Lee Ching Hwang

Prevalence of Obesity and Metabolic Syndrome in Taiwan

BACKGROUND/PURPOSE Obesity and metabolic syndrome (MS) are major risk factors for the development of type 2 diabetes and cardiovascular diseases (CVD). This study estimated the prevalence of obesity and MS in Taiwan. METHODS Data from a nationwide cross-sectional population-based survey of 5936 participants (2815 men, 3121 women; age range, 20-79.9 years) in 2002 were analyzed. Obesity was defined as a body mass index (BMI) > or = 27 kg/m(2) according to the criteria of the Department of Health in Taiwan. The prevalence of MS was estimated using the definitions of the modified Adult Treatment Panel III (ATP III), the International Diabetes Federation for Chinese (MS-IDF(C)) and the MS criteria for Taiwanese (MS-TW). RESULTS The overall prevalence of obesity in men was significantly greater than in women (19.2% vs. 13.4%, p < 0.0001). The age-standardized prevalence of MS was 15.7% by the modified ATP III criteria, 14.3% by the MS-IDF(C) criteria and 16.4% by the MS-TW criteria. The prevalence of obesity and MS significantly increased with age (trend test, p < 0.0001) in men and women. The risk of MS and its components increased significantly with BMI, and showed a marked increase with BMI > or = 24 kg/m(2). MS as classified by the MS-IDF(C) criteria failed to identify subjects at high risk of CVD who did not have abdominal obesity, including those with hypertension, type 2 diabetes and dyslipidemia. CONCLUSION This study found a high prevalence of obesity and MS in Taiwan. The definitions of MS by the modified ATP III and MS-TW criteria were better able to detect high CVD risk than the MS-IDF(C) criteria.

Uric acid level as a risk marker for metabolic syndrome: A Chinese cohort study

OBJECTIVE Despite some epidemiologic research demonstrating a positive relationship between serum uric acid (SUA) levels and the prevalence of metabolic syndrome (MetS), prospective data on SUA as a predictor of MetS incidence are limited. METHODS The authors examined SUA as a risk marker for incident MetS in a prospective study of 3857 subjects who were free of MetS at baseline recruitment. Hyperuricemia was defined as SUA ≥7.7 mg/dL for men and ≥6.6 mg/dL for women. The MetS was defined according to a unified criteria set by several major organizations. RESULTS During a mean follow-up of 5.41 years, 476 participants developed MetS. A significantly stepwise increase in the incidence of MetS across tertiles of SUA was observed in the whole group (p for trend <0.001). Among women, this association was more robust than in men. After adjustment for age, variations of blood pressure, triglycerides, HDL-C, glucose, and waist circumference, females in the middle and upper tertiles of SUA had significantly higher risk of developing MetS when compared with subjects in the lowest tertile [adjusted-HR (95% CI) was 1.67 (1.12-2.49) and 3.18 (2.20-4.60), respectively; p for trend <0.001]. Overall, hyperuricemia was a significantly independent risk determinant for MetS in women, but it was a non-significant factor for MetS mediating waist circumference and serum triglycerides in men. CONCLUSION SUA concentration is more closely associated with MetS in females than in males. Future investigations are needed to explore the underlying mechanisms involved in the sex-related association between SUA concentration and MetS risk.

Evidence for improved control of hypertension in Taiwan: 1993-2002.

Objective This study reports the prevalence of hypertension, proportions of awareness, treatment, and control in the 2002 Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH), and compared the changes of hypertension prevalence, awareness, treatment, and control in two recent nationwide surveys. Methods TwSHHH is the second nationwide survey designed to assess the prevalence, awareness, treatment, and control of hyperglycemia, hyperlipidemia, and hypertension. The TwSHHH survey applied a multistage, stratified, and random sampling during 2002 with a total of 7566 participants. Among them, 3088 male and 3391 female participants were 19 years old and over and were selected from households throughout Taiwan. The data of Nutrition and Health Survey in Taiwan (NAHSIT), the first nationwide survey to assess disease and nutrition status during 1993–1996, was also applied to compare changes of the prevalence, awareness, treatment, and control of hypertension between the two surveys. Results Compared with the NAHSIT, the prevalence of hypertension on TwSHHH decreased significantly in female adults, between 1993–1996 and 2002. In both males and females of all age groups, the awareness, treatment, and control of hypertension significantly and substantially improved between NAHSIT and TwSHHH. These results also correlated in time with the implementation of National Health Insurance since 1995. The favorable changes in education and availability of care may account for improved control of hypertension and, possibly, its prevention. Conclusions There was a significant improvement of hypertension awareness, treatment, and control in the TwSHHH survey compared with the NAHSIT survey in Taiwan.

Uric acid concentration as a risk marker for blood pressure progression and incident hypertension: a Chinese cohort study.

OBJECTIVE Little is known about serum uric acid (SUA) role for hypertension in the Asian countries with low cardiovascular events. We aimed to explore the relationship in a comprehensive Chinese cohort. METHODS Participants in the Taiwanese Survey on Prevalences of Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH) who were free of hypertension at baseline recruitment in 2002 (n=3257) were evaluated for the longitudinal association between baseline SUA and blood pressure progression (BPP) and incident hypertension. RESULTS During a mean follow-up of 5.41 years, 1119 persons (34.3%) had experienced progression to a higher blood pressure stage and 496 persons (15.2%) had developed hypertension. In multivariate analyses, the adjusted hazard ratios (HRs) [95% confidence intervals (CIs)] comparing the highest and lowest SUA quartiles were 1.78 (1.11-2.02, P for trend .004) for BPP and 1.68 (1.23-2.04, P for trend .028) for incident hypertension. The positively graded relationships between SUA concentration and blood pressure outcomes were observed in both males and females. More interestingly, a statistically significant trend for increasing risk of BPP and incident hypertension across SUA quartiles was most pronounced in participants with abdominal obesity. CONCLUSION We concluded that SUA level was an independent predictor of blood pressure progression and incident hypertension in a Chinese population.

Impact of metabolic syndrome on the incidence of chronic kidney disease: a Chinese cohort study.

Aim:  Metabolic syndrome (MetS) is a major culprit in cardiovascular disease and chronic kidney disease (CKD) in Western populations. We studied the longitudinal association between MetS and incident CKD in Chinese adults.

Description and prediction of the development of metabolic syndrome: a longitudinal analysis using a markov model approach.

Background Delineating the natural history of metabolic syndrome (MetS) is prerequisite to prevention. This study aimed to build Markov models to simulate each component’s progress and to test the effect of different initial states on the development of MetS. Methods MetS was defined with revised AHA/NHLBI criteria. Each reversible multistate Markov chain consisted of 8 states (no component, five isolated component states, 2-component state, and MetS state). Yearly transition probabilities were calculated from a five-year population-based follow up studywhich enrolled 2,247 individuals with mean aged 32.4 years at study entry. Results In men, high BP or a 2-component state was most likely to initiate the progress of MetS. In women, abdominal obesity or low HDL were the most likely initiators. Metabolic components were likely to occur together. The development of MetS was an increasing monotonic function of time. MetS was estimated to develop within 15 years in 12.7% of young men with no component, and 2 components developed in 16.3%. MetS was estimated to develop in 10.6% of women with at the age of 47, and 2 components developed in 14.3%. MetS was estimated to develop in 24.6% of men and 27.6% of women with abdominal obesity, a rate higher than in individuals initiating with no component. Conclusions This modeling study allows estimation of the natural history of MetS. Men tended to develop this syndrome sooner than women did, i.e., before their fifth decade of life. Individuals with 1 or 2 components showed increased development of MetS.

Ethnic variation in hypertension prevalence of women in Taiwan

The prevalence and risk factors of hypertension vary in ethnic groups. This study aimed to estimate the hypertension prevalence and to compare risk factors associated with hypertension in women of four ethnic groups in Taiwan. The study subjects were participants in the Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia (TwSHHH) enrolled in 2002. In this analysis, only 2810 women who were at age of 20–80 years old and whose father and mother had same ethnic background (Minnan, Hakka, Aborigines or Mainland Chinese) were included. Results showed that there were significant ethnic differences in the prevalence of hypertension, obesity indices, fasting glucose, dyslipidaemia, hyperuricaemia, history of alcohol drinking and tobacco smoking and socioeconomic status. Aborigines had the highest prevalence of hypertension (28.6%) and diabetes mellitus (8.9%), whereas the Minnan group had the second highest prevalence of hypertension (19.2%) and diabetes mellitus (7.9%). Both age and central obesity were associated with an increased prevalence of hypertension except central obesity in Mainland Chinese in all four ethnic groups. Compared with the Mainland Chinese as the referent, the multivariate-adjusted odds ratio (OR) (95% CI) was 1.19 (0.63–2.26), 1.92 (1.15–3.21) and 2.03 (1.00–4.12) for Hakka, Minnan and Aborigines, respectively. Elevated body mass index (⩾27.0 vs <24.0 kg m−2) and central obesity were significantly associated with hypertension showing multivariate-adjusted OR (95% CI) of 1.68 (1.18–2.38) and 1.95 (1.48–2.57), respectively. In addition, dyslipidaemia, hyperuricaemia and diabetes associated with higher OR for hypertension in Minnan women. In conclusion, there were ethnic variations in hypertension prevalence and determinants in Taiwanese women.

The Link of Self-Reported Insomnia Symptoms and Sleep Duration with Metabolic Syndrome: A Chinese Population-Based Study.

STUDY OBJECTIVES The aims of this study are to investigate the relationships of metabolic syndrome (MetS) with insomnia symptoms and sleep duration in a Chinese adult population. METHODS Data from a nationwide epidemiological survey conducted on residents from randomly selected districts in Taiwan in 2007 were used for this cross-sectional population-based study. A total of 4,197 participants were included in this study. Insomnia symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), were assessed using the Insomnia Self-Assessment Inventory questionnaire. Subjects were divided into 3 groups based upon their reported sleep duration (< 7, 7-8, and ≥ 9 h per night). Odds ratios (ORs) and 95% confidence intervals (CIs) derived from multivariable logistic regression were used to evaluate the study aims. RESULTS The endorsement of DIS and DMS were cross-sectionally associated with the MetS after adjustment for sleep duration (OR [95% CI] was 1.24 [1.01-1.51] and 1.28 [1.02-1.61], respectively). In addition, short sleep duration was significantly associated with the prevalence of MetS independent of insomnia symptoms (OR [95% CI] was 1.54 [1.05-2.47]). However, there was no significant combined effect of insomnia symptoms and sleep duration on the prevalence of MetS. CONCLUSIONS The current investigation shows that short sleep duration and insomnia symptoms, specifically DIS and DMS, were significant correlates of MetS. These findings should be replicated in prospective studies using both sleep duration and sleep quality measures.

Impact of metabolic syndrome components on incident stroke subtypes: a Chinese cohort study.

Limited evidence is available on the risk differences in the development of stroke subtypes in relation to particular clustering patterns of the metabolic syndrome (MetS) components. A follow-up study of a Chinese cohort involving 10 292 individuals was performed to assess the roles of cluster patterns of the MetS components in the prediction of incident stroke subtypes. During follow-up, there were 161 incident cases of ischemic strokes and 41 incident cases of hemorrhagic strokes. Among MetS components, only the hypertensive trait was associated with significantly elevated risks of both ischemic and hemorrhagic strokes. Furthermore, MetS with hypertension as components was associated with increased risk of ischemic and hemorrhagic strokes (adjusted hazards ratio (95% confidence interval) was 2.96 (1.94–4.50) and 2.93 (1.25–6.90), respectively) as compared with those who had neither hypertension nor MetS. Notably, as the number of the MetS components increased, the risk of ischemic stroke significantly and dose-dependently increased. This implies a cumulative effect of MetS components in elevating the risk of ischemic stroke. These findings suggest that MetS comprises heterogenous clusters with respect to the risk of developing the subtype of stroke.