Association between Grip Strength, Obesity, and Cardiometabolic Risk Factors among the Community-Dwelling Elderly Population in Taiwan.

The aim of this study was to evaluate the association between grip strength, obesity, and cardiometabolic risk factors among elderly individuals with different grip strength statuses and weight statuses in Taiwan. We conducted a series of community-based health surveys among the elderly population in Chiayi County, Taiwan from 2017 to 2019. This is a cross-sectionally designed health check-up program that was conducted by the local public health bureau. Anthropometric characteristics, handgrip strength, diabetes, and cardiometabolic risk profiles were measured using standard methods. This study recruited 3739 subjects (1600 males and 2139 females). The non-obese subjects had lower blood glucose (BG) levels compared to the obese subjects. The BG levels of non-obese and obese subjects were 102.7 ± 25.6 mg/dL vs. 109.1 ± 34.3 mg/dL for males; and 102.8 ± 30.1 mg/dL vs. 112.5 ± 40.3 mg/dL for females (both p < 0.001). The grip strength was negatively associated with BG in both sexes (ß = -0.357, p < 0.001 for males and ß = -0.385, p < 0.05 for females). The relationship between the grip strength and the risk of diabetes showed that for every 1 kg increase in the grip strength, there was a 4.1% and 4.5% decrease in the risk for developing diabetes for males and females, respectively (OR = 0.959, 95% CI = 0.940-0.979 for males and OR = 0.955, 95% CI = 0.932-0.978 for females). A higher handgrip strength is associated with a lower BG level and a lower risk for diabetes mellitus in the elderly Taiwanese subjects. Additional health promotion should focus on the obese and sarcopenic population to prevent cardiometabolic comorbidities in later life.

Obesity, waist circumference, and appendicular muscle mass ratio in relation to blood pressure among the community-dwelling elderly population in Taiwan.

Hypertension is known to be related to obesity and both are the major factors for cardiovascular diseases. The relationship between body composition and blood pressure (BP) are discussed recently. Our study aims to evaluate the association between waist circumference (WC) and appendicular muscle mass (AMM) in relation to BP among the community-dwelling elderly population. Total 3739 patients (1600 males and 2139 females) were recruited in a series of community-based surveys that were conducted among the elderly population in Taiwan from 2017 to 2019. We collected data on anthropometric characteristics, handgrip strength, and BP using standard methods. AMM was calculated with an equation. History of chronic disease and lifestyle profiles were collected using questionnaires. The group with high AMM to body weight ratio (AMMW) showed lower systolic BP (SBP) (136.8 ± 19.1 to 140.6 ± 17.0 for males; 137.8 ± 18.3 to 142.7 ± 17.5 for females, both P < .001). Among central obese persons those with higher AMMW ratio had lower SBP. In the final model, AMMW in percentage is negatively associated to SBP (ß = -0.641 in male, -0.780 in female, both P < .01). In other words, every 10% increase in AMMW is associated with decrease of SBP 6.41 mmHg in male and 7.80 mmHg in female. Obesity and central obesity were positively associated with BP. The AMMW ratio was negatively associated with HTN and with a protective effect on BP even among the central obese. Health promotion programs to increase physical training may prevent hypertension among the elderly in Taiwan.

Association between grip strength and anthropometric characteristics in the community-dwelling elderly population in Taiwan.

BACKGROUND: Sarcopenia and muscle weakness in elderly are contributed burden of public health and impact on quality of life. Weak grip strength was key role in diagnosis of sarcopenia and reported increased mortality, function declined in elderly. This study evaluated the association between GS and each common anthropometric characteristic in community-dwelling elderly. DESIGN AND METHOD: From 2017 to 2019, we conducted a community-based health survey among the elderly in Chiayi county, Taiwan. Participants were 65 years old or older, and total of 3,739 elderly subjects (1,600 males and 2,139 females) with a mean age of 76 years (range 65-85 years old) were recruited. General demographic data and lifestyle patterns were measured using a standard questionnaire. Anthropometric characteristics such as body height, body weight, body mass index (BMI), body waist and hip circumference, and body fat were measured by standard methods. GS was measured using a digital dynamometers (TKK5101) method. RESULTS: The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females (p < 0.001). For both sexes, elderly subjects with the same body weight but smaller body waist circumference had greater GS. The subjects with the same body waist size but heavier weight had greater GS. Furthermore, after adjusting for age, lifestyles, disease status, and potential anthropometric variable, multivariate regression analyses indicated that BMI was positively associated with GS (for males, beta = 0.310 and for females beta = 0.143, both p < 0.001) and body waist was negatively associated with GS (for males, beta = -0.108, p < 0.001; for females, beta = -0.030, p = 0.061). CONCLUSIONS: This study suggested that old adults with higher waist circumstance had weaker GS. Waist circumstance was negatively associated with GS, body weight was positively associated with GS in contrast. It may implies that central obesity was more important than overweight for GS in elderly.

Relationship of Multimorbidity, Obesity Status, and Grip Strength among Older Adults in Taiwan.

Background: The combination of multiple disease statuses, muscle weakness, and sarcopenia among older adults is an important public health concern, and a health burden worldwide. This study evaluates the association between chronic disease statuses, obesity, and grip strength (GS) among older adults in Taiwan. Methods: A community-based survey was conducted every 3 years among older adults over age 65, living in Chiayi County, Taiwan. Demographic data and several diseases statuses, such as diabetes mellitus, hypertension, cerebrovascular disease, cardiovascular disease, and certain cancers, were collected using a questionnaire. Anthropometric characteristics were measured using standard methods. Grip strength was measured using a digital dynamometer (TKK5101) method. Results: A total of 3739 older individuals were recruited (1600 males and 2139 females) with the mean age of 72.9 years. The mean GS was 32.8 ± 7.1 kg for males and 21.6 ± 4.8 kg for females. GS significantly decreased most in males with cerebrovascular disease (from 33.0-29.5 kg, p < 0.001) and in females with diabetes mellitus (from 21.8-21.0 kg, p < 0.01). GS was highest in older adults with obesity (body mass index ≥ 27 kg/m2); however, there was no significant change of GS as the disease number increased. Conclusion: Older adults who have two, rather than one or greater than three chronic diseases, have significantly lower GSs than those who are healthy. Stroke and CKD for males, and hypertension and diabetes for females, are important chronic diseases that are significantly associated with GS. Furthermore, being overweight may be a protective factor for GS in older adults of both sexes.

Health Literacy Teaching Beliefs, Attitudes, Efficacy, and Intentions of Middle School Health and Physical Education Teachers.

BACKGROUND: Health education (HE) courses in schools are vital paths for improving teenagers' health literacy. HE and physical education (PE) teachers lead HE courses, and their teaching intentions and competency influence the effectiveness of the courses and the ability to promote students' health literacy. This study attempted to understand HE and PE teachers' health literacy teaching intentions and professional competency and to investigate their relationships. METHODS: This study adopted a cross-sectional design. A questionnaire survey was administered to 906 middle school HE and PE teachers in Taiwan by mail, and 545 provided valid data with consent. RESULTS: Participants had a favorable health literacy (47.78/50), positive health literacy teaching beliefs and attitudes, and acceptable efficacy. They intended to implement health literacy instruction within the subsequent year. Teaching beliefs, attitudes, and efficacy were all positively correlated with intentions (all p < .001). Demographic variables, health literacy, and teaching beliefs, attitudes, and efficacy explained 33.5% of the variance of teaching intentions. CONCLUSION: Teaching beliefs, attitudes, and efficacy were crucial predictors of health literacy teaching intentions. To improve students' health literacy, educational authorities and schools should pay attention to HE and PE teachers' intentions and vital factors, thereby enhancing teachers' willingness to perform health literacy instruction.

Medical services utilization and expenditure of obesity-related disorders in Taiwanese adults.

OBJECTIVES: To evaluate medical service utilization and medical expenditure associated with obesity-related diseases among different weight status subjects in Taiwan. METHODS: A cross-sectional survey based on the National Health Interview Survey performed in 2001. Subjects greater than 20 years old who lived in Taiwan, as corroborated by National Health Insurance (NHI), during 2001, were included. Overall, the data set included 15,461 subjects with age of 20-85 years old. After excluding those subjects with incomplete or missing data or who refused to link their data with the NHI data, 12,283 subjects were used for analyses. RESULTS: In general, obesity-related disorders, such as hypertension, diabetes mellitus (DM), and cardiovascular diseases have increasing prevalence with greater body mass index (BMI; P<0.001). Obese subjects (BMI≧27kg/m(2) ) had the highest prevalence of hypertension (31.9%), after DM (26.9%). After adjusting for age, smoking, drinking and obesity-related disorders, it was found that medical utilization in outpatient increases from 1.33 to 4.04 visits/year (P<0.001) and in-hospital increases from 0.05 to 0.07 admissions/year (P>0.05) with higher BMI. Average outpatient expenditure (including physician fee, laboratory test and drug costs) per year is NT$1201, 1857, 3960, and 5118 (at an exchange rate of NT$32 to US$1) for underweight, normal, overweight, and obese subjects, respectively (P<0.001). CONCLUSIONS: Medical utilization and outpatient medical expenditure was found to increase with higher BMI status. However, there was a J-shaped (in female) or even negative (in male) relationship between BMI and in-hospital medical expenditures. Further studies are needed to resolve this major public health problem, even in a developing country such as Taiwan.

Influence of knowledge and attitudes on smoking habits among young military conscripts in Taiwan.

BACKGROUND: The purpose of this study was to identify and describe the knowledge and attitudes of cigarette smoking that are associated with smoking habits among young military conscripts in Taiwan. METHODS: We conducted a cross-sectional survey of young conscripts in southern and eastern Taiwan between August 1 and December 31, 2001. We selected 3,249 young military conscripts who had served more than 1 month in the military, based on specific criteria. We used a standard structured questionnaire to collect information about the respondents' sociodemographic characteristics, lifestyle, knowledge, attitude, and cigarette smoking practices. RESULTS: Our findings showed that among smoking young military conscripts, knowledge about smoking was lower and attitudes toward smoking were more negative when compared with the non-smokers. Knowledge and attitudes about smoking varied with sociodemographic characteristics (age, education level, residential area) and lifestyle (cigarette smoking, betel nut chewing, alcohol drinking), all p < 0.05. Subjects with greater knowledge about smoking had a lower risk of smoking (odds ratio, 0.88; 95% confidence interval, 0.86-0.91). But this characteristic diminished after being adjusted for potential confounders. In addition, subjects with a higher attitude score about smoking had relatively lower risk for cigarette smoking when compared to those with a lower attitude score, even after adjusting for potential confounders (odds ratio, 0.93; 95% confidence interval, 0.91-0.94). CONCLUSION: Knowledge and attitudes about smoking are significantly associated with the status of cigarette smoking. These findings can help public health professionals develop effective policies and smoking prevention and cessation programs among young military conscripts in Taiwan.

Predictors of cigarette smoking behavior among military university students in Taiwan.

BACKGROUND: The smoking rate among Taiwanese adolescents remains high. In any age group, smoking behavior can be influenced by personal, social, and familial factors. In adolescents, many factors, including psychological, physical, emotional, and interpersonal relationships, both social and familial, interact to influence smoking behavior. At present, no data are available on smoking behavior in military students in Taiwan. Understanding the factors that influence smoking behavior is a critical element in smoking cessation programs. PURPOSE: The purpose of this study was to investigate the prevalence and predictors of smoking behaviors among military university students in Taiwan. METHODS: Using a cross-sectional design, 2,477 students were recruited for this study from seven universities across Taiwan. Structured questionnaires were used to collect data covering demographics, family environment, school environment, cigarette smoking attitudes, self-efficacy, and cigarette smoking behaviors. Both descriptive statistics and logistic regression were for the data analysis. A probability threshold of.05 was considered as statistically significant. RESULTS: The prevalence of smoking among students in Taiwan has been recently reported as 5.7%. Of this number, 12.8% started smoking after enrollment in school and 33.3% became regular smokers. The main reason for first contact with smoking was curiosity. Avoiding the stress and the difficulties of smoking cessation explained continuing smoking behaviors. Over 80% of smokers attempted to quit but could not decide when to start. Age, peer influence, and self-efficacy were major predictors of student smoking behaviors. CONCLUSIONS/IMPLICATIONS: Smoking prevalence was not high among these students. However, more than one in four smokers became regular smokers after enrollment at school. Tobacco control and prevention strategies proved to be of vital importance, as peer influence and self-efficacy represented major predictors of smoking behaviors.

Albumin administration in patients with severe sepsis due to secondary peritonitis.

BACKGROUND: To determine whether or not intravenous administration of human albumin can reduce mortality in patients with severe sepsis due to secondary peritonitis. METHODS: Adult patients who were admitted to the surgical intensive care unit (SICU) who fulfilled the criteria of severe sepsis due to secondary peritonitis were consecutively included in this retrospective study. Patients who received and those who did not receive at least a daily minimum of 25 g intravenous human albumin for 3 days during their first 7 days of SICU admission were classified as the study group and control group, respectively. RESULTS: A total of 133 patients were included in this study. For patients with baseline serum albumin < or = 20 g/L, 28-day mortality was significantly lower in the study group. For patients with baseline serum albumin > 20 g/L, albumin administration had no significant effects on 28-day mortality. CONCLUSION: For patients with severe sepsis due to secondary peritonitis, albumin administration may reduce 28-day mortality in patients whose baseline serum albumin is < or = 20 g/L, but no such effect was found in patients whose baseline serum albumin was > 20 g/L.

Factors associated with cigarette smoking among young military conscripts in taiwan.

BACKGROUND: The purpose of this study was to identify the most important risk factors that influence cigarette smoking among young adult military conscripts in Taiwan. METHODS: A cross-sectional survey was conducted among young conscripts (19-25 years old) in Taiwan from August to December 2001. A total of 3,569 conscripts who had served more than 1 month in the military were chosen. Information regarding cigarette smoking and other factors was collected using a standard structured questionnaire. RESULTS: Subjects whose lifestyles included betel-nut chewing (OR, 16.81; 95% CI, 11.35-25.91) and alcohol drinking (OR, 2.11; 95% CI, 1.54-2.90) were more likely to smoke compared to subjects without these adverse behaviors. Subjects whose education stopped at junior high school or before were more likely to smoke compared to those with a university degree (OR, 5.36; 95% CI, 3.77-7.69). Subjects who had a higher proportion of peers who smoked were more likely to smoke compared to those with no peers who smoked (OR, 3.16; 95% CI, 2.42-4.15). Subjects whose parents and peers approved of smoking were also at a higher risk for smoking compared with those whose parents and peers disapproved (father's approval---OR, 3.28 and 95% CI, 2.02-5.43; mother's approval---OR, 3.11 and 95% CI, 1.47-7.12; peer approval---OR, 2.27 and 95% CI, 1.60-3.22). CONCLUSION: From this study, we found that education level, betel-nut chewing, alcohol intake, smoking behavior of peers, and the attitudes of parents and peers toward smoking are all associated with the risk of a young adult conscripts becoming a habitual cigarette smoker. These results provide insight for targeting critical risk factors in helping these individuals control or cease their cigarette smoking habit in the future.

Visual fields during acute exposure to a simulated altitude of 7620 m.

BACKGROUND: The hypoxia associated with sudden exposure to high altitude is known to impair vision and may thereby affect flight safety. However, no data were available regarding hypoxic effects on visual fields. The aim of this study was to evaluate black-and-white visual field sensitivity with acute hypoxia during acute exposure to a simulated altitude of 7620 m. METHODS: Subjects were 15 male pilots 26-39 yr of age. We measured arterial oxygen saturation (S(aO2)%) using transdermal pulse oximetry while the visual field was measured within a 30 degrees eccentricity in the right eye by computerized perimetry. The subject breathed 100% O2 for 30 min before and during chamber ascent, then removed his mask while measurements were performed. RESULTS: The S(aO2)% and visual field sensitivities (mean +/- SD) at ground level were 99.1 +/- 0.4% and 43.9 +/- 2.1 dB, respectively. During hypoxia, the S(aO2)% dropped to 64.0 +/- 5.4% within 3 min. Mean visual sensitivity was significantly reduced by 7.2 +/- 1.6 dB. Furthermore, peripheral sensitivity was slightly but significantly more diminished than central sensitivity. CONCLUSIONS: Severe acute hypoxia reduces central and moderate peripheral black-and-white vision by a factor of two with the strongest effect in the periphery.

The impacts of a school-wide no smoking strategy and classroom-based smoking prevention curriculum on the smoking behavior of junior high school students.

BACKGROUND: This study aimed at exploring the impacts of a school-wide no smoking strategy and a classroom-based smoking prevention curriculum on smoking-related knowledge, attitude, behavior, and skill of junior high school students. METHODS: Using a pre-post quasi-experimental design, 469 seventh-to ninth-grade students at four junior high schools in Taiwan, were selected and separated into three groups according to class unit. Experimental group A experienced a school-wide no smoking strategy and a six-session smoking prevention curriculum. Experimental group B experienced only the school-wide no smoking strategy. The control group experienced no intervention. The students were tested 1 week before intervention began and 1 week after it ended. RESULTS: Experimental group A exhibited a better understanding than either experimental group B or the control group of the dangers of smoking and of techniques for refusing cigarettes; and in fact, group A indicated low smoking intention than experimental group B. Experimental group A also had a better attitudes towards resisting smoking than the control group. However, the intervention had no demonstrable effect on the smoking behavior and on the smoking substitution methods of students. CONCLUSIONS: To reduce the smoking rates among junior high school students, diversified school-wide no smoking strategies and standardized, diversified instruments should be adopted so that outcomes of smoking prevention work may be assessed more objectively and effectively.

Aggregation of adverse behaviors and its affecting factors among young military conscripts in Taiwan.

The authors studied the prevalence of the aggregation in common lifestyle habits, namely, cigarette smoking, alcohol drinking, and betel-nut chewing and the demographic correlates of individual aggregation in these lifestyle behaviors among young military conscripts in Taiwan. Cross-sectional screening was conducted among conscripts in southern and eastern sections of Taiwan from Aug. 1st to Dec. 31st 2001. Totally, 3913 conscripts who had more than 1 month of service were included in this multistage sampling study. Information on smoking, drinking, and betel-nut chewing habits were ascertained as part of a self-administered questionnaire completed by examinees at the service unit. Aggregation in lifestyle habits was studied by comparing the observed and expected proportions (O/E ratio) with their 95% confidence intervals (CI) for zero, one, two, and three simultaneously occurring lifestyle habits. The study results showed a significant clustering of lifestyle habits studied; the number of subjects was greater than expected in groups with two (for cigarette smoking and betel-nut chewing, O/E ratio=1.17, 95%CI=1.06-1.28), and three (O/E ratio=5.63, 95%CI=5.06-6.20) lifestyle habits. Determinants for this clustering of lifestyle habits included lower educational levels and residential area in southern and eastern sections of Taiwan. There was a significant individual aggregation in lifestyle habits including cigarette smoking, alcohol drinking, and betel-nut chewing in the health survey among young military conscripts. In addition, young military conscripts with low educational levels and residential area in southern and eastern sections of Taiwan had an apparent tendency toward the aggregation in these lifestyle habits.

Obesity, plasma high sensitivity C-reactive protein levels and insulin resistance status among school children in Taiwan.

OBJECTIVE: To evaluate the degree of obesity and plasma high sensitivity C-reactive protein (hs-CRP) levels in relation to insulin resistance status among school children in Taiwan. METHODS: After multistage sampling, we randomly selected 1438 children (701 boys and 737 girls) with the mean age of 13.4 years (from 12 to 16) in Taipei in 2003. Anthropometric measures and plasma biochemical variables (including lipid profiles, glucose and insulin) were measured using standard methods. Plasma hs-CRP levels were measured using nephelometric methods. We calculated insulin resistance (IR) index using HOMA methods and further calculated a gender-specific insulin resistance syndrome (IRS) summary score by adding the quartile ranks from the distribution of systolic blood pressure (SBP), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and insulin levels of each children. A high IRS summary score corresponds to higher levels of SBP, TG and insulin levels and lower levels of HDL-C. RESULTS: Boys were taller, heavier, had larger BMI, glucose, IRS summary score and hs-CRP than girls; however, there is no difference in plasma TG, insulin levels, and IR index between genders. Plasma hs-CRP levels were positively correlated with anthropometric measures, TG, insulin levels, IR index, and IRS summary score and negatively correlated with HDL-C. Anthropometric measures, plasma TG, insulin levels, IR index and IRS summary score were significantly higher in children with higher plasma hs-CRP levels (test for trend p<0.05). After adjustment for age, heart rate, smoking and drinking, hs-CRP continued to be positively associated with anthropometric variables (weight and BMI), insulin levels, and IR index and negatively correlated with HDL-C in both genders. Plasma hs-CRP levels were also positively associated with TG and IRS summary score in boys and glucose in girls. However, after further adjusting for BMI, the association of hs-CRP on TG, insulin levels, IR index and IRS summary score disappeared in boys and on body weight, HDL-C, insulin level and IR index disappeared in girls. CONCLUSION: Plasma hs-CRP levels are positively related to anthropometric variables, such as body weight and BMI, insulin levels, IR index and IRS summary score and negatively related to HDL-C in Taiwanese children. Moreover, the degree of body fat status (as measured by BMI) plays a more significantly role on insulin resistance status than hs-CRP levels among Taiwanese children.

Prevalence of adverse behaviors among young military conscripts in Taiwan.

OBJECTIVES: To evaluate cigarette smoking prevalence and to examine the clustering of adverse behaviors among young military conscripts in Taiwan. METHODS: Cross-sectional screening was conducted among conscripts in southern and eastern sections of Taiwan from August 1 to December 31, 2001. A total of 7,931 conscripts who had > 1 month of service were included in this multistage sampling study. RESULTS: Adjusted prevalence rates of cigarette smoking before and during military service were 49.2% and 51.9%, respectively. The prevalence of smoking slightly increased during military service, and this was statistically significant. Adjusted prevalence was highest in the Navy (53.8%) and lowest in the Air Force (48.4%). Less education and longer duration of service were associated with increased prevalence of smoking. Conscripts with high school educations or below and those in service > 18 months had higher adjusted prevalence rates (65.6% and 55.2%, respectively). During military service, the adjusted prevalence rates of smoking among conscripts were similar in different geographic areas. There was significant aggregation of adverse behaviors, such as cigarette smoking, alcohol consumption, and betel nut chewing, among these young military conscripts in Taiwan. CONCLUSIONS: The prevalence of cigarette smoking was slightly increased during military service. Furthermore, the prevalence of cigarette smoking was still higher among military conscripts, compared with the general population in Taiwan, which suggests that military service is a potential factor associated with cigarette smoking for adolescents and young adults. This finding and the aggregation of adverse behaviors among conscripts indicate that more surveillance and intervention studies are needed to evaluate the best way to control and to stop smoking among military conscripts in Taiwan.

Dramatic and prolonged decrease of whole salivary secretion in nasopharyngeal carcinoma patients treated with radiotherapy.

OBJECTIVES: This study evaluates: (1) the change in whole salivary secretion rates of nasopharyngeal carcinoma patients before, during, and after radiotherapy, especially during the first week of irradiation; (2) the recovery capability of salivary glands up to 2 years postirradiation; and (3) the possible prognostic factors affecting salivary gland functions. STUDY DESIGN: Fifty patients who completed conventional radiotherapy using either once-per-day or hyperfractionated technique were included. Both unstimulated and stimulated whole salivary flow rates and ratios (flow rate compared with baseline) were measured before, during, 1, 3, and 6 months, and 1 and 2 years after radiotherapy. Multivariate analysis of potential prognostic factors affecting the salivary secretion ratio was made. RESULTS: Salivary glands were very radiosensitive and responded to radiation very early. After 720 cGy at the fourth day of the 8-week treatment, the unstimulated and stimulated salivary flow rates had decreased by 40%-50%. The nadir was reached in many patients after 3600 cGy (4 weeks). A second phase of decrease in salivary secretion was noted after completion of radiotherapy. CONCLUSIONS: Different mechanisms may be responsible for salivary response after low and high dose of radiation. This study shows no recovery of salivary secretion during the follow-up period, and the best strategy for managing radiation-induced salivary gland damage may be reduction of radiation dose to the glands.

Relationship between plasma adiponectin levels and metabolic risk profiles in Taiwanese children.

OBJECTIVE: Adiponectin, a novel adipokine with antiinflammatory and insulin-sensitizing properties, has an important role in glucose metabolism and is negatively correlated with body fat amount in adults. The purpose of this study was to evaluate the association of plasma adiponectin level with metabolic risk profiles and insulin resistance status among Taiwanese children. RESEARCH METHODS AND PROCEDURES: We enrolled 1,248 children (608 boys and 640 girls) to ascertain their demographic, anthropometric, and cardiovascular risk factors distribution in Taipei. We measured plasma insulin, adiponectin, and leptin levels by radioimmunoassay (Linco Research Inc, St. Charles, MO). We calculated an insulin resistance index (IRI) using the Homeostasis Model Assessment model and also calculated an insulin resistance syndrome (IRS) summary score for each individual by adding the quartile ranks from the distribution of systolic blood pressure, serum triglyceride, high-density lipoprotein-cholesterol (HDL-C) (inverse), and insulin levels. RESULTS: In general, the boys had larger BMI, higher systolic blood pressure, serum total cholesterol, and triglyceride, and lower plasma leptin and adiponectin levels than girls. Plasma adiponectin levels were correlated negatively with BMI, leptin, insulin, IRI, and IRS summary score but positively correlated with HDL-C in both boys and girls. In multivariate regression analyses, adiponectin was negatively associated with insulin (girls only), IRI (girls only), and IRS score, and positively associated with HDL-C in both genders even after adjusting for age, BMI, plasma leptin level, and other potential confounders. DISCUSSION: These data suggest that plasma adiponectin levels were negatively associated with metabolic risk profiles that may have played a protective role in the development of insulin resistance among Taiwanese school children.

Prevalence and factors associated with the consumption of betel-nut among military conscripts in Taiwan.

OBJECTIVE: This study evaluates the prevalence of betel-nut chewing among military personnel stationed on Taiwan's offshore islands. Furthermore, this study examines variables to identify which may predict a greater predilection toward betel-nut chewing among the conscript population studied. METHODS: A cross-sectional mass screening was conducted of compulsory military service personnel stationed on Taiwan's offshore islands between August 1 and December 31, 2001. A total of 7574 military employees were included in this survey. Information regarding betel-nut chewing habits were ascertained using a standard structured questionnaire, which including the level and duration of betel-nut chewing as well as respondents' knowledge, attitude and practices with regard to consumption of this product. RESULTS: Conscripts were found to be less likely to chew betel-nut regularly while performing military service. There are 1535 (20.3%) of respondents reporting to habitually chew betel-nut prior to active duty shrank to 1048 (13.8%) after going on active-duty. The most reasons to chew betel-nut among the recruits after military services are curiosity (33.3%) and as a stimulant (29.8%). About 46% of military employees who currently chew betel-nut report an interest to quit in the future. The risk factors for betel-nut chewing include individual factors (e.g., age, education, knowledge, and attitude toward betel-nut chewing), lifestyle habits (e.g., cigarette smoking), and familial factors (e.g., consumption of betel-nut by parents). More interesting, the recruits had the habit of cigarette smoking associated with increase risk for betel-nut chewing (OR: 7.18; 95% CI: 5.66-9.20). CONCLUSIONS: Although the military has made considerable progress in reducing betel-nut chewing on military campuses, the prevalence of betel-nut chewing is still relatively high and, in 2001, affected about one quarter of all military personnel stationed on the abovementioned offshore islands. In future efforts to lower betel-nut consumption among high risk groups, targeting the group of conscripted military personnel described in this study should be considered.

Insulin, proinsulin and insulin resistance status in relation to lipid profiles among school children in Taiwan-The Taipei Children Heart Study.

PURPOSE: Evidence suggests that there may be a metabolic syndrome characterized by hyperinsulinemia or insulin resistance associated with increased cardiovascular disease risk. The purpose of this study is to evaluate insulin, proinsulin or insulin resistance to determine which is the best parameter to predict lipid profiles among children in Taiwan. METHODS: After multi-stage sampling, we randomly included 852 school children (415 boys and 437 girls) with a mean age of 13 yr in this study. We measured insulin and intact proinsulin levels by RIA (<0.2% cross-reactivity) and estimated insulin resistance index (IRI) using the homeostatic model assessment (HOMA) method. We used standard methods to measure atherosclerotic lipid profiles including total cholesterol (CHOL), triglyceride (TG), HDL-C, apolipoprotein A (ApoA), apolipoprotein B (ApoB), and lipoprotein[a] and calculated LDL-C and TCHR (total cholesterol to HDL-C ratio) levels. RESULTS: Girls had higher CHOL, LDL-C, ApoA and ApoB levels than boys (p < 0.001). There was no significant difference in insulin, proinsulin and IRI status between boys and girls. Among boys, insulin, proinsulin and IRI were positively correlated with TG, ApoB and TCHR and negatively related to HDL-C. Among girls, these associations were attenuated and became insignificantly for TCHR and HDL-C. After adjusting for potential confounders, IRI and insulin were still positively associated with TG and ApoB levels and negatively associated with HDL-C in boys. However, in girls, proinsulin and insulin were positively associated with TG only. Finally, in the stepwise regression analyses, IRI was a better predictor of TG, HDL-C, and ApoB than insulin or proinsulin in boys. However, in girls, proinsulin was a stronger predictor than insulin or IRI for TG and TCHR. CONCLUSION: From this study, we found that IRI (in boys) and proinsulin (in girls) levels are generally more significant and stronger parameters than insulin for predicting lipid profiles among children in Taiwan.

Incidence and cofactors of hepatitis C virus-related hepatocellular carcinoma: a prospective study of 12,008 men in Taiwan.

In a community-based prospective study, the authors examined the independent and interactive effects of hepatitis C virus (HCV) infection and cofactors, including hepatitis B virus (HBV) infection and lifestyle habits, on the incidence of hepatocellular carcinoma (HCC) in Taiwan. At baseline recruitment, subjects were evaluated with regard to second-generation HCV antibody (anti-HCV), hepatitis B surface antigen, and serum alanine aminotransferase, as well as cigarette smoking, alcohol drinking, and betel quid chewing habits. A total of 12,008 male residents aged 30-64 years without a history of HCC were included in the study. Between July 1990 and June 2001, 112 incident cases of HCC were identified among the subjects and included in the analysis. Persons with anti-HCV positivity alone had a 20-fold increased risk of developing HCC in comparison with those who were negative for anti-HCV. In statistical assessment of additive interaction, HCV and HBV tended to act independently in the pathogenesis of HCC. The results of this study suggest that HCV plays a significant role in hepatocarcinogenesis in an area endemic for chronic HBV infection.