Effects of ketoanalogues on skeletal muscle mass in patients with advanced chronic kidney disease: real-world evidence.

OBJECTIVE: Ketoanalogue (KA) supplementation in patients with chronic kidney disease (CKD) on a restricted protein diet has been shown to maintain their nutritional status in clinical trials. However, a gap existed between the findings of the clinical trials and the real-world practice. The aim of this prospective observational study was to evaluate the KA effect on skeletal muscle mass in patients with stage 4-5 CKD. METHODS: Among 170 patients with CKD screened, 148 were recruited. Patients were defined as KA or non-KA users. During a 12-mo follow-up, skeletal muscle and body fat mass were measured via bioelectrical impedance analysis at baseline, 6 mo (n = 108), and 12 mo (n = 85). RESULTS: Among the patients (mean age, 66.5 ± 12.9 y), KA users tended to maintain skeletal muscle and body fat mass, whereas non-KA users had a significantly reduced muscle mass (P = 0.011) and body fat gain (P = 0.004). Stratified by median age, in patients ≥68 y of age, non-KA users yielded the most significant muscle mass reduction and fat mass gain, whereas KA users revealed no changes in skeletal muscle and fat mass. CONCLUSION: In real-world practice, we concluded that KA supplementation favorably prevents skeletal muscle mass loss and fat mass gain in elderly patients with stage 4-5 CKD.

Association of SARC-F Questionnaire and Mortality in Prevalent Hemodialysis Patients.

Sarcopenia is common in patients undergoing chronic hemodialysis, which leads to poor outcomes. SARC-F (sluggishness, assistance in walking, rising from a chair, climb stairs, falls), a self-report questionnaire, is recommended as an easily applied tool for screening sarcopenia in older people. However, there are limited data regarding its use in patients undergoing chronic hemodialysis. Therefore, we aimed to evaluate the association between SARC-F and mortality in these patients. SARC-F questionnaire was applied in 271 hemodialysis patients (mean age 64.4 ± 14.3 years) at baseline. The association between SARC-F and mortality during a 24-month follow-up was analyzed. During this follow-up period, 40 patients (14.8%) died. The discriminative power of SARC-F score for predicting mortality was 0.716 (95% confidence interval (CI) = 0.659-0.769; p < 0.001). The best cut-off was a score ≥ 1, which provided 85.0% sensitivity, 47.2% specificity, 21.8% positive predictive value, and 94.8% negative predictive value. Kaplan-Meier curves showed that patients with SARC-F ≥ 1 exhibited a higher risk of mortality than those with SARC-F < 1 (p < 0.001). Moreover, a stepwise decline in survival with higher SARC-F scores was also observed. After full adjustments, SARC-F ≥ 1 was independently associated with increased mortality (hazard ratio = 2.87, 95% CI = 1.11-7.38; p = 0.029). In conclusion, SARC-F applied for sarcopenia screening predicted mortality in patients undergoing chronic hemodialysis.

Low serum adiponectin level is associated with central arterial stiffness in patients undergoing peritoneal dialysis.

OBJECTIVE: Adiponectin has antidiabetic, anti-atherosclerotic, and anti-inflammatory functions and protects against vascular damage. Carotid-femoral pulse wave velocity (cfPWV) is a noninvasive method for measuring central artery stiffness, which is known to be associated with cardiovascular disease in peritoneal dialysis (PD) patients. This study was conducted to evaluate the relationship between central arterial stiffness and serum adiponectin levels in PD patients. MATERIALS AND METHODS: Fasting blood samples were obtained from 60 PD patients, and the cfPWV value was measured using a validated tonometry system. In this study, cfPWV values of >10 m/s were used to define the high arterial stiffness group according to the European Society of Hypertension and the European Society of Cardiology guidelines. RESULTS: Among 60 patients with PD, 19 patients (31.7%) were included in the high arterial stiffness group. When compared to those in the control group, the high arterial stiffness group patients were older (P = 0.029), had longer PD vintage (P = 0.001), higher diastolic blood pressures (P = 0.030), higher fasting glucose (P = 0.014), and lower serum adiponectin levels (P = 0.001). After multivariable logistic regression analysis, serum adiponectin (odds ratio, 0.612; 95% confidence interval: 0.426-0.879; P = 0.008) was identified as an independent predictor of arterial stiffness. The multivariable regression analysis also showed that the adiponectin level (ß = -0.408; adjusted R 2 change = 0.183; P < 0.001) was negatively associated with cfPWV values in patients undergoing PD. CONCLUSION: Low serum adiponectin level is an independent marker of arterial stiffness in patients undergoing PD.

Serum Malondialdehyde-Modified Low-Density Lipoprotein Is a Risk Factor for Central Arterial Stiffness in Maintenance Hemodialysis Patients.

Circulating malondialdehyde-modified low-density lipoprotein (MDA-LDL) acts as a marker of oxidative stress and is associated with atherosclerotic cardiovascular disease. The relationship between serum MDA-LDL levels and aortic stiffness (AS) in patients with hemodialysis (HD) was evaluated. There were 155 HD patients enrolled in this study. Carotid-femoral pulse wave velocity (cfPWV) was measured by a validated tonometry system. Patients with cfPWV >10 m/s were used to define the AS group, while those with values of ≤10 m/s were regarded as the control group. Serum MDA-LDL levels were measured using a commercial enzyme-linked immunosorbent assay. Sixty-eight patients (43.9%) who were defined as AS sufferers, and were older, had a higher percentage of diabetes and hypertension and higher systolic blood pressure and serum MDA-LDL level compared to subjects in the control group. After adjusting for factors significantly associated with AS by multivariable logistic regression analysis, it was revealed that serum MDA-LDL levels, diabetes, and hypertension were independent predictors of AS in HD patients. Multivariable forward stepwise linear regression analysis also showed that a logarithmically transformed MDA-LDL level was significantly correlated with cfPWV values in HD patients. In HD patients, a high serum MDA-LDL level was positively associated with cfPWV values and was a significant predictor of the development of high AS.

Serum Sclerostin But Not DKK-1 Correlated with Central Arterial Stiffness in End Stage Renal Disease Patients.

Sclerostin and dickkopf-1 (DKK1) played a role in the development of cardiovascular diseases and arterial stiffness in chronic kidney disease (CKD) patients but with controversial results of patients in end-stage renal disease (ESRD) including hemodialysis (HD) and peritoneal dialysis (PD). This study aimed to examine the association between the mode of dialysis or the values of sclerostin or DKK1 and carotid-femoral pulse wave velocity (cfPWV) in ESRD patients. There were 122 HD and 72 PD patients enrolled in this study. By a validated tonometry system, cfPWV was measured and then segregated patients into values of >10 m/s as the high central arterial stiffness (AS) group and values ≤ 10 m/s as the control group. Serum levels of sclerostin and DKK1 were measured using a commercial enzyme-linked immunosorbent assay kit. Possible risk factors for the development of AS were analyzed by logistic regression analysis. There were 21 (29.2%) of PD and 53 (43.4%) of HD in the high AS group. Compared to patients in the control group, those in the high AS group were older, had more comorbidities, had higher systolic blood pressure, and had higher serum levels of fasting glucose, C-reactive protein, and sclerostin. Levels of sclerostin (adjusted OR 1.012, 95% CI. 1.006-1.017, p = 0.0001) was found to be an independent predictor of high AS in ESRD patients by multivariate logistic regression analysis. Furthermore, receiver operating characteristic curve analysis showed the optimal cut-off values of sclerostin for predicting AS was 208.64 pmol/L (Area under the curve 0.673, 95% CI: 0.603-0.739, p < 0.001). This study showed that serum levels of sclerostin, but not DKK1 or mode of dialysis, to be a predictor for high central AS in ESRD patients.

[Early Warning Systems: Introduction and Application].

Related studies in the literature indicate that over half (50-84%) of patients exhibit physiological variations 6 hours before experiencing cardiac arrest. Early warning systems improve the ability of medical teams to detect patient deterioration and then immediately treat sudden cardiac arrest during patient hospitalization. This article aims to strengthen general understanding among clinical medical staffs of the early warning system. Understanding the reasons and motivations for establishing this system is expected to help readers better distinguish the physiological monitoring indicators of this system and its importance in terms of improving patient safety. In particular, using the system to identify patients at risk levels of medium or higher will help facilitate their timely transfer to an intensive care unit for appropriate monitoring and care. This article further explores the application of early warning systems in nursing to help nurses understand their professional roles and responsibilities as members of the rapid-response team. Finally, information in this article teaches medical staffs how to avoid unanticipated cardiac arrest events, create a comprehensive patient safety environment, and improve the quality of medical care.

Serum Fibroblast Growth Factor 21 Levels Are Positively Associated with Metabolic Syndrome in Patients with Type 2 Diabetes.

BACKGROUND: Fibroblast growth factor 21 (FGF21) acts as a potent metabolic regulator. Serum FGF21 levels were significantly higher in obesity and type 2 diabetes mellitus (T2DM) populations. The aim of this study was to evaluate the relationship between serum FGF21 levels and metabolic syndrome (MetS) in T2DM patients. METHODS: Fasting blood samples were obtained from 126 T2DM patients. MetS and its components were defined according to the diagnostic criteria from the International Diabetes Federation. Serum FGF21 concentrations were measured using a commercially available enzyme-linked immunosorbent assay. RESULTS: Among these patients, 84 (66.7%) had MetS. Female gender, hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), waist circumference (WC), body weight (BW), body mass index (BMI), body fat mass, fasting glucose, glycated hemoglobin level (HbA1c), triglyceride level (TG), urine albumin-to-creatinine ratio (UACR), insulin level, homeostasis model assessment of insulin resistance (HOMA-IR), and FGF21 levels were higher, whereas high-density lipoprotein cholesterol level (HDL-C) and estimated glomerular filtration rate (eGFR) were lower in DM patients with MetS. Univariate linear analysis revealed that hypertension, BMI, WC, body fat mass, SBP, DBP, logarithmically transformed TG (log-TG), low-density lipoprotein cholesterol (LDL-C) level, log-glucose, log-creatinine, log-UACR, log-insulin, and log-HOMA-IR positively correlated, whereas HDL-C and eGFR negatively correlated with serum FGF21 levels in T2DM patients. Multivariate forward stepwise linear regression analysis revealed that body fat mass (adjusted R 2 change = 0.218; P=0.008) and log-TG (adjusted R 2 change = 0.036; P < 0.001) positively correlated, whereas eGFR (adjusted R 2 change = 0.033; P=0.013) negatively correlated with serum FGF21 levels in T2DM patients. CONCLUSIONS: This study showed that higher serum FGF21 levels were positively associated with MetS in T2DM patients and significantly positively related to body fat mass and TG but negatively related to eGFR in these subjects.

Association of Low Serum Adiponectin Levels with Aortic Arterial Stiffness in Patients with Type 2 Diabetes.

Adiponectin, an anti-inflammatory and anti-atherogenic protein, affects glucose metabolism. High serum adiponectin levels are associated with decreased diabetes mellitus (DM) risks. Aortic arterial stiffness (AS) is associated with cardiovascular disease and mortality in type 2 DM patients. We assessed the association between adiponectin levels and aortic AS in type 2 DM patients. We measured serum adiponectin levels in 140 volunteers with type 2 DM and assigned patients with carotid-femoral pulse wave velocity (cfPWV) >10 m/s to the aortic AS group (n = 54, 38.6%). These patients had higher systolic (p = 0.001) and diastolic (p = 0.010) blood pressures; body fat masses (p = 0.041); serum triglyceride (p = 0.026), phosphorus (p = 0.037), and insulin (p = 0.040) levels; and homeostasis model assessment of insulin resistance values (p = 0.029) and lower estimated glomerular filtration rates (p = 0.009) and serum adiponectin levels (p = 0.001) than controls. Multivariable logistic regression analysis adjusted for confounders showed serum adiponectin levels (OR 0.922; 95% CI, 0.876-0.970; p = 0.002) as an independent predictor of aortic AS. Multivariable forward stepwise linear regression analyses showed that serum adiponectin levels (ß = -0.283, adjusted R2 change: 0.054, p < 0.001) were negatively associated with cfPWV. Thus, serum adiponectin level is an independent predictor of aortic AS in type 2 DM patients.

Serum osteoprotegerin is an independent marker of central arterial stiffness as assessed using carotid-femoral pulse wave velocity in hemodialysis patients: a cross sectional study.

BACKGROUND: Cardiovascular morbidity and mortality are highly prevalent in patients with end-stage renal disease, and osteoprotegerin (OPG) may be an important link between bone loss and vascular calcification. This study was conducted to evaluate the relationship between central arterial stiffness and serum OPG levels in hemodialysis (HD) patients. METHODS: Blood samples were collected from 120 HD patients, and the carotid-femoral pulse wave velocity (cfPWV) value was measured using a validated tonometry system. The cfPWV value of > 10 m/s was used to define the high artery stiffness group. Serum OPG levels were analyzed categorically into tertiles. RESULTS: Of the 120 HD patients, 53 (44.2%) were defined as the high arterial stiffness group, who had higher values of systolic blood pressure (p = 0.038), serum calcium (p = 0.007), and OPG (p <  0.001) levels and a higher prevalence of diabetes mellitus (DM, p = 0.001). Increasing tertiles of serum OPG levels were significantly associated with greater height (p = 0.011), male gender (p = 0.008), higher cfPWV values (p = 0.020), and lower intact parathyroid hormone (iPTH, p = 0.049) levels. Multivariable linear regression analysis showed that cfPWV value was independently associated with DM (ß = 1.83, p = 0.008) and increasing tertiles of serum OPG levels (ß = 0.89 and 1.63 for tertile 2 and tertile 3, respectively, p for trend = 0.035) in HD patients. Multivariable logistic regression analysis revealed that, in addition to age, DM, low iPTH levels, and high serum calcium levels, increasing tertiles of serum OPG levels (OR = 5.34 for tertile 2; OR = 7.06 for tertile 3; p for trend = 0.002) were an independent predictor of high arterial stiffness in HD patients. Serum calcium levels positively correlated with cfPWV value only in the highest OPG tertile group (r = 0.408, p = 0.009). CONCLUSION: A positive association was detected between serum OPG levels and central arterial stiffness in HD patients, and patients with high serum OPG levels may have greater influence of calcium load on central arterial stiffening.

High serum adipocyte fatty acid binding protein concentration linked with increased aortic arterial stiffness in patients with type 2 diabetes.

BACKGROUND: Adipocyte fatty acid binding protein (A-FABP) is a novel adipokine that contributes to the development of metabolic disorder, type 2 diabetes mellitus (T2DM) and atherosclerosis. We determined the correlation between serum A-FABP and aortic stiffness in T2DM patients. METHODS: Fasting blood samples were obtained from 156 patients with T2DM. Serum A-FABP concentration were determined using a commercial enzyme immunoassay. Carotid-femoral pulse wave velocity (cfPWV) was measured using SphygmoCor System, and cfPWV values of >10 m/s were defined as high aortic stiffness. RESULTS: Sixty participants (38.4%) fell under the high aortic stiffness group. This group, compared to the control group, showed older age (P = .004), higher systolic blood pressure (P < .001), diastolic blood pressure (P = .027), urine albumin-to-creatinine ratio (P = .003), serum A-FABP (P < .001) and lower estimated glomerular filtration rate (P = .001). After adjusting for factors significantly associated with aortic stiffness using multivariable logistic regression analysis, serum A-FABP [OR = 1.029 (1.002-1.058), P = .039] was found to be an independent predictor of aortic stiffness in T2DM patients. CONCLUSIONS: Serum A-FABP is positively correlated with aortic arterial stiffness in patients with T2DM.

Osteocalcin and carotid-femoral pulse wave velocity in patients on peritoneal dialysis.

OBJECTIVE: Vascular calcification is a cardiovascular risk factor in dialysis patients. Vascular calcification involves a complex process of biomineralization resembling osteogenesis, which leads to arterial stiffness. Osteocalcin is the most abundant noncollagenous protein in the bone matrix. It is synthesized in the bone by osteoblasts and reflects the rate of bone formation. The aim of this study was to evaluate the relationship between serum osteocalcin levels and the carotid-femoral pulse wave velocity (cfPWV) in peritoneal dialysis (PD) patients. MATERIALS AND METHODS: Serum intact osteocalcin and cfPWV were measured in 62 PD patients. Those with CfPWV values >10 m/s were defined as the high central arterial stiffness group, while those with values ≤10 m/s were regarded as the low central arterial stiffness group, according to the European Society of Hypertension and of the European Society of Cardiology guidelines. RESULTS: Seventeen of the 62 PD patients (27.4%) were in the high central arterial stiffness group. The high central arterial stiffness group were older (P = 0.002), had a longer PD vintage (P = 0.018), and had higher serum osteocalcin levels (P = 0.001) than those in the low group. Multivariate logistic regression analysis showed that the osteocalcin level (odds ratio: 1.069, 95% confidence interval (CI): 1.005-1.137, P = 0.035), PD vintage (odds ratio: 1.028, 95% CI: 1.010-1.048, P = 0.003), and age (odds ratio: 1.081, 95% CI: 1.005-1.162, P = 0.035) were independently associated with central arterial stiffness in PD patients. Among these patients, cfPWV (ß: 0.216, P = 0.001) values and log-transformed intact parathyroid hormone (ß: -'0.447, P < 0.001) levels were independently associated with the osteocalcin level in PD patients after multivariate forward stepwise linear regression analysis. CONCLUSION: Older PD patients with a longer PD vintage and higher serum osteocalcin levels had higher central arterial stiffness as measured by cfPWV. The serum osteocalcin level is an independent marker of central arterial stiffness in PD patients.

High serum leptin level is associated with peripheral artery disease in adult peritoneal dialysis patients.

OBJECTIVE: Peripheral artery disease (PAD) is associated with systemic atherosclerosis and indicates an increased risk of mortality in peritoneal dialysis (PD) patients. A high leptin level accelerates atherosclerosis in apoE-deficient mice. The purpose of this study was to examine the association of serum leptin level and PAD in adult PD patients. MATERIALS AND METHODS: The clinical characteristics of sixty PD patients recruited from June 2015 to October 2016 were obtained. Serum leptin concentrations were determined. Ankle-brachial index (ABI) values were measured and those with a left or right ABI <0.9 were defined as the low ABI group. RESULTS: Twenty of these 60 PD patients (33.3%) had diabetes mellitus and 32 patients (53.3%) had hypertension. Thirteen PD patients (21.7%) were in the low ABI group. Higher serum leptin (P = 0.002) and C-reactive protein (CRP, P < 0.001) levels were found in the low ABI group compared with those in the normal ABI group. More number of patients with diabetes (P = 0.015) and current smokers (P = 0.037) were noted in the low ABI group than in the normal ABI group. After adjustment for factors that were significantly associated with PAD in multivariate logistic regression analysis, each increase of 1 ng/mL in the serum leptin level (odds ratio [OR], 1.062; 95% confidence interval [CI], 1.014-1.114; P = 0.012) and each increase of 0.1 mg/dL in the serum CRP level (OR, 1.107; 95% CI, 1.011-1.211; P = 0.028) were found to be independent predictors of PAD in PD patients. CONCLUSION: Higher serum leptin and CRP levels correlated positively with the diagnosis of PAD in PD patients.

Negative Correlation of Serum Adiponectin Levels With Carotid-Femoral Pulse Wave Velocity in Patients Treated With Hemodialysis.

PURPOSE: The aim of this study was to evaluate the relationship between serum adiponectin levels and carotid-femoral pulse wave velocity (cfPWV) in hemodialysis (HD) patients. METHOD: Blood samples were obtained from 120 HD patients. cfPWV was measured with a validated tonometry system (SphygmoCor; AtCor Medical, West Ryde, Australia). Serum adiponectin levels were measured using a commercially available enzyme-linked immunosorbent assay kit. RESULTS: By univariate linear analysis of cfPWV in HD patients, we found that diabetes ( r = .281, p = .002), pre-HD body weight ( r = .194, p = .033), post-HD body weight ( r = .192, p = .036), waist circumference ( r =.210, p = .022), and body fat mass ( r = .194, p = .034) were positively correlated, whereas adiponectin level ( r = -.254, p = .005) was negatively correlated with cfPWV in HD patients. Multivariate forward stepwise linear regression analysis showed that diabetes (ß = .274, p = .006) and adiponectin level (ß = -.215, p = .016) were independent predictors of cfPWV in HD patients. Moreover, post-HD body weight (ß = -.274, p = .041), waist circumference (ß = -.311, p < .001), logarithmically transformed triglyceride level (log-TG; ß = -.186, p = .031), and log-glucose (ß = -.225, p = .008) were negatively associated with adiponectin levels in HD patients after multivariable forward stepwise linear regression analysis. CONCLUSIONS: Among HD patients, serum adiponectin level was inversely associated with cfPWV level, and post-HD body weight, waist circumference, log-TG, and log-glucose were negatively associated with adiponectin level.

Positive correlation of serum leptin levels and peripheral arterial stiffness in patients with type 2 diabetes.

OBJECTIVE: Leptin plays a pathophysiologic role in the pathogenesis of aortic dysfunction and peripheral arterial stiffness (PAS). Our aim was to evaluate the risk factors for developing PAS and the association of leptin and PAS in patients with type 2 diabetes mellitus (DM). MATERIALS AND METHODS: Fasting blood samples were obtained for biochemical data and leptin determinations from 105 patients with type 2 DM. In this study, we applied an automatic pulse wave analyzer (VaSera VS-1000) to measure the brachial-ankle pulse wave velocity (baPWV); a baPWV value >14.0 m/s on either side was considered high PAS. RESULTS: Seventy-five patients (71.4%) had high PAS and they included a higher percentage of patients with hypertension (P < 0.001), older age (P < 0.001), and a higher body fat mass (P = 0.043), systolic blood pressure (P < 0.001), diastolic blood pressure (P = 0.016), serum blood urea nitrogen (P = 0.003), and leptin level (P < 0.001), and lower height (P = 0.027) and glomerular filtration rate (P < 0.001) compared with type 2 DM patients with low PAS. After adjusting for factors significantly associated with PAS in these patients by multivariate logistic regression analysis, age (ß = 0.470, adjusted R2 change = 0.279; P < 0.001), logarithmically transformed leptin (log-leptin, ß = 0.259, adjusted R2 change = 0.085; P = 0.001), and hypertension (ß = 0.197, adjusted R2 change = 0.031; P = 0.011) were significant independent predictors of PAS in type 2 DM patients. CONCLUSION: The serum leptin level could be a predictor of PAS in type 2 DM patients.

Serum cystatin C is independently associated with aortic arterial stiffness in patients with type 2 diabetes.

BACKGROUND: Higher cystatin C levels are associated with an increased cardiovascular risk. We evaluated the association between serum cystatin C and aortic arterial stiffness in patients with type 2 diabetes mellitus (DM). METHODS: Fasting blood samples were collected from 170 patients with type 2 DM. Carotid-femoral pulse wave velocity (cfPWV) values > 10 m/s were used to define the high aortic arterial stiffness group. RESULTS: Sixty-seven patients with DM (39.4%) were defined as the high aortic arterial stiffness group. Patients with DM in the high aortic arterial stiffness group had older age (P = 0.003), higher systolic blood pressure (P < 0.001), diastolic blood pressure (P = 0.045), triglyceride (P = 0.046), blood urea nitrogen (P = 0.038), creatinine (P = 0.006), urine albumin-to-creatinine ratio (P = 0.004), and serum cystatin C (P < 0.001) levels but lower estimated glomerular filtration rate (P < 0.001). Multivariate logistic regression analysis showed that serum cystatin C level (each increase of 0.1 mg/l, odds ratio: 1.369, 95% confidence interval (CI): 1.049-1.787, P = 0.021) was still an independent predictor of aortic arterial stiffness in patients with DM. CONCLUSION: Serum cystatin C level positively correlated with aortic arterial stiffness among patients with type 2 DM.

Serum sclerostin as an independent marker of peripheral artery disease in elderly persons.

Sclerostin is now being recognized as performing a multitude of physiological functions and is associated with coronary artery calcification. Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis in elderly persons. This study aimed to determine whether high serum sclerostin is associated with PAD in elderly persons. Blood samples were obtained from 68 participants in the study older than 65 years. Ankle-brachial index (ABI) values were measured using the automated oscillometric method (VaSera VS-1000). PAD was considered present if the left or right ABI values were less than 0.9 and included in the low ABI group. Serum sclerostin levels were measured using a commercial enzyme-linked immunosorbent assay kit. Among elderly participants, 13 (19.1%) were in the low ABI group. Elderly participants had higher statin use (P = 0.015), serum intact parathyroid hormone (P < 0.001), C-reactive protein (P = 0.027), and sclerostin (P < 0.001) levels in the low ABI group than in the normal ABI group. Serum sclerostin (odds ratio: 1.050, 95% confidence interval: 1.013-1.089, P = 0.008) was the independent predictor of PAD in elderly participants in multivariate logistic regression analysis. A high serum sclerostin level is a risk factor for PAD in the elderly.

Leptin is an independent marker of metabolic syndrome in elderly adults with type 2 diabetes.

OBJECTIVE: It is well established that patients with metabolic syndrome (MetS) demonstrate elevated levels of serum leptin. The aim of this study is to identify fasting serum leptin as an independent marker of MetS in geriatric diabetic patients. MATERIALS AND METHODS: Sixty-four patients over 65 years old with type 2 diabetic mellitus (T2DM) were assessed for MetS based on the diagnostic criteria of the International Diabetes Federation. Fasting blood samples including serum leptin concentrations were obtained from the participants. Leptin levels were determined using a commercial enzyme immunoassay. RESULTS: Forty-five (70.3%) of the 64 geriatric T2DM patients enrolled in this study were found to have MetS. This group of participants compared with those in the non-MetS group had higher serum levels of leptin (P = 0.004), triglycerides (P = 0.005), fasting glucose (P = 0.049), glycated hemoglobin (P = 0.016), white blood cells (P = 0.003), C-reactive protein (CRP, P = 0.028), insulin (P < 0.001), higher homeostatic model assessment insulin resistance values (HOMA1-IR and HOMA2-IR, both P < 0.001), a higher body weight (P = 0.024), body mass index (P < 0.001), body fat mass (P < 0.001), waist circumference (P < 0.001), systolic blood pressure (BP) (P < 0.001), diastolic BP (P < 0.001), percentage of women (P = 0.011), prevalence of hypertension (P = 0.042), and a lower level of serum high-density lipoprotein cholesterol (P = 0.001). Univariate linear analysis of the clinical variables associated with the fasting serum leptin level revealed that height (P = 0.020) had a negative correlation, while body fat mass (P < 0.001) and logarithmically transformed CRP (log-CRP, P < 0.001) had positive correlations with serum leptin levels. Multivariate forward step-wise linear regression analysis of the variables significantly associated with fasting serum leptin levels showed that body fat mass (P < 0.001) and log-CRP (P = 0.001) were independent predictors of these values. CONCLUSION: Serum leptin is positively correlated with MetS. It serves as an independent marker of MetS in elderly patients with T2DM.

Hypoadiponectemia is associated with metabolic syndrome in patients with type 2 diabetes.

Adipose tissue-expressed adiponectin levels are inversely related to the degree of adiposity, and a reduction in adiponectin serum levels is accompanied by insulin resistance. The aim of this study was to evaluate the relationship between serum adiponectin concentration and metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (DM). Fasting blood samples were obtained from 150 volunteers with type 2 DM. MetS and its components were defined according to diagnostic criteria from the International Diabetes Federation. Serum adiponectin concentrations were measured using a commercially available enzyme-linked immunosorbent assay. Among the 150 patients with type 2 DM, 102 (68.0%) had MetS. Female gender (P = 0.007), hypertension (P = 0.005), systolic blood pressure (P < 0.001), diastolic blood pressure (DBP, P < 0.001), waist circumference (P < 0.001), body weight (P < 0.001), body mass index (BMI, P < 0.001), fasting glucose (P = 0.035), triglyceride (TG) level (P < 0.001), glycated hemoglobin level (HbA1c, P = 0.020), insulin level (P < 0.001), and homeostasis model assessment of insulin resistance (HOMA-IR, P < 0.001) were higher in DM patients who had MetS, whereas high-density lipoprotein cholesterol (HDL-C) concentrations (P < 0.001) and adiponectin levels (P < 0.001) were lower. Univariate linear analysis revealed that logarithmically transformed age (log-age, r = 0.279; P = 0.001) and HDL-C (r = 0.246; P = 0.002) positively correlated, whereas height (r = -0.183; P = 0.025), body weight (r = -0.282; P < 0.001), BMI (r = -0.237; P = 0.004), waist circumference (r = -0.249; P = 0.002), DBP (r = 0.252; P = 0.002), log-TG (r = 0.255; P = 0.002), log-insulin (r = -0.298; P < 0.001), and log-HOMA-IR (r = 0.288; P < 0.001) negatively correlated with serum adiponectin levels in patients with type 2 DM. Multivariate forward stepwise linear regression analysis revealed that log-age (adjusted R2 change = 0.069; P < 0.001) positively correlated, whereas log-insulin (adjusted R2 change = 0.182; P = 0.002) and HDL-C (adjusted R2 change = 0.037; P = 0.006) negatively correlated with serum adiponectin levels in patients with type 2 DM. This study showed that lower serum adiponectin levels were positively associated with MetS in patients with type 2 DM and significantly positively related to age but negatively related to serum insulin and HDL-C levels in these subjects.

[Reflection on the Health and Gender Mainstreaming of Indigenous Women in Taiwan].

Gender and race issues have caused rapid cultural and societal changes to affect the healthcare of indigenous women, which involves complicated, cultural meanings. The present paper begins by outlining the gender perspective and then elaborates on the present gender mainstreaming and status of indigenous women's healthcare in Taiwan. Furthermore, this paper identifies the current difficulties experienced by Taiwanese indigenous women, including those related to the lack of adequate healthcare data and gender analyses on indigenous women and the lack of regular research on healthcare strategies for indigenous women. Therefore, the present paper proposes to establish health policy references that are gender and race sensitive. The health policy not only addresses racial and gender concerns regarding healthcare information but also focuses on the analysis of indigenous healthcare information. Indigenous women's health concerns are discussed here within the framework of healthcare policy through the perspective of gender mainstreaming. Additionally, we will analyze and evaluate the effects of gender in order to establish inspection and management processes that integrate the concept of gender into policy development and implementation, thus promoting relevant health policies. During the processes of planning, implementing, and evaluating healthcare policies, women should unite to contribute toward indigenous women's health policies and gender mainstreaming.