Metabolic and genetic risk factors associated with pre-diabetes and type 2 diabetes in Thai healthcare employees: A long-term study from the Siriraj Health (SIH) cohort study.

BACKGROUND: The study of non-communicable diseases (NCDs) in a developing country like Thailand has rarely been conducted in long-term cohorts, especially among the working-age population. We aim to assess the prevalence and incidence of risk factors and their associations underlying NCDs, especially type-2 diabetes mellitus (T2DM) among healthcare workers enrolled in the Siriraj Health (SIH) study cohort. METHODS: The SIH study was designed as a longitudinal cohort and conducted at Siriraj hospital, Thailand. A total of 5,011 participants (77% women) were recruited and follow-up. Physical examinations, blood biochemical analyses, family history assessments, behavior evaluations, and genetics factors were assessed. RESULTS: The average age was 35.44±8.24 years and 51% of participants were overweight and obese. We observed that men were more likely to have a prevalence of T2DM and dyslipidemia (DLP) compared to women. Aging was significantly associated with pre-diabetes and T2DM (P<0.001). Additionally, aging, metabolic syndrome, and elevated triglycerides were associated with the development of pre-diabetes and T2DM. The minor T allele of the rs7903146(C/T) and rs4506565 (A/T) were associated with a high risk of developing pre-diabetes with odds ratios of 2.74 (95% confidence interval [CI]: 0.32-23.3) and 2.71 (95% CI: 0.32-23.07), respectively; however, these associations were statistically insignificant (P>0.05). CONCLUSION: The findings of the SIH study provide a comprehensive understanding of the health status, risk factors, and genetic factors related to T2DM in a specific working population and highlight areas for further research and intervention to address the growing burden of T2DM and NCDs.

Prevalence and Characteristics of Prediabetes and Metabolic Syndrome in Seemingly Healthy Persons at a Health Check-Up Clinic.

Purpose: This study investigated the prevalence and characteristics of prediabetes (PreDM) and metabolic syndrome (MetS) in seemingly healthy persons attending a health check-up clinic at a tertiary care hospital. Patients and Methods: This was a cross-sectional study that enrolled 1213 subjects (339 male, 874 female) who underwent an annual health check-up at Siriraj Hospital, Bangkok, Thailand from 2009 to 2019. Factors that independently related to PreDM were analyzed using unconditional logistic regression analysis with adjustments for age, BMI, and gender. Results: The prevalence of PreDM and MetS was 54.3% and 19.7% respectively. Participants with impaired fasting glucose (IFG) and glycated hemoglobin (HbA1c) 38.8-46.4 mmol/mol had significantly higher waist circumference (WC) and blood pressure (BP) compared to those with IFG or HbA1c 38.8-46.4 mmol/mol alone (P < 0.05). Among three PreDM subgroups, the average age was lowest in the HbA1c 38.8-46.4 mmol/mol subgroup (P < 0.001). PreDM participants with MetS were older (p = 0.03), had higher WC, BP, fasting plasma glucose and serum triglyceride level (all P < 0.001) but had lower serum high-density lipoprotein (HDL) cholesterol level (P < 0.001). Multivariate analysis revealed high MetS score, obesity, and low serum HDL cholesterol level to be independently associated with PreDM with odds ratios of 9.02 (95% confidence interval [CI]: 4.03-20.18), 1.8 (95% CI: 1.07-3.04), and 1.42 (95% CI: 1.02-1.96), respectively. Conclusion: The prevalence of PreDM and MetS was relatively high in seemingly healthy persons. Distinct PreDM subgroups with or without MetS exhibited diverse clinical and biochemical features suggesting dissimilar pathogenesis.

Impact of KCNQ1, CDKN2A/2B, CDKAL1, HHEX, MTNR1B, SLC30A8, TCF7L2, and UBE2E2 on risk of developing type 2 diabetes in Thai population.

BACKGROUND: Several type 2 diabetes (T2D) susceptibility loci identified via genome-wide association studies were found to be replicated among various populations. However, the influence of these loci on T2D in Thai population is unknown. The aim of this study was to investigate the influence of eight single nucleotide polymorphisms (SNPs) reported in GWA studies on T2D and related quantitative traits in Thai population. METHODS: Eight SNPs in or near the KCNQ1, CDKN2A/2B, SLC30A8, HHEX, CDKAL1, TCF7L2, MTNR1B, and UBE2E2 genes were genotyped. A case-control association study comprising 500 Thai patients with T2D and 500 ethnically-matched control subjects was conducted. Associations between SNPs and T2D were examined by logistic regression analysis. The impact of these SNPs on quantitative traits was examined by linear regression among case and control subjects. RESULTS: Five SNPs in KCNQ1 (rs2237892), CDK2A/2B (rs108116610, SLC30A8 (rs13266634), TCF7L2 (rs7903146) and MTNR1B (rs1387153) were found to be marginally associated with risk of developing T2D, with odds ratios ranging from 1.43 to 2.02 (p = 0.047 to 3.0 × 10-4) with adjustments for age, sex, and body mass index. Interestingly, SNP rs13266634 of SLC30A8 gene reached statistical significance after correcting for multiple testing (p = 0.0003) (p < 0.006 after Bonferroni correction). However, no significant association was detected between HHEX (rs1111875), CDKAL1 (rs7756992), or UBE2E2 (rs7612463) and T2D. We also observed association between rs10811661 and both waist circumference and waist-hip ratio (p = 0.007 and p = 0.023, respectively). In addition, rs13266634 in SLC30A8 was associated with glycated hemoglobin (p = 0.018), and rs7903146 in TCF7L2 was associated with high-density lipoprotein cholesterol level (p = 0.023). CONCLUSION: Of the eight genes included in our analysis, significant association was observed between KCNQ1, CDKN2A/2B, SLC30A8, TCF7L2, and MTNR1B loci and T2D in our Thai study population. Of these, CDKN2A/2B, SLC30A8, and TCF7L2 genes were also significantly associated with anthropometric, glycemic and lipid characteristics. Larger cohort studies and meta-analyses are needed to further confirm the effect of these variants in Thai population.

A WEIGHT-LOSS PROGRAM FOR MEDICAL STUDENTS IN THAILAND: AN EVALUATION OF RELATED KNOWLEDGE, PREVAILING ATTITUDES, AND PROGRAM OUTCOMES FOR WEIGHT LOSS.

Millions of people, worldwide, struggle with being overweight or obese. Medical students, who will eventually become physicians, should be good role models for patients; however, some medical students are themselves overweight or obese. The aim of this study was to evaluate the efficacy of a weight-loss program for medical students in Thailand. A six-month weight reduction program was designed consisted of three full-day sections that were scheduled, as follows: Day One, End of Week One, and End of Week Eight. The interventions incorporated various behavior modification strategies. Participant anthropometric measurements were recorded. Obesity-related knowledge, perception, attitude, and inappropriate weight-loss behaviors were obtained by validated questionnaire. At the end of the study, statistically significant weight loss was demonstrated (median 2.70 kg, p<0.05) compared to baseline. Moreover, participant knowledge significantly increased and inappropriate weight-loss behaviors significantly decreased (p<0.05 and p<0.05, respectively) compared to baseline. Given the demonstrated modest effectiveness of this low-intensity weight reduction program, this intervention should be considered as an effective education tool for medical students.

Certain hormonal markers in urban Thai adults with metabolic syndrome.

BACKGROUND: The prevalence of metabolic syndrome (MS) accompanied with cardiometabolic complications has progressively increased in Thailand. The roles of insulin resistance, leptin, adiponectin, and free testosterone as prognostic indicators of MS among Thai population were evaluated MATERIAL AND METHOD: Men and women aged 34 to 89 years (n = 308) having 0-5 criteria of MS according to NCEP III with Asian-specific cut-points for waist circumference were enrolled in this cross-sectional study. Blood glucose, lipids, insulin, leptin, adiponectin, and free testosterone were measured RESULTS: Each component of MS, especially the enlarged waist, adversely affected insulin sensitivity. MS subjects were at higher risk for developing insulin resistance, decreasing of plasma adiponectin, and increasing of leptin and the leptin/ adiponectin ratio in comparison to non-MS individuals. The hormonal changes that have been shown to be associated with increased cardiometabolic risk were amplifiedas more MS criteria have been met. Odds ratios of increased leptin/adiponectin ratio among MS group were highest in comparison to others. Free testosterone levels declined with age and did not discriminate men with MS. CONCLUSION: The results indicate the benefit of hormonal assessment, particularly the leptin/adiponectin ratio in identifying MS individuals with high cardiometabolic disease risk.

Factors associated with dengue prevention and control in two villages in a central Thai province: a retrospective review.

OBJECTIVE: To study the factors associated with dengue prevention and control in Moo 6 (the 6th village) and Moo 7 of Tambon Kaeng-phak-kut, Thaluang District, Lopburi Province. MATERIAL AND METHOD: The authors reviewed the raw data collected by public health officers and village health volunteers (VHVs) as their routine tasks. The authors analyzed the data, 30 dwellings per each village, to compare the demographics, knowledge, attitude, and practice of subjects from Moo 6, a dengue-outbreak community, with that from Moo 7, a control group, as well as larval indices between these 2 studied groups. The present retrospective study is approved by Siriraj Institutional Review Board, Certificate of Approval No. Si393/2012. RESULTS: Both groups of subjects had no statistically significant difference in basic dengue knowledge (p = 0.862), attitude towards dengue prevention and control, practical knowledge (p = 0.457), and actual practice to eliminate Aedes larvae and prevent it laying eggs, except for the practice of managing water container in bathroom or toilet (p = 0.015). On the other hand, dengue incidence and larval indices of both villages were apparently different. CONCLUSION: Although incorrect basic dengue and practical knowledge of subjects from both villages were similar dengue outbreak in Moo 6 of Tambon Kaeng-phak-kut was superior. It may be due to difference in actual practice on larval elimination in water container in bathroom or toilet as well as other factors other than personal factors such as public services, public places, and community surroundings.

Abnormal liver enzymes in Thai patients with metabolic syndromes.

OBJECTIVE: Elevated transaminases have been found to be associated with metabolic syndrome (MS) in many populations but little is known in Asians. The present study aimed to investigate the association between elevated hepatic enzymes in Thai patients diagnosed with MS. MATERIAL AND METHOD: A cross-sectional study on 2,585 Thais was conducted. Blood pressure, waist circumference, fasting plasma glucose, triglyceride, HDL-cholesterol, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) were measured. MS was diagnosed using NCEP/ATP III criteria with modified waist circumference for Asian. The association between MS with elevated liver enzymes was performed using logistic regression. RESULTS: Twenty-seven percent of the subjects were found to have MS. The MS group had significantly higher mean AST, ALT, and ALP levels than the non-MS group (mean (SD) for AST 29.86 (18.97), 24.08 (12.71); ALT 38.39 (29.14), 24.38 (18.57); and ALP 73.45 (27.09), 65.72 (21.27) for MS and non-MS, respectively, p < 0.05). MS was significantly associated with elevated liver enzymes. The adjusted odds ratios (OR) were 2.2 (95% confidence interval (CI): 1.6-2.9), 2.3 (95% CI: 1.8-3.0), and 2.2 (95% CI: 1.1-4.2) for elevated AST, ALT, and ALP, respectively. ALT/AST ratio of > or = 1 was significantly associated with MS in both genders (adjusted ORs: 1.72 (95% CI: 1.28-2.32) for men and 2.30 (95% CI: 1.68-3.16) for women). CONCLUSION: There is a strong association between metabolic syndrome and elevated liver enzymes. Further study is needed to investigate the long-term sequelae of liver abnormalities in those with metabolic syndrome in Thai population.

Lipid-lowering treatment in hypercholesterolemic patients: the CEPHEUS Thailand survey.

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) has become the leading cause of death and disability in Thailand. Low-density lipoprotein cholesterol is the major risk factor of this condition that can be intervened by means of lifestyle modification and pharmacologic treatment. Adequacy of hypercholesterolemia treatment with lipid lowering drugs in Thailand needed to be more clarified. The present study was conducted to determine low-density cholesterol goal attainment in Thai population at risk for developing ASCVD. MATERIAL AND METHOD: Twenty-seven physicians with their 909 hypercholesterolemic patients whose age of > or = 18 years, actively under pharmacologic treatment for at least three months with no dose adjustment for a minimum of six weeks from seven centers across Thailand were enrolled. Plasma glucose, total cholesterol, LDL cholesterol, HDL-cholesterol, and triglyceride levels were measured after overnight fast. Demographic and other relevant data including information on lipid lowering drug used were retrieved. Patients' awareness, knowledge on their management, compliance, and satisfaction were evaluated by questionnaire survey as well as physicians' use of guidelines, choice of management and goal setting, and their attitudes towards lipid management. Cardiovascular risk level and LDL goal were assessed by the updated 2004 NCEP-ATP III guidelines. RESULTS: All patients had LDL goal of < 130 mg/dl with 86.1% needed LDL goal of < 100 mg/dL. Overall, 52.7% of the patients reached their LDL goal. The most prescribed treatment was statin monotherapy (82.7%). LDL goal attainment was inversely associated with LDL goal set by NCEP-ATP III according to the patients' risk profile, with only 16.7% of those who were in the very high risk group with LDL goal of < 70 mg/dL achieved their goal whereas 60.6% and 84.7% of those with high (LDL goal < 100 mg/dl) and moderately high-risk (LDL goal < 130 mg/dl) achieved their goal, respectively (p < 0.001). Other factors associated with less favorable LDL goal attainment were coronary heart disease, carotid artery disease, diabetes, 10-year risk of > 20%, and metabolic syndrome (p < 0.05 for all). Type of lipid lowering drug was not significantly associated with LDL goal attainment. CONCLUSION: LDL goal attainment was not achieved in a high proportion of Thai patients especially in those who had high to very high risk for developing cardiovascular disease. Despite availability of well-established treatment guideline and efficacious lipid lowering drugs, many patients still miss the opportunity to effectively control their lipid profile.

Body shape and metabolic abnormalities in Thai HIV-infected patients.

Fat and metabolic abnormalities and their associated factors in HIV-infected patients in Thailand were examined. Body fat and fasting lipids (total cholesterol, TC; triglyceride, TG; and HDL-cholesterol, HDL-c) were evaluated in 247 HIV-infected Thais. Body fat was evaluated by subjects and blinded observers, and measured using dual-energy X-ray absorptiometry. Descriptive statistics and logistic regression were used for analyses. Antiretroviral (ARV)-treated Thais were significantly older, more likely to be male, and had higher education and income compared to untreated subjects. The prevalence of lipoatrophy was 10.3% in ARV-naive patients, 36.7% in patients receiving non-protease inhibitor (PI)-based ARV, and 78.7% in PI-based ARV-treated patients (p < 0.001). Excess abdominal or neck fat was found in 0.8%, 6.7%, and 24.6% of the naive, non-PI-treated, and PI-treated, respectively (p < 0.001). Hypercholesterolemia (TC > or = 240 mg/dl) was found in 4.8%, 26.6%, and 42.6%; hypertriglyceridemia (TG > or = 150 mg/dl) in 8.2%, 48.3%, and 75.4%; and low HDL-c (HDL-c < 40 mg/dl) in 42.9%, 20.0%, and 31.2% of the naive, non-PI treated, and PI-treated, respectively (p < 0.05 for all). Central to peripheral fat ratios were 1.11 +/- 0.03, 1.45 +/- 0.06, and 1.93 +/- 0.08 for the naive, non-PI, and PI-treated, respectively (p < 0.001). Treatment was associated with abnormal fat. The adjusted ORs (95% CI) of lipoatrophy for excess fat were 4.6 (2.0-10.7); 6.3 (0.6-71.1) for ARV-naive vs. non-PI; 5.6 (3.4-9.1); 10.7 (3.4-33.8) for ARV-naive vs. PI, and 5.7 (2.4-13.9); 5.3 (1.2-11.4-13.9) for ARV-naive vs. PI. ARV-associated metabolic abnormalities are common in this non-Western population. Appropriate selection and monitoring of ARV treatment are critical to minimize the risk of long-term complications.