence of renal damage was significantly higher in Group 3 than in Group 2 patients. Renal scars only were visualized in Group 3 patients. However, other clinical data were not statistically different among the three group patients. Type 2 DM women with UTI history, especially if they had upper UTI have a significantly higher prevalence of renal damage than in those without UTI.