Yi-Chen Huang

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.

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).

Vitamin D Decreases Risk of Breast Cancer in Premenopausal Women of Normal Weight in Subtropical Taiwan

Background Evidence for an association between vitamin D status and breast cancer is now more convincing, but is uncertain in subtropical areas like Taiwan. This hospital-based case-control study examined the relationship of breast cancer with vitamin D intake and sunlight exposure. Methods A total of 200 incident breast cancer cases in a Taipei hospital were matched with 200 controls by date of interview and menopausal status. Information on risk factors for breast cancer was collected in face-to-face interviews and assessed with reference to vitamin D intake (foods and nutrients) and sunlight exposure. Vitamin D intake was divided into quartiles, and threshold effect was evaluated by comparing Q2–Q4 with Q1. Results After controlling for age, education, parity, hormone replacement therapy, body mass index (BMI), energy intake, menopausal status, and daily sunlight exposure, the risk of breast cancer in participants with a dietary vitamin D intake greater than 5 µg per day was significantly lower (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.24–0.97) than that of participants with an intake less than 2 µg per day. In analysis stratified by menopausal status and BMI, both dietary vitamin D and total vitamin D intakes were associated with a protective effect among premenopausal women. There was a significant linear trend for breast cancer risk and dietary vitamin D intake in premenopausal women (P = 0.02). In participants with a BMI lower than 24 kg/m2 (ie, normal weight), dietary vitamin D intake was inversely related to breast cancer risk (P for trend = 0.002), and a threshold effect was apparent (Q2–Q4 vs Q1: OR, 0.46; 95% CI, 0.23–0.90). Conclusions Vitamin D had a protective effect against breast cancer in premenopausal women of normal weight in subtropical Taiwan, especially an intake greater than 5 µg per day.

Physical function mitigates the adverse effects of being thin On mortality in a free-living older Taiwanese cohort

ObjectivesTo examine the significance of underweight and physical function as well as their interaction on mortality in the aged.DesignProspective cohort.SettingThe Elderly Nutrition and Health Survey in Taiwan during 1999–2000.ParticipantsTotal of 1435 representative free-living elders (739 men and 696 women).MeasurementsBody composition was assessed by various anthropometrics. Physical function score (PF, ranged 0–100) was derived from the SF-36®. Death by December 31, 2006 was the outcome measure.ResultsAfter 7.9 (median: 7.0) years follow-up, 381 (223 men, 158 women) of 1435 eligible participants had died. Those with the lowest PF (<45) had 3.43 (hazards ratio (HR), 95% confidence interval (CI) = 2.20–5.36) times the all-cause mortality risk of the highest PF (≥58). Interactions for PF and BMI (P =0.02) and for PF and wrist circumference (P =0.09) on death were found after controlling for potential confounders. Jointly, compared to normal-BMI-highest-PF, the greatest HR for death occurred where BMI <18.5 kg/m2 was combined with the lowest-PF after covariate adjustments (HR = 8.67, 95% CI = 3.77–20.0). Similarly, the lowest arm muscle circumference (MAMC)-PF had a HR of 5.22 compared to mid-MAMC-highest-PF. However, percent and absolute body fat, estimated by bioelectrical impedance, was comparable to non-sarcopenic individuals.ConclusionThin elderly Taiwanese with sarcopenia, and less skeleton, are at the most risk of death, especially if physical function is limited.

Prediction of all-cause mortality by B group vitamin status in the elderly

BACKGROUND & AIMS Little is known about the direct relationship of B vitamins to mortality in the elderly. All-cause mortality by vitamin B status, using dietary (B-1, B-2, niacin, B-6) or biochemical data (erythrocyte transketolase reductase, erythrocyte glutathione reductase, plasma pyridoxal-phosphate, folate and serum B-12) was evaluated. METHODS The Taiwanese Elderly Nutrition and Health Survey (1999-2000) provided 1747 participants 65 years and over. Dietary and biochemical data were collected at baseline. Survivorship was determined until December 31, 2008. RESULTS Survivors had higher vitamin B-1 and niacin intakes and pyridoxal-phosphate and folate concentrations. Controlled for confounders, and relative to the lowest tertile of vitamin B-1 or B-6 intakes, the hazard ratios (95% confidence interval) for tertile 3 were 0.74 (0.58-0.95) and 0.74 (0.57-0.97); both p for trend values were <0.05. Further adjustment for dietary diversity led to insignificant findings. For pyridoxal-phosphate, compared to those with deficiency levels, the multivariable-adjusted hazard ratios (95% confidence interval) for adequacy was 0.52 (0.38-0.71) with p for trend <0.0001 and unchanged with dietary diversity adjustment. CONCLUSIONS Higher vitamin B-1 and B-6 intakes and plasma pyridoxal-phosphate were associated with lower risk of mortality up to 10 years and could be achieved by increased dietary diversity.

Optimal Dairy Intake Is Predicated on Total, Cardiovascular, and Stroke Mortalities in a Taiwanese Cohort

Objective: Dairy foods help achieve essential nutrient adequacy. This role may be conflicted where so-called chronic diseases prevail. We have examined associations between dairy intake and mortality where dairy foods have not been traditional. Methods: A representative Taiwanese cohort of 3810 subjects, aged 19–64 years, derived from the Nutrition and Health Survey in Taiwan (NAHSIT, 1993–1996) was linked to death registration (1993–2008). Participants were categorized by 4 dairy weekly intake frequencies from 0 to >7 times. Mortality hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional-hazards models. Results: Nonconsumers of dairy products included 30.7% of the men and 22.1% of the women. Adverse sociodemographic and personal behaviors were generally significantly associated with lower dairy consumption. After adjustment for covariates, together with body mass index (BMI) and supplement use, those with 3–7 times/week intakes had an HR (95% CI) for all-cause mortality of 0.61 (0.39–0.96) with a significant dose–response trend (p = 0.043). Similarly, the HR for cardiovascular disease (CVD) mortality with dairy weekly intake frequency >7 was 0.14 (0.02–0.97) with a significant linear trend (p = 0.007). For stroke, the corresponding HR (95% CI) was 0.03 (0.00–0.28) with a linear trend. By age and with adjustment for dietary quality, food, and calcium or vitamin D intake, significance and dose–response relationships remained. Dairy intake and cancer mortality were not associated. Conclusion: In a Chinese food culture, a dairy foods intake in adults up to 7 times a week does not increase mortality and may have favorable effects on stroke.

Low and high homocysteine are associated with mortality independent of B group vitamins but interactive with cognitive status in a free-living elderly cohort

Hyperhomocysteinemia and cognitive impairment both predict mortality and partly because of dietary associations. We have hypothesized that for, nutritional reasons, homocysteine and cognition may act jointly to determine elder survival. In a Nutrition and Health Survey in Taiwan (1999-2000), some 1412 representative elderly were followed up for mortality up to 10 years. Cognition was assessed by the Short Portable Mental Status Questionnaire. Food and B vitamin intakes with their biomarkers, and plasma homocysteine, were measured at baseline. The possible effects of cognition on homocysteine-associated mortality were ascertained with Cox proportional-hazards models. Homocysteine was higher in those who were older, male, and single, consumed less fish and tea, and with alcohol and smoking. In models adjusted for these variables, when homocysteine exceeded 14.5 μmol/L, mortality was 1.80-fold more than when <9.3 μmol/L (hazard ratio [HR], 1.80; 95% confidence interval [95% CI], 1.20-2.71). P for trend was 0.002 and interactive with sex (P < .002). However, these homocysteine-mortality associations were dependent on cognition (P = .03); adjustment for food intake or nutrient status made little difference. Homocysteine did not predict cognitive impairment (adjusted OR, 1.40; 95% CI = 0.50-3.93). Vitamins B(1), B(2), and B(6) accounted somewhat for cognitive impairment. Cognition predicted mortality, fully adjusted for available covariates and also for homocysteine (HR, 3.66; 95% CI, 1.64-8.20) but interactively with homocysteine. Thus, the B-group vitamin insufficiency and cognitive impairment associations with premature mortality are confirmed. Yet cognition is inter-related with homocysteine in its association with survival in ways not detectably altered by foods or food-derived vitamins.

Optimal Dietary and Plasma Magnesium Statuses Depend on Dietary Quality for a Reduction in the Risk of All-Cause Mortality in Older Adults

The association between dietary or plasma magnesium (Mg) with diabetes incidence and with mortality in free-living elderly was investigated. A total of 1400 participants from the Taiwanese Nutrition Survey, aged ≥ 65 years, and diabetes-free from the 1999–2000 were assessed. The dietary intake and plasma Mg concentration were obtained through 24h dietary recall and health examination at baseline. Participants were classified by quartiles (Q) of dietary Mg or by the plasma Mg normal range (0.75–0.95 mmol/L). Dietary diversity score (DDS, range 1–6) represented the dietary quality. During 8 and 10 years, 231 incident diabetes cases and 475 deaths were identified. Cox’s proportional-hazards regression was used to evaluate the association between Mg and health outcomes. The hazard ratios (95% confidence interval) for death in Q2 and Q3 of Mg intakes with DDS > 4 were 0.57 (0.44–0.74) and 0.59 (0.39–0.88), respectively, compared with the lowest intake and DDS ≤ 4 participants. Participants with normal and high plasma Mg in conjunction with high DDS had relative risks of 0.58 (0.37–0.89) and 0.46 (0.25–0.85) in mortality compared with low plasma Mg and lower DDS. Optimal dietary Mg intake and plasma Mg depend on dietary quality to reduce the mortality risk in older adults.

Breakfast is associated with the metabolic syndrome and school performance among Taiwanese children.

Skipping breakfast is associated with adverse child health profiles including obesity, higher blood pressure, higher serum cholesterol, and poor cognitive function. We aimed to explore the association between breakfast with school performance and the metabolic syndrome (MetS) in Taiwanese children. Participants were enrolled from the representative Elementary School Childrens Nutrition and Health Survey in Taiwan (2001-2002). Diet, waist circumference, blood pressure, blood glucose, triglyceride, and high-density lipoprotein cholesterol concentrations were assessed in 1287 boys and 1114 girls. Their school and social performances were examined using the modified Scale for Assessing Emotional Disturbance questionnaire. Logistic and linear regression analyses were used to estimate the risk of MetS and also the association between breakfast consumption frequency and school or social performance. When breakfast consumption was regular, overall dietary quality was better. Children who consumed breakfast daily exhibited lower risks of high blood pressure (OR=0.37, 95% CI=0.19-0.71) and of MetS (OR=0.22, 95% CI=0.09-0.51) compared with children who consumed breakfast 0-4 times per week. Furthermore, children who consumed breakfast daily exhibited a higher overall competence (OC) score (β=0.71, p<0.05) in a dose-response manner (p for trend=0.02). This association was not dependent on overall diet or MetS. In conclusion, consuming breakfast daily is associated with better school performance, a lower risk of high blood pressure, and MetS independent of overall dietary quality. Thus, breakfast on school days is a factor in school performance and health.

Sleep Quality in the Survival of Elderly Taiwanese: Roles for Dietary Diversity and Pyridoxine in Men and Women

Objectives: The purpose of this study was to investigate dietary contributors to relationships between sleep and all-cause mortality among elderly men and women using a prospective cohort study. Setting: The representative Nutrition and Health Survey in Taiwan (NAHSIT) for elders during 1999–2000. Subjects: One thousand eight hundred sixty-five individuals aged ≥65 years from NAHSIT (942 men and 923 women). Measures of Outcome: Dietary diversity scores (DDS) were from 24-hour dietary recalls. Participants were examined and fasting blood was taken. Sleep quality was assessed by questionnaire and classified as poor, fair, or good. Death registry linkage was made until December 31, 2008. Results: For women, poor sleepers had significantly lower vegetable and vitamin B-6 intakes compared to good sleepers (p < 0.05). For men, good and fair sleepers had a lower risk of death compared to poor sleepers after adjustment with hazards ratios (HRs) and 95% confidence intervals (CIs) of 0.60 (0.42–0.87) and 0.55 (0.36–0.86). The joint HRs for “DDS > 4 and good sleep” were 0.38 (0.22–0.66) for men and 0.52 (0.30–0.88) for women compared to “DDS ≤ 4 and poor sleep.” The joint HRs for “plasma pyridoxal phosphate (PLP) adequate and fair sleep” were 0.27 (0.11–0.65) and 0.49 (0.23–1.07) compared to “insufficient and poor sleep” for men and women; for women, PLP adequacy provided significantly reduced HRs for good and poor sleep. Conclusions: Sleep quality played a more important role in mortality for men than for women. Sufficient dietary diversity in men could offset the adverse effect on mortality of poor sleep. In women, PLP predicts mortality more than sleep does.