Yi Ching Yang

Diseases Caused by Enterovirus 71 Infection

The purpose of this review was to explore the epidemiology, pathogenesis, virology, and management of enterovirus 71 (EV71) infection. Published literature was surveyed by Medline using the keyword “EV71.” The reported incidence of cases of hand-foot-mouth disease/herpangina varied from year to year; seasonal variations in incidence were observed, with a peak in incidence during the summer season. Most cases of hand-foot-mouth disease/herpangina hospitalized for complications occurred in children less than 5 years old. The brainstem was the most likely major target of EV71 infection. Different enteroviruses cocirculate in the community annually. The emergence of the EV71 epidemic in the Asia Pacific region has been associated with the circulation of 5 genetic lineages (genotypes B3, B4, C1, C2, C4) that appear to be undergoing rapid evolutionary changes. The relationship between the gene structure of the EV71 virus and the factors that ensure its survival, ease of transmission, and evasion of immunity is still unclear. EV71 central nervous system involvement causes serious clinical illness, death, and long-term neurologic and psychiatric disorders in young children. EV71 infection has emerged as an important public health problem. Vaccine development is recommended for the prevention of EV71 infection in the future.

A Population-based Study of the Prevalence and Associated Factors of Diabetes Mellitus in Southern Taiwan

Diabetes mellitus is one of the major health care problems in Taiwan, since the mortality rate has increased from 7.91 per 100 000 in 1980 to 35.1 per 100 000 in 1996. To determine the prevalence of diabetes in southern Taiwan and to investigate possible associated factors, a stratified systematic cluster sampling of 1638 subjects (780 men and 858 women) aged ≥20 years living in Tainan city was investigated with a standard 75‐g oral glucose tolerance test. The crude prevalence of diabetes in Tainan was 9.0 % (10.3 % men and 7.9 % women) and the age‐adjusted prevalence was 9.2 % (10.4 % men and 8.1 % women). The crude prevalence of IGT was 14.0 % (13.8 % men and 14.1 % women), and the age‐adjusted prevalence was 15.5 % (15.0 % men and 15.9 % women). The prevalence of diabetes by using the revised new diagnostic criteria was 7.5%. The prevalence of diabetes and IGT increased significantly with age for both genders, although the rises in prevalence of IGT in women was less consistent. Diabetic and IGT subjects were older and had higher levels of BMI, triglyceride, systolic and diastolic blood pressure, and higher prevalence of obesity, hypertension, and dyslipidemia but indulged in less physical activity than non‐diabetic subjects. The significant factors associated with the newly diagnosed diabetes were age, family history of DM, BMI, systolic blood pressure, physical activity, and serum triglyceride levels.

Epidemiologic study of type 2 diabetes in Taiwan

Diabetes mellitus (DM) in adults is a global health problem, although its prevalence varies widely between different populations and the rate has generally increased worldwide. In Taiwan, the mortality rate from DM has almost doubled over the past 10 years. The prevalence of DM in Taiwan was established between 1985 and 1996 and the rates were between 4.9 and 9.2%. The prevalence of impaired glucose tolerance (IGT) was 15.5% (men 15% and women 15.9%). The prevalence of DM and IGT increased significantly with age for both genders. The significant factors associated with newly diagnosed DM were age, BMI, family history of DM, systolic blood pressure (hypertension), physical activity and serum triglyceride levels. The prevalence of large vessel disease (LVD) in DM and non-diabetic subjects were 20.0 and 12.9%, respectively. Among diabetics, 15.8% had ischemic heart disease (IHD), 1.7% leg vessel disease (leg VD), and 2.5% stroke. In non-diabetics, the prevalence of the aforementioned macroangiopathies were 11.5, 0.2 and 1.2%, respectively. The diabetics had a significantly higher prevalence of macrovascular disease than non-diabetic subjects. The most significantly associated with the LVD was serum cholesterol levels. Serum cholesterol and HbA1(c) were significantly associated with the development of IHD. Cigarette smoking and female gender were significantly associated with the leg VD. The prevalence of diabetic retinopathy (DR) was 35.0%. (background DR 30%, preproliferative DR 2.8% and proliferative DR 2.2%, respectively.) The prevalence of DR for previously and newly diagnosed diabetics were 45.2 and 28.3% (men 42.8 vs. 33.3% and women 47.5 vs. 24.8%), respectively. From multiple logistic regression analysis, duration of DM was the most important risk factor related to DR. Diabetic subjects treated with insulin had a higher risk of developing retinopathy than those treated with dietary control. The prevalence of nephropathy and neuropathy were 12.9 and 23.5%, respectively. For those patients with and those without nephropathy and neuropathy, the duration of DM, percentage of insulin treatment, percentage of hypertension, and fasting plasma glucose were significantly different. Diabetic duration, hypertension, insulin treatment and glycemic control consistently correlated with nephropathy and neuropathy. In conclusion, the prevalence of DM in Taiwan was between 4.9 and 9.2%, and the prevalence of IGT was 15.5%. The possible risk factors of newly diagnosed diabetes were age, family history of DM, BMI, SBP (hypertension), physical activity and triglyceride levels. Diabetes in Chinese subjects share many characteristics similar to other Asian populations. The burden imposed by the chronic complications of diabetes is massive. In Taiwan, the mortality rates from DM have increased greatly over the past 10 years. Reduction of the modificable risk factors such as BMI, hypertenion and dyslipidemia, and increase of physical activity and good glycemic control through public health efforts may help to reduce the risk of DM and its chronic complications.

A study on the sleep quality of incoming university students.

This study was designed to examine the prevalence and the risk factors of poor sleep quality in 4318 incoming university students in Taiwan. The test battery comprised a self-administered structured questionnaire, including items related to personal medical history and lifestyle habits, the Measurement of Support Functions (MSF), Pittsburgh Sleep Quality Index (PSQI), Chinese Internet Addiction Scale-Revision (CIAS-R), neuroticism subscale of the Maudsley Personality Inventory (MPI), and the 12-item Chinese Health Questionnaire (CHQ-12). Of the total study population, 2360 students (54.7%) were classified into the poor sleep quality group, as defined by a PSQI score ≥6. Based on the results of multivariate logistic regression analysis, poor sleep quality was significantly associated with undergraduate students, female gender, skipping breakfast, tea drinking, a higher tendency toward internet addition, poor social support, higher neuroticism, and higher CHQ scores. Poor sleep quality is prevalent among incoming university students in Taiwan, and more work is needed on the identification of the factors influencing poor sleep, and in providing systematic education in the importance of sleep and time management skills to university students.

Relationships of age, menopause and central obesity on cardiovascular disease risk factors in Chinese women.

OBJECTIVE: To evaluate the inter-relationships of age- and menopause- related changes of general obesity and body fat distribution and their independent effects on cardiovascular risk factors.DESIGN: Cross-sectional study.SUBJECTS: One-hundred and thirty-six premenopausal and 193 postmenopausal Chinese women with body mass index (BMI)<30 kg/m2.MEASUREMENTS: Anthropometric surrogates of general obesity (BMI, total body fat percentage) and central obesity (waist-to-hip ratio, centrality index) were measured. Blood pressure, 75 g oral glucose tolerance test, glycosylated hemoglobin A1c and lipid profiles were also measured.RESULTS: Significant correlation coefficients between age, general obesity, central obesity and cardiovascular disease risk factors were noted. Through the menopausal transition, the BMI and total body fat percentage were increased significantly. After adjustments for age and BMI, the postmenopausal women showed higher android fat percentage, centrality index, glycosylated hemoglobin A1c, serum concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol and atherogenic indices than the premenopausal women. In multiple stepwise regression models, age exerted independent effects on oral glucose tolerance test 2 h plasma glucose level, systolic and diastolic blood pressure, total cholesterol level, and LDL cholesterol. Menopause was an independent variable in relation to the changes of glycosylated hemoglobin A1c, total and LDL cholesterol levels, triglyceride levels and atherogenic indices. The centrality index was the major independent variable of all the cardiovascular disease risk factors, except total and LDL cholesterol level. However, the variation of total body fat percentage had no independent effect on any cardiovascular disease risk factors.CONCLUSION: Through the aging and menopausal effects, women will increase total body fat content, favoring the central body fat distribution. Age, menopause and central obesity were all independent and significant factors to the cardiovascular disease risk factors in Chinese women.

Sleep duration is a potential risk factor for newly diagnosed type 2 diabetes mellitus

U-shaped patterns have been observed for the relationship between sleep duration and diabetes. In addition, prediabetes is associated with the risk of cardiovascular diseases and diabetes. However, there are few studies investigating the relationship between sleep duration and prediabetes/newly diagnosed diabetes. The aim of this study is to examine the relationship between sleep duration and prediabetes/newly diagnosed diabetes in a Taiwanese population. After excluding the subjects with a high risk of obstructive sleep apnea, those with a positive history of diabetes, or those taking hypnotic drugs, a total of 3470 adults were recruited from a health checkup center. Each subject completed a self-administrated structured questionnaire on sleep duration and lifestyle factors. Prediabetes/diabetes was defined following the definition of the American Diabetes Association. Subjects with different sleep durations were classified into short (<6.0 hours), normal (6.0∼8.49 hours), and long sleepers (≥8.5 hours). The proportion of subjects with normal glucose tolerance, prediabetes, and newly diagnosed diabetes was 71.9%, 22.9%, and 5.2%, respectively. There were significant differences in age, sex, weight, education level, body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, alcohol and coffee drinking habits, family history of diabetes, and sleep duration among the 3 glycemic groups. In multinomial regression, both short and long sleepers had a higher risk of newly diagnosed diabetes; and the odds ratio were 1.55 (95% confidence interval, 1.07-2.24) and 2.83 (1.19-6.73), respectively. However, sleep duration was not found to relate to prediabetes. In conclusion, both short and long sleep durations were independently associated with newly diagnosed diabetes, but not with prediabetes.

Increased arterial stiffness in subjects with impaired glucose tolerance and newly diagnosed diabetes but not isolated impaired fasting glucose.

CONTEXT Studies have shown that diabetes mellitus increased brachial-ankle pulse-wave velocity (baPWV), but the impact of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) remains controversial. OBJECTIVE Our objective was to investigate the impact of the different glycemic states on baPWV in a relatively healthy Chinese population. DESIGN, SETTING, AND PATIENTS We enrolled 4938 subjects in the health examination center of the National Cheng Kung University Hospital from October 2006 to August 2009 after excluding those who were under medications for diabetes, hypertension, or hyperlipidemia or had a history of cardiovascular disease. MAIN OUTCOME MEASURES The baPWV values to assess arterial stiffness were calculated as the distance traveled by the pulse wave divided by the time taken to travel the distance. The participants were classified into normal glucose tolerance (NGT; n = 3777), isolated IFG (n = 221), IGT (n = 726), and newly diagnosed diabetes (NDD; n = 214) groups. RESULTS The mean values of baPWV were 1284.9 ± 205.2, 1379.6 ± 226.8, 1408.1 ± 251.7, and 1500.8 ± 282.5 cm/sec in NGT, isolated IFG, IGT, and NDD groups, respectively. The isolated IFG, IGT, and NDD groups had a higher baPWV value as compared with the NGT group. In a multiple linear regression test, both IGT and NDD groups, but not the isolated IFG group, had significantly higher baPWV values after adjustment for age, sex, body mass index, waist to hip ratio, smoking, alcohol consumption, habitual exercise, systolic blood pressure, and lipid profiles. CONCLUSIONS Subjects with IGT and NDD, but not isolated IFG, exhibit a greater arterial stiffness.

The Association between Nonalcoholic Fatty Pancreas Disease and Diabetes

Background Fatty infiltration of the pancreas has been shown to interfere with insulin secretion. Both insulin sensitivity and secretion are important in the pathogenesis of diabetes and prediabetes. However, the relationship between diabetes, prediabetes, and fatty pancreas remains unknown. We aim to investigate the relationships that fatty pancreas and nonalcoholic fatty liver disease (NAFLD) have with prediabetes and diabetes in a Chinese population. Patients and Methods This was a cross-sectional study. A total of 7,464 subjects were recruited. NAFLD and fatty pancreas were assessed by sonography. Clinico-metabolic parameters were compared among subjects with normoglycemia, prediabetes, and diabetes. Multinomial logistic regression was used to evaluate the relationship between fatty pancreas and NAFLD and diabetes or prediabetes with adjustment for cardiometabolic risk factors. Results With an increase in glycemia, a significantly greater proportion of subjects had NAFLD and fatty pancreas (test for trend p<0.05). Similar trends were also found for hypertension, general and central obesity, low-HDL cholesterol, and hypertriglyceridemia. In the logistic regression analysis, age, hypertension, male gender, hypertriglyceridemia, and central obesity were significantly associated with prediabetes and diabetes. Furthermore, the ORs of prediabetes and diabetes for NAFLD were 1.798 (95% CI 1.544–2.094) and 2.578 (95% CI 2.024–3.284), respectively. In addition, fatty pancreas was independently related to diabetes (OR, 1.379; 95% CI, 1.047–1.816) and prediabetes (OR, 1.222; 95% CI, 1.002–1.491) in male subjects. Conclusions Both NAFLD and fatty pancreas were associated with diabetes independent of age, gender, adiposity, and other cardiometabolic risk factors. Fatty pancreas was also related to prediabetes in males.

Endoplasmic Reticulum Stress Induces the Expression of Fetuin-A to Develop Insulin Resistance

Fetuin-A is a biomarker reported to be important in many metabolic disorders, including obesity, diabetes, and hepatic steatosis. Although it is well known that fetuin-A is increased in diabetes and nonalcoholic fatty liver disease (NAFLD), the levels of fetuin-A in diabetic patients with NAFLD are unknown. Furthermore, the regulation of fetuin-A expression is still obscure. In this study, a total of 180 age- and sex-matched subjects with normal glucose tolerance, NAFLD, newly diagnosed diabetes (NDD), and NDD with NAFLD were recruited. We found that the levels of fetuin-A were significantly increased in NDD with NAFLD as compared with NDD or NAFLD subjects. We further used HepG2 cells to investigate the regulation of fetuin-A. Treatment with endoplasmic reticulum (ER) stress activator, thapsigargin, increased the expression of fetuin-A mRNA and protein in a time- and dose-dependent manner. Pretreatment with ER stress inhibitor, 4-phenylbutyrate, reversed high glucose or palmitate-induced fetuin-A expression. Moreover, treatment with 4-phenylbutyrate in both streptozotocin-induced and high-fat diet-induced diabetic mice not only decreased hepatic fetuin-A levels but also improved hyperglycemia. Taken together, we found that fetuin-A levels were increased in diabetes patients with NAFLD. Moreover, ER stress induced by high glucose and palmitate increased the expression of fetuin-A and further contributed to the development of insulin resistance.

The association between self-reported sleep quality and overweight in a Chinese population.

Sleep quality and obesity are associated with type 2 diabetes, hypertension, and metabolic syndrome. However, there is limited research on the association between sleep quality and obesity, and thus the aim of this study is to investigate this relationship in a Chinese population.