Mean arterial pressure is better at predicting future metabolic syndrome in the normotensive elderly: a prospective cohort study in Taiwan.

OBJECTIVE: To compare four different blood pressure (BP) measurements-systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP)-in predicting future metabolic syndrome (MetS) among the normotensive elderly population, and to estimate the optimal cutoff value of the best single measurement for clinical practice. METHODS: A total of 2782 non-medicated participants aged ≥ 60 years were enrolled in a standard health examination program in Taiwan from January 2004 to December 2013. Two thirds of the participants were randomly designated as the training group (n=1855) and the other one third as the validation group (n=927). The mean follow-up time was 3.60 years for both the training and validation groups. MAP and PP were calculated from SBP and DBP. RESULTS: SBP, DBP, and MAP were associated with future MetS, whereas PP was not. MAP had the largest hazard ratio in Cox regression (men 1.342 [95% CI 1.158-1.555] and women 1.348 [95% CI 1.185-1.534] in the training group; men 1.640 [95% CI 1.317-2.041] and women 1.485 [95% CI 1.230-1.794] in the validation group) and the largest area under the receiver operating characteristic curve (men 0.598 ± 0.021 and women 0.602 ± 0.021 in the training group). Multivariable Cox regression further indicated that a higher MAP level was independently associated with the future occurrence of MetS. Participants with MAP above the cutoff value (84.0mm Hg for men, 83.3mm Hg for women) had a higher cumulative incidence of MetS than did their counterparts after four years' follow-up in both the training and validation groups. The results derived from the training data could be replicated in the validation data, indicating that the results were generalizable across distinct samples. CONCLUSIONS: MAP is more accurate than SBP, DBP, and PP in predicting future MetS among the normotensive geriatric population. Calculation of MAP is recommended when dealing with normotensive patients aged ≥ 60 years in clinical practice.

Adiposity measurements in association with metabolic syndrome in older men have different clinical implications.

Obesity is a major public health problem, and measuring adiposity accurately and predicting its future comorbidities are important issues. Therefore, we hypothesized that 4 adiposity measurements, body mass index (BMI), waist circumference (WC), waist-to-height ratio, and body fat percentage, have different physiological meanings and distinct associations with adverse health consequences. This study aimed to investigate the relationship of these 4 measurements with metabolic syndrome (MetS) components and identify the most associated factor for MetS occurrence in older, non-medicated men. Cross-sectional data from 3004 men, all 65 years of age and older, were analyzed. The correlation and association between adiposity measurements and MetS components were evaluated by Pearson correlation and multiple linear regression. Based on multivariate logistic regression, BMI and WC were significantly associated with MetS and were selected to build a combined model of receiver operating characteristic curves to increase the diagnosis accuracy for MetS. The results show that BMI is independently associated with systolic and diastolic blood pressure; WC and body fat percentage are associated with fasting plasma glucose and log transformation of triglyceride; BMI and WC are negatively associated with high-density lipoprotein cholesterol (HDL-C); and WC is a better discriminate for MetS than BMI, although the combined model (WC + BMI) is not significantly better than WC alone. Based on these results, we conclude that the 4 adiposity measurements have different clinical implications. Thus, in older men, BMI is an important determinant for blood pressure and HDL-C. Waist circumference is associated with the risk of fasting plasma glucose, HDL-C, triglyceride, and MetS occurrence. The combined model did not increase the diagnosis accuracy.

High normotension is associated with higher metabolic syndrome risk in postmenopausal women.

AIM: Cardiovascular disease and diabetes are important causes for mortality in older people. Both hypertension and prehypertension are correlated with them. Recently, health promotion and disease prevention in postmenopausal women have become an essential issue of public health policy. The present study aimed to evaluate whether the harmful effects of blood pressure (BP) could still be found in normotensive postmenopausal women (below 120/80 mmHg). METHODS: A total of 4539 normotensive postmenopausal women aged 51 years or older, undergoing routine health examinations, were enrolled in the cross-sectional analyses. To mitigate the effect of age on BP, participants within the same age were divided into tertiles according to their systolic BP (SBP). Then, participants in the low-SBP tertile of each age stratum were pooled together to form a larger group (low-normal SBP group [LNSBP]). Similarly, the middle- and high-normal SBP were grouped accordingly (MNSBP and HNSBP). Metabolic syndrome (MetS) was considered to be a surrogate for future cardiovascular disease and diabetes. RESULTS: The study showed that HNSBP bore a higher likelihood of having abnormal MetS components, elevated low-density lipoprotein cholesterol levels and a higher odds ratio (1.46; 95% confidence interval 1.17-1.81) for having MetS than LNSBP. In contrast, age, body mass index, fasting plasma glucose and low-density lipoprotein cholesterol were significantly related to SBP in multiple regression analysis. CONCLUSIONS: The risk of having MetS was significantly associated with higher SBP even within normotension. Primary prevention, such as lifestyle modification, and more strict control of BP should be stressed in postmenopausal women.

Increased incidence of metabolic syndrome in older men with high normotension.

INTRODUCTION: Hypertension and prehypertension are correlated with future cardiovascular disease (CVD) and diabetes. Whether these harmful effects of the blood pressure (BP) could be found in normotensive is of interest. METHODS: In this cross-sectional study, totally 2388 normotensive older men aged 65-80 years undergoing routine health examinations were enrolled. To eliminate the influence of age on BP, subjects were initially grouped in each age stratum. Then in each age-stratum, subjects were further grouped into low, middle and high-tertile systolic BP (SBP) subgroups. Finally, all the low-tertile subgroups in each age stratum were gathered to form Group-1. Similarly, Group-2 (middle-tertile) and Group-3 (high-tertile) were also created. Metabolic syndrome (MetS) was regarded as having risks for future CVD and diabetes. RESULTS: Age, waist circumstance (WC), fasting plasma glucose (FPG) and log triglyceride (TG) were independently and significantly correlated with SBP by multiple linear regression analysis. On the other hand, logistic regression showed that Group-3 had significant higher odds ratios (ORs) for having abnormal WC, FPG and TG. In addition, Group-3 presented a 1.55-fold OR (p < 0.001) for having MetS than Group-1. CONCLUSIONS: In normotensive older men, the risk for having MetS was significantly associated with higher SBP. Primary prevention of hypertension should be stressed.

An examination of cancer-related fatigue through proposed diagnostic criteria in a sample of cancer patients in Taiwan.

BACKGROUND: Fatigue among cancer patients has often been reported in the literature; however, great variations have been documented, ranging from 15% to 90%, probably due to the lack of a widely accepted definition and established diagnostic criteria for cancer-related fatigue. The objective of this study was to evaluate the proposed International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) criteria in a sample of cancer patients from a medical center and a regional teaching hospital in northern Taiwan. More accurate prevalence estimates of CRF may result in improved diagnoses and management of one of the most common symptoms associated with cancer and its treatment. METHODS: Since self-reporting from patients is the most effective and efficient method to measure fatigue, the ICD-10 criteria for fatigue were used. The ICD-10 criteria questionnaire was translated into Chinese and was approved by experts. Patients were recruited from outpatient palliative and oncology clinics and from palliative and oncology inpatient units. RESULTS: Of the 265 cancer patients that were interviewed between 21 October 2008 and 28 October 2009, 228 (86%) reported having at least 2 weeks of fatigue in the past month, and further evaluation with the ICD-10 criteria showed that 132 (49.8%) had cancer-related fatigue. Internal consistency was very good, which was indicated by a Cronbach alpha of 0.843. CONCLUSION: The prevalence of diagnosable CRF in the patients in this sample, of whom most were under palliative treatment, was 49.8%, which was probably somewhat lower than in some of the previous reports that have used less-strict criteria. In addition, among the various criteria of the proposed diagnostic criteria, the most frequently reported symptoms in our sample populations were regarding sleep disturbance and physical factors. Although they will require further replication in other samples, these formal diagnostic criteria can serve as a step toward a common language and a better understanding of the severity range of CRF.