Ching-Lung Cheung

Low handgrip strength is a predictor of osteoporotic fractures: cross-sectional and prospective evidence from the Hong Kong Osteoporosis Study

Handgrip strength (HGS) is a potentially useful objective parameter to predict fracture since it is an indicator of general muscle strength and is associated with fragility and propensity to fall. Our objective was to examine the association of HGS with fracture, to evaluate the accuracy of HGS in predicting incident fracture, and to identify subjects at risk of fracture. We analyzed a cross-sectional cohort with 2,793 subjects (1,217 men and 1,576 women aged 50–101xa0years) and a subset of 1,702 subjects which were followed for a total of 4,855 person-years. The primary outcome measures were prevalent fractures and incident major fragility fractures. Each standard deviation (SD) reduction in HGS was associated with a 1.24-fold increased odds for major clinical fractures even after adjustment for other clinical factors. A similar result was obtained in the prospective cohort with each SD reduction in HGS being associated with a 1.57-fold increased hazard ratio of fracture even after adjustment for clinical factors. A combination of HGS and femoral neck bone mineral density (FN BMD) T-score values (combined T-score), together with other clinical factors, had a better predictive power of incident fractures than FN BMD or HGS T-score alone with clinical factors. In addition, combined T-score has better sensitivity and specificity in predicting incidence fractures than FN BMD alone. This study is the first study to compare the predictive ability of HGS and BMD. We showed that HGS is an independent risk factor for major clinical fractures. Compared with using FN BMD T-score of −2.5 alone, HGS alone has a comparable predictive power to BMD, and the combined T-score may be useful to identify extra subjects at risk of clinical fractures with improved specificity.

Association of handgrip strength with chronic diseases and multimorbidity - A cross-sectional study

The prevalence of chronic diseases has risen along with increased longevity. Co-occurrence of two or more chronic diseases in an individual (multimorbidity) is prevalent and poses a huge burden to individuals and the society. However, determinants of multimorbidity are largely unknown. Handgrip strength is a general indicator of muscle strength and linked with premature mortality. However, its role in multimorbidity has never been evaluated. To investigate the relationships between handgrip strength and multiple chronic diseases and multimorbidity, and to assess the usefulness of age and handgrip as a marker of chronic diseases and multimorbidity in a community dwelling sample of men and women, we analyzed a cross-sectional cohort with 1,145 subjects (748 men and 397 women) aged 50xa0years and older living in Hong Kong. Low handgrip strength was significantly associated with increased odds of having five and three chronic diseases in men and women, respectively, after controlling for age, body mass index, history of smoking, educational level, marital level and comorbidity. Multivariable-adjusted handgrip strength was significantly decreased with the number of chronic diseases in men (trend, Pu2009=u20090.001), but the trend in women was marginal (trend, Pu2009=u20090.06). Conversely, multivariable-adjusted age was significantly increased with the number of chronic diseases in women (trend, Pu2009=u20090.033), but not in men (trend, Pu2009=u20090.118). In conclusion, handgrip strength is associated with multiple chronic diseases and multimorbidity in men and women after adjustment of confounding factors. It shows a linear trend of association with the number of chronic diseases in men, but not in women. Since handgrip strength is a biomarker of multiple physiological systems, its augmentation may be a feasible strategy to improve general health and decrease likelihood of having multiple chronic diseases and hence, premature mortality.

Serum β-2 microglobulin predicts mortality in people with diabetes.

OBJECTIVEnSerum β-2 microglobulin (B2M) level predicts mortality in chronic kidney disease. Glycation of B2M is cytotoxic and may contribute to the risk of mortality in diabetic patients. Our objective was to evaluate the relationship between B2M and mortality in diabetic patients.nnnMETHODSnIn this prospective study, 896 participants of the Third National Health and Nutrition Examination Survey with diabetes were included in the analysis. Serum B2M level was used in multivariate Cox regression analysis to predict all-cause and diabetes-related mortality.nnnRESULTSnDuring a median follow-up of 11.8 years (range 0.1-18.2 years) and 9220.5 person/years, 541 (42.4%) and 207 (16.8%) participants died from all causes and diabetes-related causes respectively. One natural-log unit of B2M was significantly associated with all-cause (hazard ratio (HR)=6.53, 95% CI 2.07-20.6) and diabetes mortality (HR=7.35, 95% CI 1.01-53.38) after multivariable adjustment. Similar results were obtained when B2M was analyzed as tertiles or in the threshold model (T1+T2 vs. T3). Examination of regression splines suggests a linear increase in hazard for mortality with increasing B2M levels.nnnCONCLUSIONSnSerum B2M level is a novel predictor of all-cause and diabetes-related mortality in people with diabetes regardless of renal function.

High ferritin and low transferrin saturation are associated with pre-diabetes among a national representative sample of U.S. adults.

BACKGROUND & AIMSnIron overload is known to cause diabetes. However, the underlying mechanism is poorly understood. We therefore studied the association of different markers of iron metabolism, namely ferritin, erythrocyte protoporphyrin and transferrin saturation (TSAT, as defined by a percentage of transferrin that is saturated with iron) with pre-diabetes (preDM) in US adults without chronic kidney disease, anemia, and iron deficiency.nnnMETHODSnData on 2575 participants of the National Health and Nutrition Examination Survey (NHANES) 1999-2002 who were free of diabetes, chronic kidney disease, iron deficiency, and anemia were analyzed. Data on 3876 participants of the NHANES III (1988-1994) were used as replication. Homeostasis model assessment of insulin resistance (HOMA-IR), blood glycosylated hemoglobin level (HbA1C), fasting glucose, insulin, and preDM (defined as a fasting plasma glucose 100-125 mg/dl or an HBA1C value 5.7-6.4%) were measured as the outcomes.nnnRESULTSnLogistic regression analyses indicated independent associations of high ferritin (Ptrend = 0.028) and low TSAT (P(trend) = 0.029) with preDM after adjusting for sociodemographics, physical activity (active/sedementary), metabolic and inflammatory markers (triglycerides, total cholesterol, HDL cholesterol, mean arterial pressure, CRP, white cell count, and albumin), and liver enzymes (GGT, Alk phos, AST, and ALT). The NHANES III data showed similar associations. Combining the results showed a more significant association for high ferritin (P(meta) = 0.016) and low TSAT (P(meta) = 0.002). Moreover, TSAT was associated with HbA1C, fasting glucose, insulin, and HOMA-IR (P(meta) ≤ 0.001).nnnCONCLUSIONSnHigher ferritin and lower TSAT are associated with higher risk of preDM in a general population without confounding diseases. Further research is needed to examine the underlying mechanism of these two indices, especially TSAT, in the pathophysiology of preDM.

Utilization of glucose, blood pressure, and lipid lowering medications among people with type II diabetes in the United States, 1999–2010

PURPOSEnChanges in relation to drug treatment to various control targets for diabetes were studied using the National Health and Nutrition Examination Survey, 1999-2010.nnnMETHODSnData on 3094 participants aged 20 years or older with diagnosed type II diabetes were analyzed. Use of medications for lowering glucose, blood pressure, and lipids in the past month was assessed by questionnaire. Data from two survey cycles were combined together to produce estimates for each 4-year period.nnnRESULTSnUsage of metformin increased from 34.8% to 53.8% and was the most prevalent medications during this period (P < .001), and half of subjects taking metformin could achieve glycated hemoglobin less than 7.0% in 2007-2010. Dipeptidyl peptidase-4 inhibitors were used by 7.4% of participants in 2007-2010. Usage of angiotensin receptor blockers and beta-blockers increased significantly from 7.4% to 21.4% and from 15.3% to 31.8%, respectively from 1999 to 2010 (P ≤ .001). A total of 64.7% of participants could attain blood pressure control by 2007-2010. Usage of statins doubled in 1999-2010 and 52.2% of subjects took statins by 2007-2010 (P < .001).nnnCONCLUSIONSnMetformin is the first-line drug for diabetes while dipeptidyl peptidase-4 inhibitors started to be used since 2007. Blood pressure control improved in 1999-2010 partly due to increased drug prescriptions. Although statins were widely used about half of the participants did not take them.

Genetic variants in GREM2 are associated with bone mineral density in a southern Chinese population.

CONTEXTnGremlin 2 (GREM2) is a regulator of osteoblast differentiation and osteogenesis. A recent genome-wide association study identified GREM2 as a novel susceptibility gene for trabecular volumetric bone mineral density (BMD).nnnOBJECTIVEnWe investigated whether GREM2 gene variants were associated with areal BMD in southern Chinese people.nnnRESEARCH DESIGN AND METHODSnWe genotyped 108 single-nucleotide polymorphisms (SNPs) in 417 cases (defined as BMD Z-score ≤-1.28) and 359 controls (defined as BMD Z-score ≥+1). Multivariable logistic regression using an additive model was used to evaluate the association. The most associated SNPs of BMD at the spine, femoral neck, and total hip was then replicated in an additional 454 cases and 401 controls.nnnRESULTSnTwelve, 13, and 14 SNPs showed nominal association with BMD at the spine, femoral neck, and total hip, respectively. The minor alleles of rs9728351 (odds ratio [OR] = 2.56; 95% confidence interval [CI] = 1.33-4.92), rs11588607 (OR = 1.65; 95% CI = 1.14-2.4), and rs4454537 (OR = 1.87; 95% CI = 1.22-2.86) were associated with the low BMD at the spine, femoral neck, and total hip, respectively. Among these SNPs most associated with BMD, rs4454537 was successfully replicated in an independent cohort (OR = 1.59; 95% CI = 1.05-2.4). Meta-analysis showed that the minor allele of rs4454537 was associated with low total hip BMD with an OR of 1.72 (95% CI = 1.28-2.31) (P = 3.2 × 10(-4); P(corrected) = .043).nnnCONCLUSIONSnThe minor allele of rs4454537 is significantly associated with low BMD at the total hip of southern Chinese people. Our study further suggests GREM2 as a novel susceptibility gene for osteoporosis.

Osteoporosis in East Asia: Current issues in assessment and management

The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.

Hay fever and hypertension in the US adult population.

Abstract Purpose: Hypertension is associated with inflammation. Whether the inflammation caused by allergic diseases such as allergic rhinitis can predispose to hypertension is controversial. Therefore, we studied the association between hay fever and hypertension in the United States National Health and Nutrition Examination Survey (NHANES). Methods: We analyzed data on 1883 men and 2029 women in NHANES 2005–2006. We included participants aged 20 years or older who had valid data on hay fever and hypertension. Results: 13.5% of the participants had a previous diagnosis of hay fever and 36.2% of them had hypertension. There were ethnic differences in the prevalence of previous hay fever diagnosis (pu2009<u20090.001) and hypertension (pu2009<u20090.001). There was no significant association between previous hay fever diagnosis and hypertension in men in any age group. The association between previous hay fever diagnosis and hypertension in women was significant in those aged 20–39 years (ORu2009=u20092.59, 95%CIu2009=u20091.26–5.30, pu2009=u20090.013). The association between previous hay fever diagnosis and hypertension in women aged form 20 to 39 years remained significant after adjustment for age, race and body mass index (ORu2009=u20092.74, 95%CIu2009=u20091.48–5.06, pu2009=u20090.003). After further adjustment for physical activity, alcohol consumption and smoking, the association was not attenuated (ORu2009=u20092.68, 95%CIu2009=u20091.38–5.18, pu2009=u20090.006). Further adjustment for liver enzymes, C-reactive protein and immunoglobulin E level attenuated the association slightly (ORu2009=u20092.72, 95%CIu2009=u20091.19–6.22, pu2009=u20090.021). Conclusions: In this nationally representative population-based survey, previous hay fever diagnosis is not significantly associated with hypertension in adults overall. There is an association in subgroup of young women aged 20–39. Further work is needed to confirm that this is a true association.

Serum beta-2 microglobulin concentration predicts cardiovascular and all-cause mortality.

This Open Access Journal issue contain Selected Abstracts presented at the 18th International Congress of the International Society of Cardiovascular Pharmacotherapy (ISCP) ... 2013

Reduced serum beta-trace protein is associated with metabolic syndrome

OBJECTIVESnβ-trace protein (BTP), also known as lipocalin-type prostaglandin D2 synthase, has shown to regulate glucose and lipid metabolism in vivo. We sought to study the relationship of serum BTP with diabetes and metabolic syndrome (MetS).nnnMETHODSnData on 3136 participants aged ≥20 years of the National Health and Nutrition Examination Survey III were examined. Logistic regression was used to assess the association of BTP with diabetes and MetS.nnnRESULTSnReduced levels of BTP were associated with diabetes and MetS in age, sex, and race/ethnicity adjusted models. After further multivariable adjustment, BTP levels in quartile 1 remained significantly associated with MetS (odds ratio 2.04 [95% CI 1.14-3.70], Ptrend = 0.003) when compared with quartile 4. Among the five components of MetS, BTP was associated with hypertriglyceridemia (Ptrend < 0.001) but not diabetes (Ptrend = 0.099).nnnCONCLUSIONnMetS is associated with a reduced serum level of BTP.