Association of life events and depressive symptoms among early postmenopausal Chinese women in Hong Kong.

OBJECTIVE: This study examined the occurrence of stressful life events (SLEs) and its association with the risk of developing depressive symptoms in midlife women. METHODS: A total of 518 Hong Kong Chinese postmenopausal women aged 50 to 64 years were recruited through random telephone dialing. Information on sociodemographic, health, and lifestyle variables was obtained through face-to-face interviews at baseline, and at 3-year (T1) and 5-year (T2) follow-up. A Centre of Epidemiological Study Depression scale (CES-D) score ≥16 was used to indicate high depressive symptoms. At T2, SLEs were assessed by a 21-item life-event scale, adapted from the Holmes and Rahe Social Readjustment Rating Scale for Adults. Potential confounders were controlled for in the multivariable logistic regression analysis on the relation between SLEs and high depressive symptoms among 379 women without CES-D score ≥16 at T1. RESULTS: 87.6% had experienced SLEs since T1 and 11.9% had CES-D score ≥16 at T2. Compared with those without SLEs, women with one to three SLEs had 2.7-fold (95% CI, 0.6-12.1) increased risk of having CES-D score ≥16, whereas those with four to nine SLEs had 5.2-fold (95% CI, 1.1-25.4) increased risk. A dose-response relationship was observed (P for trend = 0.005). Each additional SLEs experienced was associated with a 28% (95% CI, 1.07-1.54) increased risk of high depressive symptoms. CONCLUSIONS: Hong Kong Chinese women encounter many SLEs at midlife. Multiple episodes of SLE had a cumulative effect on the onset of depressive symptoms. Our findings have important implications for the identification and management of midlife women with high depressive symptoms.

Relationship between menopause status, attitude toward menopause, and quality of life in Chinese midlife women in Hong Kong.

OBJECTIVES: This cross-sectional study aimed to explore the relationship between menopause status and attitude toward menopause, and also its relationship with quality of life (QoL) of Chinese midlife women in Hong Kong. METHODS: Hong Kong Chinese women aged 40 to 59 years were recruited through computer-generated random telephone dialing. Information was obtained through telephone interviews based on a structured questionnaire. Women were classified into 3 groups: premenopausal, perimenopausal, and postmenopausal. Menopause Belief Scale and Utian Quality of Life Scale (QoL) were used to measure respondents' attitude toward menopause and their QoL. Information on social, health, and lifestyle factors was also collected. RESULTS: The mean age of the participants was 49.4 ±â€Š5.2 years. Respondents generally had a positive attitude toward menopause. Compared with premenopausal women, postmenopausal women were noted to have significantly higher attitude score toward menopause. No significant differences in QoL score were noted among women of the 3 menopause statuses. Stepwise regression analysis showed that women with more positive attitude toward menopause tended to have higher QoL score. Furthermore, better self-reported health status, doing physical activities, higher education level, being married, and non-smoking status were associated with better QoL. CONCLUSIONS: Postmenopausal women tended to have more positive attitude toward menopause. Although menopause status did not seem to be associated with QoL, attitude toward menopause, self-reported health status, as well as social and lifestyle factors were associated with QoL in Chinese midlife women.

Relationship between dietary intake and the development of type 2 diabetes in a Chinese population: the Hong Kong Dietary Survey.

OBJECTIVE: To study the relationship between dietary intake and the development of type 2 diabetes among Chinese adults. DESIGN: A prospective cohort study. Dietary assessment was carried out using a validated FFQ. Principal component analysis was used to identify dietary patterns. Dietary glycaemic load and variety of snacks were also calculated. SETTING: A hospital-based centre at the Queen Mary Hospital in Hong Kong SAR, China. SUBJECTS: A total of 1010 Chinese adults aged 25-74 years who participated in a territory-wide dietary and cardiovascular risk factor prevalence survey in 1995-1996 were followed up for 9-14 years for the development of diabetes. RESULTS: A total of 690 (68·3 %) individuals completed follow-up during 2005-2008 and seventy-four cases of diabetes were identified over the follow-up period. Four dietary patterns were identified ('more snacks and drinks', 'more vegetables, fruits and fish', 'more meat and milk products' and 'more refined grains'). After adjustment for age, sex, BMI, waist-to-hip ratio, smoking, alcohol intake, participation in exercise/sports and family history of diabetes, the more vegetables, fruits and fish pattern was associated with a 14 % lower risk (OR per 1 sd increase in score = 0·76; 95 % CI 0·58, 0·99), whereas the more meat and milk products pattern was associated with a 39 % greater risk of diabetes (OR per 1 sd increase in score = 1·39; 95 % CI 1·04, 1·84). Dietary glycaemic load, rice intake, snack intake and variety of snacks were not independently associated with diabetes. CONCLUSIONS: The more vegetables, fruits and fish pattern was associated with reduced risk and the more meat and milk products pattern was associated with an increased risk of diabetes.

Haplotype effect in the IGF1 promoter accounts for the association between microsatellite and serum IGF1 concentration.

OBJECTIVE: Systemic insulin-like growth factor 1 (IGF1) level is an important risk factor for various diseases. The inter-individual variation of serum IGF1 is determined by environmental and genetic factors, which are attributed to a microsatellite in IGF1 promoter. However, the exact nature of the underlying regulatory elements accounting for this association has not been characterized. Here, we defined the haplotype patterns, including both SNPs and the microsatellite, in the Chinese population, and investigated their regulatory effect on serum IGF1 level. This is the first study in which haplotype patterns of the microsatellite and SNPs in the IGF1 promoter are examined together. METHODS: The linkage disequilibrium (LD) patterns of IGF1 were examined using tagSNPs of the IGF1 regulatory region. The microsatellite, three tagSNPs and haplotypes were correlated with serum IGF1 concentration in 450 normal premenopausal Chinese women. RESULTS: Common alleles of the microsatellite were in strong LD with the three tagSNPs and were associated with particular haplotypes composed of SNPs. Neither the CA repeat number nor SNPs alone showed a robust association with serum IGF1 concentration. On the other hand, the haplotype T-19-A-T was significantly associated with serum IGF1 level. CONCLUSION: No association was found between SNPs and microsatellite alone. However, the haplotype showed better correlation with serum IGF1 level. The results indicate that the previously observed correlation with microsatellite was because of a haplotype effect in the IGF1 promoter. Microsatellite or tagSNPs alone are not the primary regulatory elements of IGF1 expression. The exact regulatory genetic variant needs to be defined by functional genetic studies.

Utilization of emergency room and hospitalization by Chinese nursing home residents: a cross-sectional study.

OBJECTIVES: This study determined factors associated with increased use of emergency room (ER) and hospitalization of Chinese nursing home residents. DESIGN: A cross-sectional study. SETTING: The setting was 14 nursing homes in Hong Kong. PARTICIPANTS: Participants were 1820 Chinese nursing home residents. MEASUREMENTS: Data on facility factors and resident factors were collected. Resident factors were mainly collected by the Minimum Data Set-Resident Assessment Instrument 2.0 (MDS-RAI 2.0). RESULTS: Residing in a for-profit home (OR=6.51), having less than one third of time spent in activities (OR=1.84), having had recent fall (OR=3.81), having renal failure (OR=3.17), having had recent initiation of new medications (OR=1.42), and having had recent physician visit (OR=1.67) were factors associated with increased use of ER. Male gender (OR=1.49), having a body mass index (BMI) less than 18.5 kg/m(2) (OR=1.51), being more functionally dependent (OR=1.18 per 1-point increment in the ADL Hierarchy Scale), having higher burden of illness (OR=1.29 per 1-point increment in the CHESS score), having a feeding tube (OR=3.07), having an indwelling urinary catheter (OR=2.75), having had recent fall (OR=1.94), having respiratory tract infection (OR=2.05), having Parkinson's disease (OR=1.55), having anemia (OR=1.70), having had recent initiation of new medications (OR=2.08), and having had recent physician visit (OR=1.83) were factors associated with increased risk of hospitalization. CONCLUSIONS: Although some of the associated factors reflect frailty characteristics of residents, differences in association between for-profit and not-for-profit institutions provide evidence of overreliance on the ER, perhaps as a result of inadequate primary care support.

Defining sarcopenia in terms of risk of physical limitations: a 5-year follow-up study of 3,153 chinese men and women.

OBJECTIVES: To examine the definition of sarcopenia in Chinese subjects by relating the value of appendicular skeletal muscle mass (ASM) divided by height squared to physical functional outcomes after 4 years. DESIGN: Four-year prospective study. SETTING: A Chinese community in Hong Kong SAR China. PARTICIPANTS: Three thousand one hundred fifty-three community-living men and women aged 65 and older. METHODS: Information collected by questionnaire included demographics, health limitation on activities of daily living (ADLs), self-care, physical activity level, dietary intake, and psychosocial functioning. Measurements included height, weight, grip strength, step length in a 6-minute walk, and body composition. Four-year outcomes for those with ASM in kg per height in meters squared (ASM/ht(2)) less than 2 standard deviations (SDs) and 2 SDs or more below the young adult mean value were compared using analysis of variance and logistic regression, adjusting for potential confounding factors such as age, fat mass, presence or absence of malnutrition, dietary protein and vitamin D intake, comorbidity, and cognitive impairment. RESULTS: Participants with ASM/ht(2) 2 SDs or more below the young adult mean had lower grip strength and greater limitation in climbing stairs and general ADLs after adjusting for confounding factors. A U-shaped relationship was observed between physical limitation and ASM/ht(2), with increasing physical limitation below or above a range of 7.25 to 6.75 kg/m(2) in men and 6.00 to 6.25 kg/m(2) in women. Values of 5.25 to 6.74 kg/m(2) in women were associated with approximately 30% less risk of functional limitation after 5 years. No clear cutoff was found in men. CONCLUSION: Sarcopenia may be defined in terms of a range of values for ASM/ht(2) associated with the lowest risk of future physical limitations. The importance of establishing a quantitative value for the definition of sarcopenia may facilitate future interventional studies using pharmacological or nonpharmacological strategies.

Impact of caregiving on health and quality of life: a comparative population-based study of caregivers for elderly persons and noncaregivers.

This study aims to investigate the impact of caregiving on the health status and quality of life (QOL) of primary informal caregivers (PCGs) of elderly care recipients in Hong Kong. A total of 246 PCGs and 492 matched noncaregiver (NCG) controls were identified in a population-based cross-sectional study through random telephone dialing. Their health status and QOL were assessed based on structured questionnaires and Short Form 36 (SF-36) Health Survey. Multiple conditional logistic regression analysis showed that compared with NCGs, PCGs had significantly increased risks for reporting worse health, more doctor visits, anxiety and depression, and weight loss. Female PCGs were more likely to report chronic diseases, symptoms, and insomnia. PCGs, particularly women, had significantly lower scores in all eight domains of SF-36 Health Survey. High caregiver burden score (Zarit Burden Scale) was positively associated with adverse physical and psychological health and poorer QOL. The results indicate that PCGs, particularly women, had an adverse physical and psychological health profile and poorer QOL compared with NCGs.

Influence of different health-care systems on health of older adults: a comparison of Hong Kong, Beijing urban and rural cohorts aged 70 years and older.

OBJECTIVE: To explore the hypothesis that better health status of elderly populations is primarily determined by the provision of freely accessible health service at low or no cost to the user and a social welfare system. METHOD: Information was collected by questionnaire from surveys of three cohorts of elderly (70 years and older) Chinese. Data from two health-care systems were compared: the low-cost or free government-subsidized system in Hong Kong, and the market-orientated user-pays system in urban (Beijing), and rural China. RESULTS: The Beijing rural cohort had the best health profile, whereas the Hong Kong cohort had the worst, despite the better lifestyle practices in the Hong Kong and Beijing urban cohorts compared with the Beijing rural cohort, and higher socioeconomic status in the Beijing urban and Hong Kong cohorts. However, the Beijing rural cohort had the highest prevalence of functional limitations. CONCLUSION: While health-care systems may affect life expectancy at birth, psychosocial, lifestyle and socioeconomic factors influence subsequent health status of elderly people in a complex manner.

Effects of soy isoflavone supplementation on cognitive function in Chinese postmenopausal women: a double-blind, randomized, controlled trial.

OBJECTIVE: To investigate whether soy-derived isoflavone extract improves performance in cognitive function and quality of life in Chinese postmenopausal women. DESIGN: The study was a 6-month double-blind, randomized, placebo-controlled, parallel group trial. Participants were community-dwelling women aged 55 to 76 years; 191 eligible women were randomly assigned to receive a daily oral intake of 80 mg soy-derived isoflavones or an identical-appearing placebo for 6 months. Standardized neuropsychological tests of memory, executive function, attention, motor control, language, and visual perception and a global cognitive function assessment were administered face-to-face individually at baseline and at 6-months posttreatment. The validated Chinese version of the Short Form-36 was used for quality of life measurements. RESULTS: Of the participants, 88% (168 women: 80 among the supplementation group and 88 among the placebo group) completed the trial. Intention-to-treat analysis, conducted for 176 participants with 6-month assessment results, revealed no significant differences in outcome measures between treatment groups. Subgroup analysis among the good compliers only (consumed at least 80% of the supplements or placebo; n = 168) and among the age groups younger or older than 65 years also indicated no significant differences for any outcome measures. Types of complaints of adverse events were similar in both treatment groups and included mainly gastrointestinal and musculoskeletal problems. CONCLUSIONS: This 6-month trial indicates that 80-mg soy-derived isoflavone supplementation did not improve performance on standard neuropsychological tests and overall quality of life in generally healthy Chinese postmenopausal women.

A prospective study of the effects of 1-year calcium-fortified soy milk supplementation on dietary calcium intake and bone health in Chinese adolescent girls aged 14 to 16.

The Chinese diet is low in calcium, including among adolescent girls, with an average intake around 500 mg per day. In this study, we compared the percentage change in bone mineral density and content of the spine and hip region in a 1-year follow-up study between 104 adolescent girls aged 14 to 16 years receiving 375 ml calcium-fortified soymilk supplementation and 95 girls in the control group. The mean percentage changes of bone mineral density/content (BMD/BMC) and standard deviation (SD) at 1 year for the supplementation and control groups were as follows: neck of the femur BMD 2.7+/-2.94%, 1.8+/-3.49% (P = 0.08); trochanter BMD 3.3+/-3.27%, 1.6+/-2.94% (P < or = 0.001); intertrochanter BMD 3.6+/-3.05%, 2.32+/-2.95% (P = 0.002); total hip BMD 3.1+/-2.39%, 2.05+/-2.22% (P = 0.001); total hip BMC 3.8+/-3.05%, 2.6+/-2.96% (P = 0.006). The percent difference between the percentage of bone changes in the supplementation and control groups [100x (soymilk-control)/control] ranged from 45 to 113%. We observed no differences in the spine BMD/C and no differences in changes of height and weight between the soymilk supplementation and control groups, which yielded similar results. Stepwise multivariate regression analysis including height, weight, growth stage, dietary energy, protein, calcium from usual diet and physical activity also showed that supplementation was significantly associated with a percentage increase in BMD/C at the hip. We conclude that 375 ml calcium-fortified soymilk supplementation, or an equivalent of about two glasses, is among the effective strategies for bone acquisition and the optimization of peak bone mass in adolescent girls.

Frailty index as a measure of biological age in a Chinese population.

BACKGROUND: The concept of a frailty index, developed in Canadian elderly populations as an indicator of biological age as opposed to chronological age, was tested in an elderly Chinese population to determine whether it is applicable in a different ethnic and cultural setting. METHODS: A data set including 62 physical, psychological, and socioeconomic variables from a cohort of 2,032 persons 70 years and older (999 men, 1,033 women) was used. The distribution of the index was evaluated using the Cramer-von Mises goodness-of-fit test, and multiple linear regression was used to assess its relationship with age and sex. A biological age for each participant was calculated based on an inverse regression of age on mean frailty index and sex. The Cox proportional hazards regression model was used to assess the ability of biological age to predict death. RESULTS: The distribution of the frailty index most closely resembled a Weibull distribution. The frailty index increased with age until the mid-80s, when it leveled off, and was higher in women than men for each age group. The distribution of biological age is wider than that for chronological age, and it strongly predicted death. Women had an estimated 20% lesser chance of dying at a given time than did men of the same chronological age and degree of frailty. CONCLUSIONS: The study confirms the robustness of the concept and method of calculating the frailty index developed in elderly Canadian populations. It also suggests that the sex difference in life expectancy may have an underlying genetic basis independent of frailty.

The prevalence of Apo E4 genotype and its relationship to bone mineral density in Hong Kong Chinese.

Apolipoprotein E (Apo E) polymorphism has been implicated in many chronic diseases, including Alzheimer disease and osteoporosis. Significant association of the Apo E4 allele to low bone mineral density (BMD) has been repeatedly reported. We here examined the Apo E genotype frequencies in the Chinese population (n = 692) and its relationship to BMD. A significantly lower frequency (a prevalence of 7%) of the E4 alleles was found in our Chinese subjects compared to that reported in Caucasians (14.7%) or in Japanese (11.7%). However, no significant association between the Apo E4 allele and BMD Z score was observed in our test subjects; this may be due to the rarity of the Apo E4 allele frequency in Chinese, which requires a larger sample size for detection of significant association. Significant associations detected between Apo E2 allele and BMD at the femoral neck in elderly women (P = 0.02) and at the spine in elderly men (P = 0.03) were in the opposite direction and thus regarded as false-positive results. It is concluded that the Apo E4 allele is rare in Chinese, and a larger population size is needed to see if Apo E4 is associated with BMD in Chinese.

Impact of osteoarthritis on quality of life in a Hong Kong Chinese population.

OBJECTIVE: To measure the impact of osteoarthritis (OA) on quality of life in the Hong Kong Chinese population. METHODS: This was a cross sectional, retrospective, non-random, cohort design stratifying disease severity and presence or absence of joint prostheses. Patients with OA (n = 574; 136 men and 438 women) were recruited from rheumatology, family medicine, orthopedics, and geriatric medicine clinics. They were divided into 2 equal groups based upon disease severity (either American College of Rheumatology functional classes I and II, or III and IV). The 36-item Medical Outcomes Study Short-Form Health Survey (SF-36) and Western Ontario and McMaster Universities (WOMAC) OA Index were used. RESULTS: Patients with severe disease had lower mean scores in all SF-36 domains and higher mean scores in all WOMAC domains, indicating poorer quality of life. Scores in patients who had had arthroplasty were better than those with severe disease only in certain domains: role physical, general health, vitality, and mental health (SF-36); and pain (WOMAC). Women with OA had poorer scores compared to men for bodily pain, general health, and mental health after adjusting for age and disease severity. Low educational attainment was independently associated with poorer scores when disease severity was taken into account. CONCLUSION: OA has a significant impact on quality of life, only partly ameliorated by arthroplasty, as assessed by the SF-36 and WOMAC in this population.

Osteoporosis in Chinese patients with anorexia nervosa.

OBJECTIVE: A case-control study was conducted to determine whether bone mass is reduced in Chinese patients with anorexia nervosa (AN) and to study the risk factors for low bone mass in the same population. METHOD: Bone mineral density (BMD) of the lumbar spine and hip was measured by dual-energy X-ray absorptiometry in 42 AN patients and 221 controls. RESULTS: Patients with AN had a significantly lower BMD in the total hip and spine compared with controls (p <.001). In AN patients, linear regression showed that lowest body mass index (BMI) was positively associated with BMD in the hip (p = .04) whereas duration of illness was negatively associated with BMD in the hip (p = .05). DISCUSSION: Chinese patients with AN are at risk of low BMD. Duration of illness and lowest BMI were significant predictors of reduced BMD in Chinese patients with AN.

Soy protein consumption and bone mass in early postmenopausal Chinese women.

Recent interest has been shown in the potential beneficial effects of phytoestrogens on bone health. As the early years of menopause are a period of rapid bone loss, and the risk for osteoporosis increases substantially, the habitual intake of soy protein and isoflavones may play a role in the retardation of bone loss. This paper reports the results of the baseline cross-sectional analysis of the association between dietary soy protein intake and bone mineral density/content in a population-based study of Chinese women. The sample comprised 454 healthy Chinese women (mean age 55.1 +/- 3.57) within the first 12 years of postmenopause. We estimated the dietary intake of soy protein and isoflavones, and other key nutrients, including dietary protein and calcium, using the quantitative food frequency method. Bone mineral density (BMD) and content (BMC) at the spine, hip and total body were measured with a dual energy X-ray densitometer (Hologic 4500A). Soy protein consumption was categorized as quartiles of intake, and related to BMD values at the spine and hip, and BMC of total body. Stratified analyses were carried out among women within or at least 4 years postmenopausal. We observed few differences in BMD/BMC values among the intake quartiles in women within the first 4 years of menopause. However, among the later postmenopausal women, we noted a dose-response relationship with increasing higher BMD values at the trochanter, intertrochanter as well as the total hip and total body with increasing soy protein intake quartiles (P<0.05 from tests for trend). The BMD values differed by about 4-8% between the first and fourth soy protein intake quartiles. Though women from the fourth intake quartile had a 2.9% higher BMD value compared with those from the first intake quartile, the difference was not statistically significant. Stepwise multiple linear regression analyses showed the association between soy intake quartiles and hip BMD as well as total body BMC values remained after adjusting for body weight, which was retained in the final model. Analyses based on soy isoflavones content yielded similar results. This study demonstrated that, among women after the initial few years postmenopausal, soy protein/isoflavones intake had a modest but significant association with hip BMD as well as total body BMC. The effects of soy protein and soy isoflavones on bone health should be further explored in populations with habitual dietary soy intake.

Comparison of Pueraria lobata with hormone replacement therapy in treating the adverse health consequences of menopause.

OBJECTIVE: Pueraria lobata (PL) is used as a traditional Chinese herbal remedy for menopausal symptoms, as well as an ingredient in preparations for conditions affecting menopausal women, such as osteoporosis, coronary heart disease, and some hormone-dependent cancers. The scientific basis for its action may be its action as a phytoestrogen. DESIGN: To examine the effects of PL in comparison with hormone replacement therapy (HRT) on lipid profile, sex hormone levels, bone turnover markers, and indices of cognitive function. For the study, 127 community-living, postmenopausal women aged 50 to 65 years were randomized to receive HRT (n = 43), PL (equivalent to 100 mg isoflavone; n = 45), or no treatment (n = 39) for 3 months. The following measurements were carried out at baseline and after 3 months for all participants: menopausal symptoms questionnaire; neuropsychological tests covering memory, attention, motor speed, and word-finding ability; quality of life (SF36); lipid profile; urinary deoxypyridinoline; dietary phytoestrogen intake and urinary phytoestrogen; estradiol; follicle-stimulating hormone; and luteinizing hormone. RESULTS: Only participants in the HRT group showed a mean reduction in cholesterol and low-density lipoprotein cholesterol that was significantly different from that of the control group. No significant changes in lipid profile or follicle-stimulating hormone and luteinizing hormone were observed in the PL group compared with the controls. However, both the HRT and PL groups showed an improvement in Mini-Mental State Examination score and attention span compared with the case of participants receiving no treatment. HRT and PL had different effects on cognitive function; HRT improved delayed recall, whereas flexible thinking seemed improved in the PL group. CONCLUSIONS: This study was unable to demonstrate a scientific basis for the use of PL for improving the health of postmenopausal women in general. However, the effect of PL on cognitive function deserves further study.

Factors associated with menopausal symptom reporting in Chinese midlife women.

OBJECTIVES: this paper examines whether menopausal status, sociodemographic factors, self-perceived health, and social stress are related to symptom reporting in a community-based sample of Chinese women in midlife. METHODS: a random telephone survey of perimenopausal women aged 44-55 years was conducted in 1996. Eligible subjects were identified through telephone dialing of a random sample of the numbers listed in the residents' telephone directory. Standardized questionnaire on social and health information, as well as a 21-item symptom checklist, were administered over the telephone. Logistic regress analyses were performed to find out if menopausal status and other social and health factors were independently associated with overall symptom reporting as well as high prevalence of reporting of each of the five symptom groups - psychological, musculoskeletal, non-specific somatic, respiratory and vasomotor. RESULTS: we observed that compared with premenopausal women, women going through menopausal transition had a 2.3- to threefold increased risk of reporting more symptoms. The prevalence of symptom reporting was lower in postmenopausal women, but remained slightly elevated compared with premenopausal women. Factors including currently not working, decreased household income in the past year, worry over friends/relatives, and health affecting daily activities were also independently associated with symptom reporting. Among these factors, reporting health affecting daily activities had the strongest association with symptom reporting. CONCLUSIONS: compared with pre and postmenopausal women, perimenopausal women had the highest reports of symptom complaints. Social, psychological and health factors were also independently associated with symptom reporting.