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Aim: The study was conducted in order to examine the sex-specific association of serum uric acid (SUA) levels with elevated serum alanine aminotransferase (ALT) in a Taiwanese military cohort. Methods: We made a cross-sectional examination of the sex-specific relationship using 6728 men and 766 women, aged 18-50 years from a large military cohort in Taiwan. SUA levels within the reference range ( Results: The prevalence of hyperuricemia and elevated ALT in men were 18.7% and 12.7%, respectively, and in women were 3.3% and 2.1%, respectively. As compared with the lowest SUA quartile, hyperuricemia was associated with elevated ALT in men (odds ratios (OR): 1.62, 95% confidence intervals (CI): 1.19-2.20) after controlling for age, service specialty, body mass index, metabolic syndrome components, current cigarette smoking, alcohol intake status, and weekly exercise times, but the associations for the other SUA quartiles were null. By contrast, the associations of hyperuricemia (OR: 0.81, 95% CI: 0.10-6.64) and the other SUA quartiles with elevated ALT were null in women. Conclusion: Our findings suggest that the relationship between each SUA level and elevated ALT may differ by sex among military young adults. The mechanism for the sex difference requires further investigations.

Purpose: To investigate the association of preexisting hypertension at admission with the mortality in patients with systolic heart failure (HF). Method: We prospectively investigated the association of preexisting hypertension with the mortality among 1351 patients with HF in Taiwan during an average 12 months (range: 8 months–18 months) follow-up period. A multivariate cox regression analysis for the overall cohort and a subgroup analysis by age were performed. Results: After adjustment for all potential risk factors, the associations of preexisting hypertension with cardiovascular mortality were significantly reduced in the overall cohort and those aged less than 65 years (hazard ratios (HR): 0.53, 95% confidence intervals (CI): 0.33–0.84, and 0.28, 95% CI: 0.11–0.67, respectively). However, the associations with all-cause mortality were not significantly different in these two groups (HR: 0.77, 95% CI: 0.54–1.09, and 0.59, 95% CI: 0.32–1.07, respectively). Furthermore, the associations were all nonsignificant in the patients aged older than 65 years. Conclusion: Preexisting hypertension have an inverse association with cardiovascular mortality in the Asian patients with systolic HF, particularly for those with younger ages. Keywords: Reverse epidemiology, Pre-existing hypertension, Heart failure

Objective To analyze 48 cases the risk factors of vancomycin-resistant Enterococcus (VRE) infections, the antibiotic costs after infection, and the survival conditions. Design 1:3 matched case-control study a medical center in the eastern Taiwan area. The case group, patients with VRE bacterial strains detected at the sterile sites, and the control group were randomly selected from invasive vancomycin-sensitive Enterococcus (VSE) infected patients at the nearest time point by taking the occurrence time of each VRE infection case as the reference time. Fisher exact tests were conducted in order to verify the existence of differences between the case and control groups; survival analysis was applied to explore the prognoses of the VRE infection cases. Results The mortality rate of the invasive VRE infection cases was 64.6%, which is obviously higher than that of the invasive VSE infection cases (39.4%); the fact of taking chemotherapy during a hospital stay as well as the use of third-generation cephalosporin, glycopeptides, and medicines of the metronidazole category before the infections, are the risk factors of future invasive VRE infections. Moreover, the antibiotic costs after the infections of invasive VRE infection cases are much higher than those of the VSE infection cases (the average daily cost is 3,433 new Taiwan dollars (NTD) vs. 1,742 NTD). Conclusions The history of receiving chemotherapy, the use of third-generation cephalosporin, glycopeptides, and medicines of the metronidazole category before the infections are the risk factors of VRE infections. The antibiotic costs after the infections of invasive VRE infection cases are much higher than those of the VSE infection cases.

BackgroundHyperuricemia is associated with a higher risk of death in patients with coronary artery disease (CAD). In contrast, overweight or obesity was associated with survival benefits in this population. However, the relation of body mass index (BMI) and serum uric acid (SUA) to mortality has not been clarified in this population.MethodsWe studied a cohort of 1202 patients with angiographic CAD from the ET-CHD registry during 1997–2003 in Taiwan. To evaluate the relation of BMI and SUA on mortality, the subjects were categorized into 4 groups by BMI≧25kg/m2 (overweight or obesity) or BMI

a b s t r a c t Background: Low estimated glomerular filtration rate (eGFR) and body mass index (BMI) have been known as poor prognostic factors in patients with coronary artery disease (CAD). Besides, high BMI was associated with higher survival rate in patients on dialysis as well. However, the relation of eGFR and BMI to mortality has not been clarified in non-dialysis CAD patients. Methods: We studied a cohort of 1243 non-dialysis patients with angiographic CAD from the ET-CHD registry during 1997-2003 in Taiwan. To evaluate the relation of eGFR and BMI to mortality, the subjects were categorized into 4 groups by BMI higher or lower than 25 kg/m 2 and eGFR higher or lower than 60 mL/min/1.73 m 2 , a cut-off value for chronic kidney disease (CKD). At a mean follow-up of 5.4 years, cardiac and all-cause deaths were the primary end points. Results: In the high BMI group, CKD was a strong predictor of cardiac and overall mortality (hazard ratio (HR): 1.63 (95% CI: 1.05-2.53) and 2.17 (95% CI: 1.54-3.07), respectively). Besides, CKD marginally elevated the mortality risk in the low BMI group. Among CKD patients, BMI was not associated with mortality except for a high death rate in patients with BMI lower than 21 kg/m2. In contrast, in non-CKD patients, high BMI group had a lower cardiac and overall mortality than the low BMI group (HR: 0.75 (95% CI: 0.48-1.16) and 0.55 (95% CI: 0.39-0.77), respectively). Conclusions: Among non-dialysis CAD patients in eastern Taiwan, lower eGFR was associated with worse prognosis regardless of BMI levels. Notably, in patients with high BMI, the relationship between CKD and mortality was extremely remarkable. Moreover, the obesity-mortality paradox phenomenon was

ObjectiveTo assess the relative validity and reproducibility of the quantitative FFQ used in the Tzu Chi Health Study (TCHS).DesignThe reproducibility was evaluated by comparing the baseline FFQ with the 2-year follow-up FFQ. The validity was evaluated by comparing the baseline FFQ with 3 d dietary records and biomarkers (serum folate and vitamin B12). Median comparison, cross-classification and Spearman correlation with and without energy adjustment and deattenuation for day-to-day variation were assessed.SettingTCHS is a prospective cohort containing a high proportion of true vegetarians and part-time vegetarians (regularly consuming a vegetarian diet without completely avoiding meat).SubjectSubsets of 103, seventy-eight and 1528 TCHS participants were included in the reproducibility, dietary record-validity and biomarker-validity studies, respectively.ResultsCorrelations assessing the reproducibility for repeat administrations of the FFQ were in the range of 0·46–0·65 for macronutrients and 0·35–0·67 for micronutrients; the average same quartile agreement was 40%. The correlation between FFQ and biomarkers was 0·41 for both vitamin B12 and folate. Moderate to good correlations between the baseline FFQ and dietary records were found for energy, protein, carbohydrate, saturated and monounsaturated fat, fibre, vitamin C, vitamin A, K, Ca, Mg, P, Fe and Zn (average crude correlation: 0·47 (range: 0·37–0·66); average energy-adjusted correlation: 0·43 (range: 0·38–0·55); average energy-adjusted deattenuated correlation: 0·50 (range: 0·44–0·66)) with same quartile agreement rate of 39% (range: 35–45%), while misclassification to the extreme quartile was rare (average: 4% (range: 0–6%)).ConclusionsThe FFQ is a reliable and valid tool to rank relative intake of major nutrients for TCHS participants.

Objectives The effect of type 2 diabetes mellitus (DM) on mortality was more pronounced in women than men with coronary artery disease (CAD) in the pre-stent era before 1996. However this relationship is controversial in the post-stent era. Methods We studied a cohort of 1073 patients with angiographically defined CAD from the Eastern Taiwan integrated health care delivery system of Coronary Heart Disease (ET-CHD) registry during 1997–2003 in Tzu-Chi General Hospital, Hualien, Taiwan. To evaluate gender-specific DM effect on mortality, the subjects were divided into 4 groups: diabetic women ( n = 147), non-diabetic women ( n = 127), diabetic men ( n = 239), and non-diabetic men ( n = 560). At a mean follow-up of 5.4 years, cardiac and all-cause mortality were the primary end points. Results Annual total mortality rates were 10.2%, 5.1%, 7.2%, and 4.8%; annual cardiac mortality rates were 8.2%, 3.0%, 4.3%, and 2.6% for diabetic women, non-diabetic women, diabetic men, and non-diabetic men, respectively. Multivariate Cox regression models, adjusted for possible confounders showed that gender-specific hazard ratios (HRs) of DM for total mortality were 2.02 (95% CI: 1.32–3.09), and 1.72 (95% CI: 1.32–2.25) for women and men, respectively. The HRs for total mortality associated with diabetes were not different between women and men ( p = 0.53). Similarly, adjusted gender-specific HRs of DM for cardiac mortality were 2.46 (95% CI: 1.45–4.19) for women, and 1.83 (95% CI: 1.28–2.62) for men, which were also not significantly different ( p = 0.36). Conclusions Among patients with CAD, the impact of DM on mortality was consistently higher in women than in men, but the differences across sexes were not statistically significant after 1996 in Taiwan.

BACKGROUND Among patients with coronary artery disease (CAD), high-density lipoprotein cholesterol (HDL-C) is a cardiac protective factor. In contrast, body mass index (BMI) is inversely related to mortality, and this is known as the obesity-mortality paradox. The relationship of HDL-C and BMI to mortality, however, has not been clarified well. The aim of this study was to evaluate the impact of HDL-C and BMI on mortality among CAD patients. METHODS AND RESULTS A cohort of 1,114 angiographic CAD patients from the ET-CHD registry during 1997-2003 in Taiwan was studied. The subjects were categorized into 4 groups according to BMI ≥ 25 kg/m(2) (overweight/obese) or BMI

Background. An increased incidence of cancer in chronic dialysis patients has not been confirmed in the Chinese population. The aim of this population-based study was to examine the risk of various types of cancers in chronic dialysis patients in Taiwan. Methods. Data of 92 348 chronic dialysis patients extracted from the National Health Institutes Research Database during 1997–2008 were analyzed. Patients newly diagnosed with end-stage renal disease, free of cancer and receiving dialysis for >3 months were eligible for inclusion in the study. Results. After a mean follow-up of 4.4 years, a new cancer was diagnosed in 4328 chronic dialysis patients. The standardized incidence ratio (SIR) of chronic dialysis patients was 1.4 [95% confidence interval (CI): 1.3–1.4] and annual incidence of cancer was 1.1%. A trend of an increased SIR of cancer was observed in young patients and within the first year of dialysis. Bladder cancer carried the highest SIR (SIR: 8.2, 95% CI: 6.7–9.9) and had the highest frequency (21.2%). Importantly, the frequency (15.3%) of liver cancer was the second highest and the SIR (SIR: 1.4, 95% CI: 1.2–1.5) of liver cancer in chronic dialysis patients was higher than that of their healthy counterparts. Unexpectedly, chronic dialysis patients had a significantly reduced risk of developing lung cancer. Conclusion. Increased risk of cancer in chronic dialysis patients is confirmed in the Taiwanese population and it is necessary to develop different strategies for cancer screening in chronic dialysis patients among different ethnicities.

Muscular dystrophies (MD) comprise a heterogeneous group of hereditary myopathic diseases. In this group, myotonic MD is associated with an increased cancer risk. However, the cancer risk in other types of MD is unclear. To address this gap in knowledge, we assessed data obtained from the Taiwan Health Insurance Program database. A total of 1,272 patients with MD diagnosed between 1997 and 2009 were enrolled. They were followed up for cancer during the same period by record linkage with the cancer certification in Taiwan. Age- and sex-standardized incidence ratios (SIRs) of overall and site-specific cancers were calculated. For congenital and progressive hereditary MD, there were 685 and 505 cases (males: 69.5% and 80.6%), the median ages at diagnosis were 16 and 13 years, and the mean follow-up durations were 7.12 and 5.06 years, respectively. In addition, cancers were developed in 10 patients with congenital MD and 3 patients with progressive hereditary MD. Female MD patients exhibited an increased cancer risk, yielding an SIR of 3.37 [95% confidence interval (CI) = 1.38-8.25] in congenital MD and 2.95 (95% CI = 0.95-9.19) in hereditary progressive MD. Site-specific cancer SIRs were not powered to be significantly different. In conclusion, genetic defects in hereditary MD may increase cancer risks in females and a sex difference should be further investigated.

The association of metabolic syndrome (MetS) components with elevated serum alanine aminotransferase (ALT) levels, a marker of hepatic injury, may differ between men and women. However, the sex-specific association in a military young population which has a low prevalence of MetS was unclear. We conducted a cross-sectional examination in 6738 men and 766 women, aged 18–50 years, from the cardiorespiratory fitness study in armed forces (CHIEF) in eastern Taiwan. The components of MetS were defined according to the updated International Diabetes Federation (IDF) ethnic criteria for Asians. Elevated ALT levels were defined as ≥40 U/L for both sexes and ≥30 U/L for women alternatively. Multivariate logistic regression analysis was performed to determine the sex-specific association between MetS components and elevated ALT. The prevalence of MetS and elevated ALT in men were 11.9% and 12.7% respectively, and in women were 3.5%, and 3.8% respectively. In men, high-density lipoprotein < 40 mg/dL, blood pressures ≥ 130/85 mmHg, serum triglycerides ≥ 150 mg/dL, and waist size ≥ 90 cm were associated with elevated ALT (odds ratios (OR) and 95% confidence intervals: 1.59 (1.34–1.90), 1.40 (1.19–1.65), 2.00 (1.68–2.39), and 1.68 (1.38–2.04); all p < 0.001); whereas in women, only fasting plasma glucose ≥ 100 mg/dL was associated with elevated ALT ≥ 40 U/L (OR: 7.59 (2.35–24.51), p = 0.001) and ALT ≥ 30 U/L (2.67 (0.89–7.95), p = 0.08). Our findings suggest that the relationship between metabolic abnormalities and elevated ALT may differ by sex, possibly due to the MetS more prevalent in young adult men than in women.

The body mass index (BMI)-mortality paradox has been well known in patients with obstructive coronary artery disease (CAD). However, this phenomenon has rarely been described among elderly patients over a 5-year follow-up.We studied a cohort of 722 elderly patients (age 65 years) with angiographic CAD from the ET-CH D registry during 1997-2003 in eastern Taiwan. To evaluate the BMI effect on mortality, the elderly subjects were categorized into 5 groups by BMI (kg/m2): underweight and normal-low weight (21), normal-high weight (21-23.9) overweight (24-26.9), mild obesity (27-29.9) and moderate/severe obesity (30). At a maximal 10-year follow-up, cardiac and all-cause deaths were the primary end points.After multivariate analysis, patients from the category of under weight and normal-low weight in reference to those from the normal-high weight category had a significantly higher risk of cardiac and all-cause mortality (hazard ratio (HR): 1.68 (95% CI: 1.04-2.70) and 2.02 (95% CI: 1.42-2.87), respectively) following a median of 5.4 years. Obese elderly patients tended to have the lowest risk of all-cause death across all the study BMI categories in the early stage. However, after 5 years, mortality increased in the obese patients surviving beyond 5 years, and was higher than that in overweight patients.The obesity-mortality paradox was present in elderly patients with angiographic CAD in Taiwan and the risk of death was significantly higher in those with a BMI21 kg/n2. However, a J-shaped relationship between mortality and BMI developed after 5 years of follow-up.

To compare the recurrence risk of parameniscal cysts between arthroscopic meniscectomy with open cystectomy (arthroscopic excision) and entirely arthroscopic techniques with intra-articular cyst decompression (arthroscopic decompression).A retrospective longitudinal study was conducted at a medical centre in Taiwan between 2002 and 2012. Patients with symptomatic parameniscal cysts undergoing either arthroscopic excision or arthroscopic decompression were included. Parameniscal cyst recurrence was evaluated every 3 months after surgery. The recurrence risk associated with treatment group, cyst volume, and meniscal tear circumference was investigated.This study included 241 young to middle-aged men and women. Of these, 112 underwent arthroscopic excision and 129 underwent arthroscopic decompression. During an average 26-month follow-up period, the arthroscopic decompression group had a sixfold higher recurrence risk [prevalence: 4 and 21 %, respectively; hazard ratio, HR 6.0 (95 % confidence interval, CI 2.3-15.6); p 0.001] than the arthroscopic excision group. Furthermore, meniscal tears12 mm in circumference and a cyst volume 2.4 cm(3) conferred a fivefold higher recurrence risk than both lesions of smaller dimensions, both in the overall population and in the arthroscopic decompression group [HRs 5.3 (95 % CI 2.3-12.2) and 5.35 (95 % CI 2.2-13.3), respectively; p values0.001 for both].The suggestion of our study is that the recurrence of parameniscal cysts may be strongly related to large cystic lesions and large meniscal tears. Arthroscopic excision is preferable for treating parameniscal cysts, which are large cystic lesions with large meniscal tears, to reduce the recurrence risk.III.

thesemechanical factors are evenmore important for the development of reobstruction after stent insertion than typical vascular risk factors are. Our study has several limitations. The first limitation is the retrospective study design. Second we only included symptomatic endpoints, so we cannot rule out that patients developed an asymptomatic reobstruction in our cohort. A low CHA2DS2-VASc score is also associated with a low risk for reobstruction after PTA of the SFA. Especially diabetes and hypertension were main risk factors for the development of a symptomatic reobstruction in our PTA patients. In patients after stent insertion in the SFA, reobstruction rate was high and did not further increase with the CHA2DS2-VASc score. References

Keyword: Electrocardiographic changes Left-sided spontaneous pneumothorax Young male adults with left-sided pneumothorax had faster heart beat rates and greater corrected QT interval and T-axis reflectingmyocardial ischemia possibly related to the increased pleural pressure. In addition, smaller R wave in leads I and V4–V6 as well as greater R wave in leads aVR and V1 were present in those with left-sided pneumothorax suggesting a condition of heart rotation from left to right. Furthermore, compared with those with small pneumothorax estimated by light index b 20% (n = 20) [6], smaller S wave in leads V2–V3 was observed in those with large pneumothorax (n = 43) indicating that there was more air trapping

Cigarettesmokingis recognizedasanimportantriskfactorfor car-diovascular disease for decades [1]. Among patients with acute coro-nary events, current smoker has been observed to be paradoxicallyassociated with a survival benefit. This is called as the “smoker's para-dox” [2,3]. On average, symptomatic smokers were found with youngeragesandlowerratesofcomorbiditythannon-smokersatentryinprevi-ous studies [4]. Therefore, thephenomenon may be mostly reasoned bythe discrepancies in baseline characteristics. In addition, some reportsuncovered that the “smoker's paradox” was only present in short-termbutitwasalmostabsentwithfollow-uplongerthan6 months[5].Nota-bly, most of these studies were carried out in the fibrinolysis era. Hencetherewerefewerreportswithregardtotheissuespeci ficallyforpatientsundergoing percutaneous coronary intervention (PCI). Furthermore, arecent large-sized report from the combined Korean Acute MyocardialInfarction Registry (KAMIR) and the Korean Myocardial Infarction(KorMI) registry revealed that current smokers were associated with a48% decrease in the risk of total death in reference to non-smokers at1 year after primary PCI for acute MI [6]. This study implied that anethnic differencemightbe presentin the “smoker's paradox”.Thereforewe conducted a meta-analysis to compare the impact of smoking statusat baseline on the subsequent coronary events between Asian andnon-Asian patients with PCI and follow-up longer than 6 months.Detailedsearchstrategiesweredesignedtoidentifystudiesevaluatingtheeffectofbaselinesmokingstatusonthemortalityandcardiaceventsfollowing PCI for at least 6 months. One author (Lin GM) pre-screenedthe search results from MEDLINE and Cochrane Central Register ofControlled Trials (CENTRAL) from 1970 to 2013 and removed citationsthat were not relevant. Two reviewers (Lin GM and Li YH) indepen-dently reviewed the remaining citations and performed data extrac-tion. Disagreements were resolved through consensus. Study qualitywas assessed using the New Castle–Ottawa quality scale (NOS) for ob-servational studies [7]. Studies were required to separately report theadjusted risk ratios of total or cardiac deaths/events in patients by thesmokingstatusatentry.Theprimaryoutcomewastotalorcardiacmor-tality and the secondary outcomes were target vessel revascularization(TVR) and recurrent MI. Finally, there were ten articles (four for Asiansand six for non-Asians) extracted to synthesize their results and thestudy characteristics were displayed in Table 1 [6,8–16].Ofnote,thefollow-upperiodsinmostoftheseselectedPCIregistrieswere reported between 6 months and 1 year(three for Asians and fivefor non-Asians) and longer than 3 years (one for Asians and one fornon-Asians). Additionally, we analyzed the adjusted hazard ratios(HRs) of all-cause death at 1 year and 3 years, respectively betweensmokers and non-smokers with PCI in the Eastern Taiwan integratedhealth care delivery system of Coronary Heart Disease (ET-CHD) regis-try in Table 2 [17–19].The baseline profiles of patients undergoing PCI werepresented aspercentages or as mean ± SD. Chi-square tests were used to testbaseline differences across the study groups for categorical variables.Since most continuous variables in this study did not follow a normaldistribution, Wilcoxon rank sum test, a nonparametric method with-out the requirement of normal assumption, was used to determinethe difference between smokers and non-smokers. Cox proportionalhazard regression models were used to determine the adjusted HRsfor total death associated with the baseline smoking status. All con-founders listed in Table 2 were entered into the model except totalcholesterol, triglycerides, and glucose levels which were removedfrom thefinal model due to their high association with the other co-variates. All statistical analyses were performed with SAS version 9.2(SAS Institute, Cary, NC). A P b 0.05 was considered statisticallysignificant.

Serum uric acid (SUA) has been observed to be highly associated with the development of cardiovascular disease for more than 50 years. Several studies have reported elevated SUA as an independent predictor of mortality in patients with coronary artery disease (CAD) after adjustment for classic risk factors but some studies did not find similar results.Between January 1997 and December 2003, a prospective cohort study was performed in 1054 patients with angiographically defined CAD, and their classic risk factors and SUA levels were determined at enrollment. The study cohort was followed for an average of 3.2 years, with a median of 3.1 years. The main outcome measure was death from cardiac disease and any cause.Of all study patients, 789 (74.9%) were men and 265 (25.1%) were women. The mean age of the male and female patients was 64.8 and 66.9 years, respectively. The mean SUA level of all patients was 410.4 μmol/L. There were grading effects of SUA quartiles on cardiac and all-cause mortality in univariate and multivariate Cox regression analyses. After adjustment, the multivariate analyses revealed that patients in the highest SUA quartile (487 μmol/L) had 2.08 (95% CI=1.19-3.62, p=0.01) fold increased risk of cardiac death, and 1.68 (95% CI=1.10-2.57, p=0.017) fold increase risk of overall mortality compared with the lowest quartile (315 μmol/L).SUA may be a significant predictor of cardiac and overall mortality, independent of classic risk factors in high-risk patients with obstructive CAD.

Background Both genetic and environmental factors have been reasoned for cancer development in schizophrenia patients. However, the influence of age of onset and duration of schizophrenia on cancer incidence has rarely been emphasized. Besides, bipolar disorder tends to resemble schizophrenia from the perspective of multiple rare mutations. Comparing pattern and risk of cancers between schizophrenia and bipolar patients is illuminating. Methods This study used the Taiwan National Health Insurance Database. A total of 71,317 schizophrenia and 20,567 bipolar disorder patients from 1997 to 2009 were enrolled. Both cohorts were followed up for cancer during the same period by record linkage with the cancer certification in Taiwan. Age and gender standardized incidence ratios (SIRs) of overall and site-specific cancers were calculated. Results The SIR for all cancers was 1.17 for the schizophrenia cohort. Increased cancer risk (SIR: 1.31, 95% CI: 1.17-1.48) was observed in females but not males. For the bipolar disorder cohort, the SIR for all cancers was 1.29, but the excess risk was found in males (SIR: 1.42, 95% CI: 1.14-1.77) and not females. Cancer risk decreases as the duration and age of onset of schizophrenia increases. If schizophrenia is diagnosed before 50, the SIRs for colorectal, breast, cervical, and uterine cancers increase but if diagnosed after 50, the SIRs for all cancers decrease except for breast cancer. In bipolar disorder, the SIRs for all site-specific cancers were insignificant. Conclusions Among schizophrenia patients, overall cancer risk varies inversely with age at diagnosis and disease duration. Besides, gender-specific cancer risks differ between schizophrenia and bipolar disorder.

The present study was designed to examine the effects of habitual consumption of Taiwanese vegetarian diets on hormonal secretion, and on lipid and glycaemic control. Of the ninety-eight healthy female adults recruited from Hualien, Taiwan (aged 31–45 years), forty-nine were Buddhist lactovegetarians and forty-nine were omnivores. Dietary intakes were measured, and blood levels of nutrients and hormones were analysed. Vegetarians consumed less energy, fat and protein, but more fibre than the omnivores. Compared with the omnivores, the vegetarians had, on average, lower BMI and smaller waist circumference. Except for slightly lower levels of thyroxine (T4) in vegetarians, vegetarians and omnivores both showed similar levels of triiodothyronine (T3), free T4, thyroid-stimulating hormone, T3:T4 ratio and cortisol. Compared with the omnivores, the vegetarians had significantly lower levels of fasting insulin (median: 35·3 v. 50·6pmol/l) and plasma glucose (mean: 4·7 (se 0·05) v. 4·9 (se 0·05) mmol/l). Insulin resistance, as calculated by the homeostasis model assessment method, was significantly lower in the vegetarians than in the omnivores (median: 1·10 v. 1·56), while β-cell function was not different between the two groups. BMI and diet were both independent predictors for insulin resistance, and contributed 18 and 15% of the variation in insulin resistance, respectively. In conclusion, Taiwanese vegetarians had lower glucose and insulin levels and higher insulin sensitivity than did the omnivores. Diet and lower BMI were partially responsible for the high insulin sensitivity observed in young Taiwanese vegetarians.

Objectives: To investigate the prevalence of GB virus C/hepatitis G virus (GBV-C/HGV) and compare the serologic responses to various GBV-C/HGV markers in eastern Taiwan aborigines. Methods: We used RT PCR and anti-HGenv u-plate to investigate the prevalence of GBV-C/HGV in eastern Taiwan aborigines. We also used ELISA, dot blot assay, and Western blot to detect the serologic responses to various GBVC/HGV markers. Results: The prevalence of GBV-C/HGV RNA in the general population of eastern Taiwan aborigines is about 5% (17317), while 14% (43317) have anti-E2 antibodies. There were no significant differences in antibody titer against one consensus core peptide (PPSSAAACSRGSPR) between GBV-C/HGV RNA-positive and -negative sera. Only 23 of 42 serum samples positive in the anti-HGenv u-plate EIA assay were positive (55%) in the dot blot assay. No positive signal was detected by Western blot using either recombinant NS3 or commercial E2 proteins. Conclusions: Antibodies against one consensus core peptide (PPSSAAACSRGSPR) may not constitute a good marker for the detection of GBV-C/HGV viremia. For the detection of anti-E2 antibodies, the anti-HGenv u-plate assay is more sensitive than the dot blot assay. Western blot assay is not a sensitive method for detecting GBVC/HGV infection.

Mild hyperhomocysteinemia is an independent risk factor for cardiovascular disease and may result from a deficiency of folate, vitamin B-6 or vitamin B-12. Because vitamin B-12 deficiency is often associated with vegetarianism, this study was designed to examine the effect of Taiwanese vegetarian diets on B-vitamin status and plasma homocysteine levels. Female Buddhist lacto-vegetarians (n = 45; 31-45 y) and matched omnivores (n = 45) recruited in Hualien, Taiwan, were investigated. Taiwanese vegetarians consumed normal amount of folate, but only 21% of Taiwan Recommended Daily Nutrient Allowances (RDNA) values of vitamin B-12. Compared with the omnivores, the vegetarians had significantly higher levels of plasma folate (14.79 +/- 7.70 vs. 11.98 +/- 8.29 nmol/L), but lower levels of vitamin B-12 (207.7 +/- 127.1 vs. 403.5 +/- 138.9 pmol/L). Fasting plasma homocysteine levels were significantly higher in vegetarians than in omnivores (mean: 11.20 +/- 4.27 vs. 8.64 +/- 2.06 micromol/L; median: 10.5 vs. 8.5 micromol/L). Fasting plasma homocysteine was inversely correlated with plasma folate and vitamin B-12 in the vegetarian group. Multiple regression analysis revealed that plasma folate, vitamin B-12 and creatinine were independent determinants of homocysteine variation and contributed to 38.6% of homocysteine variation in the vegetarians. Compared with the omnivores, vegetarians also had significantly lower serum levels of valine, isoleucine, leucine, lysine, alanine and arginine, but higher levels of glycine. In the vegetarian group, fasting plasma homocysteine correlated negatively with serum threonine, lysine, histidine, arginine and cystine, and these amino acids contributed to 38.7% of homocysteine variation. In conclusion, the Buddhist nuns who consumed a lacto-vegetarian diet had mildly elevated fasting plasma homocysteine levels presumably due to lower levels of plasma vitamin B-12.