Der-Min Wu

Plasma C-reactive protein levels and their relationship to anthropometric and lipid characteristics among children

C-reactive protein (CRP), a nonspecific marker of inflammatory status, is associated with cardiovascular disease (CVD) risk factors and the late occurrence of heart disease in adults. However, few studies assess the plasma CRP levels in healthy children. The purpose of this study is to evaluate the relationship between plasma CRP levels and anthropometric and lipid characteristics among children in Taiwan. After a multi-stage sampling of 85 junior high schools in Taipei, we randomly selected 835 children (410 boys and 425 girls) aged 12 to 16 years. Anthropometric and lipid profiles, including total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), and lipoprotein (a) were measured. We also calculated low-density lipoprotein cholesterol levels and the total cholesterol-to-HDL-C ratio as shown on the atherosclerotic index. In both genders, plasma CRP levels were significantly positively correlated with anthropometrics measures and inversely correlated with HDL-C levels. After adjusting for age, cigarette smoking, alcohol consumption, heart rate, and puberty development, children in the fourth quartile CRP subgroups were heavier and had significantly higher body mass index (BMI) and lower HDL-C levels than children with nondetected CRP. In multivariate regression models, CRP was significantly negatively associated with HDL-C levels even after adjusting for BMI in both genders. In this study, anthropometrics measures, especially BMI, were positively associated with plasma CRP levels. Furthermore, elevated CRP levels were associated with adverse lipids profiles. These data suggest that elevated plasma CRP levels might be associated with CVD risk factors that may be related to the late development of CVD in some Taiwanese children.

Relationship between plasma leptin levels and lipid profiles among school children in Taiwan – The Taipei Children Heart Study

Leptin, an adipose tissue-derived of gene product, is important in energy metabolism. However, the role of leptin in the metabolism of lipids is still not clear in humans. The purpose of this study was to evaluate the association of plasma leptin concentrations and lipid profiles among school children in Taiwan. After multistage sampling of 85 junior high schools in Taipei, we randomly selected 1264 children (617 boys and 647 girls) aged 12–16 years for this study. We measured the anthropometric variables, lifestyle factors and biochemical parameters among these children. Anthropometric measurements included body height (BH) and weight (BW) and we calculated body mass index (BMI) as the ratio of the BW to the square of the BH, expressed in kg/m2. Plasma leptin levels were measured by radioimmunoassay. We also measured lipid profiles including serum total cholesterol (CHOL), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), apolipoprotein-A1 (Apo-A1), apolipoprotein-B (Apo-B), and lipoprotein(a) (Lp(a)) levels, and calculated low density lipoprotein-cholesterol (LDL-C) levels and CHOL to HDL-C ratio (TCHR). Girls had higher leptin, CHOL, TG, HDL-C, (LDL-C), Apo-A1, Apo-B, and Lp(a) levels and lower BMI than boys did. Plasma leptin concentrations were significantly positively correlated with TG, LDL-C, and Apo-B, but negatively with HDL-C and Apo-A1 in both the genders. Children with higher plasma leptin levels (>75th percentiles) have significantly higher TG, HDL-C, LDL-C, TCHR, and Apo-B than those with relatively lower leptin levels. In multivariate regression analyses, the association between plasma leptin level and lipid profiles (such as CHOL, TG, and Apo-B) were still significant (p < 0.05) even after adjusting for BMI among boys. However, this association became attenuated and insignificant among girls. Finally, in the model that included the standard covariates, plasma leptin was the most predictive of CHOL, TG and Apo-B levels among those school children in Taiwan. Our results suggest that plasma leptin and BMI were independently associated with the lipids and lipoprotein profiles among Taiwanese Children. In both genders, children in the top 25% of the leptin distribution have more adverse lipid and lipoprotein profiles.

Joint effects of alcohol consumption and cigarette smoking on atherogenic lipid and lipoprotein profiles: Results from a study of Chinese male population in Taiwan

Background: The present study examines the effect of joint exposure to cigarette smoking and alcohol intake on serum levels of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) among Chinese male adults in Taiwan. Methods: A sample of 3311 men aged 20–59 years who reported having stable smoking and drinking behaviors during the period between January 1995 and December 1996 was selected from a periodic health checkup population. Serum lipids and lipoprotein cholesterol fractions were measured on fasting blood samples taken from participants. Statistical methods of analysis of variance and analysis of covariance were conducted to examine the associations of different smoking–drinking behavioral patterns with lipid and lipoprotein levels. Results: In the observed population, the percentages of men who had stable cigarette smoking and alcohol consumption behaviors were 39.5% (1307/3311) and 27.0% (895/3311), respectively. Mean values of TC and TG increased significantly and monotonically with increasing levels of cigarette smoking and alcohol consumption. In addition, alcohol intake was significantly associated with increased HDL-C and reduced LDL-C levels in a dose-dependent manner. More interestingly, the effect of alcohol consumption on LDL-C (negative) and TG (positive) levels was substantially greater for heavy smoker (> 20 cigarettes/day) than for light smokers (≤ 20 cigarettes/day) and non-smokers, while alcohol intake exerted a strong positive influence on HDL-C concentration regardless of levels of cigarette smoking. Conclusions: In this Chinese male population, cigarette smoking and alcohol consumption were confirmed to have similar effects on lipid and lipoprotein levels as in Caucasians. More interestingly, a significance of joint exposure to smoking and drinking in predicting lipid and lipoprotein levels was evident. These data indicate the importance of multifactorial interventions to obtain more favorable lipid and lipoprotein levels in the population.

Familial resemblance of adiposity-related parameters: Results from a health check-up population in Taiwan

The mechanisms of obesity is still unclear, however, genetic and environmental factors are two major possible causes of obesity. The purpose of this study was to assess the degree of familial resemblance of different obesity-related parameters in a health check-up population in Taiwan. We measured body mass index (BMI), waist-to-hip ratio (WHR) and percentage of body fat (BFAT) anthropometrics in 1724 members of 431 families participating in the MJ Health Screening program. Each family contributed four members, i.e. father, mother, son, and daughter. All the participants were free from coronary heart disease, hypertension, diabetes, dyslipidemia, and generally in good health. The degree of familial aggregation was measured by heritability that was calculated based on age-adjusted familial (parent-offspring, sibling, spouse) correlations. The maximal heritability estimates were 39, 30 and 35% for BMI, WHR and BFAT, respectively. For WHR, the correlation between spouses was not significant and the heritability appears to be predominantly due to genetic causes. Furthermore, for BMI and BFAT, the spouse correlations were 0.08 and 0.11, respectively. The heritabilities for BMI and BFAT were mostly explained by genetic factors and familial environmental factors such as dietary habits or physical activity. The familial resemblance of various obesity-related parameters was moderate in a health check-up population in Taiwan. While the heritability for WHR appears to be mainly due to genetic factors, the familial resemblance for BMI and percentage of BFAT may involve both genetic and familial environmental factors.

Plasma TNF-R1 and insulin concentrations in relation to leptin levels among normal and overweight children

OBJECTIVES Leptin is a multifunctional polypeptide produced primarily by adipocytes and associated with the occurrence of obesity and insulin resistance. Tumor necrosis factor-alpha (TNF-alpha), a polypeptide cytokine produced primarily by mononuclear phagocytes, plays a key role in the initiation of the inflammatory response but has a multitude of effects in many tissues. The interactions between TNF-alpha and insulin on leptin expression are complicated and have not been completely described. The purpose of this study is to evaluate interactions between TNF-alpha and insulin on circulating leptin levels among normal and overweight children. DESIGN AND METHODS After multi-stage sampling, we randomly selected 1,500 school children in this survey. All children completed a questionnaire on their disease history and lifestyle characteristics. We measured body weight, height, waist and hip circumference of children and calculated BMI and Waist-to-hip ratio (WHR). We also measured plasma tumor necrosis factor-receptor 1 (TNF-R1) by ELISA, plasma insulin and circulating leptin levels by RIA using commercial kits. We divided the children into normal or overweight groups using BMI criteria (85th percentile) to evaluate the relationship of TNF-R1 and insulin on circulating leptin concentrations. RESULTS In general, boys were taller, heavier and had higher TNF-R1 and lower leptin levels than girls. Plasma leptin levels were positively correlated with anthropometric variables and insulin levels among children in both genders. In multivariate regression analyses, plasma insulin levels were significantly positive associated with leptin levels in normal weight children. Plasma TNF-R1 levels were positively associated with leptin levels even after adjusting for BMI in girls only. CONCLUSIONS From this study, we found that plasma insulin plays certain role in leptin expression among normal weight children. However, TNF-R1 plays a more significant role in leptin expression among girls only.

Plasma homocyst(e)ine, folate and vitamin B12 levels among school children in Taiwan: The Taipei Children Heart Study

OBJECTIVE The purpose of this study is to examine the association of plasma Hcy, folate and vitamin B(12) levels on CVD risk factors among children in Taiwan. METHODS After multistage sampling, we selected randomly 1,235 children (609 boys and 626 girls) aged 12 to 15 yr. Plasma Hcy levels was measured using ABBOTT Imx analyzer, while plasma folate and vitamin B(12) were measured using ACS: 180 automated chemiluminescence analyzer. Anthropometric, blood pressure (BP) and other biochemical CVD risk factors including serum total cholesterol (CHOL), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), apolipoprotein A1 (apoA1) and B (apoB) and lipoprotein(a) [Lp(a)]were measured using standard methods. We also calculated low density lipoprotein-cholesterol (LDL-C) and TCHR (total cholesterol to HDL-C ratio) as atherogenic indices. RESULTS Boys were taller and heavier, having higher body mass index (BMI), systolic blood pressure (SBP) and plasma glucose levels but lower diastolic blood pressure (DBP), heart rate (HR), cholesterol, TG, HDL-C, LDL-C, TCHR, and Lp(a) levels than girls. Boys also had higher plasma Hcy and lower folate, vitamin B(12), levels than girls (for plasma Hcy, mean +/- SD, 10.50 +/- 4.13 vs. 8.95 +/- 2.61 micromol/L for boys vs. girls, respectively). Plasma Hcy levels were significantly correlated positively with body height, body weight, SBP and DBP in both genders. Body height, body weight, BMI and SBP levels were found to increase with trend among different quintile plasma Hcy subgroups on boys but not on girls. Plasma folate and vitamin B(12) were decreased significantly along with the higher quintile plasma Hcy subgroup in both genders. CONCLUSIONS Boys had higher plasma Hcy levels than girls after adjusting for age. Furthermore, plasma Hcy levels were significantly associated with anthropometric parameters, such as body height and weight and blood pressure, but not related with lipid profiles among children in Taiwan.

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

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

1201, 1857, 3960, and 5118 (at an exchange rate of NT

Determinants and distributions of plasma total homocysteine concentrations among school children in Taiwan

32 to US

Metabolic syndrome and its components in relation to brachial-ankle pulse wave velocity in middle-aged Taiwanese males

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.