Meei-Shyuan Lee

Type 2 diabetes increases and metformin reduces total, colorectal, liver and pancreatic cancer incidences in Taiwanese: a representative population prospective cohort study of 800,000 individuals

BackgroundMetformin protection against cancer risk in Orientals is uncertain. We examined the possible metformin effect on total, esophageal, gastric, colorectal (CRC), hepatocellular (HCC) and pancreatic cancers in a Taiwanese cohort.MethodsA representative sample of 800,000 was drawn from the Taiwanese National Health Insurance data of 2000. A cohort of 480,984 participants 20 years or older, diabetes-cancer-free on 1st January 2000 was formed and categorized as four groups by DM and metformin usage status. Eligible incident cancer events had to occur one year after the index date until the end of 2007. The Cox proportional-hazards model evaluated relative risk of cancer for treated DM patients with or without metformin. The covariates included age, gender, other oral anti-hyperglycemic medication, Charlson comorbidity index (CCI) score and metformin exposure dosage and duration.ResultsWith diabetes but no anti-hyperglycemic medication, cancer incidence density increased at least 2-fold for total, CRC and HCC. On metformin, total, CRC and HCC incidences decreased to near non-diabetic levels but to varying degrees depending on gender and cancer type (CRC in women, liver in men). Adjustment for other oral anti-hyperglycemic agents usage and CCI made the benefit of metformin more evident [hazard ratios (95% confidence intervals): total 0.12 (0.08-0.19), CRC 0.36 (0.13-0.98), liver 0.06 (0.02-0.16), pancreas 0.15 (0.03-0.79)]. There was a significant gender interaction with metformin in CRC which favored women. Metformin dosage for a significant decrease in cancer incidence was ≤500 mg/day.ConclusionsMetformin can reduce the incidences of several gastroenterological cancers in treated diabetes.

Incidence of Dementia is Increased in Type 2 Diabetes and Reduced by the Use of Sulfonylureas and Metformin

To determine incidence of dementia in type 2 diabetic (T2DM) patients, and whether there are adverse or favorable effects of oral agents (OA) in DM, we obtained a representative cohort of 800,000 from Taiwan’s National Health Insurance database. Those who, as of on January 1, 2000, were 50 years or older and dementia free (n = 127,209) were followed until December 31, 2007, in relation to absence (n = 101,816) or presence (n = 25,393) of T2DM, and whether any OA was used. Dementia was ascertained by ICD9-CM or A-code. Dementia incidence densities (DID) and fully adjusted Cox proportional hazard models were used to estimate association between dementia, DM, and OA. Notably, DID (per 10,000 person-years)was markedly increased with DM (without medication), compared to DM free subjects (119 versus 46). Using non-DM as reference, the adjusted hazard ratios (HRs) (95% confidence interval) for DM without and with OA were 2.41 (2.17–2.66) and 1.62 (1.49–1.77), respectively. For T2DM, compared with no medication, sulfonylureas alone reduced the HR from 1 to 0.85 (0.71–1.01), metformin alone to 0.76 (0.58–0.98), while with combined oral therapy the HR was 0.65 (0.56–0.74). Adjustments included cerebrovascular diseases so that non-stroke related dementias were found to be decreased in DM with sulfonylurea and metformin therapy. T2DM increases the risk of dementia more than 2-fold. On the other hand, sulfonylureas may decrease the risk of dementia, as does metformin; together, these 2 OAs decrease the risk of dementia in T2DM patients by 35% over 8 years.

Obesity pandemic, correlated factors and guidelines to define, screen and manage obesity in Taiwan.

The prevalence of obesity and associated chronic diseases has increased rapidly in Taiwan. Data from three consecutive Nutrition and Health surveys in Taiwan show that obesity prevalence has tripled for elementary school boys and doubled for girls since 1993–1996. About one‐third of boys (15.5% and 14.7% for overweight and obesity, respectively) and one‐quarter of girls were either overweight (14.4%) or obese (9.1%) in 2001–2002. For adults, obesity prevalence rates defined by body mass index ≥27 kg m−2 increased from 10.5% in men and 13.2% in women in the 1993–1996 survey, to around 17% in 2005. Prevalence of overweight was around 20% in 1993–1996 for both men or women, and increased to 30% in 2005 for men. No change was found in women. The underprivileged regions usually had higher prevalence of obesity and associated diseases. Scientific bases for Taiwan obesity definition are set out together with the screening and management plans. High‐calorie intake was associated with obesity in young children (grades 1–2), but not in older children and adults. Physical inactivity and sedentary lifestyle‐related variables were associated with obesity in men and older boys. In addition, good dietary quality was associated with a lower risk of obesity independent of energy intake in elderly Taiwanese. More research is needed to find effective determinants and public health measures for obesity, and concerted efforts are required to combat this rising health problem.

Cooking frequency may enhance survival in Taiwanese elderly

OBJECTIVE To investigate the association between cooking behaviour and long-term survival among elderly Taiwanese. DESIGN Cohort study. The duration of follow-up was the interval between the date of interview and the date of death or 31 December 2008, when censored for survivors. Information used included demographics, socio-economic status, health behaviours, cooking frequencies, physical function, cognitive function, nutrition knowledge awareness, eating out habits and food and nutrient intakes. These data were linked to death records. Cox proportional-hazards models were used to evaluate cooking frequency on death from 1999 to 2008 with related covariate adjustments. SETTING Elderly Nutrition and Health Survey in Taiwan, 1999-2000. SUBJECTS Nationally representative free-living elderly people aged ≥65 years (n 1888). RESULTS During a 10-year follow-up, 695 participants died. Those who cooked most frequently were younger, women, unmarried, less educated, non-drinkers of alcohol, non-smokers, without chewing difficulty, had spouse as dinner companion, normal cognition, who walked or shopped more than twice weekly, who ate less meat and more vegetables. Highly frequent cooking (>5 times/week, compared with never) predicted survival (hazard ratio (HR) = 0·47; 95 % CI, 0·36, 0·61); with adjustment for physical function, cognitive function, nutrition knowledge awareness and other covariates, HR was 0·59 (95 % CI, 0·41, 0·86). Women benefited more from cooking more frequently than did men, with decreased HR, 51 % v. 24 %, when most was compared with least. A 2-year delay in the assessment of survivorship led to similar findings. CONCLUSIONS Cooking behaviour favourably predicts survivorship. Highly frequent cooking may favour women more than men.

Effect on postoperative sore throat of spraying the endotracheal tube cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine.

BACKGROUND:Postoperative sore throat (POST) is a common complication after endotracheal intubation. We compared the effectiveness on POST of spraying the endotracheal tube (ETT) cuff with benzydamine hydrochloride, 10% lidocaine, and 2% lidocaine. METHODS:Three hundred seventy-two patients were randomly allocated into 4 groups. The ETT cuffs in each group were sprayed with benzydamine hydrochloride, 10% lidocaine hydrochloride, 2% lidocaine hydrochloride, or normal saline before endotracheal intubation. After insertion, the cuffs were inflated to an airway leak pressure of 20 cm H2O. Anesthesia was maintained with propofol. The patients were examined for sore throat (none, mild, moderate, or severe) at 1, 6, 12, and 24 hours after extubation. RESULTS:The highest incidence of POST occurred at 6 hours after extubation in all groups. There was a significantly lower incidence of POST in the benzydamine group than 10% lidocaine, 2% lidocaine, and normal saline groups (P < 0.05) at each observation time point. At 6 hours after extubation, the incidence of POST was significantly lower in the benzydamine group (17.0%) compared with 10% lidocaine (53.7%), 2% lidocaine (37.0%), and normal saline (40.8%) groups (P < 0.05). The benzydamine group had significantly decreased severity of POST compared with the 10% lidocaine, 2% lidocaine, and normal saline groups (P < 0.05) at each observation time point. Compared with the 2% lidocaine and normal saline groups, the 10% lidocaine group had significantly increased severity of POST at 1, 6, and 12 hours after extubation. There were no significant differences among groups in local or systemic side effects. CONCLUSIONS:Spraying benzydamine hydrochloride on the ETT cuff is a simple and effective method to reduce the incidence and severity of POST.

Dietary diversity and food expenditure as indicators of food security in older Taiwanese

Food quality is a measure of food security in vulnerable groups. The elderly are often nutritionally vulnerable, but how much of this is reflected in food quality and determined by financial status is unclear. We determined whether expenditure on dietary quality challenges food security in the aged. We used the representative Elderly Nutrition and Health Survey in Taiwan during 1999-2000 (n=1783), and evaluated dietary quality by a Dietary Diversity Score (DDS, range: 0-6) based on a 24-h dietary recall. Monthly mean national food prices were used to estimate food expenditure. In general, it was found to cost more to achieve a greater DDS. The food expenditure of subjects whose DDS=6 was 2.20 times greater than the DDS ≤3 group, after controlling for covariates. Elders of lower socioeconomic status tended to choose foods which would have cost less. However, a sub-group of elders who achieve the highest DDS with limited money offer approaches to food-money management. Nutrition policy directed to food insecure groups, like the aged, could employ health promotion strategies which reduce financial barriers to healthy eating.

Fast-food outlets and walkability in school neighbourhoods predict fatness in boys and height in girls: a Taiwanese population study.

OBJECTIVE There is increasing evidence that the school food environment contributes to childhood obesity and health in various locations. We investigated the influence of fast-food stores and convenience food stores (FS and CS, respectively) on growth and body composition in a range of residential densities for North-east Asian food culture. DESIGN Anthropometrics and birth weight of schoolchildren were obtained. Geocoded mapping of schools and food outlets was conducted. Multivariable linear regression models, adjusted for fathers ethnicity and education, as well as for household income, pocket money, birth weight, physical activity, television watching, food quality and region, were used to predict body composition from school food environments. SETTING Elementary schools and school neighbourhoods in 359 townships/districts of Taiwan. SUBJECTS A total of 2283 schoolchildren aged 6-13 years from the Elementary School Childrens Nutrition and Health Survey in Taiwan conducted in 2001-2002. RESULTS Remote and socially disadvantaged locations had the highest prevalence of lower weight, BMI, waist circumference and triceps skinfold thickness. Food store densities, FS and CS, were highest in urban Taiwan and lowest in remote Taiwan. In the fully adjusted models, FS densities predicted weight and BMI in boys; there was a similar association for waist circumference, except when adjusted for region. FS densities also predicted height for girls. Except for weight and BMI in boys, CS did not have effects evident with FS for either boys or girls. CONCLUSIONS A high FS density, more than CS density, in Taiwan increased the risk of general (BMI) and abdominal (waist circumference) obesity in boys and stature in girls. These findings have long-term implications for chronic disease in adulthood.

Chewing Ability in Conjunction with Food Intake and Energy Status in Later Life Affects Survival in Taiwanese with the Metabolic Syndrome

OBJECTIVES: To examine chewing ability and survival in older adults after 8 years of follow‐up and consider any interaction with the metabolic syndrome (MetS).

The Effectiveness of Benzydamine Hydrochloride Spraying on the Endotracheal Tube Cuff or Oral Mucosa for Postoperative Sore Throat

BACKGROUND:The etiology of postoperative sore throat (POST) is considered to be the result of laryngoscopy, intubation damage, or inflated cuff compression of the tracheal mucosa. In this study, we compared the effectiveness in alleviating POST using different approaches to benzydamine hydrochloride (BH) administration by spraying the endotracheal tube (ET) cuff or the oropharyngeal cavity, or both. METHODS:Three hundred eighty patients were included in this prospective and double-blind study, which was randomized into 4 groups: group A, oropharyngeal cavity spray of BH, and distilled water on the ET cuff; group B, both the oropharyngeal cavity and the ET cuff received BH spray; group C, the ET cuff received BH spray, and the oropharyngeal cavity received distilled water; and group D, distilled water sprayed on both the ET tube and into the oropharyngeal cavity. The patients were examined for sore throat (none, mild, moderate, severe) at 0, 2, 4, and 24 hours postextubation. RESULTS:The incidence of POST was 23.2%, 13.8%, 14.7%, and 40.4% in groups A, B, C, and D, respectively. POST occurred significantly less frequently in groups B and C compared with group D (odds ratio: 0.36; 95% confidence interval: 0.21–0.60; P < 0.05). However, there was no significant difference between groups A and D (odds ratio: 0.62; 95% confidence interval: 0.38–1.01). Moreover, there was no significant interaction between spraying BH over the oropharyngeal cavity and the ET cuff on the incidence of POST (P = 0.088). The severity of POST was significantly more intense in group D compared with groups B and C (P < 0.001). Group B had a significantly higher incidence of local numbness, burning, and/or stinging sensation compared with patients in group D (P < 0.05). CONCLUSIONS:This study indicates that spraying BH on the ET cuff decreases the incidence and severity of POST without increased BH-related adverse effects.

Increased risk of affective disorders in type 2 diabetes is minimized by sulfonylurea and metformin combination: a population-based cohort study

BackgroundTo confirm whether type 2 diabetes (T2DM) is an affective disorder (AD) precursor, and to establish possible effects of oral anti-hyperglycemic agents (OAAs).MethodsA representative cohort of 800,000 subjects was obtained from the Taiwanese National Health Insurance database on 1 January 2000. Those with consistent data (n = 762,753) were followed up between 1 January 1996 and 31 December 2007. Over this period, we assessed the presence (n = 62,988) or absence (n = 699,795) of T2DM, and whether any OAA was used (n = 40,232) or not (n = 22,756). To compare the risk of AD by diabetic status, those with T2DM were matched for birth date and gender with those without T2DM. To assess the effect of OAAs, we considered those 50 years and over. Matched AD-free patients with T2DM on OAAs were compared with those without OAAs, for age, gender, locality, health service, Charlson Comorbidity Index. and diabetes diagnosis date to avoid immortal time bias. AD incidence densities, hazard ratios (HR) and 95% confidence intervals (CIs) were calculated.ResultsCompared with diabetes-free subjects, the HR (95% CI) for AD was 2.62 (2.31 to 2.98) for patients with T2DM who were not on OAAs, and 1.08 (0.99 to 1.18) for those who were on OAAs. The AD incidence density decreased from 91.1 to 39.4 per 10,000 person-years for patients on the combination of metformin and sulfonylurea. The HR (95% CI) for AD was 0.92 (0.59 to 1.45) for those on metformin alone, 1.08 (0.84 to 1.38) for those on sulfonylurea alone, and 0.40 (0.32 to 0.50) for the combined treatment, and the decrease was not related to sequence or insulin usage. Similar patterns were seen for incident AD exclusion for up to 3 years, although more so for bipolar than unipolar.ConclusionsThe incident AD risk is increased by 2.6-fold in T2DM, and the combination of sulfonylurea and metformin minimizes this risk.