To date, the association between sleep duration or sleep quality and hyperuricemia has remained unclear. In addition, sleep duration and quality were not considered concomitantly in previous studies. ...Thus, this study was aimed toward an examination of the association of sleep duration and quality with uric acid level in a Taiwanese population. A total of 4,555 patients aged greater than or equal to18 years were enrolled in this study. The sleep duration was classified into three groups: short (5. Poor sleepers were younger and had lower body mass index, blood pressure, uric acid, blood sugar, cholesterol, creatinine level, shorter sleep duration, and engaged in less exercise but had a higher white blood cell count and prevalence of smoking as compared to good sleepers. There were also differences in body mass index, blood pressure, uric acid, blood sugar, lipid profiles, and sleep quality among subjects with different sleep durations. After adjusting for other variables, poor sleep quality was associated with lower uric acid levels. In addition, short sleep duration was positively associated with higher uric acid levels. Poor sleep quality was related to lower uric acid levels, whereas short sleep duration was associated with higher uric acid levels.
Abstract
Background/Purpose
Early unplanned hospital readmissions are burdensome health care events and indicate low care quality. Identifying at-risk patients enables timely intervention. This study ...identified predictors for 14-day unplanned readmission.
Methods
We conducted a retrospective, matched, case–control study between September 1, 2018, and August 31, 2019, in an 1193-bed university hospital. Adult patients aged ≥ 20 years and readmitted for the same or related diagnosis within 14 days of discharge after initial admission (index admission) were included as cases. Cases were 1:1 matched for the disease-related group at index admission, age, and discharge date to controls. Variables were extracted from the hospital’s electronic health records.
Results
In total, 300 cases and 300 controls were analyzed. Six factors were independently associated with unplanned readmission within 14 days: previous admissions within 6 months (OR = 3.09; 95 % CI = 1.79–5.34,
p
< 0.001), number of diagnoses in the past year (OR = 1.07; 95 % CI = 1.01–1.13,
p
= 0.019), Malnutrition Universal Screening Tool score (OR = 1.46; 95 % CI = 1.04–2.05,
p
= 0.03), systolic blood pressure (OR = 0.98; 95 % CI = 0.97–0.99,
p
= 0.01) and ear temperature within 24 h before discharge (OR = 2.49; 95 % CI = 1.34–4.64,
p
= 0.004), and discharge with a nasogastric tube (OR = 0.13; 95 % CI = 0.03–0.60,
p
= 0.009).
Conclusions
Factors presented at admission (frequent prior hospitalizations, multimorbidity, and malnutrition) along with factors presented at discharge (clinical instability and the absence of a nasogastric tube) were associated with increased risk of early 14-day unplanned readmission.
Although previous studies have explored the effect of chronic conditions on physical disability, little is known about the levels and rates of change in physical disability after a chronic condition ...diagnosis in middle-aged and older adults in the Asian population. The aim of this study is to ascertain the average levels and rates of change in the development of disability after disease diagnosis, as well as to determine the influences of sociodemographic and health-related correlates in the development of disability.
This is a retrospective cohort study analyzing data of nationally representative participants aged 50 and over with a chronic condition or having developed one during follow-ups based on data from the 1996-2011 Taiwan Longitudinal Study on Aging (TLSA) (n = 5131). Seven chronic conditions were examined. Covariates included age at initial diagnosis, gender, education level, number of comorbidities, and depression status. Physical disability was measured by combining self-reported ADL, IADL, and strength and mobility activities with 17 total possible points, further analyzed with multilevel modeling.
The results showed that (1) physical disability was highest for stroke, followed by cancer and diabetes at the time of the initial disease diagnosis. (2) The linear rate of change was highest for stroke, followed by lung disease and heart disease, indicating that these diseases led to higher steady increases in physical disability after the disease diagnosis. (3) The quadratic rate of change was highest in diabetes, followed by cancer and hypertension, indicating that these diseases had led to higher increments of physical disability in later stage disease. After controlling for sociodemographic and comorbidity, depression status accounted for 39.9-73.6% and 37.9-100% of the variances in the physical disability intercept and change over time, respectively.
Despite the fact that a comparison across conditions was not statistically tested, an accelerated increase in physical disabilities was found as chronic conditions progressed. While stroke and cancer lead to disability immediately, conditions such as diabetes, cancer, and hypertension give rise to higher increments of physical disability in later stage disease. Mitigating depressive symptoms may be beneficial in terms of preventing disability development in this population.
Objective:
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.
Design and Methods:
Subjects were recruited from the Prevention Health Center of National Cheng Kung University Hospital. Anthropometric data and metabolic parameters were measured. Being overweight or obese was defined according to the recommendations of the Department of Health in Taiwan. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
Results:
Of the total 2,803 subjects, 1,059 were classified as normal weight, 1,127 were overweight, and 617 were obese. The global PSQI score were 6.30 ± 2.56, 6.61 ± 2.96, and 7.02 ± 2.95 in subjects who were normal weight, overweight, and obese, respectively (test for trend, P < 0.001). Of the variables tested in the multivariate linear regression model, female gender, being overweight, obesity, sleep duration, and alcohol drinking were significantly associated with global PSQI scores, and in the multivariate logistic regression model, female gender, being overweight, obesity, and sleep duration were independent predictors of poor sleepers after controlling for age, gender, BMI or different weight statuses, sleep duration, alcohol drinking, smoking, habitual exercise, hypertension, newly diagnosed diabetes, total cholesterol, high‐density lipoprotein, triglyceride, estimated glomerular filtration rate, and alanine aminotransferase.
Conclusions:
In conclusion, female gender, being overweight, obesity, and sleep duration were associated with poor sleep quality independent of cardiometabolic risk factors. In clinical practice, subjects who are obese, or even only overweight, should be evaluated for the presence of sleep disturbance.
Short and long sleep duration are associated with metabolic syndrome. However, there is limited research on the association between sleep quality and metabolic syndrome, and thus the aim of this ...study is to investigate this relationship.
The cross-sectional baseline data were collected from the decoded database of the Prevention Health Center of National Cheng Kung University Hospital from 2002 to 2006. The diagnosis of metabolic syndrome was according to the statement of the American Heart Association/National Heart, Lung, and Blood Institute. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates poorer sleep quality, and a global PSQI score greater than five differentiates poor from good sleepers.
Of the 3,435 subjects recruited, 899 (26.2%) had metabolic syndrome. Subjects with metabolic syndrome had higher PSQI and prevalence of poor sleepers than those without metabolic syndrome. The multivariate lineal regression analysis showed that female gender, metabolic syndrome, sleep duration, snoring, alcohol drinking, and habitual exercise were independent predictors of PSQI. When substituting metabolic syndrome with the five components, hyperglycemia and low high-density lipoprotein cholesterol (HDL-C) were positively associated with PSQI. The multivariate logistic regression analyses showed that female gender, metabolic syndrome, sleep duration, and snoring were independently associated with being poor sleepers. Of the five components, only low HDL-C was an independent predictor of being poor sleepers.
Subjects with metabolic syndrome have higher global PSQI scores and a higher risk of being poor sleepers. Of the five components of metabolic syndrome, hyperglycemia and low HDL-C are independently associated with the global PSQI scores, while low HDL-C is an independent predictor of being poor sleepers.
Aims/hypothesis
Type 2 diabetes is highly correlated with nonalcoholic fatty liver disease (NAFLD). Hepatocyte-derived fibrinogen-related protein 1 (HFREP1) is a hepatokine that mediates NAFLD ...development; however, the role of HFREP1 in the development of insulin resistance and diabetes remains obscure.
Methods
A total of 193 age- and sex-matched participants with normal glucose tolerance, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and newly diagnosed diabetes (NDD) were recruited for a cross-sectional study. Plasma HFREP1 levels were measured and multivariate linear regression analysis was used to evaluate the relationship between HFREP1, IFG, IGT and NDD. The causal relationship between HFREP1 and insulin resistance was then investigated in animal and cell models. Glucose and insulin tolerance tests, and euglycaemic–hyperinsulinaemic clamp, were used to evaluate insulin sensitivity in animals with
Hfrep1
overexpression or knockdown in liver by lentiviral vectors. HepG2 cells were used to clarify the possible mechanism of HFREP1-induced insulin resistance.
Results
Plasma HFREP1 concentrations were significantly increased in participants with IFG, IGT and NDD. HFREP1 concentrations were independently associated with fasting plasma glucose levels, insulin resistance, IFG, IGT and NDD. Injection of recombinant HFREP1 or
Hfrep1
overexpression induced insulin resistance in mice, and HFREP1 disrupted insulin signalling to induce insulin resistance through an extracellular signal-regulated kinase (ERK)1/2-dependent pathway. Moreover, hepatic knockdown of HFREP1 improved insulin resistance in both mice fed a high-fat diet and
ob
/
ob
mice.
Conclusions/interpretation
These findings highlight the crucial role of HFREP1 in insulin resistance and diabetes, and provide a potential strategy and biomarker for developing therapeutic approaches to combat these diseases.
To describe geriatric syndromes and their relationships with quality of life in older adults with diabetes.
Community-dwelling older adults (aged >60 years) with diabetes (n = 316) participated in ...the present study. Eight geriatric syndromes, including polypharmacy (number of medications), pain (Brief Pain Inventory), urinary incontinence (International Consultation on Incontinence Questionnaire), sleep disturbance (hours of sleep), lower cognitive level (Mini-Mental State Examination), falls, depressive symptoms (Geriatric Depression Scale short form) and functional limitation (Barthel Index and Instrumental Activity of Daily Living), were assessed. The WHOQOL-BREF Taiwan version was used to measure physical, psychological, social and environmental domains of quality of life.
Polypharmacy was the most common geriatric syndrome (46.6%), followed by pain (41.5%). Participants with any of the geriatric syndromes, except for polypharmacy and sleep disturbance, had significantly poorer quality of life than those without. The Geriatric Depression Scale score was the only common and significant contributor to all four domains of quality of life, explaining 16~29% of the variance. Number of medications, pain level and cognitive level were also significant contributors, although they explained a small amount (<5%) of the variance. The number of geriatric syndromes (mode = 2) was significantly correlated with all four domains of quality of life (partial correlation r = -0.278~0.460, all P < 0.001).
Geriatric syndromes, especially polypharmacy and pain, were common among older adults with diabetes. A greater number of geriatric syndromes or a higher Geriatric Depression Scale score were associated with poorer quality of life. Further studies focusing on combinations of different geriatric syndromes or comorbidities are required. Geriatr Gerontol Int 2019; 19: 518-524.
Aims/Introduction
Contrary to the results of the majority of studies on diabetes, there are some conflicting results regarding the relationship between non‐alcoholic fatty liver disease (NAFLD) and ...prediabetes. No study has investigated the relationship between isolated glycated hemoglobin (HbA1c) in the range of 5.7–6.4% (HbA1c 5.7–6.4%) and NAFLD. Our aim was to investigate the effect of different glycemic statuses on NAFLD concomitantly categorized by fasting plasma glucose, 2‐h plasma glucose and HbA1c levels.
Materials and Methods
NAFLD was classified into three groups by ultrasonographic examination results: normal, mild and moderate‐to‐severe. Glycemic status was divided into five groups: normoglycemia, isolated HbA1c 5.7–6.4%, impaired fasting glucose without impaired glucose tolerance (IGT), IGT and newly diagnosed diabetes. For multivariable logistic regression analyses, the outcome variable was the classified three grades of fatty changes in the liver after adjusting for other potential risk covariables.
Results
In this cross‐sectional research, a total of 8,571 eligible individuals were enrolled and divided into three groups: 5,499 without fatty liver, 2,113 with mild NAFLD and 959 with moderate‐to‐severe NAFLD. Multivariable logistic regression analysis showed that IGT, impaired fasting glucose without IGT and isolated HbA1c 5.7–6.4% were associated with a higher risk of NAFLD in addition to newly diagnosed diabetes. Other positively predictive variables were male sex, obesity, overweight, central obesity, increased triglyceride and C‐reactive protein >1 mg/L. Negatively associated factors were elevated high‐density lipoprotein cholesterol levels.
Conclusions
Besides diabetes, the increased risks of different grades of NAFLD were found for prediabetic individuals categorized by impaired fasting glucose without IGT, IGT and isolated HbA1c 5.7–6.4%.
Betel nut chewing is associated with oral cancer, cardiovascular disease, liver cirrhosis, and hepatocellular carcinoma (HCC). The aim of this study was to explore the association of betel nut ...chewing with liver fibrosis in subjects with and without nonalcoholic fatty liver disease (NAFLD).
A total of 5967 subjects were enrolled. NAFLD was diagnosed with ultrasonography. Betel nut chewing was classified into non-chewing, ex-chewing, and current chewing, and cumulative dosages were calculated. The aspartate aminotransferase (AST)/platelet ratio index and NAFLD fibrosis scores (NFS) were calculated for evaluation of liver fibrosis.
NAFLD increased the associated risk of liver fibrosis in those with (odds ratio (OR): 5.51, 95% confidence interval (CI): 3.09-9.80) and without betel nut chewing (OR: 2.33, 95% CI: 1.64-3.29). In subjects without NAFLD, betel nut chewing was not associated with liver fibrosis (OR: 1.12, 95% CI: 0.44-2.86). In subjects with NAFLD, cumulative betel nut chewing and ex- and current chewing were positively associated with NFS and significant liver fibrosis.
In subjects with NAFLD, betel nut chewing, even ex-chewing, was associated with a higher risk of liver fibrosis, where higher cumulative levels were found to increase the risk of significant liver fibrosis. However, the associated risk of liver fibrosis due to betel nut chewing was insignificant in subjects without NAFLD.
Arterial stiffness has been found to be a predictive risk factor for cardiovascular disease. Simple renal cysts are associated with prehypertension, hypertension, diabetes, and increased serum ...creatinine, which are risk factors of cardiovascular events. The aim of this work was to clarify the association between simple renal cysts and arterial stiffness defined by the brachial and ankle pulse wave velocity (baPWV). Subjects with and without simple renal cysts had right baPWV values of 1522.8 ± 357.5 cm/s and 1344.2 ± 268.8 cm/s, respectively (p < 0.001). Based on multiple linear regression analysis, the presence of simple renal cysts was associated with increased baPWV values (p < 0.001). Both the size and the number of simple renal cysts were positively associated with an increased baPWV value. Subjects with a cyst size ≥2 cm (p < 0.001) and a cyst number ≥2 (p < 0.01) had higher baPWV values than those without SRCs. Simple renal cysts are associated with increased arterial stiffness.
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