Mendelian randomization on the association of obesity with vitamin D: Guangzhou Biobank Cohort Study.

BACKGROUND: Mendelian randomization (MR) analyses from the West provide evidence that obesity causes lower 25-hydroxyvitamin D [25(OH)D]. As Asian populations are prone to metabolic disorders at a lower body mass index (BMI), whether the association remains in Asian is unclear. We studied whether obesity causes vitamin D deficiency using MR analysis in Chinese. METHODS: We used data from the Guangzhou Biobank Cohort Study. A genetic score including seven BMI-related single-nucleotide polymorphisms (n = 15,249) was used as the instrumental variable (IV) for BMI. Two-stage least square regression and conventional multivariable linear regression in 2,036 participants with vitamin D data were used to analyze association of BMI with vitamin D. RESULTS: Proportion of variation explained by the genetic score was 0.7% and the first stage F-statistic for MR analysis was 103. MR analyses showed that each 1 kg/m2 higher BMI was associated with lower 25(OH)D by -2.35 (95% confidence interval (CI) -4.68 to -0.02) nmol/L. In conventional multivariable linear regression, higher BMI was also associated with lower 25(OH)D (ß = -0.26 nmol/L per 1 kg/m2 increase in BMI, 95% CI -0.46 to -0.06). Sensitivity analyses using two-sample IV analysis and leave-one-out method showed similar results. CONCLUSION: We have first shown by MR and conventional multivariable linear regression that higher BMI causes vitamin D deficiency in Chinese. Our findings highlight the importance of weight control and suggest that vitamin D supplementation may be needed in individuals with overweight or obesity.

Mental Health, Support System, and Perceived Usefulness of Support in University Students in Hong Kong Amidst COVID-19 Pandemic: A Mixed-Method Survey.

BACKGROUND: This study explored the association of students' mental health with their support system, identified the preferred ways and sources of support, investigated the perceived usefulness of available university support, and recommended actionable strategies to enhance students' mental health. METHOD: An online questionnaire survey and semi-structured focus group interviews were conducted in 2021. RESULTS: Among 1121 university students, 39.4% reported anxiety symptoms, which were less common in Chinese students and those pursuing medical and health programmes. Overall, 32.6% reported depression symptoms, which were more common in undergraduates. Both anxiety and depression symptoms were less common in students with higher resilience and support system and more common in students with family distress. Students with higher resilience had a better support system and less family distress. Perceived support from universities was lower than from peers and families. Peer support and phone contacts were the most preferred sources and ways of support. The most useful available university support was updated university guidelines, and the least useful was the emotional hotline service from universities The qualitative findings corroborated the quantitative results. CONCLUSION: We suggested that a holistic care approach and more proactive student-oriented university support would help students face adversity and enhance mental health.

Effect of puerarin supplementation on cardiovascular disease risk factors: A randomized, double-blind, placebo-controlled, 2-way crossover trial.

BACKGROUND: Cell culture and animal studies suggest puerarin could prevent cardiovascular disease (CVD). However, trials in human are scare, not primarily designed for prevention, and inadequately powered. We assessed the effect of puerarin supplementation on CVD risk factors in men using a crossover trial. METHODS: In total, 217 Chinese men aged 18-50 years without a history of CVD were recruited. They were randomized to take a puerarin supplement (90.2 mg daily) or a placebo, followed by a 4-week wash-out period, and then crossed over to the other intervention. An intention-to-treat analysis was used. Differences in primary outcomes (lipid profile such as low-density lipoprotein (LDL) cholesterol) and secondary outcomes (other CVD risk factors such as blood pressure and fasting glucose, and some potential mediating pathways such as testosterone) between supplementation and placebo within participants were compared using a paired t-test, or a crossover (CROS)-based analysis where a period effect existed. RESULTS: Lipid profile was similar after the puerarin supplementation or placebo (e.g., mean difference in LDL cholesterol: -0.02 mmol/L, 95% confidence interval (CI) -0.09 to -0.06). Conversely, fasting glucose was reduced after the puerarin supplementation (-0.13 mmol/L, 95% CI -0.25 to -0.008). There were no differences in blood pressure, testosterone, high-sensitive C-reactive protein, prothrombin time, liver or renal function. CONCLUSION: In young-to-middle-aged Chinese men, short-term puerarin supplementation did not improve the primary outcome of lipid profile, but an exploratory analysis suggested that puerarin could be beneficial for one of the secondary outcomes, i.e., fasting glucose.

An Exploratory Trial of Brief Mindfulness-Based Zentangle Art Workshops in Family Social Services during COVID-19: Transitioning from Offline to Online.

Mindfulness-based art therapy has shown to improve psychological well-being. Zentangle is an easy-to-learn, mindfulness-based art therapy suitable for everyone. We reported the transition from face-to-face to online Zentangle workshops in family social services during COVID-19. We explored feedback from face-to-face workshops and the acceptability of an online approach utilizing information communication technology (ICT) to achieve greater service reach, satisfaction, and knowledge and related outcomes. Under the Hong Kong Jockey Club SMART Family-Link Project and in collaboration with Caritas Integrated Family Service Centre-Aberdeen, this study was conducted in two phases: a four-session, face-to-face workshop (phase one) and eleven online single-session workshops (phase two) from September 2019 to September 2020. A total of 305 participants joined the workshops. Phase one participants (n = 11) reported high satisfaction (4.7 out of 5), increases in knowledge (4.2/5) and confidence (3.9/5) towards managing stress, increases in knowledge (4.1/5) and confidence (3.9/5) in showing support and care towards family members, and an increase in knowledge towards strengthening family relationships (4.0/5). Phase two participants (n = 294) also reported high satisfaction (4.7/5) and strongly agreed that ICT helped with learning Zentangle more conveniently, that they had increased knowledge and interest in Zentangle (all 4.7/5), and would definitely join the workshop again (4.8/5). The qualitative data supported the quantitative findings. We are the first to report on the utilization of ICT in an exploratory trial of brief, online Zentangle art workshops targeting the general public, with high satisfaction and positive participant experiences with ICT integration, learning Zentangle, and enhanced psychological and family well-being. This study provided preliminary evidence on the use of ICT to successfully transition face-to-face to online workshops and reach a wider audience.

Habitual tea consumption was associated with lower levels of depressive symptoms among older Chinese: Guangzhou Biobank Cohort Study.

Previous studies showed that some components in tea had potential beneficial effects on depression. However, population-based studies examining the potential benefits of tea on depression are limited. We hypothesized that older Chinese with habitual tea consumption had lower levels of depressive symptoms than those without habitual tea consumption. A cross-sectional analysis of baseline data from the Guangzhou Biobank Cohort Study was conducted. Depressive symptoms were measured by the 15-item Geriatric Depression Scale (GDS) score (continuous), with the presence defined by a GDS ≥ 8. Of 10,014 participants, 421 (4.20%) had depressive symptoms. After adjusting for potential confounders, compared with never-consumers, occasional and regular consumers had lower GDS scores (ß [95% confidence interval]: -0.29 [-0.46, -0.11] and -0.60 [-0.78, -0.42], respectively), and regular consumers showed lower odds of depressive symptoms (odds ratio [95% CI]: 0.51 (0.35-0.72). In regular tea consumers, greater frequency, amount per occasion and per week, and higher amount-years showed lower GDS score (all P for trend <0.001) and lower odds of depressive symptoms (all P for trend < .05) than nonconsumers. The results were similar by different types of tea (green tea, black tea, and oolong tea) consumed. Further adjustment for social characteristics of tea consumption attenuated the association slightly but not fully. In conclusion, habitual tea consumption was associated with lower levels of depressive symptoms among older Chinese, which might be partly explained by social interaction during consumption. Further investigation on causation and mechanisms, including mechanistic randomized controlled trials is warranted.

A Randomized Controlled Trial of a Positive Family Holistic Health Intervention for Probationers in Hong Kong: A Mixed-Method Study.

Introduction: Probationers, offenders with less serious and non-violent offences, and under statutory supervision, have low levels of self-esteem and physical health, and high level of family conflict, and poorer quality of family relationships. This study examined the effectiveness of the existing probation service and the additional use of a positive family holistic health intervention to enhance physical, psychological, and family well-being in probationers and relationships with probation officers. Methods: Probationers under the care of the Hong Kong Social Welfare Department were randomized into a care-as-usual control group (CAU), a brief intervention group (BI) receiving two 1-h individual sessions [of a brief theory-based positive family holistic health intervention integrating Zero-time Exercise (simple and easy-to-do lifestyle-integrated physical activity) and positive psychology themes of "Praise and Gratitude" in the existing probation service], or a combined intervention group (CI) receiving BI and a 1-day group activity with family members. The outcomes were physical activity, fitness performance, self-esteem, happiness, anxiety and depression symptoms, life satisfaction, quality of life, family communication and well-being, and relationships with probation officers. Self-administered questionnaires and simple fitness tests were used at baseline, 1-month and 3-month follow-up. Linear mixed model analysis was used to compare difference in the changes of outcome variables among groups, adjusted of sex, age, and baseline values. Focus group interviews were conducted. Thematic content analysis was used. Results: 318 probationers (51% male) were randomized into CAU (n = 105), BI (n = 108), or CI (n = 105) group. CAU showed enhanced physical activity, fitness performance and psychological health, and family communication with small effect sizes (Cohen's d: 0.19-0.41). BI and CI showed further improved physical activity, family communication and family well-being (Cohen's d: 0.37-0.70). Additionally, CI reported greater improvements in the relationships with probation officers than CAU with a small effect size (Cohen's d: 0.43). CI also reported greater increases in physical activity and family communication than BI with small to moderate effect sizes (Cohen's d: 0.38-0.58). Qualitative feedbacks corroborated the quantitative findings. Conclusion: Our trial provided the first evidence of the effectiveness of probation service and the additional use of an innovative, relatively low-cost, theory-based brief positive family holistic health intervention. This intervention may offer a new model for enhancing probation service. Trial Registration: The research protocol was registered at the National Institutes of Health (identifier: NCT02770898).

Brief mindfulness training for smoking cessation in Chinese women in workplaces: A pilot randomized controlled trial.

INTRODUCTION: Mindfulness training (MT) has shown preliminary efficacy as a behavioral treatment for smoking cessation. We examined the effect of a brief-MT intervention on smoking cessation for Chinese women in workplaces in Hong Kong, China. METHODS: In this pilot randomized controlled trial, 213 daily smokers were recruited from workplaces and computer-randomized into the intervention (n = 114) or control (n = 99) groups. Participants in both groups received a self-help booklet. Participants in the intervention group additionally attended 2 sessions of a brief-MT workshop. The primary outcome was self-reported 7-day point-prevalence abstinence (PPA) at 6 months. Secondary outcomes were biochemically validated abstinence (exhaled CO < 4 ppm and salivary cotinine < 10 ng/mL) and smoking reduction at 6 months. Analyses were done by intention to treat. We conducted a post-trial qualitative evaluation on participants in the intervention group (n = 14). Data were analyzed thematically. RESULTS: At 6-month follow-up, self-reported 7-day PPA were similar between the intervention and control groups (18.4% vs. 21.2%; P = 0.61). Very few participated in biochemical validation (n = 17), and validated abstinence and smoking reduction rates showed no significant difference (5.3% vs. 11.1%, P = 0.12 and 20.2% vs. 20.2%, P = 1.00, respectively). A posteriori analysis showed that brief-MT participants who were psychologically engaged with the intervention had greater 6-month PPA. Qualitative evaluation showed brief-MT reduced stress but its effectiveness was restrained by the insufficient home practice. CONCLUSIONS: This pilot trial on a brief-MT intervention for smoking cessation on Chinese women in workplaces showed feasibility, but improving compliance is needed to maximize the efficacy in future fully powered trials.

Exploratory study on the relationship between smoking and other risk behaviours among young smokers.

AIMS AND OBJECTIVES: To explore the relationship between smoking and other risk behaviours among Chinese young people in Hong Kong. BACKGROUND: There is growing concern about coexisting risk behaviours in young smokers. Information about smoking and other risk behaviours is crucial for developing interventions to promote smoking abstinence and adoption of healthy lifestyles. The relationship between smoking and other risk behaviours among Chinese young people in Hong Kong has not been explored. DESIGN: This is a mixed-method retrospective population-based study. METHODS: A retrospective population-based study was conducted with 1,147 young smokers through Youth Quitline between November 2011-July 2016. Attitudes, behaviours and experiences related to smoking and risk behaviours among Chinese young smokers were examined in semi-structured qualitative interviews with 30 participants randomly selected from the retrospective population-based study. RESULTS: In total, 45.5% participants reported engaging in at least one other risk behaviour. The interviews revealed that drinking alcohol may have a significant impact on quitting smoking. In addition, smoking may be a gateway for more serious risk behaviours during adolescence. Low health awareness may explain the unhealthy lifestyles among young smokers. CONCLUSIONS: This study bridges a gap in existing literature by exploring relationships between smoking and other risk behaviours among young people in Hong Kong. RELEVANCE TO CLINICAL PRACTICE: Given the interrelationships between smoking and other risk behaviours, a holistic approach should be used to promote smoking cessation and healthy lifestyles among young smokers. If young smokers improve their health and quit smoking at the same time, their physical and mental development will benefit as a secondary outcome.

Is Traditional Chinese Exercise Associated With Lower Mortality Rates in Older People? Evidence From a Prospective Chinese Elderly Cohort Study in Hong Kong.

The inverse association of aerobic exercise with death has been well documented. However, evidence on traditional Chinese exercise (TCE) and rate of death in older Chinese is limited. Multivariable Cox regression analysis was used to assess the associations of TCE and other types of physical activity with death from all causes and specific causes in a population-based prospective cohort of 66,820 Chinese persons (≥65 years of age) who were enrolled between July 1998 and December 2001 at all 18 Elderly Health Centers in Hong Kong and followed up until May 31, 2012. During an average of 10.9 years of follow-up, 19,845 deaths occurred. TCE was inversely associated with death from all causes (hazard ratio (HR) = 0.78, 95% confidence interval (CI): 0.74, 0.82), cardiovascular disease (HR = 0.77, 95% CI: 0.70, 0.85), cancer (HR = 0.84, 95% CI: 0.77, 0.92), and respiratory disease (HR = 0.71, 95% CI: 0.63, 0.80) but was not associated with death from accidents (excluding falls) (HR = 0.79, 95% CI: 0.44, 1.42), after adjustment for age, sex, socioeconomic position, alcohol use, smoking, body mass index, and health status. The associations did not vary by amount of TCE. Aerobic exercise had similar inverse associations as TCE, but associations for stretching exercises and walking slowly were less marked. Further studies of TCE are warranted in older Chinese.

Effects of tea consumption on renal function in a metropolitan Chinese population: the Guangzhou biobank cohort study.

OBJECTIVE: Green tea consumption has been associated with many prophylactic health benefits. This study examined for the first time associations between tea consumption and renal function in a Chinese population. DESIGN AND METHODS: Cross-sectional baseline data including demographics, and lifestyle and weekly consumption of green, black, and oolong tea were analyzed from 12,428 ambulatory subjects aged 50 to 85 years (67.3% female) that were randomly selected from the membership list of a community social and welfare association in Guangzhou, China. INTERVENTION: Associations between tea consumption and renal function were assessed using regression analyses to adjust for potential confounding factors. MAIN OUTCOME MEASURE: Renal function was assessed using the estimated glomerular filtration rate (eGFR) and in a subcohort of 1,910 participants using a spot urinary albumin-to-creatinine ratio. RESULTS: Six thousand eight hundred and seventy-two participants drank at least 1 type of tea. Oolong tea consumption was negatively associated with eGFR (ß-coefficient -0.019, P = .025), but in a gender-stratified analysis this was not the case. In men, black tea was positively associated with eGFR (ß-coefficient 0.037, P = .013), but not in women (ß-coefficient -0.002, P = .856). Otherwise, no statistically significant consistent associations between the measures of renal function and consumption of green tea, black tea, or oolong tea individually or total tea consumption were identified. CONCLUSION: Overall there was no clear evidence to suggest any consistent association between renal function and tea consumption in this large population-based study of older Chinese individuals.

Construction of a traditional Chinese medicine syndrome-specific outcome measure: the Kidney Deficiency Syndrome Questionnaire (KDSQ).

BACKGROUND: Development of Traditional Chinese Medicine (TCM) syndrome-specific outcome measures is needed for the evaluation of TCM syndrome-specific therapies. We constructed a Kidney Deficiency Syndrome Questionnaire (KDSQ) for the evaluation of the common TCM syndromes Kidney-Yin Deficiency Syndrome (KDS-Yin) and Kidney-Yang Deficiency Syndrome (KDS-Yang) in middle-aged women with menopausal symptoms. METHODS: KDS-Yin and KDS-Yang were traditionally defined by expert opinion were validated by exploratory factor analysis (EFA) and structural equation modeling (SEM). Content validity was tested by EFA on a sample of 236 women from a seminar and SEM on another sample of 321 women from a postal survey. Other psychometric properties were tested on 292 women from the seminar at baseline and two systematically selected sub-samples: 54 who reported no changes in discomforts 11-12 days after the baseline and 31 who reported changes in discomforts 67-74 days after the baseline. All participants completed the KDSQ, the Greene Climacteric Scale and the standard 12-item Short Form Health Survey. RESULTS: The EFA and SEM established the measurement models of KDS-Yin and KDS-Yang supporting content validity of the KDSQ. Internal consistency was good (Cronbach's Alpha >0.70). Construct validity was supported by theoretically-derived levels of correlation with the established external measures. Test-retest reliability was strong (ICC(agreement): KDS-Yin, 0.94; KDS-Yang, 0.93). The KDSQ was responsive to changes over time as tested by effect size and longitudinal validity. CONCLUSIONS: The KDSQ was a valid and reliable measure for KDS-Yin and KDS-Yang in Hong Kong Chinese middle-aged women with menopausal symptoms.

Dietary intake of phytoestrogen is associated with increased circulating endothelial progenitor cells in patients with cardiovascular disease.

Endogenous estrogen is known to positively influence the level and functionality of endothelial progenitor cells (EPC). However, the effect of phytoestrogen on EPC is unknown. Isoflavone is a major component of phytoestrogen. This study aims to investigate if the intake of isoflavone has any impact on the circulating level of EPC. We studied 102 consecutive patients (mean age: 66.5 ± 9.5 years, 78% male, all female post-menopausal) with cardiovascular disease (atherothrombotic stroke 62%, coronary artery disease 38%). Circulating levels of CD133(+) EPC were determined by flow cytometry. Non-invasive pulse wave velocity (PWV) was measured. Long-term intake of isoflavone was determined by a validated food frequency questionnaire. Isoflavone intake was positively associated with circulating CD133(+) EPC (r = 0.31, p = 0.001). Patients with circulating CD133(+) EPC <10th percentile had significantly lower isoflavone intake than patients with CD133(+)EPC ≥10th percentile (4.6 ± 3.7 mg/day versus 19.3 ± 30.2 mg/day, p < 0.001). A significant overall linear trend of circulating EPC across increasing tertiles of isoflavone intake was observed (p = 0.004). Adjusted for potential confounders, increased isoflavone intake from the 1st to the 3rd tertile independently predicted increased circulating CD133(+) EPC level by 221 cells/µl (95%CI: 71.4 to 369.8, relative increase 160%, p = 0.004). Gender was not a significant factor (p > 0.05). Furthermore, circulating CD133(+) EPC <10th percentile was independently predictive of increased PWV by 261.7 cm/s (95% CI: 37.1 to 486.2, p = 0.024). The study demonstrated that circulating EPC increased by more than one fold in patients with cardiovascular disease who had higher intake of isoflavone, suggesting that isoflavone may confer vascular protection through enhanced endothelial repair.

Fish consumption and mortality in Hong Kong Chinese--the LIMOR study.

PURPOSE: To investigate the association between fish consumption and mortality in 36,003 Chinese. METHODS: A case-control study collected 81% of all deaths of those aged 30+ from all four Hong Kong death registries in 1998. Relatives registering the deaths provided demographic, dietary and other lifestyle data for the deceased (case) and a similarly aged living person (control). Causes of death were provided by the Department of Health. Logistic regression was used to calculate the mortality odds ratios (ORs) for fish consumption adjusting for potential confounders in the 23,608 cases and 12,395 controls. RESULTS: Compared with the lowest fish consumption of less than or equal to three times a month, higher consumption of one to three times a week was associated with lower mortality ORs (95% confidence interval [CI]) of 0.75 (0.62-0.89) for all-cause, 0.66 (0.48-0.92) for ischemic heart disease (IHD), 0.70 (0.50-0.98) for stroke, 0.66 (0.53-0.82) for cancer, but not for injury and poisoning. The highest level of fish consumption of greater than or equal to four times a week also reduced mortality with ORs (95% CI) of 0.80 (0.68-0.94) for all-cause and 0.63 (0.47-0.85) for IHD. CONCLUSIONS: Fish consumption significantly reduced mortality from several causes in this sample. Further longitudinal studies to confirm the association are needed.

An evidence-based validation of traditional Chinese medicine syndromes.

OBJECTIVES: A standard description regarding the diagnosis of traditional Chinese medicine (TCM) syndromes based on validated evidence is needed for education, practice and evaluation of TCM syndrome-specific treatments. We studied whether an evidence-based four-step approach proposed for the validation of TCM syndromes could validate Kidney-Yin deficiency syndrome (KDS-Yin) and Kidney-Yang deficiency syndrome (KDS-Yang) in middle-aged women with menopausal symptoms. METHODS: TCM classic and contemporary literature were reviewed for the symptoms and the domain changes of KDS-Yin and KDS-Yang. Factor analysis was used to explore whether these symptoms could be grouped according to their mutual relationships in a sample of women. Latent tree models were constructed based on the factor loadings and justifiability by the theory, and were tested by structural equation modelling on another sample of women. RESULTS: The symptoms and domain changes were reviewed from the TCM literature. Exploratory factor analysis (EFA) identified symptom patterns on a sample of 236 women. Based on the findings and the TCM literature, latent tree models of KDS-Yin and KDS-Yang, showing their domain changes and domain symptoms, were constructed and could be confirmed by structural equation modelling on a sample of 323 women. CONCLUSION: KDS-Yin and KDS-Yang in middle-aged women with menopausal symptoms were validated and the four-step approach may be used to validate TCM syndromes.

Diet synergies and mortality--a population-based case-control study of 32,462 Hong Kong Chinese older adults.

BACKGROUND: Food and drink are not consumed in isolation and can have complimentary effects enhancing or blocking the overall uptake of nutrients. We investigated how combinations of foods, drinks, and smoking affected mortality. Method Adjusted logistic regression was used to assess the joint effect of healthy foods, less healthy foods, smoking, and alcohol use on mortality in a case-control study of all Chinese adults aged 60 or over who died in 1998; 21,494 dead cases (81% of all registered deaths) and 10,968 live controls were included. RESULTS: There was a significant trend of increasing all-cause mortality risk with decreasing healthy food consumption (P < 0.001), and the increase in risk was significantly steeper for people with high intakes of less healthy food (P for interaction <0.001). There was a steeper risk from increasing less healthy food intake in ever-smokers and people not drinking tea regularly (P < 0.001), while the J-shaped relationship between alcohol and mortality differed in shape with level of less healthy food intake. CONCLUSION: Intake of some dietary items may modify the effect of others. An analysis framework explicitly recognizing complementary and potentially synergistic effects of food, drinks, and smoking could enhance our understanding of dietary epidemiology.