Hao-Hsiang Chang

Sarcopenic obesity is closely associated with metabolic syndrome

OBJECTIVES Obesity is a risk factor for metabolic syndrome (MetS). We aimed to investigate whether sarcopenic obesity (SO) was associated with MetS. METHODS A total of 600 community-dwelling males and females aged 63.6 ± 10.1 years in Northern Taiwan were enrolled in this study. Sarcopenia was defined by the percentage of total skeletal mass (total skeletal muscle mass (kg)/weight (kg) x 100). Cut-offs were established at <37% in men and <27.6% in women using the bioelectrical impedance analysis (BIA) method. Obesity was defined as body mass index (BMI) ≥25 kg/m(2). MetS was defined by the consensus of National Cholesterol Education Program-Adult Treatment Panel III modified for Asians. The association between MetS and SO was examined using multivariate logistic regression analyses after controlling potential confounders. RESULTS The SO group demonstrated a higher risk for MetS (odds ratio [OR] 11.59 [95% confidence interval [CI] 6.72-19.98]) than the obese group (7.53 [4.01-14.14]) and sarcopenic group (1.98 [1.25-3.16]). The individual components including waist circumference, serum triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting serum glucose were independently associated with SO. CONCLUSION SO is a major risk factor for MetS. The BIA method and BMI can easily identify subjects at high risk for MetS. The underlying mechanism for the relationship between SO and MetS warrants further research.

Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study.

AbstractBariatric surgery has been shown to impair bone health. This study aimed to investigate the fracture risk in patients after bariatric surgery versus propensity score-matched controls. The authors used the National Health Insurance Research Database of Taiwan and identified 2064 patients who underwent bariatric surgery during 2001 to 2009. These patients were matched to 5027 obese patients who did not receive bariatric surgery, using propensity score matching accounting for age, sex, Charlson Comorbidity Index, diabetes, hypertension, hyperlipidemia and the year morbid obesity was diagnosed. The authors followed the surgical and control cohorts to death, any diagnosis of fracture, or December 31, 2012, whichever occurred first. Cox proportional hazard regression models were used to calculate relative rates of fractures in the surgical group and control group. At the end of the 12-year study period, there were 183 fractures in the surgical group (mean follow-up 4.8 years) and 374 fractures in the matched control group (mean follow-up 4.9 years). Overall, there was a 1.21-fold [95% confidence interval (CI): 1.02–1.43] significantly increased risk of fracture in the surgical group compared with the control group. Stratified by surgical procedures, malabsorptive procedures showed a significantly higher fracture risk (1.47, 95% CI: 1.01–2.15). The Kaplan-Meier estimated fracture rates were 1.60% at 1 year, 2.37% at 2 years, 1.69% at 5 years, and 2.06% after 5 years for the surgical patients, compared with 1.51%, 1.65%, 1.53%, and 1.42%, respectively, for the matched controls. Adjusted analysis showed a trend towards an increased fracture risk, 1 to 2 years after bariatric surgery. (1.42, 95% CI: 0.99–2.05). Bariatric surgery was significantly associated with an increased risk of fractures, mainly with malabsorptive procedures, with a trend of an increased fracture risk 1 to 2 years after surgery. These results provide further evidence for the adverse effects of bariatric surgery on the risk of fractures.

Outcomes of hospitalized elderly patients with geriatric syndrome: report of a community hospital reform plan in Taiwan

The purpose of this study was to evaluate the outcomes of elderly inpatients with geriatric syndromes. A prospective study involving patients aged 65 years and older in 12 community hospitals was performed. Baseline data, which included demographic characteristics, mini mental status exam, geriatric depression scale (GDS), mini nutritional assessment (MNA), activities of daily living (ADL), and instrumental activities of daily living (IADL), were collected in geriatric assessments. The primary outcome was functional deterioration; additional outcomes included mortality, re-hospitalization, and emergency department visits, as identified by telephone interview and chart review. A total of 1,008 patients were recruited: 31.2% of the participants were ADL intact, 21.3% were IADL-intact, 11.5% had depression, 29.3% had nutritional problems, and 60.3% had impaired cognition at baseline. During follow-up, 172 patients (19.3%) died, 43.8% reported ADL deterioration, and 45.9% reported IADL deterioration. On multivariate analysis, older age, low mini mental state examination (MMSE) score, and low MNA score were predictors of functional deterioration. Under the interdisciplinary team care of the Community Hospital Reform Plan (CHRP), most of the elderly patients maintained or increased their functional capacity; the one-year mortality rate was higher than that of the general population but lower than that of other studies targeting the frail elderly.

Sarcopenia is Related to Increased Risk for Low Bone Mineral Density

Lean body mass is positively correlated with bone mineral density (BMD). The association between sarcopenia and BMD is less studied. The aim of the study is to investigate the association between sarcopenia and abnormal BMD. A total of 600 community residents aged 40-85 years (mean=63.63 ± 10.12) from Taipei, Taiwan were included. Abnormal and normal BMD groups were categorized by T-score of femoral neck and lumbar spine (L2-L4) measured by dual-energy X-ray absorptiometry. Skeletal muscle mass (SM) index (SMI) was obtained from SM divided by height squared using bioelectrical impedance analysis (BIA) method. Sarcopenia was defined as SMI less than 8.87 kg/m² in men and 6.42 kg/m² in women according to previous Taiwanese sarcopenia study. The association between BMD groups and sarcopenia was examined using binary logistic regression analyses after controlling potential confounders. Subjects with sarcopenia were at higher risk for low BMD (odds ratio (OR) = 1.59, 95% confidence interval (CI)=1.06-2.39 for femoral neck BMD and OR=1.72, 95% CI=1.09-2.72 for lumbar BMD) compared with the nonsarcopenia group. Even in different gender groups with age categorized, sarcopenia was still an important independent factor in female group. The least square (LS) means of BMD of femoral neck and lumbar spine were significantly lower in sarcopenia group. The risk of low BMD increased significantly with sarcopenia.

Association of Non-alcoholic Fatty Liver Disease with Metabolic Syndrome Independently of Central Obesity and Insulin Resistance

Non-alcoholic fatty liver disease (NAFLD) is an emerging chronic liver disease that may lead to liver cirrhosis and hepatocellular carcinoma. We aimed to determine the association between the prevalence of metabolic syndrome (MetS) and NAFLD severity using semi-quantitative ultrasonography (US). A total of 614 participants were recruited from the community. NAFLD was evaluated according to the ultrasonographic Fatty Liver Indicator (US-FLI), which is a semi-quantitative liver ultrasound score. Insulin resistance was estimated with the homeostasis model assessment index for insulin resistance (HOMA-IR). NAFLD and MetS were found in 53.7 and 17.3% of the participants, respectively. Linear relationships were found between the severity of NAFLD and waist circumference, fasting glucose, HOMA-IR, triglycerides, HDL-C and blood pressure. After adjusting for confounding factors, i.e., body mass index and HOMA-IR, the odds ratios for MetS were 3.64 (95% confidence interval (CI): 1.5–8.83) for those with mild NAFLD and 9.4 (95% CI: 3.54–24.98) for those with moderate-to-severe NAFLD compared to those without NAFLD. The combination of the HOMA-IR and US-FLI scores better differentiated MetS than the HOMA-IR alone. In addition to obesity, the severity of NAFLD and the HOMA-IR both play important roles in MetS. Whether NAFLD is a component of MetS warrants further research.

High serum selenium levels are associated with increased risk for diabetes mellitus independent of central obesity and insulin resistance

Objective Selenium is an essential micronutrient for human health. Although many observational and interventional studies have examined the associations between selenium and diabetes mellitus, the findings were inconclusive. This study aimed to investigate the relationship between serum selenium levels and prevalence of diabetes, and correlated the relationship to insulin resistance and central obesity. Research design and methods This was a hospital-based case–control study of 847 adults aged more than 40 years (diabetes: non-diabetes =1:2) in Northern Taiwan. Serum selenium was measured by an inductively coupled plasma-mass spectrometer. The association between serum selenium and diabetes was examined using multivariate logistic regression analyses. Results After adjusting for age, gender, current smoking, current drinking, and physical activity, the ORs (95% CI, p value) of having diabetes in the second (Q2), third (Q3), and fourth (Q4) selenium quartile groups were 1.24 (95% CI 0.78 to 1.98, p>0.05), 1.90 (95% CI 1.22 to 2.97, p<0.05), and 5.11 (95% CI 3.27 to 8.00, p<0.001), respectively, compared with the first (Q1) quartile group. Further adjustments for waist circumference and homeostatic model assessment-insulin resistance (HOMA-IR) largely removed the association of serum selenium levels with diabetes but not in the highest quartile (compared with Q1, Q3: 1.57, 95% CI 0.91 to 2.70, Q4: 3.79, 95% CI 2.17 to 6.32). Conclusions We found that serum selenium levels were positively associated with prevalence of diabetes. This is the first human study to link insulin resistance and central obesity to the association between selenium and diabetes. Furthermore, the association between selenium and diabetes was independent of insulin resistance and central obesity at high serum selenium levels. The mechanism behind warrants further confirmation.

Statins Improve Long Term Patency of Arteriovenous Fistula for Hemodialysis.

The protective effects of statins against stenosis for permanent hemodialysis access have been repeatedly demonstrated in animal studies, but remain controversial in human studies. This study aims to evaluate the association between statin use and permanent hemodialysis access patency using a nationwide hemodialysis cohort. A total of 9862 pairs of statin users and non-users, matched by age and gender, were selected for investigation from 75404 new hemodialysis patients during 2000–2008. The effect of statins on permanent hemodialysis access patency was evaluated using Cox proportional hazards models. Compared with non-users, statin users had an overall 18% risk reduction in the composite endpoint in which angioplasty and recreation were combined (adjusted hazard ratio = 0.82 [95%CI, 0.78–0.87]) and 21% in recreation of permanent hemodialysis access (adjusted hazard ratio = 0.79 [95%CI, 0.69–0.80]). Specifically, the protective effect was found for arteriovenous fistula (adjusted hazard ratio = 0.78[95% CI, 0.73–0.82] for composite endpoint and 0.74 [95% CI, 0.69–0.80] for vascular recreation), but not for arteriovenous grafts (adjusted hazard ratio = 1.10 [95% CI, 0.98–1.24] and 0.94 [95% CI, 0.83–1.07]). Statins possess a protective effect for arteriovenous fistula against the recreation of permanent hemodialysis access. The results provide a pharmaco-epidemiologic link between basic research and clinical evidence.

Vitamin D status and risk of metabolic syndrome among non-diabetic young adults

BACKGROUND AND AIMS Low vitamin D status has been linked to obesity, insulin resistance, and metabolic syndrome. In the present study, we aimed to explore the nature and strength of the relationship between vitamin D and metabolic syndrome among non-diabetic young adults. METHODS This was a campus-based cross-sectional study of 355 non-diabetic young adult graduate students (233 males and 132 females; mean age, 23.5 ± 2.4 years) in Northern Taiwan. We measured and tested the association of serum 25-hydroxyvitamin D levels with metabolic syndrome and cardio-metabolic parameters. RESULTS A total of 24 (6.8%) recruited young adults had metabolic syndrome. There were decreasing trends of body mass index (BMI), Homeostasis Model of Assessment-Insulin Resistance (HOMA-IR) and prevalence of metabolic syndrome across increasing tertiles of vitamin D levels irrespective of age and sex (P for trend <0.05). Without adjusting for BMI or HOMA-IR, the odds of having metabolic syndrome decreased across increasing tertiles of vitamin D levels (P for trend 0.021). The odds ratio of having metabolic syndrome was 0.26 (95% confidence interval: 0.08-0.85, P = 0.025) for the highest vs. the lowest tertile of vitamin D levels. However, further adjustments for BMI and HOMA-IR largely removed the inverse association of vitamin D status with metabolic syndrome and its individual components. CONCLUSION Among non-diabetic young adults, the potential inverse relationship between vitamin D status and metabolic syndrome may be attributable to the conjunctive effects of individual obesity and insulin resistance.

Low Serum Selenium Level Is Associated With Low Muscle Mass in the Community-Dwelling Elderly

OBJECTIVES Elderly persons with low muscle mass (LMM) or sarcopenia are prone to frailty and functional decline. This study aimed to investigate the relationship between serum selenium level and skeletal muscle mass in community-dwelling elderly. DESIGN Cross-sectional observational study. SETTING AND PARTICIPANTS A total of 327 elderly Taipei citizens (mean age 71.5 ± 4.7 years) were recruited from the community. MEASUREMENTS Skeletal muscle mass was measured by bioelectrical impedance analysis. LMM was defined by low skeletal muscle index (SMI: muscle mass (kg)/[height (m)](2)). All participants were further divided into quartiles by serum selenium level and the risk for LMM among these quartiles was examined using multivariate logistic regression analyses. Estimated serum selenium levels for the LMM group vs the normal group and estimated SMI in the quartiles of serum selenium were computed by least square method in linear regression models. RESULTS The estimated mean (±standard deviation) of serum selenium level was significantly lower in the LMM group compared with the normal group after adjusting for confounders (1.01 ± 0.03 μmol/L vs 1.14 ± 0.02 μmol/L, P < .001). After adjusting for age, sex, lifestyle, and physical and metabolic factors, the odds ratios (95% confidence interval, P value) of LMM in the bottom, second, and third selenium quartile groups were 4.62 (95% CI 2.11-10.10, P < .001), 2.30 (95% CI 1.05-5.03, P < .05) and 1.51 (95% CI 0.66-3.46, P = .327), respectively, compared with the top quartile group of serum selenium level. The least square mean of SMI increased with the quartiles of serum selenium (P < .001). CONCLUSIONS This is the first study to demonstrate that low serum selenium is independently associated with low muscle mass in the elderly. The causality and underlying mechanism between selenium and low muscle mass or sarcopenia warrant further research.

The Association between Total Protein and Vegetable Protein Intake and Low Muscle Mass among the Community-Dwelling Elderly Population in Northern Taiwan

Sarcopenia, highly linked with fall, frailty, and disease burden, is an emerging problem in aging society. Higher protein intake has been suggested to maintain nitrogen balance. Our objective was to investigate whether pre-sarcopenia status was associated with lower protein intake. A total of 327 community-dwelling elderly people were recruited for a cross-sectional study. We adopted the multivariate nutrient density model to identify associations between low muscle mass and dietary protein intake. The general linear regression models were applied to estimate skeletal muscle mass index across the quartiles of total protein and vegetable protein density. Participants with diets in the lowest quartile of total protein density (<13.2%) were at a higher risk for low muscle mass (odds ratio (OR) 3.03, 95% confidence interval (CI) 1.37–6.72) than those with diets in the highest quartile (≥17.2%). Similarly, participants with diets in the lowest quartile of vegetable protein density (<5.8%) were at a higher risk for low muscle mass (OR 2.34, 95% CI 1.14–4.83) than those with diets in the highest quartile (≥9.4%). Furthermore, the estimated skeletal muscle mass index increased significantly across the quartiles of total protein density (p = 0.023) and vegetable protein density (p = 0.025). Increasing daily intakes of total protein and vegetable protein densities appears to confer protection against pre-sarcopenia status.