Reduced prostate cancer risk with green tea and epigallocatechin 3-gallate intake among Hong Kong Chinese men.

BACKGROUND: In vitro and in vivo studies suggested that polyphenol epigallocatechin 3-gallate (EGCG) in tea may have anti-carcinogenic effect on prostate cells, but this protective effect has less been examined in epidemiology studies. We aimed to investigate the association between prostate cancer (PCA) risk and habitual green tea intake among Chinese men in Hong Kong; meanwhile, the relationship with EGCG was also explored. METHODS: We consecutively recruited 404 PCA cases and 395 controls from the same hospital who had complete data on habitual tea consumption, including green, oolong, black and pu'er tea. We reconstructed the level of EGCG intake according to a standard questionnaire and the analytic values for EGCG extracted from the literature published by Lin et al. in 2003. We calculated odds ratios (ORs) for tea consumption and EGCG intake using unconditional multiple logistic regression, and examined their exposure--response relationships with PCA risk. RESULTS: A total of 32 cases and 50 controls reported habitual green tea drinking, showing an adjusted OR of 0.60 (95% confidence interval (CI): 0.37, 0.98). A moderate excess risk was observed among the habitual pu'er tea drinkers (OR=1.44, 95% CI: 1.02, 1.91). A significantly lower intake of EGCG was observed among cases (54.4 mg) than the controls (72.5 mg), which resulted in an inverse gradient of PCA risk with the increasing intake of EGCG (test for trend, P=0.015). CONCLUSION: PCA risk among Chinese men in Hong Kong was inversely associated with green tea consumption and EGCG intake, but these results need to be replicated in larger studies.

Understanding suicidality and correlates among Chinese secondary school students in Hong Kong.

Suicide has become a leading cause of mortality and morbidity for adolescents in Hong Kong. This study investigated the factors associated with suicidal ideation and attempt among the secondary school students in Hong Kong by studying a representative sample of 3383 students with a self-administered questionnaire and analysed by multiple logistic regressions analysis. Youth risk behaviours, such as heavy smoking, episodic heavy alcohol drinking, early sexual experience, and feeling hopeless, were found to be associated with both suicidal thoughts and attempts, with 'misuse of drugs' as discriminating factor that solely related to attempt and 'involvement in physical fight' solely related to suicidal thoughts. Addition of suicidal ideation is a significant explanatory variable of suicidal attempt over and above health risk behaviours. Stratified analysis of upper and lower secondary students would give better understanding of significance of various risk factor for different age groups. The disturbing prevalence of suicidal behaviour and its coexistence with other high-risk behaviour in secondary school students have implications for teachers, youth workers and public health practitioners to develop and evaluate programmes for suicide prevention.

Nutrient intake and psychological health in an elderly Chinese population.

BACKGROUND: Associations between nutrition and cognitive impairment, and nutrition and depression, have been observed. Elderly people are at risk of under nutrition, and also have higher prevalence of cognitive impairment and depression. OBJECTIVE: To examine the relationship between nutrient intake and psychological health in the elderly, adjusting for confounding factors. SUBJECTS: Three thousand nine hundred and ninety-nine men and women aged 65 years and over living in the community, with approximately equal numbers in three age groups: 65-69, 70-74, 75+ years. METHODS: Dietary intake was assessed using a 7-day food frequency questionnaire. Cognitive function was assessed by the cognitive part of the Community Screening Instrument for Dementia (CSID). Depression was assessed using the Geriatric Depression Scale (GDS). Information was also collected for confounding factors: demographics, educational level, socioeconomic status, medical history, smoking, alcohol intake, and physical activity. Logistic regression analyses were carried out to examine associations between lifestyle and dietary variables, and CSID and GDS, controlling for confounders. RESULTS: Both CSID and GDS scores were associated with co-morbidity, demographic and socioeconomic factors. Few associations between lifestyle factors and CSID score were observed. Dietary factors inversely associated with GDS score include total fat intake, vitamins A, B2, B3, C, fibre, and vegetables. In terms of nutrient density, iron and isoflavone intake were additional factors. CONCLUSION: Association exists between intake of various nutrients and psychological health independent of other confounding factors in the elderly population. A follow-up study of this cohort or interventional studies are needed to elucidate cause effect relationship.

Effect of social deprivation on mortality and the duration of hospital stay after a stroke.

BACKGROUND: We aim to assess whether social deprivation independently predicts case fatality after a stroke patient has been admitted to hospital, and to assess whether social deprivation affected duration of hospital stay. METHODS: Cohort study in a tertiary teaching hospital included consecutive patients admitted to hospital within 48 h of their stroke between 1988 and 1994. Outcome measures were case fatality at 1 year and length of hospital stay. The socioeconomic category was derived from the postcode sector of residence for the patients (Carstairs index). Cause of death was determined by data linkage to the Registrar General data for Scotland. RESULTS: 2,042 stroke patients were included. A significant age difference existed between the deprivation categories (76.0 +/- 10.9 years in the affluent cohort vs. 71.4 +/- 10.7 years in the deprived cohort). Smoking was more common in the deprived group. ECG findings and neurological score on admission were similar between the groups. No difference existed between groups for length of hospital stay (p = 0.793), and in the proportions remaining alive at 1 year (p = 0.416). When entered into a multivariate Cox regression analysis, the deprivation categories did not predict mortality. Age, sex, Philadelphia Geriatric Center Instrumental Activities of Daily Living (IADL) Scale Score, Orgogozo neurological score on admission, and ECG abnormalities were the significant predictors. CONCLUSIONS: Stroke patients living in more socially deprived areas had their strokes at an earlier age but were not at a greater risk of dying or longer hospital stay once they had been admitted to hospital.

Angiotensin converting enzyme inhibitor use is associated with higher bone mineral density in elderly Chinese.

Hypertension and osteoporosis are two major chronic diseases affecting the elderly. A cross-sectional study of 3887 Chinese men (n = 1958) and women (n = 1929) was used to explore the association between angiotensin converting enzyme inhibitor (ACEI) use and bone mineral density (BMD). The participants were aged 65 years and above, and were recruited using a combination of private solicitation and public advertising from community centers, housing estates, and the general community in Hong Kong. Demographic, medical, and lifestyle information was obtained from face to face interviews using standardized questionnaire, and physical examination measurements included anthropometry, tibial, and brachial systolic blood pressures, femoral neck, total hip, and lumbar spine BMD. In multiple regression analyses, after adjusting for age, weight, height, thiazide, beta-blocker, calcium channel blocker, statin, corticosteroid, and calcium supplement use, history of diabetes, heart disease, peripheral vascular disease, cigarette smoking, alcohol intake, and physical activity level, ACEI use was associated with higher femoral neck BMD (+0.015 g/cm2, P = 0.035) in women, and higher femoral neck (+0.015 g/cm2, P = 0.017), total hip (+0.016 g/cm2, P = 0.021), and lumbar spine (+0.043 g/cm2, P < 0.001) BMD in men. Thiazide use was associated with higher BMD at all three sites in general, although associations with BMD increase at the total hip (P = 0.07) and femoral neck (P = 0.09) were weak in men. Calcium channel blocker use was only significantly associated with BMD increase at the lumbar spine (P = 0.03) in women, and beta-blocker use did not have significant associations with BMD at any site. This study suggests that in addition to thiazide diuretics ACEI may have possible benefits in treating not only hypertension but also osteoporosis among older Chinese.

Correlates for a low ankle-brachial index in elderly Chinese.

This study examines the prevalence of atherosclerosis (using ankle-brachial index (ABI) value <0.9) and associated socioeconomic and lifestyle factors in elderly Chinese, adjusting for presence of cardiovascular diseases and body mass index, in a cross-sectional survey of 1999 men and 1999 women aged 65 years and over living in the community. A questionnaire containing information regarding socioeconomic status, medical history and lifestyle factors was administered. Measurement included height, weight, percentage body fat using dual-energy X-ray absorptiometry and ABI. The Hong Kong population (2000) age adjusted prevalence of ABI <0.9 was 5.3% for men and 11.0% for women. In multivariate analysis, old age, female gender, presence of cardiovascular diseases, cognitive impairment, prolonged 6 m walk, smoking habit and alcohol intake were positively associated with ABI <0.9, while negative associations were observed with Vitamin C intake >100 mg per day, with the lowest OR for the range 141-190 mg (OR 0.4). Physical activity level, and self rated higher social standing in the community, while significant in univariate analysis, were not included as independent significant factors in the multivariate model. Lifestyle factors and the female gender were independent risk factors for atherosclerosis in the elderly Chinese population.

Bone mineral density and the risk of peripheral arterial disease in men and women: results from Mr. and Ms Os, Hong Kong.

Previous population studies have demonstrated an association between peripheral vascular disease and bone mineral density in women, but not in men. In a large prospective cohort of 3,998 Chinese men and women aged 65 to 92 years of age in Hong Kong, the association between peripheral vascular disease and bone mineral density was explored. Demographic and lifestyle information was obtained from face to face interviews using a standardized questionnaire. This included demographic information, medical history and lifestyle factors. Physical examination measurements included anthropometry and tibial and brachial systolic blood pressures. The ratio of the posterior tibial and brachial systolic blood pressures, the ankle/arm index, was used as a measure of peripheral arteriosclerosis in the lower extremities. Bone mineral density (BMD) at the total hip and spine (L1-L4) was measured by Hologic QDR-4500 W densitometers (Hologic, Inc., Waltham, Mass.). In this cross-sectional analysis, the ankle brachial index (ABI) was positively correlated with hip BMD (correlation coefficient=0.27; P<0.001). However, after adjustment for confounders, the correlation became much weaker (correlation coefficient=0.03; P<0.05). This showed that much of the relationship between ABI and BMD could be explained by other confounders. In multiple regression analysis, an increase in ABI of 1 SD of ABI was associated with an increase of 0.5% (95% CI: 0.02%, 0.9%) in hip BMD after adjusting for age, sex, body weight, smoking status, history of diabetes, cardiovascular diseases, use of thiazide diuretics, grip strength and physical activity. Although our study shows that peripheral vascular disease in the lower extremities may be associated with decreased bone mineral density, the association is weak especially after adjustment was made for confounders. This indicates that other factors may be contributing to the association between peripheral vascular disease and osteoporosis.

An osteoporosis screening tool for Chinese men.

Several osteoporosis risk instruments have been proposed to select women for bone densitometry, but no validated instruments are currently available for men. This study aims to address this deficiency by developing and validating a Male Osteoporosis Screening Tool (MOST) for Chinese men. Two thousand ambulatory men, aged 65 and above, were recruited from the general community in Hong Kong, and a cohort of 1,970 men with valid total hip and lumbar spine dual-energy X-ray absorptiometry (DXA) measurements was included in the current analysis. A 60% random sample was selected as the training sample for developing the screening tool, and the remaining 40% constituted the validation sample. Logistic regression and receiver operating characteristic (ROC) analysis were used to identify the simplest combination of risk factors to be included in the screening tool for predicting osteoporosis at the femoral neck, total hip, or lumbar spine. Body weight and quantitative ultrasound index (QUI) were found to contribute significantly to the area under the ROC curve (AUC), yielding an AUC of 0.823 in the training sample. The resulting MOST had a sensitivity of 94% and a specificity of 46% when using a cutoff score of 3. MOST had an AUC of 0.839 in the validation sample. The risk of osteoporosis was 1% among those with MOST scores < or = 2, but 72% among those with MOST scores > 7. Using a cutoff of 3, the negative predictive value was 97.5% which suggests that the 42% with MOST scores < or = 3 may be accurately screened out as being without osteoporosis, thus saving two fifths of our DXA resources. The positive predictive value was 72% when using a cutoff of 7, implying that MOST cannot replace DXA for case-finding purposes. Nevertheless, for resource allocation and patient satisfaction, it is prudent and economical to offer DXA screening first to the 6% with MOST scores > 7.