Zih Jie Sun

Increased risk of glomerular hyperfiltration in subjects with impaired glucose tolerance and newly diagnosed diabetes

BACKGROUNDnGlomerular hyperfiltration is closely related to diabetes and may lead to subsequent nephropathy, but the association between glomerular hyperfiltration and prediabetic state is unclear. We examined the relationship of different glycemic statuses, including normal glucose tolerance (NGT), isolated impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and newly diagnosed diabetes (NDD), with glomerular hyperfiltration.nnnMETHODSnThis study included 12 833 subjects ≥20 years of age without a history of renal disease, cancer, moderate/severe anemia or diabetes and taking medications for hypertension, diabetes, hyperlipidemia or cardiovascular disease from National Cheng Kung University Hospital between January 2000 and August 2009. Hyperfiltration was defined as an estimated GFR (eGFR) above the age- and gender-specific 95th percentile for apparently healthy subjects, while hypofiltration was defined as an eGFR below the 5th percentile. eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration equation.nnnRESULTSnAfter further excluding hypofiltration and adjusting for available confounders, fasting plasma glucose (FPG), 2-hour postload glucose (2hPG), 2hPG-FPG (fluctuating blood glucose), HbA1c (average blood glucose), NDD and IGT but not isolated IFG were significantly associated with increased eGFR and a higher risk of hyperfiltration {NDD: odds ratio [OR] 1.97 [95% confidence interval (CI), 1.48-2.64], P < 0.001; IGT: OR 1.34 (95% CI 1.07-1.66), P = 0.009}.nnnCONCLUSIONSnHigh glucose states increase hyperfiltration risk. In addition to newly diagnosed diabetes, excessively high GFR also deserves attention in subjects with IGT.

Epidemiological survey of quantitative ultrasound in risk assessment of falls in middle-aged and elderly people.

The risk assessment of falls is important, but still unsatisfactory and time-consuming. Our objective was to assess quantitative ultrasound (QUS) in the risk assessment of falls. Our study was designed as epidemiological cross-sectional study occurring from March 2009 to February 2010 by community survey at a medical center. The participants were collected from systemic sample of 1,200 community-dwelling people (Male/Femaleu200a=u200a524/676) 40 years old and over in Yunlin County, Mid-Taiwan. Structural questionnaires including socioeconomic status, living status, smoking and drinking habits, exercise and medical history were completed. Quantitative ultrasound (QUS) at the non-dominant distal radial area (QUS-R) and the left calcaneal area (QUS-C) were measured. The overall prevalence of falls was 19.8%. In men, the independently associated factors for falls were age (OR: 1.04; 95%CI: 1.01∼1.06), fracture history (OR: 1.89; 95%CI: 1.12∼3.19), osteoarthritis history (OR: 3.66; 95%CI: 1.15∼11.64) and speed of sound (OR: 0.99; 95%CI: 0.99∼1.00; p<0.05) by QUS-R. In women, the independently associated factors for falls were current drinking (OR: 3.54; 95%CI: 1.35∼9.31) and broadband ultrasound attenuation (OR: 0.98; 95%CI: 0.97∼0.99; p<0.01) by QUS-C. The cutoffs at -2.5< T-score<-1 derived using QUS-R (OR: 2.85; 95%CI: 1.64∼4.96; p<0.01) in men or T-score ≦-2.5 derived using QUS-C (OR: 2.72; 95%CI: 1.42∼5.21; p<0.01) in women showed an independent association with falls. The lowest T-score derived using either QUS-R or QUS-C was also revealed as an independent factor for falls in both men (OR: 2.13; 95%CI: 1.03∼4.43; p<0.05) and women (OR: 2.36; 95%CI: 1.13∼4.91; p<0.05). Conclusions: Quantitative ultrasounds, measured either at the radial or calcaneal area, are convenient tools by which to assess the risk of falls in middle-aged and elderly people.

Factors Related to Self-Reported Attention Deficit Among Incoming University Students

Objective: This study was designed to explore physical, social/behavioral, and mental health factors among incoming university students with elevated self-reported ADHD symptoms. Method: A total of 5,240 incoming university students were recruited. The test battery included the ADHD Self-Report Scale, the Measurement of Support Functions, the Chinese Internet Addiction Scale–Revision, Quality of Life assessment, the Brief Symptoms Rating Scale, and the 10-item Social Desirability Scale. Results: ADHD symptoms were elevated in 8.6% of the sample. Only individuals with a lower social desirability score, however, were recruited for further analysis. Significant influential factors for higher self-reported levels for ADHD symptoms included greater suicidal ideation and emotional disturbance, as well as a higher Internet addiction tendency, lower levels of social support, and a greater amount of exercise. Conclusion: Given the elevated prevalence of self-reported ADHD symptoms among this sample of university students, screening for these kinds of problems to detect early challenges before students fail in college as well as identify youth with undiagnosed ADHD should be considered.

Nonalcoholic fatty liver disease vs. obesity on the risk of erosive oesophagitis

Erosive oesophagitis (EE) may be complicated by oesophageal ulcers, peptic stricture, Barretts oesophagus and oesophageal adenocarcinoma. There have been few studies examining the influence of nonalcoholic fatty liver disease (NAFLD) on EE, and even fewer exploring the simultaneous effects of NAFLD, general and central obesity on EE. We thus aim to clarify the relationship between NAFLD and EE when general and/or central obesity are considered simultaneously.

Perception of premenstrual syndrome and attitude of evaluations of work performance among incoming university female students

Background: Premenstrual syndrome (PMS) is a common condition, and for 5% of women, the influence is so severe as to interfere with their mental health, interpersonal relationships, or studies. Severe PMS may result in decreased occupational productivity. The aim of this study was to investigate the influence of perception of PMS on evaluation of work performance. Methods: A total of 1971 incoming female university students were recruited in September 2009. A simulated clinical scenario was used, with a test battery including measurement of psychological symptoms and the Chinese Premenstrual Symptom Questionnaire. Results: When evaluating employee performance in the simulated scenario, 1565 (79.4%) students neglected the impact of PMS, while 136 (6.9%) students considered it. Multivariate logistic regression showed that perception of daily function impairment due to PMS and frequency of measuring body weight were significantly associated with consideration of the influence of PMS on evaluation of work performance. Conclusion: It is important to increase the awareness of functional impairments related to severe PMS.

Tea-drinking habit among new university students: Associated factors

The habit of drinking tea is highly prevalent in Asian countries. The aim of this study was to investigate the prevalence of tea drinking and to explore the correlated factors on tea drinking among young new students in the university, using a validated self‐reported questionnaire. This study was carried out with 5936 new students in a university in Taiwan. It comprised a self‐administered structured questionnaire, including items related to personal and medical history, and lifestyle habits, using the Pittsburgh Sleep Quality Index (PSQI) and the 12‐item Chinese Health Questionnaire (CHQ‐12). Anthropometric measurements and laboratory tests were also performed. In total, 2065 (36.1%) students were in the tea‐drinking group. Multiple logistic regression analysis showed the following factors were significant predictors of tea drinking: postgraduate students (pu2009<u20090.001), coffee drinking (pu2009<u20090.001), alcohol drinking (pu2009<u20090.001), minor mental morbidity (pu2009=u20090.009), poorer sleepers (pu2009=u20090.037), higher body mass index (pu2009=u20090.004), and sugar‐sweetened beverage consumption (pu2009<u20090.001). Our data showed that the tea‐drinking habit was correlated with higher body mass index, which was contrary to the findings of a previous study. In clinical practice, perhaps we could consider more tea‐drinking‐related factors when we suggest tea consumption.

The Effect of Glycemic Status on Kidney Stone Disease in Patients with Prediabetes

Background While the evidence supporting a positive association between diabetes mellitus and kidney stone disease (KSD) is solid, studies examining the association between impaired fasting glucose (IFG) and KSD show inconsistent results. Currently, there are no studies examining the relationship between impaired glucose tolerance (IGT) and KSD. The objective of this study is to investigate the effects of different glycemic statuses on KSD. The results may help to motivate patients with diabetes to conform to treatment regimens. Methods We conducted a cross sectional study of a population that underwent health check-ups between January 2000 and August 2009 at the Health Evaluation Center of National Cheng Kung University Hospital. A total of 14,186 subjects were enrolled. The following categories of glycemic status were used according to the criteria of the 2009 American Diabetes Association: normal glucose tolerance, isolated IGT, isolated IFG, combined IFG/IGT, and diabetes. The existence of KSD was evaluated using renal ultrasonography, and the presence of any hyperechoic structures causing acoustic shadowing was considered to be indicative of KSD. Results The prevalence of KSD was 7.4% (712/9,621), 9.3% (163/1,755), 10.8% (78/719), 12.0% (66/548), and 11.3% (174/1,543) in subjects with NGT, isolated IGT, isolated IFG, combined IFG/IGT, and diabetes, respectively. Isolated IFG, combined IFG/IGT, and diabetes were associated with KSD after adjusting for other clinical variables, but isolated IGT was not. Age (41 to 64 years vs. ≤40 years, ≥65 years vs. ≤40 years), male gender, hypertension, and hyperuricemia were also independently associated with KSD. Conclusion Isolated IFG, combined IFG/IGT, and diabetes, but not isolated IGT, were associated with a higher risk of KSD.

Non-alcoholic fatty liver disease associated with increased arterial stiffness in subjects with normal glucose tolerance, but not pre-diabetes and diabetes.

Aim: To evaluate the association between non-alcoholic fatty liver disease and arterial stiffness in adults with normal glucose tolerance, pre-diabetes and newly diagnosed diabetes after excluding known diabetes. Methods: A total of 4860 subjects were divided into normal glucose tolerance, pre-diabetes and newly diagnosed diabetes groups according to the American Diabetes Association 2011 diagnostic criteria. The severity of non-alcoholic fatty liver disease was divided into mild and moderate to severe. Increased arterial stiffness was defined as brachial–ankle pulse wave velocity (baPWV)u2009⩾u20091400u2009cm/s. Results: There was a significant difference in the prevalence of mild and moderate to severe non-alcoholic fatty liver disease between subjects with and without increased arterial stiffness. Mild (odds ratio (OR)u2009=u20092.02, 95% confidence interval (CI)u2009=u20091.43–2.84) and moderate to severe (ORu2009=u20092.15, 95% CIu2009=u20091.33–3.46) non-alcoholic fatty liver disease were independently associated with increased arterial stiffness in the normal glucose tolerance group. In the pre-diabetes and diabetes groups, neither mild nor moderate to severe non-alcoholic fatty liver disease was associated with increased arterial stiffness. Conclusion: The effect of non-alcoholic fatty liver disease on arterial stiffness is apparent in subjects with normal glucose tolerance, but not in diabetes and pre-diabetes.

Factors related to self‐reported social anxiety symptoms among incoming university students

The aim of this study was to explore the lifestyle/social, personality trait and mental factors among incoming university students with higher self‐reported social anxiety symptoms (SAS).

Restrictive Spirometry Pattern Is Associated With Increased Arterial Stiffness in Men and Women

Background There is growing evidence that pulmonary function impairment is related to cardiovascular events and death. Some studies have shown that the level of FVC is negatively related to arterial stiffness, but most studies were confined to men, and none of them examined the association of the presence of restrictive spirometry pattern with arterial stiffness. Therefore, this study aimed to investigate the association of restrictive spirometry pattern with arterial stiffness by sex. Methods This study recruited 2,961 subjects after excluding those with (1) obstructive lung disease, as defined by history and pulmonary function test; (2) history of asthma, lung cancer, tuberculosis, coronary heart disease, stroke, or any pulmonary structural deformities; and (3) medications influencing BP, plasma glucose, lipid profile, and pulmonary function test. Restrictive spirometry pattern was diagnosed as an FVC < 80% of the predicted value and an FEV1/FVC ratio ≥ 70%. Increased arterial stiffness was defined as right brachial ankle pulse wave velocity (baPWV) ≥ 1,400 cm/s. Results In both men and women, FVC was negatively associated with the baPWV level. Restrictive spirometry pattern was positively associated with increased arterial stiffness in both men and women (men: OR, 2.16; 95% CI, 1.33‐3.50; women: OR, 1.95; 95% CI, 1.02‐3.72) after adjustment for other clinical variables. Conclusions Both restrictive spirometry pattern and reduced FVC were associated with a higher risk of arterial stiffness, not only in men but also in women. Clinically, assessment of arterial stiffness might be considered in individuals with restrictive spirometry pattern.