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1. Smoking and nasopharyngeal cancer: individual data meta-analysis of six prospective studies on 334 935 men

Author: Christopher Wen, Jian-Min Yuan, Wayne Gao, Zhi-Ming Mai, Chien-Jen Chen, Woon-Puay Koh, June Han Lee, Lin Xu, Yin-Chu Chien, Tai Hing Lam, Jia Huang Lin, Chaoqiang Jiang, Sai Yin Ho, Ya Li Jin, Maria Li Lung, Wan-Lun Hsu, Xifeng Wu, Feng Zhu, Renwei Wang, Wei Sen Zhang, Tong Zhu, and Chi Pang Wen
Subjects: Male, medicine.medical_specialty, Epidemiology, Population, Taiwan, individual data, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, cohort study, medicine, Humans, AcademicSubjects/MED00860, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, education, Singapore, education.field_of_study, Nasopharyngeal Carcinoma, business.industry, Smoking, Hazard ratio, Nasopharyngeal Neoplasms, General Medicine, medicine.disease, Confidence interval, meta-analysis, Observational Studies as Topic, Nasopharyngeal carcinoma, 030220 oncology & carcinogenesis, Meta-analysis, Hong Kong, business, Cohort study, Demography
Abstract: Background The role of smoking in nasopharyngeal carcinoma (NPC) remains uncertain, especially in endemic regions. We conducted an individual participant data (IPD) meta-analysis of prospective cohort studies to investigate the associations between smoking exposure and risk of NPC. Methods We obtained individual participant data of 334 935 male participants from six eligible population-based cohorts in NPC-endemic regions, including two each in Guangzhou and Taiwan, and one each in Hong Kong and Singapore. We used one- and two-stage approaches IPD meta-analysis and Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of NPC for smoking exposure adjusting for age and drinking status. Results During 2 961 315 person-years of follow-up, 399 NPC evens were ascertained. Risks of NPC were higher in ever versus never smokers (HRone-stage = 1.32, 95% CI = 1.07-1.63, P = 0.0088; HRtwo-stage = 1.27, 1.01-1.60, 0.04). These positive associations appeared to be stronger in ever smokers who consumed 16+ cigarettes/day (HRone-stage = 1.67, 95% CI = 1.29-2.16, P = 0.0001), and in those who started smoking at age younger than 16 (2.16, 1.33-3.50, 0.0103), with dose-response relationships (P-values for trend = 0.0028 and 0.0103, respectively). Quitting (versus daily smoking) showed a small reduced risk (stopped for 5+ years: HRone-stage = 0.91, 95% CI = 0.60-1.39, P = 0.66; for former smokers: HRtwo-stage = 0.84, 0.61-1.14, 0.26). Conclusions This first IPD meta-analysis from six prospective cohorts in endemic regions has provided robust observational evidence that smoking increased NPC risk in men. NPC should be added to the 12–16 cancer sites known to be tobacco-related cancers. Strong tobacco control policies, preventing young individuals from smoking, would reduce NPC risk in endemic regions.
Published: 2021

2. Using serological measures to estimate influenza incidence in the presence of secular trends in exposure and immuno‐modulation of antibody response

Author: Jonathan M. Read, Chaoqiang Jiang, Byran Dai, Derek A. T. Cummings, Yi Guan, Steven Riley, Ruiyin Shen, Hongbo Zhu, Bingyi Yang, Talia M. Quandelacy, Kin On Kwok, and Justin Lessler
Subjects: Pulmonary and Respiratory Medicine, Epidemiology, serology, 030312 virology, Antibodies, Viral, Serology, Cohort Studies, 03 medical and health sciences, immunodynamics, Influenza, Human, Humans, Medicine, Seroconversion, 0303 health sciences, business.industry, Incidence, Influenza A Virus, H3N2 Subtype, Incidence (epidemiology), Public Health, Environmental and Occupational Health, Antibody titer, Original Articles, Hemagglutination Inhibition Tests, Secular variation, Titer, Infectious Diseases, Antibody response, Influenza Vaccines, Antibody Formation, Immunology, Original Article, influenza, business, Cohort study
Abstract: Background Influenza infection is often measured by a fourfold antibody titer increase over an influenza season (ie seroconversion). However, this approach may fail when influenza seasons are less distinct as it does not account for transient effects from recent infections. Here, we present a method to determine seroconversion for non‐paired sera, adjusting for changes in individuals’ antibody titers to influenza due to the transient impact of recent exposures, varied sampling times, and laboratory processes. Methods We applied our method using data for five H3N2 strains collected from 942 individuals, aged 2‐90 years, during the first two study visits of the Fluscape cohort study (2009‐2012) in Guangzhou, China. Results After adjustment, apparent seroconversion rates for non‐circulating strains decreased while we observed a 20% increase in seroconversion rates to recently circulating strains. When examining seroconversion to the most recently circulating strain (A/Brisbane/20/2007) in our study, participants aged under 18, and over 64 had the highest seroconversion rates compared to other age groups. Conclusions Our results highlight the need for improved methods when using antibody titers as an endpoint in settings where there is no clear influenza “off” season. Methods, like those presented here, that use titers from circulating and non‐circulating strains may be key.
Published: 2020

3. Mortality in relation to changes in physical activity in middle-aged to older Chinese: An 8-year follow-up of the Guangzhou Biobank Cohort Study

Author: Weisen Zhang, Chaoqiang Jiang, Kar Keung Cheng, Yali Jin, Tai Hing Lam, Feng Zhu, Lin Xu, and Yingyue Huang
Subjects: Cardiovascular disease mortality, Male, medicine.medical_specialty, China, Health Behavior, Physical Therapy, Sports Therapy and Rehabilitation, Lower risk, Metabolic equivalent, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Mortality, Exercise, Aged, business.industry, Public health, Hazard ratio, 030229 sport sciences, Middle Aged, All-cause mortality, Confidence interval, GV557-1198.995, Sports medicine, Original Article, Female, business, RC1200-1245, Developed country, Record linkage, Sports, Cohort study, Demography, Change in physical activity, Follow-Up Studies
Abstract: Highlights • Due to rapid urbanization and despite numerous physical activity (PA) promotion programs, PA levels in China have been continuously decreasing. However, it remains unclear whether increasing or decreasing PA is beneficial for middle-aged and older Chinese. • Maintaining high levels of PA and increasing PA from low levels to high levels lowers mortality risks for those at an older age, suggesting that substantial health benefits might be achieved by consistently maintaining or increasing engagement in PA. • The increased mortality risk brought on by maintaining PA at a low level or decreasing it to a low level warrants the attention of public health officials and clinicians., Background Physical activity (PA) is generally encouraged. Studies from developed countries in the West have shown that maintenance of adequate PA or increasing PA are associated with lower mortality risk. It is unclear whether these associations apply to an older Chinese population. Hence, we examined the changes in PA prospectively among a middle-aged and older Chinese population over an average of 4 years and explored their subsequent mortality risks. Methods Metabolic equivalent scores of PA among participants in the Guangzhou Biobank Cohort Study were calculated. Participants were divided into 3 groups related to PA level, and changes in PA were classified into 9 categories. Information on vital status and causes of death from March 2008 to December 2012 (the first repeated examination) until December 31, 2017, was obtained via record linkage with the Death Registry. Results Of 18,104 participants aged 61.21 ± 6.85 years (mean ± SD), 1461 deaths occurred within 141,417 person-years. Compared to participants who maintained moderate PA, those who decreased PA from moderate or high levels to a low level had increased risks for all-cause mortality (hazard ratio (HR) = 1.47, 95% confidence interval (95%CI): 1.11–1.96). Participants who maintained a high level of PA (HR = 0.83, 95%CI: 0.70–0.98) or increased PA from low to high levels (HR = 0.71, 95%CI: 0.52–0.97) showed lower all-cause mortality risks. Those who maintained low PA levels showed a higher all-cause mortality risk, whereas those who increased their PA levels showed a non-significantly lower risk. Similar results were found for cardiovascular disease risk. Conclusion Even at an older age, maintaining a high PA level or increasing PA from low to high levels results in lower mortality risks, suggesting that substantial health benefits might be achieved by maintaining or increasing engagement in adequate levels of PA. The increased risk of maintaining a low PA level or decreasing PA to a low level warrants the attention of public health officials and clinicians., Graphical abstract Image, graphical abstract
Published: 2020

4. Glycemic Measures and Risk of Mortality in Older Chinese: The Guangzhou Biobank Cohort Study

Author: Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Wei Sen Zhang, Lin Xu, Kar Keung Cheng, Feng Zhu, and Ya Li Jin
Subjects: Blood Glucose, Male, China, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Biochemistry, Endocrinology, Risk Factors, Cause of Death, Internal medicine, Diabetes mellitus, medicine, Risk of mortality, Humans, Prospective Studies, Prospective cohort study, Aged, Biological Specimen Banks, Glycemic, Glycated Hemoglobin, Glucose tolerance test, medicine.diagnostic_test, business.industry, Biochemistry (medical), Hazard ratio, Type 2 Diabetes Mellitus, Fasting, Glucose Tolerance Test, Middle Aged, medicine.disease, Diabetes Mellitus, Type 2, Hyperglycemia, Female, business, Follow-Up Studies, Cohort study
Abstract: Context China has the largest number of people with type 2 diabetes mellitus (T2DM) in the world. Data from previous studies have suggested that up to one-fifth of individuals with diabetes would be missed without an oral glucose tolerance test (OGTT). To date, there is little information on the mortality risk of these individuals. Objective We estimated the association of different indicators of hyperglycemia with mortality in the general Chinese population. Design Prospective cohort study. Setting China. Participants A total of 17 939 participants aged 50+ years. Exposures Previously diagnosed diabetes and newly detected diabetes defined by fasting glucose (≥7.0 mmol/L), 2-hour postload glucose (≥11.1 mmol/L), or hemoglobin A1c (HbA1c, ≥6.5%). Main Outcomes Measures Deaths from all-cause, cardiovascular disease, and cancer were identified by record linkage with death registration. Results During 7.8 (SD, 1.5) years’ follow-up, 1439 deaths were recorded. Of 3706 participants with T2DM, 2126 (57%) had known T2DM, 118 (3%) were identified by isolated elevated fasting glucose, 1022 (28%) had isolated elevated postload glucose, and 440 (12%) had both elevated fasting and postload glucose. Compared with normoglycemia, the hazard ratio (95% confidence interval) of all-cause mortality was 1.71 (1.46-2.00), 0.96 (0.47-1.93), 1.43 (1.15-1.78), and 1.82 (1.35-2.45) for the 4 groups, respectively. T2DM defined by elevated HbA1c was not significantly associated with all-cause mortality (hazard ratio, 1.17; 95% confidence interval, 0.81-1.69). Conclusion Individuals with isolated higher 2-h postload glucose had a higher risk of mortality by 43% than those with normoglycemia. Underuse of OGTT leads to substantial underdetection of individuals with a higher mortality risk and lost opportunities for early intervention.
Published: 2019

5. Mendelian Randomization Focused Analysis of Vitamin D on the Secondary Prevention of Ischemic Stroke

Author: YK Wong, Chloe Y Y Cheung, Clara S. Tang, Aimin Xu, Kar Keung Cheng, Pak C. Sham, C. Mary Schooling, Karen Siu-Ling Lam, Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Ka-Wing Au, Shiu Lun Au Yeung, Hung-Fat Tse, Jo-Jo Hai, Jie V. Zhao, and Yap-Hang Chan
Subjects: Adult, Male, medicine.medical_specialty, Genotype, Myocardial Infarction, Polymorphism, Single Nucleotide, Primary prevention, Internal medicine, Mendelian randomization, medicine, Vitamin D and neurology, Secondary Prevention, Humans, Myocardial infarction, Vitamin D, Aged, Ischemic Stroke, Advanced and Specialized Nursing, Secondary prevention, business.industry, Regeneration (biology), Mendelian Randomization Analysis, Middle Aged, medicine.disease, Ischemic stroke, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Genome-Wide Association Study
Abstract: Background and Purpose: Experimental studies showed vitamin D (Vit-D) could promote vascular regeneration and repair. Prior randomized studies had focused mainly on primary prevention. Whether Vit-D protects against ischemic stroke and myocardial infarction recurrence among subjects with prior ischemic insults was unknown. Here, we dissected through Mendelian randomization any effect of Vit-D on the secondary prevention of recurrent ischemic stroke and myocardial infarction. Methods: Based on a genetic risk score for Vit-D constructed from a derivation cohort sample (n=5331, 45% Vit-D deficient, 89% genotyped) via high-throughput exome-chip screening of 12 prior genome-wide association study–identified genetic variants of Vit-D mechanistic pathways ( rs2060793 , rs4588 , and rs7041 ; F statistic, 73; P Results: In the ischemic disease subsample, 11.1% (n=49/441) had developed recurrent ischemic stroke or MI and 13.3% (n=58/441) had developed recurrent or de novo ischemic stroke/MI. Kaplan-Meier analyses showed that genetic risk score predicted improved event-free survival from recurrent ischemic stroke or MI (log-rank, 13.0; P =0.001). Cox regression revealed that genetic risk score independently predicted reduced risk of recurrent ischemic stroke or MI combined (hazards ratio, 0.62 [95% CI, 0.48–0.81]; P Conclusions: Genetically predicted lowering in Vit-D level is causal for the recurrence of ischemic vascular events in persons with prior ischemic stroke or MI.
Published: 2021

6. Brain-derived neurotrophic factor gene variants and obesity in former smokers

Author: Shanshan Yang, Tai Hing Lam, Chaoqiang Jiang, Wei Sen Zhang, Yao He, Lin Xu, Yali Jin, and Kar Keung Cheng
Subjects: Male, Waist, medicine.medical_treatment, Smoking cessation, QH426-470, Biology, Body Mass Index, Cohort Studies, Genetics, Genetic predisposition, medicine, Humans, Obesity, Smokers, business.industry, Research, Brain-Derived Neurotrophic Factor, Odds ratio, Former Smoker, medicine.disease, BDNF, Case-Control Studies, Central obesity, Cohort, Female, business, rs6265, Body mass index, TP248.13-248.65, Genome-Wide Association Study, Biotechnology, Demography, Cohort study
Abstract: Objective: From genome-wide association studies, brain-derived neurotrophic factor (BDNF) locus on chromosome 11 was the only SNP associated with both smoking and body mass index (BMI). This study aims to explore the unique genetic predisposition to obesity in former smokers by examining the effects of BDNF on BMI and waist circumference (WC). Methods: We included 15,072 ethnic Chinese participants in the Guangzhou Biobank Cohort Study (GBCS) with data of four BDNF SNPs related to both body mass index (BMI) and smoking behavior. We used baseline smoke exposure data in 2003-2007 and follow-up outcomes of general obesity (by BMI) and central obesity (waist circumference) in 2008-2012. Odds ratios (ORs) and 95% confidence intervals (CIs) for general obesity and central obesity associated with these SNPs were derived from logistic regression. Results: Of 15,072 participants (3,169 men and 11,903 women), 1,664 (11.0%) had general and 7,868 (52.2%) had central obesity. We replicated the associations of the four BDNF SNPs with obesity and smoking status in the GBCS. In 1,233 former smokers, the rs6265 GG, versus AA, genotype was associated with higher risks of general obesity (OR=1.79, 95% CI=1.06-3.01) and central obesity (OR=2.08, 95% CI=1.47-2.92) after adjustment. These associations were not significant in never or current smokers. In former heavy (≥20 cigarettes/day) smokers, the rs6265 GG genotype showed a higher odds for general obesity (OR=2.15, 95% CI=1.05-4.40), while no association was found in former light (1-9 cigarettes/day) smokers. Similar results were found for the association of rs6265 with central obesity and for the associations of other two BDNF SNPs (rs4923457 and rs11030104) with both general and central obesity. Conclusions: We firstly identified the genetic predisposition (BDNF SNPs) to general and central obesity in former smokers, particularly in former heavy smokers. Funding Statement: This study was supported by research grants from the Guangdong Natural Science Foundation of China, Guangdong, China (Grant number: 9451062001003477); the Guangzhou Science and Information Bureau, Guangzhou, China (2012J5100041); the National Natural Science Foundation of China (81773502 and 81703308). The study is funded by The University of Hong Kong Foundation for Educational Development and Research, Hong Kong; the Guangzhou Public Health Bureau and the Guangzhou Science and Technology Bureau, Guangzhou, China; and The University of Birmingham, UK. Declaration of Interests: None declared. Ethics Approval Statement: The GBCS was approved by the Medical Ethics Committee of the Guangzhou Medical Association. All participants provided written informed consent before participating.
Published: 2021

7. Natural menopausal age and cardiovascular disease risk factors in older Chinese women: Guangzhou Biobank Cohort Study

Author: Yali Jin, Lin Xu, Wei Sen Zhang, Huimin Su, Kar Keung Cheng, Tai Hing Lam, Chaoqiang Jiang, and Feng Zhu
Subjects: China, Framingham Risk Score, business.industry, Confounding, Obstetrics and Gynecology, Odds ratio, Middle Aged, Biobank, Confidence interval, Odds, Cohort Studies, Cardiovascular Diseases, Pregnancy, Risk Factors, Medicine, Humans, Female, Menopause, business, Parity (mathematics), Demography, Cohort study, Aged, Biological Specimen Banks
Abstract: OBJECTIVE To examine the associations of natural menopausal age with cardiovascular disease risk factors and whether the associations varied by parity in older Chinese women. METHODS Information of demographic characteristics, lifestyles, and reproductive factors was collected by face-to-face interview. Framingham Risk Score was used as an indicator of cardiovascular disease risk, with a score ≥ 10% considered as high cardiovascular disease risk (vs low, dichotomous). Multivariable logistic and linear regressions were used to examine the associations of menopausal age with cardiovascular disease risk factors. RESULTS Of 18,339 women aged 50+ years, the average (standard deviation) age was 61.8 (6.9) years. Compared with women with menopausal age of 45 to 54 years, after adjustment for multiple potential confounders, women with menopausal age
Published: 2021

8. White blood cell count and all-cause and cause-specific mortality in the Guangzhou biobank cohort study

Author: Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Lin Xu, Tao Wang, Ya Li Jin, Feng Zhu, Kar Keung Cheng, and Wei Sen Zhang
Subjects: Male, medicine.medical_specialty, China, White blood cell count, 030204 cardiovascular system & hematology, Pulmonary function testing, 03 medical and health sciences, Leukocyte Count, 0302 clinical medicine, Internal medicine, Cause of Death, Epidemiology, medicine, Cause-specific mortality, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Aged, Biological Specimen Banks, Granulocyte count, business.industry, lcsh:Public aspects of medicine, Respiratory disease, Hazard ratio, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Middle Aged, medicine.disease, All-cause mortality, Confidence interval, Cohort, Female, business, Cohort study, Research Article
Abstract: Background Several studies have shown positive associations between higher WBC count and deaths from all-causes, CHD, stroke and cancer among occidental populations or developed countries of Asia. No study on the association of WBC count with all-cause and cause-specific mortality in Chinese populations was reported. We studied this using prospective data from a large Chinese cohort. Methods We used prospective data from the Guangzhou Biobank Cohort Study (GBCS), a total of 29,925 participants in present study. A Cox proportional hazards regression model was used to estimate the hazard ratios (HR) and 95% confidence interval (CI). Results The hazard ratios (HR) for all-cause, CHD, and respiratory disease mortality for the highest decile of WBC count (women > 8.2 × 109/L; men > 8.8 × 109/L) was 1.83 (95% confidence interval (CI) 1.54, 2.17), 3.02 (95% CI 1.84, 4.98) and 2.52 (95% CI 1.49, 4.27), respectively, after adjusting for multiple potential confounders. The associations were similar when deaths during the first 2 years of follow-up were excluded. After further adjusting for pulmonary function, the highest decile of WBC count was associated with 90% higher risk of respiratory disease mortality (HR 1.90, 95% CI 1.08, 3.33). No evidence for an association between higher WBC count and cancer mortality was found. Sub-type analysis showed that only granulocyte count remained significantly predictive of all-cause, CHD, and respiratory disease mortality. Conclusions Elevated WBC, specifically granulocyte, count was associated with all-cause, CHD and respiratory mortality in southern Chinese. Further investigation is warranted to clarify whether decreasing inflammation would attenuate WBC count associated mortality. Electronic supplementary material The online version of this article (10.1186/s12889-018-6073-6) contains supplementary material, which is available to authorized users.
Published: 2018

9. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. Tulloch-Reid, Seppo Koskinen, James E. Bennett, Marcela González-Gross, Virginija Dulskiene, Idris Guessous, Assembekov Batyrbek, Kamarul Imran Musa, Jeannette Lee, Josep Redon, Bihungum Bista, Luisa M Macieira, Johan Sundström, Andres Metspalu, Lariane M Ono, Flora A. Ukoli, Salar Rahimikazerooni, Andrea Gualtieri, Trevor S. Ferguson, Félicité Tchibindat, Eliza Cinteza, Ha Tp Do, Tajana Zeljkovic Vrkic, Tuyen D Le, Alison J. Hayes, Abdul Basit, Chandini Nekkantti, Teresa Norat, Eunice Ugel, Gulmira Aitmurzaeva, Mariachiara Di Cesare, Abdul Hamid Zargar, Vincenzo Solfrizzi, Garry L. Jennings, Aline Meirhaeghe, Kaare Christensen, Päivi Mäki, Xu Lin, Ali Esmaeili, Joanna Baran, Aneta Grajda, Renata Cifkova, Alexandre C. Pereira, Martin Bobak, Iuliia A Rusakova, Keiu Nelis, Damian K Francis, Guansheng Ma, Axel C. Carlsson, Alejandro Diaz, Alireza Ansari-Moghaddam, N Capkova, Zumin Shi, Maria Turley, Imelda A. Agdeppa, Helena I. S. Nogueira, Marcia Scazufca, Katharina Maruszczak, Natascia Rinaldo, Paulo A. Lotufo, Nuno Lunet, Thor Aspelund, Caroline H.D. Fall, Antonio Cabrera de León, Ahmad Faudzi Yusoff, Holger Theobald, Beatriz D'Agord Schaan, Pedro Marques-Vidal, William A. Neal, Mihai Gafencu, Tandi E. Matsha, Ana B. Crujeiras, Ahmad Reza Dorosty, Alain Morejon, Weili Yan, Dominique Hange, Bekbolat Zholdin, Frédéric Gottrand, Jorge Mota, Jana Námešná, Stevo Popovic, Louise Eriksen, Line Lund Kårhus, Cihangir Erem, Juergen Breckenkamp, Mathilde Kersting, Yi Song, Martin McKee, Aleksandra Gomula, Rafaela Rosário, Enzo Manzato, S. Goya Wannamethee, Sounnia Mediene Benchekor, Azim Nejatizadeh, Krishna Kumar Aryal, Juan P. González-Rivas, Vedrana Sember, Stephen T. McGarvey, Jukka T. Salonen, Patrick Pasquet, Patricia Varona-Pérez, Amelia C. Crampin, Ramin Heshmat, Violeta Iotova, Juvenal Soares Dias-da-Costa, Oye Gureje, Aletta E. Schutte, João Luiz Bastos, Anelise Reis Gaya, Konrad Jamrozik, Dalia Luksiene, Amina Barkat, Maria Paula Santos, José Camolas, Azli Baharudin, Diego Vanuzzo, Doris Stöckl, Rosalynn Siantar, Jouko Saramies, Albertino Damasceno, Davood Khalili, Simona Bo, Martina Müller-Nurasyid, Dominique Cottel, Markku Peltonen, Fikru Tullu, Ana Isabel Rito, Angélica Ochoa-Avilés, Annette J. Dobson, Christopher T. Cowell, Charumathi Sabanayagam, Rildo de Souza Wanderley Júnior, Oanh T. H. Trinh, Farahnaz Joukar, Mostafa K. Mohamed, Mostafa Qorbani, Jeongseon Kim, Helmut Schröder, Machi Suka, Natasja M. van Schoor, Jussi Kauhanen, Teresa Haugsgjerd, Goodarz Danaei, M. Fernanda Lima-Costa, Yong Tao, Elisabetta L. Romeo, Grazyna Jasienska, Victor Guillermo Sequera, Kazem Mohammad, Yanina Zócalo, Fernanda Cunha Soares, Jianfeng Wu, Mohammad Esmaeel Motlagh, María Elena Díaz-Sánchez, Monika Zuziak, Eldridge Ferrer, Anette Varbo, Leila Beltrami Moreira, Jeremy M. 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Mini, Viktoria Anna Kovacs, Rosemarie Martin, Nahla Hwalla, Wei Zheng, Hoang Van Minh, Edward D Janus, Laetitia Huiart, Farhad Pourfarzi, Sudha Ramachandra Rao, Fred Paccaud, Marcia Makdisse, Aye Aye Sein, Enrique Gutiérrez-González, Yang Yang, Anneke Blokstra, Henrike Galenkamp, Jaume Marrugat, Nazan Yardim, Wan Nazaimoon Wan Mohamud, Jesús Ibarluzea, Julio Zuñiga Cisneros, Laura Lauria, Argyro Karakosta, Dragana P Jovic, Jun Hata, Elio Riboli, Piotr Bandosz, Xun Tang, Parvina Mukhtorova, Jean Dallongeville, Jean-Bernard Ruidavets, Anne Tjønneland, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Aleksandra Piwońska, Dusan Grafnetter, Mette Rasmussen, Daniel Weghuber, Sherali Rakhmatulloev, Martine Vrijheid, Johann Willeit, Motahareh Kheradmand, Małgorzata Mossakowska, Lechaba Tshepo, Dongfeng Gu, Hyeon Chang Kim, Vilmundur Gudnason, Maria Forsner, Peter Bjerregaard, Leon A. Simons, Rachael McLean, Japhet Killewo, Ramón Suárez-Medina, Y Nikitin, Eng Joo Tan, Jean Claude Mbanya, Aroor Bhagyalaxmi, Renata Kuciene, Kairat Davletov, Jose Eugenio Lozano, Afshin Ostovar, Niloofar Peykari, Guy De Backer, Soheir H Ahmed, Nicholas J. Wareham, Sai Yin Ho, Constanta Huidumac Petrescu, Maria Hassapidou, Iris Pigeot, Myriam Galfo, Susana Cararo Confortin, Blanca Sandra Ruiz-Betancourt, W. M. Monique Verschuren, Catterina Ferreccio, Fabio Galvano, Leila Houti, Daniel Bia, Annika Rosengren, Marcin Rutkowski, Biruta Velika, Joana Araújo, Fernando Rigo, Angela Spinelli, Scott B. McLean, Shirin Djalalinia, Marie Kunešová, Boban Mugoša, Sania Nishtar, Mangesh S. Pednekar, Shahla AlDhukair, Helle-Mai Loit, Antonis Zampelas, Altan Onat, Maciej Banach, Shohreh Naderimagham, Hajer Aounallah-Skhiri, Maja Bæksgaard Jørgensen, Yin Guo, Ewelina Czenczek-Lewandowska, Parasmani Dasgupta, Elvis Oa Wambiya, Inge Huybrechts, Raimund Erbel, Jari Jokelainen, Ana P. Ortiz, Stefan Kiechl, Emmanuel Cohen, Caleb Ochimana, Shynar Abdrakhmanova, Laura Censi, Iqbal Bata, Geetha R Menon, Snehalatha Chamukuttan, Pedro Plans-Rubio, Domenico Palli, Ana Azevedo, Slawomir Koziel, Benoît Salanave, Parinaz Mehdipour, Shu Ti Chiou, Lela Sturua, Lubica Ticha, Felipe Vogt Cureau, Jin Soo Moon, Ming-Hui Zhao, Urho M. Kujala, Nathalie Michels, Ertugrul Celikcan, Jaakko Tuomilehto, Judith Benedics, Tobias F. Rinke de Wit, Agnès Le Port, Reza Homayounfar, Andrea Rodriguez-Martinez, Tai Hing Lam, Yn-Tz Sung, Jürgen König, Kodavanti Mallikharjuna Rao, Hazzaa M. Al-Hazzaa, Karen Morgan, Bogdan Wojtyniak, Cynthia M. Pérez, Ilse Khouw, Manoli Garcia-de-la-Hera, Dong Wook Shin, Genc Burazeri, Ausra Petrauskiene, Charles Sossa Jérome, Kenisha Russell Jonsson, José Boggia, Daniela Galeone, Alice Bonilla-Vargas, Han Cg Kemper, Rahman Shiri, Stefaan Demarest, Else Karin Grøholt, San-Lin You, Adelheid Weber, Juha Auvinen, Aida Pilav, Sibel Gogen, Suzanne N Morin, Wan Mohamad Wan Bebakar, Viviane Cunha Cardoso, Kavumpurathu Raman Thankappan, Hana Zamrazilová, Frank Claessens, Karien Stronks, Helen Gonçalves, Tahir Aris, Luis Revilla, Sérgio Viana Peixoto, Zhamilya Battakova, Jing Liu, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Priscilla Duboz, Sandjaja, Tiina Laatikainen, Rafel Ramos, Sareh Eghtesad, Judith Simons, Orn Olafsson, E. Shyong Tai, Louise A. Baur, Nihal Thomas, Aung Soe Htet, Bente Sparboe-Nilsen, Paul Elliott, Soon-Woo Park, Angel R. 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Eriksson, Margarita Samoutian, Andreia N. Pizarro, Mohammed Rasoul Tarawneh, Jean Woo, Kaspar Staub, Maria Teresa Menzano, Mojtaba Farjam, Adroaldo Cesar Araujo Gaya, Mohammad El-khateeb, Zulfiqar A Bhutta, Mukharram M. Bikbov, Hsien-Ho Lin, Oscar Noboa, Thomas Waldhör, Garry Brian, Simona Costanzo, Frank Tanser, Nor Azwany Yaacob, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ioannis Pagkalos, Ivan Pećin, Carlo M. Barbagallo, Abla M. Sibai, Yuna He, Matsuda Fumihiko, Bharathi Viswanathan, Ali Reza Safarpour, Wei Cheng Lo, Abdullatif Husseini, Jiang He, Liv Elin Torheim, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Davide Noto, Panayiotis K. Yiallouros, Kelias P. Msyamboza, William R. Tebar, Yingfeng Zheng, Eha Nurk, Bhawesh Koirala, Ana Jelakovic, Suhad Bahijri, Freja B Kampmann, Qi Sheng You, Marika Ferrari, María-Elena González-Villalpando, Aline Wagner, Olfa Saidi, Anwar Batieha, Eduardo Capuano, Coimbatore Subramaniam Shanthirani, Dong Wook Kim, Albina A Fakhretdinova, Tom Wilsgaard, Maria Avdicova, Moesijanti Soekatri, Chiara Donfrancesco, Salim Mohanna, Paola Russo, Uruwan Yamborisut, Rafael dos Santos Henrique, Martin Nankap, Allan Linneberg, Khairil Si-Ramlee, Kirsten Mehlig, Christina Mavrogianni, Raluca Pop, Lèlita Santos, Graziella Bruno, Valentina Peterkova, Iná S. Santos, Georg Lappas, Alberto Palloni, Malay K. Mridha, Andrzej Pajak, Marta García-Solano, Stefaan De Henauw, Daniel Ferrante, Rute Santos, Anders Grøntved, Lucjan Szponar, Mihaela Vladulescu, Chien-An Sun, Jan A. Staessen, Paula Duarte de Oliveira, Norazizah Ibrahim Wong, Maria Nordendahl, Elaine M. Dennison, Jeonghee Lee, Diego Salmerón, Ida Maria Schmidt, Gao Pei, Noushin Mohammadifard, Igor Spiroski, Fernando Rodríguez-Artalejo, Xu Ma, Elin Pettersen Sørgjerd, Valéria Regecová, Cláudia S. Minderico, Johanna A. Otero, Jamila Abubakar Garba, Vesselka Duleva, Rui Ornelas, Ilpo Huhtaniemi, Cesar G. Victora, Lijuan Liu, Rody G. Sy, Mahmood Moosazadeh, Ali Ahmadi, Antonio Pedro Graça, Natalia Nowak-Szczepanska, Miao Li Chee, Michael Sjöström, Charles Agyemang, Shiqi Zhen, Xiu-Hua Guo, Pawel Kurjata, Jardena J. Puder, Mehrdad Azmin, Neil Murphy, Kaosar Afsana, Alireza Sadjadi, Johanna M. Geleijnse, Prashant Mathur, Elysée Claude Bika Lele, Raphael Mendes Ritti-Dias, Yannis Manios, Majid Shirani, Rosemary B. Duda, Liis Nelis, Jurate Klumbiene, Zhengming Chen, Wichai Aekplakorn, Alun Evans, Andrzej Wiecek, Lars Lind, Denise Eldemire-Shearer, Bernardo L. Horta, Macia Enguerran, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Kumiko Ohara, Ursula Kiechl-Kohlendorfer, Hermann Brenner, Przemyslaw Slusarczyk, Espen Bjertness, Jutta Stieber, Augusto Di Castelnuovo, Joel G. R. Roy, Aryeh D. Stein, Ruth Frikke-Schmidt, Vera Musil, Amaneh Shayanrad, Marcel Goldberg, Ramon O. Jimenez, Mohammad Reza Fattahi, Jolanda Hyska, Amir Houshang Mehrparvar, Elin Kolle, Mohamed Bamoshmoosh, Michelle Holdsworth, Felipe F. Casanueva, Børge G. Nordestgaard, Niels Wedderkopp, Eva Corpeleijn, Elias F. Gudmundsson, Antonio Mistretta, Daniel Lemogoum, Larissa Pruner Marques, Slavica Sović, Olli T. Raitakari, Marco Aurélio Peres, Alexandra Cucu, Gregorio Varela-Moreiras, Janine Clarke, Andrea Gazzinelli, Mieczysław Litwin, Sara Schramm, Xenophon Theodoridis, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Dimitrios Papandreou, Peter T. Katzmarzyk, Benjamin Acosta-Cazares, Ben Schöttker, Prabhdeep Kaur, Norlaila Mustafa, Shariq Rashid Masoodi, Sadaf G. Sepanlou, Adolfo Rubinstein, Francis Delpeuch, Julianne Williams, Abbas Dehghan, Leanne M. Riley, Heloisa Bettiol, Gabriele Nagel, Ellisiv B. Mathiesen, Ekaterina Stoyanova, Alisha N. Wade, Zhamyila Usupova, Arnaud Chiolero, Oonagh Markey, Jacqueline Ramke, Elena Bogova, Niveen M E Abu-Rmeileh, Nguyen D Nguyen, Tomasz Zdrojewski, Marjo-Riitta Järvelin, Jose Sanchez-Abanto, Rômulo Araújo Fernandes, Lourdes Ribas-Barba, Nalan Uysal, Mohamad Hasnan Ahmad, Krista Fischer, Maria Wany Louzada Strufaldi, Ramiro Guerrero, Farnam Mohebi, Tran Quoc Bao, Flávio Danni Fuchs, Salim Berkinbayev, Enisa Kujundzic, Sari Voutilainen, Farzad Hadaegh, Robert Lundqvist, Saeid Safiri, Iraj Mohebbi, George Luiz Lins Machado-Coelho, Annette Peters, Gonzalo Valdivia, Magdalena Korzycka, Rajiv T Erasmus, Masanori Iwasaki, Charmaine A. Duante, Sheikh Mohammed Shariful Islam, Quang Ngoc La, Ricky Eddie, Petra Rust, Daniela Rodrigues, Dirk De Bacquer, Karen Sparrenberger, Agneta Sjöberg, Thet Thet Mu, Katarzyna Dereń, Cora L. Craig, Jorge Motta, Janina Petkeviciene, Boyd Swinburn, Paibul Suriyawongpaisal, Visnja Djordjic, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Daan Kromhout, Marius B. Bjertness, Stefano Marventano, Juel Jarani, Alireza Khosravi, Eva Martos, David De Ridder, Lizzy M. Brewster, Nico Dragano, Liam Smeeth, Kenji Shibuya, Emma Ruiz Moreno, Hashem Jaddou, Grzegorz Sobek, Dimitrios Trichopoulos, Marvin Cervantes-Loaiza, Abu Am Hanif, Elaine M. Murtagh, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Kyungwon Oh, Heiner Boeing, Regina Heidinger-Felso, André Luiz Sena Guimarães, Balkish M. Naidu, Avula Laxmaiah, Ana M. B. Menezes, Marie Eliasen, Francesco Pistelli, Yuan He, Dusko Bjelica, José A. Casajús, Guang Ning, Lutgart Braeckman, Dirk Vanderschueren, Jochanan Stessman, Ivana Radic, Yi Zeng, Hans Concin, Damaskini Valvi, Sari Hantunen, Catherine Kyobutungi, Diego Augusto Santos Silva, Wenhua Zhao, Sok King Ong, Anne W. Taylor, Iraj Nabipour, Justyna Godos, Cyrus Cooper, Mattias Johansson, Samuel C. Dumith, Magdalena Muc, Sabine Schipf, Idowu O Senbanjo, Jim Mann, Rajaa Al-Raddadi, Yih Chung Tham, Kay-Tee Khaw, Joseph Cacciottolo, Ana Henriques, Sahar Saeedi Moghaddam, Reza Mohammadpourhodki, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Camilla T. Damsgaard, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Constance Schultsz, Santiago F. Gomez, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Pierre Traissac, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Eleonora d'Orsi, Irene G. M. van Valkengoed, Anna Fijałkowska, Wen-Harn Pan, Gregor Starc, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Abdullah Alkandari, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Saeed Dastgiri, Lien Braeckevelt, Nasheeta Peer, Radka Taxová Braunerová, Mohamed M. Ali, Steiner Krokstad, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Silvana Donoso, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paola Nardone, Alberto Barceló, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Miquel Porta, Vesna Jureša, Alexander D. Deev, David Faeh, Antonio Bernabe-Ortiz, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Anjani Kumar Jha, Thamara Hubler Figueiró, Jana Kratenova, Claudia M. Hormiga, Maria Tsigga, Zivka Dika, Indrapal I. Meshram, Ei Ei K. Nang, Ian Rouse, Rusidah Selamat, Paul Korrovits, Grethe S. Tell, Julie Taylor, Anabela Mota-Pinto, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Frank J Rühli, Shelly R. McFarlane, Sara Santos Sanz, Edyta Łuszczki, Maria G. Stathopoulou, Tara Coppinger, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. Fuchs, Muhammad Islam, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Maria Ruiz-Castell, Daniela Pierannunzio, Cristina Taddei, Gowri Mahasampath, Gustavo Velasquez-Melendez, Hanna Tolonen, Sudhir Kowlessur, Bagher Larijani, Laura Torres-Collado, Susi Kriemler, Ali Akbar Shayesteh, Cynthia Robitaille, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Line Tang Møllehave, Vincent Jr DeGennaro, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Kodanda R Kanala, Gert B. M. Mensink, Abhijit Sen, Sergej M. Ostojic, Hanan F. Abdul Rahim, Hélène Delisle, Francisco J. Félix-Redondo, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Bethlehem D. Solomon, Erik Lykke Mortensen, Nikhil D. Patel, Reynaldo Martorell, Ching-Yu Cheng, Stine Schramm, Hana Shimizu-Furusawa, Jacek Jóźwiak, Radwan Qasrawi, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Son Thai Pham, Simona Giampaoli, Dong Zhao, Indah Suci Widyahening, Merete Osler, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, Giota Touloumi, Janice Luisa Lukrafka, Adela Chirita-Emandi, Maryam Kavousi, Sanja Musić Milanović, Jean-Michel Gaspoz, Jalila El Ati, Sauli Herrala, Liang Xu, Pilar Guallar-Castillón, Bee Koon Poh, Luis Serra-Majem, Jonathan E. Shaw, Belong Cho, Daphne Mirkopoulou, Salvador Villalpando, Yuki Fujita, Tiffany K. Gill, Nish Chaturvedi, Erkin M. Mirrakhimov, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Deepak Amarapurkar, Deepa Weerasekera, Diana A. Santos, Marjeta Majer, Herman Schargrodsky, Bruna Gonçalves Cordeiro da Silva, Ebrahim Eftekhar, Jesús Vioque, Marisa K. Sophiea, Teresa Shamah-Levy, María Dolores Chirlaque, Mohd Azahadi Omar, Stefan Söderberg, Isabel O. Oliveira, Joanne Katz, Xingwang Ye, Christophe Tzourio, Marie Zins, Aneta Weres, Ulrich Keil, Haiquan Xu, Akihiro Yoshihara, Rachel Dankner, Gabriella Gruden, Maroje Sorić, Hanspeter Stamm, Kim Overvad, Yanping Li, Carsten Oliver Schmidt, Christa L. Lilly, Veikko Salomaa, Gilad Twig, Senthil K Vasan, Qian Wang, Liufu Cui, Andrzej Galbarczyk, Sylvain Sebert, Wilma M. Hopman, Karl-Heinz Jöckel, Ari Voutilainen, Peter Schnohr, Jerzy Chudek, Katia Vergetti Bloch, Vincenzo Capuano, Jyh Eiin Wong, Torben Jørgensen, Anja Schienkiewitz, Nader Saki, Carolina Tarqui-Mamani, Maria Cecília Formoso Assunção, Kazi M. Jamil, Juraci Almeida Cesar, Pedro J Ortiz, Delphine De Smedt, Luciana Zaccagni, Lynne M. Boddy, Jie Hao, David Alejandro González-Chica, Romana Roccaldo, Sara Magnacca, Peter Stehle, Victoria Farrugia Sant'Angelo, Gry Skodje, Maryam Keramati, Tabara Yasuharu, Ali Ghanbari, Gyulli M. Kazakbaeva, Takuro Furusawa, Felicia Cañete, Kari Kuulasmaa, Justina Vaitkeviciute, (NCD-RisC), NCD Risk Factor Collaboration, Imperial College London, Harvard T.H. Chan School of Public Health, Middlesex University [London], Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Montpellier Interdisciplinary center on Sustainable Agri-food systems (Social and nutritional sciences) (UMR MoISA), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Wellcome TrustEuropean Commission, Clinical Developmental Psychology, APH - Mental Health, Sociology, The Social Context of Aging (SoCA), Nutrition and Health, Iurilli, Maria LC [0000-0003-0409-1635], Zhou, Bin [0000-0002-1741-8628], Ezzati, Majid [0000-0002-2109-8081], Apollo - University of Cambridge Repository, Epidemiology and Data Science, APH - Aging & Later Life, APH - Societal Participation & Health, Public and occupational health, APH - Health Behaviors & Chronic Diseases, VU University medical center, APH 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Ltd, Orebro University, University of London, Universitas Indonesia, Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs, Children’s Hospital of Fudan University, University of Cyprus, Niigata University, International Medical University, Iran University of Medical Sciences, Center for Diabetes and Endocrine Care, Peking University First Hospital, Jiangsu Provincial Center for Disease Control and Prevention, Sun Yat-sen University, West Kazakhstan Medical University, Inner Mongolia Medical University, University of Ghana, Maria Lc Iurilli , Bin Zhou , James E Bennett , Rodrigo M Carrillo-Larco , Marisa K Sophiea , Andrea Rodriguez-Martinez , Honor Bixby , Bethlehem D Solomon , Cristina Taddei , Goodarz Danaei , Mariachiara Di Cesare , Gretchen A Stevens , Leanne M Riley , Stefan Savin , Melanie J Cowan , Pascal Bovet , Albertino Damasceno , Adela Chirita-Emandi , Alison J Hayes , Nayu Ikeda , Rod T Jackson , Young-Ho Khang , Avula Laxmaiah , Jing 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Chiara Donfrancesco , Silvana P Donoso , Angela Döring , Maria Dorobantu , Ahmad Reza Dorosty , Kouamelan Doua , Nico Dragano , Wojciech Drygas , Jia Li Duan , Charmaine A Duante , Priscilla Duboz , Rosemary B Duda , Vesselka Duleva , Virginija Dulskiene , Samuel C Dumith , Anar Dushpanova , Vilnis Dzerve , Elzbieta Dziankowska-Zaborszczyk , Ricky Eddie , Ebrahim Eftekhar , Eruke E Egbagbe , Robert Eggertsen , Sareh Eghtesad , Gabriele Eiben , Ulf Ekelund , Mohammad El-Khateeb , Jalila El Ati , Denise Eldemire-Shearer , Marie Eliasen , Paul Elliott , Reina Engle-Stone , Macia Enguerran , Rajiv T Erasmus , Raimund Erbel , Cihangir Erem , Louise Eriksen , Johan G Eriksson , Jorge Escobedo-de la Peña , Saeid Eslami , Ali Esmaeili , Alun Evans , David Faeh , Albina A Fakhretdinova , Caroline H Fall , Elnaz Faramarzi , Mojtaba Farjam , Victoria Farrugia Sant'Angelo , Farshad Farzadfar , Mohammad Reza Fattahi , Asher Fawwad , Francisco J Felix-Redondo , Trevor S Ferguson , Romulo A Fernandes , Daniel Fernández-Bergés , Daniel Ferrante , Thomas Ferrao , Marika Ferrari , Marco M Ferrario , Catterina Ferreccio , Eldridge Ferrer , Jean Ferrieres , Thamara Hubler Figueiró , Anna Fijalkowska , Günther Fink , Krista Fischer , Leng Huat Foo , Maria Forsner , Heba M Fouad , Damian K Francis , Maria do Carmo Franco , Ruth Frikke-Schmidt , Guillermo Frontera , Flavio D Fuchs , Sandra C Fuchs , Isti I Fujiati , Yuki Fujita , Matsuda Fumihiko , Takuro Furusawa , Zbigniew Gaciong , Mihai Gafencu , Andrzej Galbarczyk , Henrike Galenkamp , Daniela Galeone , Myriam Galfo , Fabio Galvano , Jingli Gao , Manoli Garcia-de-la-Hera , Marta García-Solano , Dickman Gareta , Sarah P Garnett , Jean-Michel Gaspoz , Magda Gasull , Adroaldo Cesar Araujo Gaya , Anelise Reis Gaya , Andrea Gazzinelli , Ulrike Gehring , Harald Geiger , Johanna M Geleijnse , Ali Ghanbari , Erfan Ghasemi , Oana-Florentina Gheorghe-Fronea , Simona Giampaoli , Francesco Gianfagna , Tiffany K Gill , Jonathan Giovannelli , Glen 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, Zhanna Kalmatayeva , Ofra Kalter-Leibovici , Yves Kameli , Freja B Kampmann , Kodanda R Kanala , Srinivasan Kannan , Efthymios Kapantais , Argyro Karakosta , Line L Kårhus , Khem B Karki , Marzieh Katibeh , Joanne Katz , Peter T Katzmarzyk , Jussi Kauhanen , Prabhdeep Kaur , Maryam Kavousi , Gyulli M Kazakbaeva , Ulrich Keil , Lital Keinan Boker , Sirkka Keinänen-Kiukaanniemi , Roya Kelishadi , Cecily Kelleher , Han Cg Kemper , Andre P Kengne , Maryam Keramati , Alina Kerimkulova , Mathilde Kersting , Timothy Key , Yousef Saleh Khader , Davood Khalili , Kay-Tee Khaw , Bahareh Kheiri , Motahareh Kheradmand , Alireza Khosravi , Ilse Msl Khouw , Ursula Kiechl-Kohlendorfer , Stefan Kiechl , Japhet Killewo , Dong Wook Kim , Hyeon Chang Kim , Jeongseon Kim , Jenny M Kindblom , Heidi Klakk , Magdalena Klimek , Jeannette Klimont , Jurate Klumbiene , Michael Knoflach , Bhawesh Koirala , Elin Kolle , Patrick Kolsteren , Jürgen König , Raija Korpelainen , Paul Korrovits , Magdalena Korzycka , 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, Luxia Zhang , Zhen-Yu Zhang , Dong Zhao , Ming-Hui Zhao , Wenhua Zhao , Shiqi Zhen , Wei Zheng , Yingfeng Zheng , Bekbolat Zholdin , Maigeng Zhou , Dan Zhu , Marie Zins , Emanuel Zitt , Yanina Zocalo , Julio Zuñiga Cisneros , Monika Zuziak , Majid Ezzati , Sarah Filippi, Epidemiology, Iurilli, Maria LC, Zhou, Bin, Bennett, James E, Carrillo-Larco, Rodrigo M, Sophiea, Marisa K, Rodriguez-Martinez, Andrea, Bixby, Honor, Solomon, Bethlehem D, Taddei, Cristina, Danaei, Goodarz, Di Cesare, Mariachiara, Stevens, Gretchen A, Riley, Leanne M, Savin, Stefan, Cowan, Melanie J, Bovet, Pascal, Damasceno, Albertino, Chirita-Emandi, Adela, Hayes, Alison J, Ikeda, Nayu, Jackson, Rod T, Khang, Young-Ho, Laxmaiah, Avula, Liu, Jing, Miranda, J Jaime, Saidi, Olfa, Sebert, Sylvain, Sorić, Maroje, Starc, Gregor, Gregg, Edward W, Abarca-Gómez, Leandra, Abdeen, Ziad A, Abdrakhmanova, Shynar, Ghaffar, Suhaila Abdul, Rahim, Hanan F Abdul, Abu-Rmeileh, Niveen M, Garba, Jamila Abubakar, Acosta-Cazares, 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Poudyal, Anil, Poulimeneas, Dimitrio, Pouraram, Hamed, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J, Price, Jacqueline F, Providencia, Rui, Puder, Jardena J, Pudule, Iveta, Puhakka, Soile E, Puiu, Maria, Punab, Margu, Qasrawi, Radwan F, Qorbani, Mostafa, Bao, Tran Quoc, Radic, Ivana, Radisauskas, Ricarda, Rahimikazerooni, Salar, Rahman, Mahfuzar, Rahman, Mahmudur, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina, Rakhmatulloev, Sherali, Rakovac, Ivo, Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramke, Jacqueline, Ramos, Elisabete, Ramos, Rafel, Rampal, Lekhraj, Rampal, Sanjay, Rarra, Vayia, Rascon-Pacheco, Ramon A, Rasmussen, Mette, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M, Regecová, Valéria, Revilla, Lui, Rezaianzadeh, Abba, Ribas-Barba, Lourde, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, Rinaldo, Natascia, de Wit, Tobias F Rinke, Rito, Ana, Ritti-Dias, Raphael M, Rivera, Juan A, Robitaille, Cynthia, Roccaldo, Romana, Rodrigues, Daniela, Rodríguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, María, Rodríguez-Villamizar, Laura A, Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Rojroongwasinkul, Nipa, Romaguera, Dora, Romeo, Elisabetta L, Rosario, Rafaela V, Rosengren, Annika, Rouse, Ian, Roy, Joel GR, Rubinstein, Adolfo, Rühli, Frank J, Ruidavets, Jean-Bernard, Ruiz-Betancourt, Blanca Sandra, Ruiz-Castell, Maria, Moreno, Emma Ruiz, Rusakova, Iuliia A, Jonsson, Kenisha Russell, Russo, Paola, Rust, Petra, Rutkowski, Marcin, Sabanayagam, Charumathi, Sacchini, Elena, Sachdev, Harshpal S, Sadjadi, Alireza, Safarpour, Ali Reza, Safiri, Saeid, Saki, Nader, Salanave, Benoit, Martinez, Eduardo Salazar, Salmerón, Diego, Salomaa, Veikko, Salonen, Jukka T, Salvetti, Massimo, Samoutian, Margarita, Sánchez-Abanto, Jose, Sandjaja, null, Sans, Susana, Marina, Loreto Santa, Santos, Diana A, Santos, Ina S, Santos, Lèlita C, Santos, Maria Paula, Santos, Osvaldo, Santos, Rute, Sanz, Sara Santo, Saramies, Jouko L, Sardinha, Luis B, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savva, Savy, Mathilde, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D, Rosario, Angelika Schaffrath, Schargrodsky, Herman, Schienkiewitz, Anja, Schipf, Sabine, Schmidt, Carsten O, Schmidt, Ida Maria, Schnohr, Peter, Schöttker, Ben, Schramm, Sara, Schramm, Stine, Schröder, Helmut, Schultsz, Constance, Schutte, Aletta E, Sein, Aye Aye, Selamat, Rusidah, Sember, Vedrana, Sen, Abhijit, Senbanjo, Idowu O, Sepanlou, Sadaf G, Sequera, Victor, Serra-Majem, Lui, Servais, Jennifer, Ševcíková, Ludmila, Shalnova, Svetlana A, Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K, Shaw, Jonathan E, Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shengelia, Lela, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Subjects: Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed
Published: 2021

10. Adiposity change and mortality in middle-aged to older Chinese: an 8-year follow-up of the Guangzhou Biobank Cohort Study

Author: Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Wei Sen Zhang, Ya Li Jin, Ying Yue Huang, Feng Zhu, Kar Keung Cheng, and Lin Xu
Subjects: Male, medicine.medical_specialty, China, Waist, Epidemiology, Body Mass Index, Weight loss, Risk Factors, medicine, Humans, Obesity, Prospective Studies, Mortality, Prospective cohort study, general endocrinology, Adiposity, Aged, Biological Specimen Banks, Geriatrics, business.industry, geriatric medicine, public health, General Medicine, Middle Aged, Diabetes Mellitus, Type 2, Medicine, Female, medicine.symptom, Underweight, Waist Circumference, business, Body mass index, Demography, Cohort study, Follow-Up Studies
Abstract: ObjectiveTo examine the associations of change in body mass index (BMI) and waist circumference (WC) over an average of 4 years with subsequent mortality risk in middle-aged to older Chinese.DesignProspective cohort study based on the Guangzhou Biobank Cohort Study.SettingCommunity-based sample.Participants17 773 participants (12 956 women and 4817 men) aged 50+ years.Primary and secondary outcome measuresPrimary outcome measure was all-cause mortality. Secondary outcome measures were cardiovascular disease (CVD) and cancer mortality. Causes of death were obtained via record linkage, and coded according to the International Classification of Diseases (tenth revision).Results1424 deaths (53.4% women) occurred in the 17 773 participants (mean age 61.2, SD 6.8 years) during an average follow-up of 7.8 (SD=1.5) years, and 97.7% of participants did not have an intention of weight loss . Compared with participants with stable BMI, participants with BMI loss (>5%), but not gain, had a higher risk of all-cause mortality (HR=1.49, 95% CI 1.31 to 1.71), which was greatest in those who were underweight (HR=2.45, 95% CI 1.31 to 4.59). Similar patterns were found for WC. In contrast, for participants with a BMI of ≥27.5 kg/m2, BMI gain, versus stable BMI, was associated with 89% higher risk of all-cause mortality (HR=1.89, 95% CI 1.25 to 2.88), 72% higher risk of CVD mortality (HR=1.72, 95% CI 0.80 to 3.72) and 2.27-fold risk of cancer mortality (HR=2.27, 95% CI 1.26 to 4.10).ConclusionIn older people, unintentional BMI/WC loss, especially in those who were underweight was associated with higher mortality risk. However, BMI gain in those with obesity showed excess risks of all-cause and cancer mortality, but not CVD mortality. Frequent monitoring of changes in body size can be used as an early warning for timely clinical investigations and interventions and is important to inform appropriate health management in older Chinese.
Published: 2020

11. Association of hepatitis B surface antigen seropositivity and hepatitis B surface antibody seropositivity with diabetes: a cross-sectional study based on two Chinese populations in Guangdong, China

Author: Wei Sen Zhang, Ya Li Jin, Yuantao Hao, Tai Hing Lam, Chaoqiang Jiang, Yuan Liu, Lin Xu, and Tong Zhu
Subjects: Male, HBsAg, China, Hepatitis B virus, Cross-sectional study, Population, Type 2 diabetes, Serology, Diabetes mellitus, medicine, Humans, Hepatitis B Antibodies, education, hepatitis B surface body, Aged, education.field_of_study, Hepatitis B Surface Antigens, diabetes, business.industry, General Medicine, Middle Aged, medicine.disease, hepatitis B surface antigen, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Public Health, business, Body mass index, Demography, Cohort study
Abstract: ObjectivesTo examine whether hepatitis B surface antigen (HBsAg) seropositivity and hepatitis B surface antibody (HBsAb) seropositivity were associated with the presence of diabetes in two population-based studies in southern China, the Guangzhou Biobank Cohort Study (GBCS) and the Major Infectious Disease Prevention and Control (MIDPC) study.DesignA cross-sectional study.SettingThe GBCS was conducted among a community social and welfare organisation with branches in all 10 districts of Guangzhou. The MIDPC was conducted among the community residents in two districts of Guangzhou and three districts of Zhongshan.Participants4947 participants from the GBCS and 4357 participants from the MIDPC were included in this study.Primary and secondary outcome measuresType 2 diabetes was the main study outcome, which was diagnosed by fasting blood glucose ≥7.0 mmol/L, and/or self-reported history of diabetes.ResultsAfter adjusting for age, sex, education, occupation, smoking status, alcohol use, physical activity and body mass index, we found no association of HBsAg seropositivity in GBCS or MIDPC (OR=1.12, 95% CI 0.74 to 1.69, and OR=0.83, 95% CI 0.59 to 1.17, respectively), and HBsAb seropositivity (OR=0.85, 95% CI 0.65 to 1.12, OR=1.00, 95% CI 0.86 to 1.16, respectively) with the presence of diabetes. Null associations were found for analysis pooling GBCS and MIDPC data after similar adjustment. The adjusted OR for the associations of HBsAg seropositivity and HBsAb seropositivity with the presence of diabetes in the pooled sample was 0.91 (95% CI 0.70 to 1.19) and 0.98 (95% CI 0.86 to 1.12), respectively.ConclusionsTaking advantage of data from two large cross-sectional studies, we found no association of serological status of HBsAg and HBsAb with the presence of diabetes or glucose measures.
Published: 2020

12. Adiposity and mortality in older Chinese: an 11-year follow-up of the Guangzhou Biobank Cohort Study

Author: Wei Sen Zhang, Tai Hing Lam, Chaoqiang Jiang, Feng Zhu, Kar Keung Cheng, Ya Li Jin, and Lin Xu
Subjects: Male, China, Waist, lcsh:Medicine, 030209 endocrinology & metabolism, Article, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Sex Factors, Neoplasms, Medicine, Humans, 030212 general & internal medicine, Obesity, Mortality, lcsh:Science, Adiposity, Aged, Biological Specimen Banks, Multidisciplinary, business.industry, lcsh:R, Hazard ratio, Confounding, Middle Aged, medicine.disease, Biobank, Confidence interval, Risk factors, Cardiovascular Diseases, lcsh:Q, Female, Waist Circumference, business, Body mass index, Demography, Cohort study, Follow-Up Studies
Abstract: Previous studies on Chinese showed mixed results describing the relationship between obesity and mortality. The optimum levels of body mass index (BMI) and waist circumference (WC) are inconsistent. In the Guangzhou Biobank Cohort Study, after excluding ever smokers and those with poor health, 19,405 Chinese (50+ years) recruited from 2003 to 2008 were followed-up until 2017. During an average follow-up of 11.5 (standard deviation = 2.3) years, 1,757 deaths were recorded. All-cause mortality showed a J-shaped association with BMI, with the lowest mortality risks at 22.5 kg/m2 for both men and women. In those with BMI ≥ 22.5 kg/m2, an increase of 5 kg/m2 was associated with 29% higher all-cause mortality (hazard ratio (HR) = 1.29, 95% confidence interval (CI) 1.15–1.46), 30% higher cancer mortality (1.30, 95% CI 1.08–1.57), and 37% higher cardiovascular disease (CVD) mortality (1.37, 95% CI 1.13–1.67) after adjustment for potential confounders. In this first cohort study in one of the most economically developed cities in China, the lowest all-cause mortality was observed for a BMI of 22.5 kg/m2 in all participants, and a WC of 78 cm in men and 72 cm in women.
Published: 2020

13. Development and validation of a prediction model for airflow obstruction in older Chinese: Guangzhou Biobank Cohort Study

Author: Wei Sen Zhang, Tai Hing Lam, Chaoqiang Jiang, Peymane Adab, G. Neil Thomas, Jing Pan, K.K. Cheng, Ewout W. Steyerberg, Feng Zhu, Ya Li Jin, and Public Health
Subjects: Male, Risk, Pulmonary and Respiratory Medicine, Spirometry, Logistic regression, Decision Support Techniques, Cohort Studies, Pulmonary Disease, Chronic Obstructive, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Asian People, Prevalence, medicine, Humans, 030212 general & internal medicine, Aged, Asthma, Aged, 80 and over, Models, Statistical, medicine.diagnostic_test, business.industry, Age Factors, Middle Aged, Nomogram, medicine.disease, Confidence interval, 030228 respiratory system, Cohort, Female, business, Body mass index, Forecasting, Cohort study, Demography
Abstract: Objective To develop and validate a prediction model for airflow obstruction (AO) in older Chinese. Methods. Design Multivariable logistic regression analysis in large population cohort of Chinese aged ≥50 years. Participants Model development: 8762 Chinese aged ≥50 years were selected from the early phase recruits to the Guangzhou Biobank Cohort Study (GBCS) (recruited from September 2003 to May 2006). Internal validation: 100 bootstrap samples drawn with replacement from the development sample. External validation: 8395 Chinese aged ≥50 years from later phase GBCS (recruited from September 2006 to January 2008). Outcomes AO was defined by a forced expiratory volume in 1 s/forced vital capacity ratio Results 839 (9.6%) and 764 (9.1%) individuals had AO in the development and temporal validation samples respectively. The predictors in the prediction model included sex, age, body mass index groups, smoking status, presence of respiratory symptoms, and history of asthma. Model development and validation was stratified by sex. Model performance including calibration (calibration-in-the-large −0.017 vs. −0.157; and calibration slope 0.88 vs. 1.02), discrimination (C-statistic 0.72 vs. 0.63 with 95% confidence interval 0.69–0.75 vs. 0.62–0.73) and clinical usefulness (decision curve analysis) in the external temporal validation sample were more satisfactory in men than that in women. Prediction models with risk thresholds (13% in men and 7% in women) and easy-to-use nomograms were developed to assess the probability of AO. Conclusion The diagnostic models based on readily available epidemiologic and clinical information with satisfactory performance can assist physicians to identify older individuals at high risk of AO and may improve the efficiency of spirometry for active case finding. Further validation beyond the Chinese population is warranted.
Published: 2020

14. Egg consumption and the risk of cardiovascular disease and all-cause mortality: Guangzhou Biobank Cohort Study and meta-analyses

Author: Tai Hing Lam, Chaoqiang Jiang, Feng Zhu, G. Neil Thomas, Jean Woo, Wei Sen Zhang, Kar Keung Cheng, Lin Xu, and Ya Li Jin
Subjects: Male, 0301 basic medicine, China, medicine.medical_specialty, Eggs, Medicine (miscellaneous), 030209 endocrinology & metabolism, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Internal medicine, Epidemiology, medicine, Humans, Prospective Studies, Prospective cohort study, Stroke, Proportional Hazards Models, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Proportional hazards model, Hazard ratio, Middle Aged, medicine.disease, Confidence interval, Diet, Death, Cardiovascular Diseases, Female, business, Record linkage, Follow-Up Studies, Cohort study
Abstract: Eggs are highly nutritious but concerns over their cholesterol content have led to dietary avoidance among many. There are also important international differences in relevant dietary guidance. We conducted the first prospective study in China investigating the association of egg consumption, cardiovascular disease (CVD) mortality, and a meta-analysis. We included 28,024 participants without CVD at baseline (2003-8) in Guangzhou Biobank Cohort Study. All-cause and CVD mortality were identified through record linkage. We used Cox proportional hazards regression. We followed the Meta-analysis Of Observational Studies in Epidemiology reporting guidelines. During 275,343 person-years follow-up (average 9.8 years), we found 2685 all-cause and 873 CVD deaths. We found no significant difference in all-cause mortality between higher (7+ eggs/week) and low consumption (
Published: 2018

15. Age at menarche and cardiovascular risk factors using Mendelian randomization in the Guangzhou Biobank Cohort Study

Author: Gabriel M. Leung, Shiu Lun Au Yeung, Wei Sen Zhang, Lin Xu, Tai Hing Lam, Chaoqiang Jiang, C. Mary Schooling, and Kar Keung Cheng
Subjects: 0301 basic medicine, Epidemiology, Single-nucleotide polymorphism, Type 2 diabetes, Polymorphism, Single Nucleotide, Childhood obesity, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Asian People, Risk Factors, Mendelian randomization, Humans, Medicine, Genetic Predisposition to Disease, 030212 general & internal medicine, Aged, Aged, 80 and over, Menarche, business.industry, Public Health, Environmental and Occupational Health, Mendelian Randomization Analysis, Middle Aged, Stepwise regression, medicine.disease, 030104 developmental biology, Cardiovascular Diseases, Cohort, Female, business, Demography, Cohort study
Abstract: Observational studies show earlier age at menarche associated with higher risk of cardiovascular disease although these studies could be confounded by childhood obesity or childhood socioeconomic position. We tested the hypothesis that earlier age at menarche is associated with poorer cardiovascular risk factors using a Mendelian randomization design. We conducted a Mendelian randomization study in a large Southern Chinese cohort, the Guangzhou Biobank Cohort Study (n = 12,279), to clarify the causal role of menarche in cardiovascular disease risk factors including blood pressure, lipids, fasting glucose, adiposity and type 2 diabetes. A genetic allele score was obtained from single nucleotide polymorphisms associated with age at menarche using stepwise regression and with cross validation. Estimates of the association of age at menarche with cardiovascular disease risk factors were obtained using two stage least squares regression. Height was included as a positive control outcome. The F-statistic for the allele score (rs17268785, rs1859345, rs2090409, rs4452860 and rs4946651) was 19.9. Older age at menarche was associated with lower glucose (− 0.39 mmol/L per year older menarche, 95% confidence interval (CI) − 0.78 to − 0.001) but not clearly with any other cardiovascular risk factors. Older age at menarche was also associated with taller height. Age at menarche did not appear to affect cardiovascular disease risk factors except for glucose in an inverse manner. However, these results need to be confirmed in larger Mendelian randomization studies.
Published: 2017

16. Genetic scores for BMI related to metabolically unhealthy obesity in an older Chinese population

Author: Wei Sen Zhang, Shanshan Yang, Tai Hing Lam, Chaoqiang Jiang, Kar Keung Cheng, Yao He, Lin Xu, Yali Jin, and Yiyan Wang
Subjects: Male, medicine.medical_specialty, China, Genotype, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Single-nucleotide polymorphism, Overweight, Polymorphism, Single Nucleotide, Body Mass Index, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Asian People, Risk Factors, Internal medicine, medicine, Humans, Obesity, Prospective Studies, Prospective cohort study, Chinese population, business.industry, fungi, medicine.disease, Middle age, 030220 oncology & carcinogenesis, Female, medicine.symptom, business, Body mass index, Cohort study
Abstract: OBJECTIVE In this study, a genetic risk score (GRS) for the body mass index (BMI) tested and built using a large sample of Chinese individuals aged at least 50 years in southern China. We collected information regarding the participants' weights at 20 years of age and middle age and tested the BMI-GRS effect modes. METHODS This study involved a prospective study design. The genetic data of the participants in from the Guangzhou Biobank Cohort Study and selected BMI-related single-nucleotide polymorphisms (SNPs) were used to establish the GRS. RESULTS We included 13 597 participants with 12 SNPs. After adjusting for covariates, the high-GRS group was 36% (95% CI: 25%-48%) and 34% (95% CI: 23%-47%) more likely of being overweight at baseline and follow-up, respectively, and 56% (95% CI: 34%-82%) and 49% (95% CI: 29%-72%) more likely of being obese at baseline and follow-up, respectively, compared with the low-GRS group (P-value for all trends
Published: 2019

17. All-cause and cause-specific mortality from restrictive and obstructive spirometric patterns in Chinese adults with and without dyspnea: Guangzhou Biobank Cohort Study

Author: Wei Sen Zhang, Peymane Adab, Feng Zhu, Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Jing Pan, and Ya Li Jin
Subjects: Pulmonary and Respiratory Medicine, Spirometry, Male, medicine.medical_specialty, China, Lung Neoplasms, Airflow obstruction, Cohort Studies, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Lung cancer, medicine.diagnostic_test, business.industry, Proportional hazards model, Hazard ratio, Chinese adults, Middle Aged, medicine.disease, Confidence interval, respiratory tract diseases, Airway Obstruction, Dyspnea, 030228 respiratory system, Cardiovascular Diseases, Female, business, Cohort study, Follow-Up Studies
Abstract: Objective To study whether abnormal spirometric patterns were associated with differential mortality in Chinese adults with and without dyspnea. Methods Guangzhou Biobank Cohort Study (GBCS) participants were classified by spirometric patterns and presence of dyspnea into 6 groups: normal spirometry (NS), restriction on spirometry (ROS) and airflow obstruction (AO), each with and without dyspnea. Adjusted hazard ratios (aHRs) were calculated for mortality using Cox models. Results Among 16777 subjects, 1595 (9.5%) had ROS, 1036 (6.2%) had AO and 1009 (6.0%) had dyspnea. A total of 1993 deaths (11.9%) occurred during 11-year follow-up. Using NS without dyspnea as reference, NS with dyspnea was significantly associated with increased cardiovascular mortality risk (aHRs 1.61 (95% confidence interval (CI) 1.18–2.19); ROS with and without dyspnea were associated with increased risks of all-cause (aHRs 1.46 (95% CI 1.28–1.66) and 1.81 (95% CI 1.33–2.47)) and cardiovascular mortality (aHRs 1.89 (95% CI 1.55–2.31) and 1.85 (95% CI 1.12–3.03)), but not of lung cancer mortality (aHRs 1.33 (95% CI 0.91–1.94) and 1.35 (95% CI 0.49–3.70)); AO with and without dyspnea were associated with increased risks of all-cause (aHRs 1.59 (95% CI 1.36–1.86) and 2.36 (95% CI 1.77–3.15)), cardiovascular (aHRs 1.43 (95% CI 1.08–1.90) and 1.61 (95% CI 0.91–2.82)) and lung cancer mortality (aHRs 1.91 (95% CI 1.29–2.84) and 3.01 (95% CI 1.46–6.23)). These associations did not vary by sex or smoking status (all P-values for interaction >0.05). Conclusion Both ROS and AO, with and without dyspnea, were associated with increased all-cause and cardiovascular disease mortality. The increased risk of all-cause was greater and that of cardiovascular mortality was lower for AO than ROS. AO showed significantly increased risk of lung cancer but ROS did not. (272 words).
Published: 2018

18. A comparison of hemagglutination inhibition and neutralization assays for characterizing immunity to seasonal influenza A

Author: Derek A. T. Cummings, Jonathan M. Read, Shuying Wang, Shaun A. Truelove, Steven Riley, Chaoqiang Jiang, Hongbo Zhu, Kin On Kwok, Yi Guan, Justin Lessler, Wellcome Trust, National Institutes of Health, Medical Research Council (MRC), National Institute for Health Research, and Burroughs Wellcome Fund
Subjects: Male, 0301 basic medicine, cross-protection, microneutralization test, Epidemiology, Cross Protection, Antibodies, Viral, Spearman's rank correlation coefficient, Neutralization, Influenza A Virus, H1N1 Subtype, 0302 clinical medicine, Medicine, 030212 general & internal medicine, Child, neutralization test, Aged, 80 and over, biology, Middle Aged, 3. Good health, Titer, Infectious Diseases, 1117 Public Health And Health Services, Influenza A virus, Original Article, Female, Seasons, Antibody, influenza, Adult, Pulmonary and Respiratory Medicine, China, Adolescent, cross‐protection, Young Adult, 03 medical and health sciences, Neutralization Tests, Virology, Influenza, Human, Linear regression, Humans, Aged, Rank correlation, Hemagglutination assay, business.industry, Public Health, Environmental and Occupational Health, 1103 Clinical Sciences, Original Articles, Hemagglutination Inhibition Tests, immunity, Antibodies, Neutralizing, 030104 developmental biology, Immunology, Humoral immunity, biology.protein, hemagglutination inhibition test, business
Abstract: BACKGROUND: Serum antibody to influenza can be used to identify past exposure and measure current immune status. The two most common methods for measuring this are the hemagglutination inhibition assay (HI) and the viral neutralization assay (NT), which have not been systematically compared for a large number of influenza viruses. METHODS: 151 study participants from near Guangzhou, China were enrolled in 2009 and provided serum. HI and NT assays were performed for 12 historic and recently circulating strains of seasonal influenza A. We compared titers using Spearman correlation and fit models to predict NT using HI results. RESULTS: We observed high positive mean correlation between HI and NT assays (Spearman's rank correlation, rho=0.86) across all strains. Correlation was highest within subtypes and within close proximity in time. Overall, an HI=20 corresponded to NT=10, and HI=40 corresponded to NT=20. Linear regression of log(NT) on log(HI) was statistically significant, with age modifying this relationship. Strain-specific area under a curve (AUC) indicated good accuracy (>80%) for predicting NT with HI. CONCLUSIONS: While we found high overall correspondence of titers between NT and HI assays for seasonal influenza A, no exact equivalence between assays could be determined. This was further complicated by correspondence between titers changing with age. These findings support generalized comparison of results between assays and give further support for use of the hemagglutination inhibition assay over the more resource intensive viral neutralization assay for seasonal influenza A, though attention should be given to the effect of age on these assays. This article is protected by copyright. All rights reserved.
Published: 2016

19. Genetically predicted 17beta-estradiol, cognitive function and depressive symptoms in women: A Mendelian randomization in the Guangzhou Biobank Cohort Study

Author: Shiu Lun Au Yeung, Kar Keung Cheng, C. Mary Schooling, Gabriel M. Leung, Wei Sen Zhang, Tai Hing Lam, and Chaoqiang Jiang
Subjects: Genetic Markers, China, medicine.medical_specialty, Epidemiology, Neuropsychological Tests, Polymorphism, Single Nucleotide, law.invention, 03 medical and health sciences, Cognition, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Mendelian randomization, Humans, Medicine, 030212 general & internal medicine, Mini–Mental State Examination, Estradiol, medicine.diagnostic_test, Depression, business.industry, Confounding, Public Health, Environmental and Occupational Health, Mendelian Randomization Analysis, Confidence interval, 030220 oncology & carcinogenesis, Hong Kong, Female, Geriatric Depression Scale, business, Cohort study
Abstract: Objective The role of estrogen in cognitive function and depressive symptoms is controversial due to discrepancies between results from randomized controlled trials (RCT) and observational studies. Mendelian randomization analysis may provide further insights concerning the role of estrogen in these outcomes as it assesses the effect of lifelong endogenous exposure but is less vulnerable to confounding than observational studies. Method We used separate sample instrumental variable analysis to estimate the association of log 17β estradiol with cognitive function (Delayed 10 word recall, and Mini Mental State Examination (MMSE)) and depressive symptoms (Geriatric Depression Scale (GDS)) in older Chinese women of the Guangzhou Biobank Cohort Study (GBCS, n = 3086). The estimate was derived based on the Wald estimator, the ratio of the association of genetic determinants (rs1008805 and rs2175898) of log 17β-estradiol with cognitive function and depressive symptoms in GBCS and the association of log 17β-estradiol with genetic determinants in the sample of young women in Hong Kong (n = 236). Results Genetically predicted 17β-estradiol was not associated with delayed 10-word recall (0.42 words per log increase in 17β-estradiol (pmol/L), 95% confidence interval (CI) − 0.49 to 1.34) MMSE (0.39 per log increase in 17β-estradiol (pmol/L), 95% CI − 0.87 to 1.65) or GDS (0.24 per log increase in 17β-estradiol (pmol/L), 95% CI − 0.57 to 1.05). Conclusion These results were largely consistent with evidence from RCTs and did not show any beneficial effect of estrogen on cognitive function and depressive symptoms. However, larger Mendelian randomization analyses are needed to identify any minor effects.
Published: 2016

20. Genetically predicted 17beta-estradiol and cardiovascular risk factors in women: a Mendelian randomization analysis using young women in Hong Kong and older women in the Guangzhou Biobank Cohort Study

Author: Tai Hing Lam, Chaoqiang Jiang, Jie V. Zhao, Kar Keung Cheng, Shiu Lun Au Yeung, Wei Sen Zhang, C. Mary Schooling, and Gabriel M. Leung
Subjects: Genetic Markers, China, medicine.medical_specialty, Waist, Epidemiology, Polymorphism, Single Nucleotide, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Waist–hip ratio, Risk Factors, Internal medicine, Mendelian randomization, medicine, Humans, 030212 general & internal medicine, Risk factor, Aged, Aged, 80 and over, Framingham Risk Score, Estradiol, business.industry, Mendelian Randomization Analysis, Middle Aged, Cardiovascular Diseases, 030220 oncology & carcinogenesis, Hong Kong, Female, business, Body mass index, Cohort study
Abstract: Purpose The role of estrogen in cardiovascular health remains contested with discrepancies between findings from randomized controlled trials and observational studies. Mendelian randomization, which assesses the effect of lifelong endogenous exposure, may help elucidate these discrepancies. Methods We used separate sample instrumental variable analysis to estimate the association of log 17β-estradiol with factors related to cardiovascular disease risk (systolic and diastolic blood pressure, lipids, fasting glucose, body mass index, waist hip ratio, and waist circumference) and Framingham score, a predictor of 10-year risk of ischemic heart disease events, in older Chinese women from the Guangzhou Biobank Cohort Study (GBCS, n = 3092). The estimate was derived using the Wald estimator, that is, the ratio of the association of genetic determinants (rs1008805 and rs2175898) of log 17β-estradiol with cardiovascular disease risk factors and Framingham score in GBCS and the association of these genetic determinants with log 17β-estradiol in a sample of young women from Hong Kong (n = 236). Results Genetically, higher 17β-estradiol was not associated with any cardiovascular disease-related risk factor or with Framingham score (−0.01, 95% confidence interval = −1.34 to 1.31). Conclusions Lifetime exposure to estrogen does not appear to be cardioprotective via the cardiovascular disease-related risk factors examined.
Published: 2016

21. Sleep quality and cognitive impairment in older Chinese: Guangzhou Biobank Cohort Study

Author: Tai Hing Lam, Ya Li Jin, Xiao Qing Ma, Feng Zhu, Chaoqiang Jiang, G. Neil Thomas, Lin Xu, and Wei Sen Zhang
Subjects: Gerontology, Male, Aging, China, Pittsburgh Sleep Quality Index, 03 medical and health sciences, 0302 clinical medicine, Medicine, Memory impairment, Humans, Cognitive Dysfunction, 030212 general & internal medicine, Effects of sleep deprivation on cognitive performance, Sleep Hygiene, Aged, Memory Disorders, Mini–Mental State Examination, medicine.diagnostic_test, business.industry, Cognition, General Medicine, Odds ratio, Middle Aged, Mental Status and Dementia Tests, Confidence interval, Databases as Topic, Sleep Deprivation, Female, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, Cohort study
Abstract: Background evidence concerning the relationship between sleep quality and cognitive impairment is limited and inconsistent. Objective to examine the association of sleep quality with memory impairment and poor cognitive function in a large sample of older Chinese. Methods 15,246 participants aged 50+ years of the Guangzhou Biobank Cohort Study who attended the second physical examination from 2008 to 2012 were included. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI), and cognitive performance was assessed using both Delayed Word Recall Test (DWRT) and Mini-Mental State Examination (MMSE). Memory impairment was defined by DWRT score Results after adjusting for potential confounders, lower habitual sleep efficiency was associated with a higher risk of memory impairment and poor cognitive function with a dose-response pattern (both P for trend Conclusions in older Chinese people, lower habitual sleep efficiency was associated with a higher risk of memory impairment and poorer cognitive function.
Published: 2018

22. Relationship between pulmonary function and peripheral vascular function in older Chinese: Guangzhou biobank cohort study-CVD

Author: Jing Pan, Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Wei Sen Zhang, Ya Li Jin, Lin Xu, Feng Zhu, Kar Keung Cheng, and Peymane Adab
Subjects: Pulmonary and Respiratory Medicine, Spirometry, Male, medicine.medical_specialty, Vital capacity, Aging, China, Pulmonary function, Brachial Artery, 030204 cardiovascular system & hematology, Pulse Wave Analysis, Pulmonary function testing, Cohort Studies, 03 medical and health sciences, FEV1/FVC ratio, Peripheral Arterial Disease, 0302 clinical medicine, Vascular Stiffness, Internal medicine, Peripheral arterial disease (PAD), Medicine, Humans, Ankle Brachial Index, Correlation of Data, Pulse wave velocity, Aged, lcsh:RC705-779, medicine.diagnostic_test, business.industry, lcsh:Diseases of the respiratory system, Odds ratio, Vascular function, medicine.disease, Arterial stiffness, Respiratory Function Tests, Tibial Arteries, 030228 respiratory system, Cohort, Cardiology, Female, business, Research Article
Abstract: Background Findings describing the relationship between pulmonary function and peripheral vascular function have been inconclusive. We explored this relationship in Guangzhou Biobank Cohort Study-Cardiovascular Subcohort (GBCS-CVD). Methods Brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI) were measured by a waveform analyser, and pulmonary function by turbine flowmeter spirometry. Predicted forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were derived using equations for Chinese. Regression analyses were used to investigate the association. Results Of 1528 older Chinese, 980 (64.1%) had arterial stiffness (baPWV ≥1400 cm/s), but only 29 (1.9%) had peripheral arterial disease (PAD) (ABI
Published: 2018

23. Evaluation of Moderate Alcohol Use With QT Interval and Heart Rate Using Mendelian Randomization Analysis Among Older Southern Chinese Men in the Guangzhou Biobank Cohort Study

Author: Chaoqiang Jiang, Gabriel M. Leung, Kar Keung Cheng, C. Mary Schooling, Shiu Lun Au Yeung, Meijing Long, Wei Sen Zhang, Bin Liu, and Tai Hing Lam
Subjects: Male, China, medicine.medical_specialty, Alcohol Drinking, Epidemiology, Polymorphism, Single Nucleotide, QT interval, Unit of alcohol, Cohort Studies, Electrocardiography, Asian People, Heart Rate, Internal medicine, Mendelian randomization, Heart rate, medicine, Humans, Aged, ALDH2, Aged, 80 and over, business.industry, Aldehyde Dehydrogenase, Mitochondrial, Mendelian Randomization Analysis, Aldehyde Dehydrogenase, Middle Aged, Confidence interval, Cardiovascular Diseases, business, Cohort study
Abstract: Western observational studies show that moderate alcohol use is associated with lower cardiovascular disease (CVD) risk, but these associations may be confounded by the healthier attributes of moderate users in these settings. Mendelian randomization analysis may help to ascertain the causal effect of moderate alcohol use on specific factors related to CVD and thereby clarify the role of alcohol. We used Mendelian randomization analysis with the aldehyde dehydrogenase 2 gene (ALDH2) as an instrumental variable to examine the association of alcohol units (10 g of ethanol) per day with heart rate-corrected QT interval and heart rate assessed from electrocardiogram among 4,588 older southern Chinese men in the Guangzhou Biobank Cohort Study (2003-2008). The F statistic was 77 for ALDH2 on alcohol use, suggesting little weak-instrument bias. Instrumental variable analysis showed that alcohol units were not associated with the corrected QT interval, with β = 1.04 (95% confidence interval: -0.61, 2.70) milliseconds, but they were associated with increased heart rate, with β = 0.98 (95% confidence interval: 0.04, 1.92) beat per minute. This study suggests that moderate alcohol use in men is not beneficial for heart function via QT interval or heart rate but could be detrimental. Future studies using specific cardiovascular outcomes may elucidate how alcohol affects different aspects of the cardiovascular system and, hence, the overall effects of alcohol on CVD can be estimated.
Published: 2015

24. Genetically predicted testosterone and electrocardiographic QT interval duration in Chinese: a Mendelian randomization analysis in the Guangzhou Biobank Cohort Study

Author: Bin Liu, Weisen Zhang, Tai Hing Lam, Gabriel M. Leung, Chaoqiang Jiang, Lin Xu, Kar Keung Cheng, C. Mary Schooling, Jie V. Zhao, and Mei Jing Long
Subjects: Male, China, medicine.medical_specialty, Epidemiology, Polymorphism, Single Nucleotide, QT interval, Cohort Studies, Electrocardiography, Age Distribution, Aromatase, Heart Rate, Internal medicine, Mendelian randomization, Heart rate, Humans, Medicine, Testosterone, Aged, Aged, 80 and over, Framingham Risk Score, business.industry, Confounding, Testosterone (patch), General Medicine, Mendelian Randomization Analysis, Middle Aged, Confidence interval, Endocrinology, Cardiology, Hong Kong, business, Cohort study
Abstract: Background QT interval prolongation, a predictor of cardiac arrhythmias, and elevated heart rate are associated with higher risk of cardiovascular mortality. Observationally testosterone is associated with shorter corrected QT interval and slower heart rate; however, the evidence is open to residual confounding and reverse causality. We examined the association of testosterone with electrocardiogram (ECG) parameters using a separate-sample instrumental variable (SSIV) estimator. Methods To minimize reverse causality, a genetic score predicting testosterone was developed in 289 young Chinese men from Hong Kong, based on a parsimonious set of single nuclear polymorphisms (rs10046, rs1008805 and rs1256031). Linear regression was used to examine the association of genetically predicted testosterone with QT interval, corrected QT interval [using the Framingham formula (QTf) and Bazett formula (QTb)] and heart rate in 4212 older (50þ years) Chinese men from the Guangzhou Biobank Cohort Study. Results Predicted testosterone was not associated with QT interval [� 0.08ms per nmol/l testosterone, 95% confidence interval (CI) � 0.81 to 0.65], QTf interval (0.40ms per nmol/l testosterone, 95% CI � 0.12 to 0.93) or heart rate (0.26 beats per minute per nmol/l testosterone, 95% CI � 0.04 to 0.56), but was associated with longer QTb interval (0.66ms per nmol/l testosterone, 95% CI 0.02 to 1.31). Conclusions Our findings do not corroborate observed protective associations of testosterone with QT interval or heart rate among men, but potentially suggest effects in the other direction. Replication in a larger sample is required.
Published: 2014

25. Past Occupational Dust Exposure, Depressive Symptoms and Anxiety in Retired Chinese Factory Workers: The Guangzhou Biobank Cohort Study

Author: Yali Jin, Tai Hing Lam, Chaoqiang Jiang, Lin Xu, Kar Keung Cheng, and Qiu-Hong Lin
Subjects: Male, Gerontology, China, Cumulative Exposure, Anxiety, medicine.disease_cause, Asbestos, Cohort Studies, Interviews as Topic, Risk Factors, Occupational Exposure, Environmental health, Manufacturing Industry, Odds Ratio, Humans, Medicine, Life Style, Aged, Depressive Disorder, Retirement, Construction Materials, business.industry, Public Health, Environmental and Occupational Health, Occupational dust exposure, Dust, Odds ratio, Middle Aged, Silicon Dioxide, Mental health, Coal, Female, Geriatric Depression Scale, Self Report, medicine.symptom, business, Cohort study
Abstract: Objective Few studies have systematically investigated the impact of past occupational dust exposure on mental health. We examined whether retired factory workers exposed to any of the 4 dusts of silica, cement, coal and asbestos had more depressive symptoms and anxiety in southern China, which has experienced rapid economic development. Methods We used data from the Guangzhou Biobank Cohort Study phase 3. Exposures, lifestyle, symptoms and medical history of the participants were assessed with a structured interview. Self-reported intensity and duration of past occupational dust exposure were used to derive cumulative exposure. Outcome measures were assessed by the 15-item Chinese version of the Geriatric Depression Scale (score ≥5) and the single-item on anxiety. Results The results revealed that 359 workers were exposed to at least one of the 4 dusts and that 1,253 were unexposed (controls). After adjustment of multiple confounders, greater risks of depressive symptoms were associated with high exposure to silica (odds ratio (OR) of 3.12, 95% CI of 1.17-8.31) and asbestos (OR of 6.90; CI of 1.29-36.75). Risks of anxiety were higher in those with low or high exposures to dust (OR of 2.01 and CI of 1.04-3.87 and OR of 2.29 and CI of 1.30-4.03, respectively) and cement (OR of 3.20 and CI of 1.27-8.07 and OR of 2.30 and CI of 1.09-4.87, respectively), and those with high exposure to silica (OR of 5.29, CI of 1.76-15.92). Conclusions Past occupational exposures to silica, cement, coal and asbestos dusts were associated with adverse mental health outcomes in retired factory workers. The mechanism underlying the relationship between occupational exposures and psychological symptoms in later life needs to be further studied.
Published: 2014

26. Promoting smoking cessation in China: a foot-in-the-door approach to tobacco control advocacy

Author: David C. N. Wong, Li Yang, Shou Yong Tan, Bin Jiang, Yee Tak Derek Cheung, Yao He, Kar Keung Cheng, Tai Hing Lam, Chaoqiang Jiang, Sophia S. C. Chan, and Lei Wu
Subjects: Male, medicine.medical_specialty, China, Health Knowledge, Attitudes, Practice, Capacity Building, Internationality, WHO Framework Convention on Tobacco Control, medicine.medical_treatment, Health Personnel, education, Advisory Committees, Pilot Projects, Smoking Prevention, 03 medical and health sciences, 0302 clinical medicine, Environmental health, medicine, Humans, 030212 general & internal medicine, Tobacco harm reduction, Tobacco Use Cessation, Government, 030505 public health, Public health, Tobacco control, Public Health, Environmental and Occupational Health, Smoke-Free Policy, Smoking cessation, Hong Kong, Female, Smoking Cessation, Business, 0305 other medical science, Foot-in-the-door technique
Abstract: Introduction: The Chinese government’s implementation of the MPOWER policies and compliance with the WHO Framework Convention on Tobacco Control requirements has been slow. We used the ‘foot-in-the-door’ approach to promote tobacco control advocacy through capacity building of healthcare leaders, and establishment of smoking cessation clinics in Guangzhou and Beijing (two of the largest cities in China). Methods: This collaborative pilot project involved the University of Hong Kong and three major hospitals in Guangzhou and Beijing. A steering committee conducted the smoking cessation training workshops starting from April 2006, and set up three smoking cessation model clinics during August 2006 to October 2008. We followed up the trained health care professionals (HCPs) in 2014 and 2015 to assess their impacts on tobacco control beyond smoking cessation. Results: We emphasized the importance of the general tobacco control atmosphere during smoking cessation training of 139 HCPs to motivate them to engage in tobacco control advocacy. In addition to enhancing their knowledge and skills in cessation, the HCPs were then involved in the establishment of three in-hospital smoking cessation clinics and served as smoking cessation counselors since June 2008. Moreover, they ventured outside the clinics and the community to publicize smoking cessation. Their effort has contributed to smoke-free legislation, better surveillance on smoking and media advocacy on tobacco control in China. Conclusions: The training and establishment of smoking cessation clinics could serve as a means to motivate and empower HCPs who could contribute to broaden tobacco control policy in China.
Published: 2017

27. Association of adiposity with pulmonary function in older Chinese: Guangzhou Biobank Cohort Study

Author: Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Jing Pan, Feng Zhu, Wei Sen Zhang, Kar Keung Cheng, Tong Zhu, Ya Li Jin, Lin Xu, and Peymane Adab
Subjects: Pulmonary and Respiratory Medicine, Male, Pediatrics, medicine.medical_specialty, China, Vital Capacity, Pulmonary function testing, Body Mass Index, Cohort Studies, 03 medical and health sciences, FEV1/FVC ratio, 0302 clinical medicine, Asian People, Forced Expiratory Volume, medicine, Odds Ratio, Humans, 030212 general & internal medicine, Obesity, Exercise, Lung, Adiposity, Aged, Respiratory Sounds, business.industry, Waist-Hip Ratio, Smoking, Chinese adults, Middle Aged, medicine.disease, Biobank, Asthma, 030228 respiratory system, Spirometry, Obesity, Abdominal, Central Adiposity, Female, Waist Circumference, business, Body mass index, Cohort study
Abstract: Objective We examined the association between different adiposity indices and pulmonary function in Chinese adults in the Guangzhou Biobank Cohort Study (GBCS). Methods Participants with body mass index (BMI) low limits of normal and FVC % Results Of 16186 participants (mean age 61.4 ± 7.2 years; 74.0% women), 116 (0.7%) had only general obesity (BMI ≥28 kg/m2), 4079 (25.2%) had only central obesity (WC: ≥90 cm in men, ≥80 cm in women) and 1591 (9.8%) had both central obesity and general obesity. Comparing to those with neither central nor general obesity, those with only central adiposity and with both central and general obesity had lower pulmonary function (adjusted β range from -2.85 to -6.02 for FEV1% and FVC%, adjusted OR range from 1.14 to 1.70, all P 0.05). Both FEV1% and FVC% decreased per standard deviation increase in obesity indices (adjusted β from -0.46 to -3.17, all P Conclusion Central adiposity and its indices, but not general adiposity and BMI, were independently associated with lower pulmonary function and higher risk of restrictive respiratory defect in older Chinese.
Published: 2017

28. Adiposity and incident diabetes within 4 years of follow-up: the Guangzhou Biobank Cohort Study

Author: GN Thomas, Feng Zhu, Y. L. Jin, W. S. Zhang, Kar Keung Cheng, Tai Hing Lam, T. Zhu, Chaoqiang Jiang, and Lin Xu
Subjects: Adult, Male, medicine.medical_specialty, China, Waist, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Risk Factors, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Obesity, Abdominal obesity, Adiposity, Aged, Biological Specimen Banks, Aged, 80 and over, business.industry, Incidence (epidemiology), Incidence, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Surgery, Diabetes Mellitus, Type 2, Female, medicine.symptom, business, Cohort study, Follow-Up Studies
Abstract: Aim Whether different adiposity measures predict incident diabetes differentially in general Chinese populations is unclear. We investigated this in Chinese people aged 50+ years in the Guangzhou Biobank Cohort Study. Methods Waist circumference and BMI were measured at baseline, and fasting glucose was measured at both baseline and follow-up examinations. Incident diabetes was defined as fasting glucose ≥ 7.0 mmol/l, glucose after 2-h oral glucose tolerance test ≥ 11.1 mmol/l, and/or self-reported physician-diagnosed diabetes during the follow-up period. Results Of 15 752 people without diabetes at baseline from 2003 to 2008, 1779 (11.3%) developed incident diabetes during the follow-up from 2008 to 2012 (mean = 3.6 years, sd = 1.0). After mutually adjusting each other and adjusting for other potential confounders, waist circumference showed a higher predictive value than BMI. The odds ratio (OR) (95% confidence interval (CI) was 1.50 (95% CI 1.37–1.64) for a 1 sd increment in waist circumference and 1.21 (95% CI 1.11–1.33), for a 1 sd increment in BMI. Similarly, after mutual adjustment, abdominal obesity was associated with an almost twofold odds of incident diabetes (OR 1.93, 95% CI 1.71–2.17), which was higher than that for general obesity (OR 1.76, 95% CI 1.50–2.06). The area under receiver operating characteristic curve (AUC) for waist circumference was higher than that for BMI [AUC = 0.676 (95% CI 0.660–0.686) vs. 0.665 (95% CI 0.651–0.678), P = 0.02]. Conclusion Abdominal obesity predicted incident diabetes in older people better than general obesity. Our findings may be an early warning signal for local government or public health practitioners to develop and investigate more effective intervention programmes for diabetes, and should also be disseminated to the public to pay more attention to this important public health issue. This article is protected by copyright. All rights reserved.
Published: 2017

29. Age at menarche and depressive symptoms in older Southern Chinese women: A Mendelian randomization study in the Guangzhou Biobank Cohort Study

Author: Lin Xu, C. Mary Schooling, Tai Hing Lam, Chaoqiang Jiang, Wei Sen Zhang, Gabriel M. Leung, Shiu Lun Au Yeung, and Kar Keung Cheng
Subjects: 0301 basic medicine, Gerontology, Male, medicine.medical_specialty, China, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Asian People, Epidemiology, Mendelian randomization, Medicine, Humans, 030212 general & internal medicine, Biological Psychiatry, Depression (differential diagnoses), Aged, Aged, 80 and over, Menarche, business.industry, Depression, Age Factors, Stepwise regression, Mendelian Randomization Analysis, Middle Aged, Psychiatry and Mental health, 030104 developmental biology, Cohort, Regression Analysis, Geriatric Depression Scale, Female, business, Cohort study
Abstract: To clarify the causal role of age at menarche in depressive symptoms we conducted a Mendelian randomization study using a large Southern Chinese cohort (n = 12,233). A genetic allele score was derived using stepwise regression with cross validation. Older age at menarche was not associated with geriatric depression scale score. Our findings suggest that higher rates of depression in women are likely attributable to other factors which require investigation.
Published: 2017

30. Aldehyde dehydrogenase 2—a potential genetic risk factor for lung function among southern Chinese: evidence from the Guangzhou Biobank Cohort Study

Author: Peymane Adab, Tai Hing Lam, Kar Keung Cheng, Chaoqiang Jiang, Kin Bong Hubert Lam, Gabriel M. Leung, Catherine Mary Schooling, Bin Liu, Wei Sen Zhang, and Shiu Lun Au Yeung
Subjects: Male, China, Vital capacity, Alcohol Drinking, Genotype, Epidemiology, Vital Capacity, Physiology, Aldehyde dehydrogenase, Polymorphism, Single Nucleotide, Cohort Studies, Asian People, Risk Factors, Forced Expiratory Volume, Humans, Medicine, Sex Distribution, Allele, Life Style, Lung, Alleles, Aged, ALDH2, Aged, 80 and over, biology, business.industry, Aldehyde Dehydrogenase, Mitochondrial, Smoking, Confounding, Confounding Factors, Epidemiologic, Aldehyde Dehydrogenase, Middle Aged, Body Height, Confidence interval, Socioeconomic Factors, Linear Models, biology.protein, Female, business, Cohort study
Abstract: Purpose In Asia, moderate alcohol users have better lung function. Never users have more inactive aldehyde dehydrogenase 2 (ALDH2) alleles (A) potentially generating confounding because inactive alleles may increase acetaldehyde exposure and reduce lung function. Methods We examined the association of ALDH2 genotypes with percentage predicted lung function (forced expiratory volume in 1 second; forced vital capacity) for age, sex, and height among 5641 older Chinese using multivariable linear regression. Results ALDH2 genotypes were associated with alcohol use and height but not other attributes. Inactive alleles were inversely associated with lung function (percentage predicted forced expiratory volume in 1 second −1.52%, 95% confidence interval [CI], −2.52% to −0.51% for one inactive allele and −2.05%, 95% CI, −3.85% to −0.26% for two inactive alleles compared with two active alleles; and for percentage predicted forced vital capacity −1.25%, 95% CI −2.15% to −0.35% and −1.65%, 95% CI, −3.25% to −0.04%). The association of moderate use with lung function was attenuated after adjusting for ALDH2, in addition to other potential confounders. Conclusions Previous findings in Chinese may be confounded by ALDH2. High frequency of inactive ALDH2 alleles in East Asia may exacerbate the effect of environmental acetaldehyde exposure on lung function and potentially on chronic obstructive pulmonary disease.
Published: 2014

31. The Relationship between Occupational Stress, Burnout, and Turnover Intention among Managerial Staff from a Sino‐Japanese Joint Venture in Guangzhou, China

Author: Tai Hing Lam, Chaoqiang Jiang, and Qiu-Hong Lin
Subjects: Male, China, Coping (psychology), Administrative Personnel, Public Health, Environmental and Occupational Health, Personnel Turnover, Workload, Burnout, Job Satisfaction, Eysenck Personality Questionnaire, Social support, Cross-Sectional Studies, Psychoticism, Humans, Regression Analysis, Female, Professional Autonomy, Job satisfaction, Occupational stress, Psychology, Emotional exhaustion, Burnout, Professional, Occupational Health, Clinical psychology
Abstract: Objective The aim of this study was to analyze the associations between occupational stress, burnout and turnover intention and explore their associated factors among managerial staff in Guangzhou, China. Methods This cross-sectional study recruited 288 managerial employees from a Sino-Japanese joint venture automobile manufacturing enterprise in Guangzhou. The questionnaire included questions about sociodemographic characteristics, smoking, drinking and physical activity and the Chinese versio ns of the Occupational Stress Indicator (OSI), Maslach Burnout Inventory (MBI), Eysenck Personality Questionnaire (EPQ), Simplified Coping Style Questionnaire (SCSQ) and Social Support Rating Scale (SSRS). The response rate was 57.6%. Stepwise regression analysis was performed to examine the associations between burnout and occupational stress and turnover intention and related factors. Results The respondents had a high level burnout on the personal accomplishment subscale and had a high prevalence of turnover intention. Neuroticism, psychoticism, job satisfaction, occupational stress and social support were strong predictors of emotional exhaustion. Psychoticism, passive coping, occupational stress, objective support, utilization of support, male gender and job satisfaction were strong predictors of depersonalization. Active and passive coping and job satisfaction were strong predictors of personal accomplishment. Job dissatisfaction and emotional exhaustion were strong predictors of turnover intention. Conclusions High occupational stress and low job satisfaction were associated with high burnout, particularly in the emotional exhaustion and depersonalization dimensions. Low job satisfaction and high emotional exhaustion were associated with high turnover intention among employees. Personality traits, social support and coping style were also found to be associated with burnout.
Published: 2013

32. Uric acid levels, even in the normal range, are associated with increased cardiovascular risk: The Guangzhou Biobank Cohort Study

Author: Lin Xu, Kar Keung Cheng, Li Ming Huang, Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Tong Zhu, Hong Yu, Bin Liu, Wei Sen Zhang, and Ya Li Jin
Subjects: Male, China, medicine.medical_specialty, Physical examination, Risk Assessment, chemistry.chemical_compound, Reference Values, Risk Factors, Surveys and Questionnaires, Diabetes mellitus, Internal medicine, Prevalence, medicine, Humans, Hyperuricemia, Normal range, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Serum uric acid, Middle Aged, Prognosis, medicine.disease, Biobank, United Kingdom, Uric Acid, Survival Rate, Endocrinology, chemistry, Cardiovascular Diseases, Uric acid, Female, Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract: To examine the association between serum uric acid (UA) levels and cardiovascular risk factors in subjects without diabetes or hyperuricemia.6172 women and 2662 men aged 50+ years without diabetes from Phase 1 of the Guangzhou Biobank Cohort Study were included. Data on personal history, physical examination and biochemical parameters were collected. Subjects were categorized by serum UA concentration, and the association between UA levels and cardiovascular risk factors was examined using generalized linear models.In both men and women with normouricemia (UA420 μmol/l in men and360 μmol/l in women), tertiles of UA levels were adversely associated with body mass index, waist circumference, waist-to-hip ratio, total- and HDL-cholesterol, apolipoprotein A1, systolic and diastolic blood pressures, pulse pressure, fasting plasma glucose and white blood cell count (P value for trend ranged from 0.04 to0.001), and also consistently associated with metabolic disorders including obesity, hypertension, hypertension treatment, dyslipidemia, waist circumference increased since the age of 18 years and the metabolic syndrome (P value for trend ranged from 0.02 to0.001).Increasing UA levels, even in subjects with normouricemia and without diabetes, were associated with increasing prevalence of cardiovascular risk factors, suggesting that clinically dichotomous definition of hyperuricemia may be inadequate and high-normal value of UA may warn of metabolic disorders.
Published: 2013

33. Alcohol consumption and electrocardiographic left ventricular hypertrophy and mediation by elevated blood pressure in older Chinese men: The Guangzhou Biobank Cohort Study

Author: Tai Hing Lam, Chaoqiang Jiang, Bin Liu, G. Neil Thomas, Y. H. Chan, Wei Sen Zhang, JM Lin, Mei Jing Long, Ya Li Jin, and Kar Keung Cheng
Subjects: Male, medicine.medical_specialty, Health (social science), Alcohol Drinking, Diastole, Blood Pressure, Toxicology, Left ventricular hypertrophy, Biochemistry, Cohort Studies, Electrocardiography, Behavioral Neuroscience, Asian People, Risk Factors, Internal medicine, Humans, Medicine, cardiovascular diseases, Risk factor, Aged, Aged, 80 and over, business.industry, General Medicine, Odds ratio, Middle Aged, medicine.disease, Chinese people, Cross-Sectional Studies, Endocrinology, Blood pressure, Neurology, Case-Control Studies, Hypertension, Hypertrophy, Left Ventricular, business, Body mass index, Cohort study
Abstract: Chinese people have a markedly lower alcohol consumption than people in the West. Whether alcohol consumption at such levels is associated with left ventricular hypertrophy, and the role of blood pressure (BP) in this relationship is unclear. We investigated the association between alcohol consumption and electrocardiographic left ventricular hypertrophy (ECG-LVH) and the mediating role of BP in Chinese men aged ≥50 years.A case-control analysis was conducted on baseline cross-sectional data from the community-based Guangzhou Biobank Cohort Study (2003-2008), using standard 12-lead resting electrocardiograms. By comparing 191 new ECG-LVH cases with 4311 controls, excessive drinking (210 g/week) showed excess risks for ECG-LVH (odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.12-3.24), after adjusting for education, income, occupation, physical activity, smoking, body mass index, fasting glucose, triglyceride, total cholesterol, high-density lipoprotein cholesterol, BP, and antihypertensive medication. Mediation analysis showed a significant mediating effect of BP on the association between excessive drinking and ECG-LVH: systolic (31%) and diastolic (16%). After multivariate adjustment, no significant association was found between occasional drinking (once/week: OR = 1.20, 95% CI = 0.80-1.80) and moderate drinking (≥once/week to ≤210 g/week: OR = 0.88, 95% CI = 0.53-1.47) with increased/decreased risk of ECG-LVH.Alcohol consumption at210 g/week in Chinese men is an independent risk factor for ECG-LVH. Low power prevented us from examining whether drinking atonce/week to ≤210 g/week is associated with decreased/increased risk of ECG-LVH. Elevated BP partially mediates between alcohol and ECG-LVH. A Mendelian randomization approach with a large sample size is warranted to determine the relations among alcohol consumption, BP, and LVH.
Published: 2013

34. Effect of alcohol and aldehyde dehydrogenase gene polymorphisms on alcohol-associated hypertension: the Guangzhou Biobank Cohort Study

Author: Tai Hing Lam, Chaoqiang Jiang, Wei Sen Zhang, Lin Xu, Bin Liu, Kar Keung Cheng, and Catherine Mary Schooling
Subjects: Adult, Male, medicine.medical_specialty, Mean arterial pressure, Alcohol Drinking, Genotype, Physiology, Alcohol, Cohort Studies, aldehyde dehydrogenase gene polymorphisms, chemistry.chemical_compound, Asian People, Risk Factors, Internal medicine, Internal Medicine, medicine, Humans, Genetic Predisposition to Disease, Aged, Alcohol dehydrogenase, ALDH2, Genetics, Polymorphism, Genetic, biology, alcohol, business.industry, Alcohol Dehydrogenase, Acetaldehyde, blood pressure, Odds ratio, Aldehyde Dehydrogenase, Middle Aged, Endocrinology, Blood pressure, chemistry, Hypertension, biology.protein, Original Article, Cardiology and Cardiovascular Medicine, business
Abstract: The effects of alcohol dehydrogenase (ADH) 2 and aldehyde dehydrogenase (ALDH) 2 genotypes on the alcohol–blood pressure association are unclear. We examined the association of ADH2 or ALDH2 genotypes with blood pressure in older Chinese men. Based on the Guangzhou Biobank Cohort Study (GBCS), 4792 men with valid ADH2, ALDH2 genotypes were included, and genotyping of rs1229984 ADH2 and rs671 ALDH2 (AA, AG/GA or GG) was performed using a Sequenom Mass-Array platform. Information on socio-demographics and lifestyle factors, including alcohol use, was obtained from a questionnaire, and blood pressure was measured. Among alcohol drinkers, systolic and diastolic blood pressure (SBP and DBP) and mean arterial pressure (MAP) were highest for men with the GG ADH2 genotype (136.6, 77.9 and 97.5 mm Hg, respectively), followed by those with the (AA/AG ADH2+GG ALDH2) genotype (133.4, 77.6 and 96.2 mm Hg, respectively) and then the (AA/AG ADH2+AA/AG ALDH2) genotype (SBP=132.6, DBP=76.6 and MAP=95.2 mm Hg) (P for trend ranged 0.025–0.035). After adjustment for potential confounders, as well as frequency or amount of alcohol use, men with the GG ADH2 genotype were more likely to have hypertension (odds ratio (OR)=1.62, 95% confidence interval 1.15–2.28) as were men with the (AA/AG ADH2+AA/AG ALDH2) genotype (OR=1.40, 95% confidence interval 1.01–1.96) compared with men with the (AA/AG ADH2+GG ALDH2) genotype). ADH2 or ALDH2 genotypes were unrelated to hypertension among those who never drink alcohol. ADH2 genotype influences blood pressure and risk of hypertension among male alcohol drinkers, suggesting that the hypertensive effect of alcohol is due to ethanol rather than acetaldehyde.
Published: 2013

35. Alcohol consumption and aortic arch calcification in an older Chinese sample: The Guangzhou Biobank Cohort Study

Author: C. Mary Schooling, Wei Sen Zhang, Lin Xu, Kar Keung Cheng, Tai Hing Lam, Chaoqiang Jiang, and G. Neil Thomas
Subjects: Male, China, medicine.medical_specialty, Alcohol Drinking, Aortic Diseases, Aorta, Thoracic, Cohort Studies, Age Distribution, Outcome variable, Asian People, Risk Factors, Surveys and Questionnaires, Internal medicine, Prevalence, medicine, Humans, Sex Distribution, Vascular Calcification, Life Style, Aged, Aged, 80 and over, business.industry, Odds ratio, Middle Aged, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, Confidence interval, Surgery, Lifestyle factors, Female, Aortic arch calcification, Cardiology and Cardiovascular Medicine, business, Older people, Alcohol consumption, Cohort study
Abstract: Objective To examine the association between alcohol consumption and aortic arch calcification (AAC) in an older Chinese sample. Methods In 27,844 older people aged 50–85, socioeconomic position and lifestyle factors were assessed by a questionnaire. The presence and severity of AAC were diagnosed from chest X-ray by two experienced radiologists. Results In men, the risk for AAC increased significantly in frequent or excessive drinkers [adjusted odds ratio (OR)=1.36 (95% confidence interval (CI) 1.16–1.59) and 1.49 (1.21–1.83) for those who drank >5times/week and those who drank excessively, respectively] (P for trend from 0.002 to 0.001). When AAC was analyzed as an outcome variable with 3 categories of severity, significant dose–response relations between the severity of AAC and alcohol consumption were observed, with those who drank frequently (>5/week) or excessively having more serious AAC (P for trend=0.03 and 0.02, respectively). No significant association was found in women as few drank excessively. Conclusion The presence and severity of AAC were associated with quantity or frequency of alcohol consumption in a dose–response pattern, suggesting that alcohol drinking, even when moderate, has no benefit for AAC. Excessive drinking increased the risk of AAC by 50% compared to never drinkers.
Published: 2013

36. Mental health and asthma in China: the Guangzhou Biobank Cohort Study

Author: Adrian Loerbroks, Kin Bong Hubert Lam, Jos A. Bosch, Wei Sen Zhang, Kar Keung Cheng, Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Peymane Adab, and Klinische Psychologie (Psychologie, FMG)
Subjects: Adult, Male, medicine.medical_specialty, China, Alternative medicine, Cohort Studies, Environmental health, Epidemiology, Confidence Intervals, Prevalence, Medicine, Humans, Psychiatry, Applied Psychology, Depression (differential diagnoses), Asthma, Cultural Characteristics, business.industry, Depression, Middle Aged, medicine.disease, Biobank, Mental health, Health psychology, Mental Health, Female, business, Cohort study
Abstract: Background: There is consistent evidence of the co-occurrence of poor mental health and asthma in Western populations. Since the experience and expression of mental health is partly culturally determined, it is of interest to examine if similar associations are found in other cultural settings. In that regard, very little is known about the association between mental health and asthma in Asian countries, such as China.Purpose: The aim of this study was to investigate the relationship between mental health and asthma in a large sample from China.Method: We used data from the Guangzhou Biobank Cohort Study phase 3 (n = 9,280). Participants reported physician-diagnosed asthma. Mental health measures included the 15-item Chinese version of the Geriatric Depression Scale (GDS-C) and the SF-12 Mental Component Summary (MCS) score. We compared the prevalence of asthma by GDS-C and MCS scores by estimating prevalence ratios (PRs) and their corresponding 95% confidence intervals (95% CI), using Poisson regression.Results: Compared to those without depression, the prevalence of asthma was higher in those with moderate or severe depression levels (PR = 2.63, 95% CI = 1.58-4.40 and PR = 4.43, 95% CI = 1.62-12.09, p for trend ≤0.0001). The prevalence of asthma increased by 46% with every 1 standard deviation increase of the GDS-C score (PR = 1.46, 95% CI = 1.24-1.73). The MCS score was not associated with asthma.Conclusion: Depressive symptoms were associated with asthma prevalence in a Chinese population. Further research into the mechanism and potential directions of causality is warranted.
Published: 2013

37. Influence of heart rate at rest for predicting the metabolic syndrome in older Chinese adults

Author: Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Kar Keung Cheng, Bríain ó Hartaigh, Jos A. Bosch, Wei Sen Zhang, and Klinische Psychologie (Psychologie, FMG)
Subjects: Male, medicine.medical_specialty, China, Endocrinology, Diabetes and Metabolism, Rest, Logistic regression, Cohort Studies, Endocrinology, Age Distribution, Asian People, Heart Rate, Predictive Value of Tests, Risk Factors, Diabetes mellitus, Internal medicine, Heart rate, Internal Medicine, medicine, Odds Ratio, Humans, Aged, Dyslipidemias, Metabolic Syndrome, business.industry, Chinese adults, General Medicine, Odds ratio, Middle Aged, medicine.disease, Lipids, Logistic Models, Quartile, Hyperglycemia, Physical therapy, Cardiology, Female, Metabolic syndrome, business, Cohort study
Abstract: The aim of this study was to examine the relationship between seated resting heart rate and the metabolic syndrome (MetS) among older residents of Guangzhou, South China. A total of 30,519 older participants (≥50 years) from the Guangzhou Biobank Cohort Study were stratified into quartiles based on seated resting heart rate. The associations between each quartile and the MetS were assessed using multivariable logistic regression. A total of 6,907 (22.8 %) individuals were diagnosed as having the MetS, which was significantly associated with increasing heart rate quartiles (P < 0.001). Participants in the uppermost quartile (mean resting heart rate 91 ± 8 beats/min) of this cardiovascular proxy had an almost twofold increased adjusted risk (odds ratio (95 % CI) = 1.94 (1.79, 2.11), P < 0.001) for the MetS, as compared to those in the lowest quartile (mean resting heart rate, 63 ± 4 beats/min). Heart rate, which is an inexpensive and simple clinical measure, was independently associated with the MetS in older Chinese adults. We hope these observations will spur further studies to examine the usefulness of resting heart rate as a means of risk stratification in such populations, for which targeted interventions should be implemented.
Published: 2013

38. Exposure to secondhand smoke and risk of peripheral arterial disease in southern Chinese non-smokers: The Guangzhou Biobank Cohort Study-Cardiovascular Disease Sub-cohort

Author: Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Kar Keung Cheng, Daniel F. Mackay, L. Lu, and Jill P. Pell
Subjects: Surgeon general, Male, medicine.medical_specialty, China, Time Factors, Cross-sectional study, Comorbidity, Tissue Banks, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, Peripheral Arterial Disease, 0302 clinical medicine, Risk Factors, Internal medicine, Environmental health, medicine, Odds Ratio, Humans, Radiology, Nuclear Medicine and imaging, Ankle Brachial Index, 030212 general & internal medicine, Risk factor, Chi-Square Distribution, business.industry, General Medicine, Odds ratio, Middle Aged, medicine.disease, body regions, Cross-Sectional Studies, Logistic Models, Cohort, Multivariate Analysis, Surgery, Female, Tobacco Smoke Pollution, Cardiology and Cardiovascular Medicine, Risk assessment, business, Cohort study
Abstract: Objectives We studied the association between secondhand smoke (SHS) exposure and peripheral arterial disease (PAD) in Chinese non-smokers. Methods We conducted a cross-sectional study using baseline data from the Guangzhou Biobank Cohort Study: Cardiovascular Disease Sub-cohort Study (GBCS-CVD). Guangzhou residents aged ≥ 50 years were recruited between 2003 and 2008. Baseline data included measurement of ankle brachial pressure index (ABPI) and self-reported smoking status and SHS exposure. Univariate and multivariate logistic regression analyses were used to analyze the association between SHS and PAD (defined as ABPI Results Of the 1507 non-smokers, 24 (1.6%) had PAD. Of these, 12 were men and 12 were women. Exposure to SHS at home of ≥25 h per week was reported by 16.7% of PAD cases compared with 3.8% of those without PAD (χ2 test, p = 0.003). After adjustment for potential confounders, exposure to ≥25 h per week at home was still associated with PAD (adjusted OR 7.86, 95% CI 2.00–30.95, p = 0.003), with suggestion of a dose-response relationship. Conclusions Our results extend the US Surgeon General’s 2006 report that SHS exposure is an independent risk factor for PAD. National smoke-free legislation is needed to protect all people from exposure.
Published: 2016

39. Mendelian randomization estimates of alanine aminotransferase with cardiovascular disease: Guangzhou Biobank Cohort study

Author: Kar Keung Cheng, Wei Sen Zhang, C. Mary Schooling, Feng Zhu, Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Lin Xu, and Ya Li Jin
Subjects: 0301 basic medicine, Male, medicine.medical_specialty, Myocardial Ischemia, Polymorphism, Single Nucleotide, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Mitogen-Activated Protein Kinase 10, Risk Factors, Diabetes mellitus, Internal medicine, Mendelian randomization, Genetics, medicine, Humans, Genetic Predisposition to Disease, cardiovascular diseases, 030212 general & internal medicine, Molecular Biology, Genetics (clinical), Genetic Association Studies, Triglycerides, Biological Specimen Banks, biology, Confounding, Membrane Proteins, Mendelian Randomization Analysis, Alanine Transaminase, General Medicine, Odds ratio, Lipase, medicine.disease, 030104 developmental biology, Alanine transaminase, Cardiovascular Diseases, biology.protein, Female, Body mass index, Cohort study
Abstract: Observational studies of the association of alanine aminotransferase (ALT) levels with ischaemic heart disease (IHD) and cardiovascular disease (CVD) risk factors are inconsistent, probably because of confounding and reverse causality. Mendelian randomization (MR) provides less confounded results. We used MR analysis to assess the associations of ALT (U/L) with IHD, diabetes and other CVD risk factors. We used instrumental variable analysis based on two single nucleotide polymorphism (SNPs) HSD17B13/MAPK10 (rs6834314) and PNPLA3/SAMM50 (rs738409) to assess the associations of ALT (U/L) with IHD, diabetes and other CVD risk factors in the Guangzhou Biobank Cohort Study (GBCS). Observationally in 19,925 participants ALT levels were strongly positively associated with self-reported IHD, systolic and diastolic blood pressure, low-density lipoprotein- and total cholesterol, triglycerides, fasting glucose, body mass index, waist circumference, heart rate (HR) and diabetes, but were not associated with uncorrected QT interval, HR-corrected QT interval or high-density lipoprotein-cholesterol. In the MR study, using a credible genetic instrument (F-statistic = 23) for ALT, ALT levels were negatively associated with IHD (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87 to 0.97) and triglycerides (β - 0.08, 95% CI - 0.13 to - 0.03), but were not associated with other CVD risk factors. Our results using Mendelian randomization suggest that ALT reduces the risk of IHD, probably through reducing triglyceride levels. The underlying mechanisms deserve further investigation.
Published: 2016

40. Exome-chip association analysis reveals an Asian-specific missense variant in PAX4 associated with type 2 diabetes in Chinese individuals

Author: Feng Zhu, Carol H.Y. Fong, Pak C. Sham, Ka-Wing Au, Jo Jo S H Hai, Bernard M.Y. Cheung, Tong Zhu, Clara S. Tang, Aimin Xu, Tai Hing Lam, Chaoqiang Jiang, Chloe Y Y Cheung, Michele M A Yuen, G. Neil Thomas, Hung-Fat Tse, Yu Cho Woo, Ya Li Jin, Chi Ho Lee, Kelvin H M Kwok, Kathryn C.B. Tan, Lin Xu, Stacey S. Cherny, Kar Keung Cheng, Wing Sun Chow, and Karen S.L. Lam
Subjects: 0301 basic medicine, Male, Genotype, Endocrinology, Diabetes and Metabolism, Mutation, Missense, Type 2 diabetes, Biology, Polymorphism, Single Nucleotide, 03 medical and health sciences, Intergenic region, Asian People, Internal Medicine, medicine, Missense mutation, Humans, Paired Box Transcription Factors, Exome, Genetic Predisposition to Disease, Genotyping, Genetic association, Aged, Genetics, Homeodomain Proteins, Chinese population, Middle Aged, medicine.disease, 030104 developmental biology, Diabetes Mellitus, Type 2, PAX4, Female, Genome-Wide Association Study
Abstract: Genome-wide association studies (GWASs) have identified many common type 2 diabetes-associated variants, mostly at the intronic or intergenic regions. Recent advancements of exome-array genotyping platforms have opened up a novel means for detecting the associations of low-frequency or rare coding variants with type 2 diabetes. We conducted an exomechip association analysis to identify additional type 2 diabetes susceptibility variants in the Chinese population.An exome-chip association study was conducted by genotyping 5640 Chinese individuals from Hong Kong, using a custom designed exome array, the Asian Exomechip. Single variant association analysis was conducted on 77,468 single nucleotide polymorphisms (SNPs). Fifteen SNPs were subsequently genotyped for replication analysis in an independent Chinese cohort comprising 12,362 individuals from Guangzhou. A combined analysis involving 7189 cases and 10,813 controls was performed.In the discovery stage, an Asian-specific coding variant rs2233580 (p.Arg192His) in PAX4, and two variants at the known loci, CDKN2B-AS1 and KCNQ1, were significantly associated with type 2 diabetes with exome-wide significance (pWe identified the association of a PAX4 Asian-specific missense variant rs2233580 with type 2 diabetes in an exome-chip association analysis, supporting the involvement of PAX4 in the pathogenesis of type 2 diabetes. Our findings suggest PAX4 is a possible effector gene of the 7q32 locus, previously identified from GWAS in Asians.
Published: 2016

41. Past dust and GAS/FUME exposure and COPD in Chinese: The Guangzhou Biobank Cohort Study

Author: Jon G Ayres, Wei Sen Zhang, Martin R. Miller, Kar Keung Cheng, Kin Bong Hubert Lam, Tai Hing Lam, Peymane Adab, Chaoqiang Jiang, G. Neil Thomas, and Peng Yin
Subjects: Spirometry, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, China, Cross-sectional study, Population, Vital Capacity, Cumulative Exposure, complex mixtures, Cohort Studies, Pulmonary Disease, Chronic Obstructive, Population attributable fraction, Internal medicine, Forced Expiratory Volume, Occupational Exposure, Chronic respiratory symptoms, medicine, Prevalence, COPD, Humans, education, education.field_of_study, medicine.diagnostic_test, business.industry, Dust, Odds ratio, Middle Aged, medicine.disease, Prognosis, Confidence interval, respiratory tract diseases, Occupational Diseases, Cross-Sectional Studies, Attributable risk, Physical therapy, Female, Gases, business
Abstract: Summary The impact of occupational dust and gas/fume exposure on chronic obstructive pulmonary disease (COPD) in developing countries has not been quantified. We examined the relationship between past dust and fume exposure and prevalence of COPD and respiratory symptoms in a cross-sectional analysis of a large Chinese population sample. Participants in the Guangzhou Biobank Cohort Study ( n = 8216; 27.3% men, mean age 61.9 ± 6.8 years) had spirometry and a structured interview including exposures, symptoms, and lifestyle. Self-reported intensity and duration of dust and gas/fume exposure was used to derive cumulative exposure. COPD was diagnosed from spirometry using lower limit of normal based on prediction equations. COPD was associated with high exposure to dust or gas/fume (exposed: 87/1206 v non-exposed: 191/3853; adjusted odds ratio: 1.41; 95% confidence interval (CI) 1.06, 1.87) with no evidence of effect modification by smoking. Respiratory symptoms were associated with exposures to dust and gas/fume, with adjusted odds ratios for chronic cough/phlegm of 1.57 (1.13, 2.17) and 1.39 (1.20, 1.60) for dyspnoea. The overall population attributable fraction for COPD due to occupational exposure was 10.4% (95% CI -0.9%, 19.5%). Occupational dust and gas/fume exposure is associated with an increased prevalence of COPD in this Chinese sample, independent of smoking. The population attributable fraction in Chinese is similar to that in Western populations.
Published: 2012
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42. Inequality and inequity in access to health care and treatment for chronic conditions in China: the Guangzhou Biobank Cohort Study

Author: Tim Elwell-Sutton, Wei Sen Zhang, Catherine Mary Schooling, Chaoqiang Jiang, Tai Hing Lam, Kar Keung Cheng, and Gabriel M. Leung
Subjects: Male, China, Inequality, media_common.quotation_subject, Health Services Accessibility, Cohort Studies, Environmental health, Health care, medicine, Humans, Healthcare Disparities, Aged, media_common, Aged, 80 and over, Equity (economics), business.industry, Health Policy, Health Services, Middle Aged, Payment, medicine.disease, Biobank, Social Class, Chronic Disease, Household income, Female, Medical emergency, business, Cohort study
Abstract: Non-communicable diseases (NCDs) are a large and rapidly-growing problem in China and other middle-income countries. Clinical treatment of NCDs is long-term and expensive, so it may present particular problems for equality and horizontal equity (equal treatment for equal need) in access to health care, although little is known about this at present in low- and middle-income countries. To address this gap, and inform policy for a substantial proportion of the global population, we examined inequality and inequity in general health care utilization (doctor consultations and hospital admissions) and in treatment of chronic conditions (hypertension, hyperglycaemia and dyslipidaemia), in 30 499 Chinese adults aged ≥50 years from one of China's richest provinces, using the Guangzhou Biobank Cohort Study (2003-2008). We used concentration indices to test for inequality and inequity in utilization by household income per head. Inequality was decomposed to show the contributions of income, indicators of 'need for health care' (age, sex, self-rated health, coronary heart disease risk and chronic obstructive pulmonary disease) and non-need factors (education, occupation, out-of-pocket health care payments and health insurance). We found inequality and inequity in treatment of chronic conditions but not in general health care utilization. Using more objective and specific measures of 'need for health care' increased estimates of inequity for treatment of chronic conditions. Income and non-need factors (especially health insurance, education and occupation) made the largest contributions to inequality. Further work is needed on why access to treatment for chronic conditions in China is restricted for those on low incomes and how these inequities can be mitigated.
Published: 2012

43. Evaluation of Moderate Alcohol Use and Cognitive Function Among Men Using a Mendelian Randomization Design in the Guangzhou Biobank Cohort Study

Author: Tai Hing Lam, Chaoqiang Jiang, Wei Sen Zhang, Bin Liu, Gabriel M. Leung, SL Au Yeung, Catherine Mary Schooling, and Kar Keung Cheng
Subjects: Genetic Markers, Male, China, medicine.medical_specialty, Alcohol Drinking, Genotype, Epidemiology, Population, Polymorphism, Single Nucleotide, Unit of alcohol, Cohort Studies, Cognition, Mendelian randomization, Humans, Medicine, Least-Squares Analysis, Psychiatry, education, Aged, Aged, 80 and over, Psychological Tests, education.field_of_study, Mini–Mental State Examination, medicine.diagnostic_test, business.industry, Aldehyde Dehydrogenase, Mitochondrial, Confounding, Mendelian Randomization Analysis, Aldehyde Dehydrogenase, Middle Aged, Confidence interval, Multivariate Analysis, Linear Models, business, Demography, Cohort study
Abstract: Observational studies usually show that moderate alcohol use is associated with better cognitive function. Such studies are vulnerable to residual confounding arising from systematic differences between moderate alcohol users and others. A Mendelian randomization study carried out in a suitable population, such as southern Chinese men, in which alcohol use is low to moderate and is influenced by genotype, offers an alternative and superior approach for clarifying the causal effect of moderate alcohol use on cognitive function. The authors used aldehyde dehydrogenase 2 (ALDH2) genotype (AA, GA, or GG) as an instrumental variable in 2-stage least squares analysis to obtain unbiased estimates of the relation of alcohol consumption (measured in alcohol units (10 g ethanol) per day) with cognitive function, assessed from delayed 10-word recall score (n = 4,707) and Mini-Mental State Examination (MMSE) score (n = 2,284), among men from the Guangzhou Biobank Cohort Study (2003-2008). ALHD2 genotype was strongly associated with alcohol consumption, with an F statistic of 71.0 in 2-stage least squares analysis. Alcohol consumption was not associated with delayed 10-word recall score (-0.03 words per alcohol unit, 95% confidence interval: -0.18, 0.13) or MMSE score (0.06 points per alcohol unit, 95% confidence interval: -0.22, 0.34). Moderate alcohol use is unlikely to be cognitively protective.
Published: 2012

44. Smoking and nasopharyngeal carcinoma mortality: a cohort study of 101,823 adults in Guangzhou, China

Author: Sai Yin Ho, Wei Sen Zhang, Zhi-Ming Mai, Lin Xu, Ching-Man Lo, Tai Hing Lam, Chaoqiang Jiang, and Jia-Huang Lin
Subjects: Adult, Male, Surgeon general, China, Cancer Research, Alcohol Drinking, Risk Factors, Genetics, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, Aged, 80 and over, Nasopharyngeal Carcinoma, Chinese, Traditional medicine, business.industry, Proportional hazards model, Incidence, Incidence (epidemiology), Carcinoma, Smoking, Hazard ratio, Nasopharyngeal Neoplasms, Middle Aged, medicine.disease, Oncology, Nasopharyngeal carcinoma, Cohort, Female, Guangzhou Occupational Cohort, business, Research Article, Cohort study, Demography
Abstract: Background Nasopharyngeal carcinoma (NPC), also known as Cantonese cancer, is rare worldwide, but has particularly high incidence in North Africa and Southeast Asia, especially in Guangdong, China, such as Guangzhou. Tobacco causes head and neck cancers, but nasopharyngeal carcinoma is not included as causally related to smoking in the 2014 United States Surgeon General’s report. Prospective evidence remains limited. We used Guangzhou Occupational Cohort data to conduct the first and robust prospective study on smoking and NPC mortality in an NPC high-risk region. Methods Information on demographic characteristics and smoking status was collected through occupational health examinations in factories and driver examination stations from March 1988 to December 1992. Vital status and causes of deaths were retrieved until the end of 1999. Cox proportional hazard model was used to assess the association of smoking with NPC mortality. Results Of 101,823 subjects included for the present analysis, 34 NPC deaths occurred during the average 7.3 years of follow up. The mean age (standard deviation) of the subjects was 41 (5.7) years. Compared with never smokers, the hazard ratio (HR) of NPC mortality was 2.95 (95 % confidence interval 1.01–8.68; p = 0.048) for daily smokers and 4.03 (1.29–12.58; p = 0.016) for smokers with more than 10 pack-years of cumulative consumption, after adjusting for age, sex, education, drinking status, occupation and cohort status and accounting for smoking-drinking interaction. The risk of NPC mortality increased significantly with cigarettes per day (p for trend = 0.01) and number of pack-years (p for trend = 0.02). Conclusions In this first and largest cohort in a high NPC risk region, smoking was associated with higher NPC mortality. The findings have shown statistically significant dose–response trend between smoking amount and smoking cumulative consumption and the risk of NPC mortality, but due to the small event number, further studies with larger sample size are needed to confirm the findings in the present study. Our results support that smoking is one of the risk factors likely to be causally associated with NPC mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1902-9) contains supplementary material, which is available to authorized users.
Published: 2015

45. Cohort Profile: A study of influenza immunity in the urban and rural Guangzhou region of China: the Fluscape Study

Author: Derek A. T. Cummings, Jonathan M. Read, Hongbo Zhu, Kin On Kwok, Justin Lessler, Shuying Wang, Chaoqiang Jiang, Lina Kim, Yi Guan, Marisa Hast, Steven Riley, Lijiu Tan, and Medical Research Council (MRC)
Subjects: Adult, Male, Rural Population, 0301 basic medicine, China, medicine.medical_specialty, Adolescent, Urban Population, Epidemiology, Antibodies, Viral, E-Pages, Cohort Studies, Young Adult, 03 medical and health sciences, Age Distribution, 0302 clinical medicine, Immunity, Environmental health, Influenza, Human, medicine, Humans, Sex Distribution, Young adult, Child, Aged, Public, Environmental & Occupational Health, Aged, 80 and over, Science & Technology, Vaccination, 0104 Statistics, General Medicine, Middle Aged, EVOLUTION, 030104 developmental biology, Geography, 1117 Public Health And Health Services, Child, Preschool, Cohort, VIRUS, Female, Age distribution, Life Sciences & Biomedicine, 030217 neurology & neurosurgery, Cohort study
Published: 2015

46. Dose-Response Relation Between Physical Activity and Cognitive Function: Guangzhou Biobank Cohort Study

Author: Wei Sen Zhang, Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Kar Keung Cheng, and Lin Xu
Subjects: Aged, 80 and over, Male, Gerontology, China, Epidemiology, business.industry, Recall test, Confounding, Cognition, Odds ratio, Middle Aged, Motor Activity, Anthropometry, Confidence interval, Metabolic equivalent, Cohort Studies, Humans, Medicine, Cognitive Dysfunction, Female, business, Aged, Cohort study
Abstract: To examine, via cross-sectional analysis, the dose-response association between physical activity and cognitive function in Chinese subjects.A total of 27,651 participants aged 50 to 85 years were recruited from 2003 to 2008. Information on potential confounders, including demographic and anthropometric characteristics, socioeconomic position, lifestyle, and disease history, was collected by standardized interview and procedures. Cognitive function was assessed by the delayed 10-word recall test (DWRT).When the International Physical Activity Questionnaire was used, we found that most of the participants were classified as physically active (53.1%), with 42.4% moderately active and 4.5% physically inactive. Significant dose-response relations across quintiles of metabolic equivalent value (METs) with DWRT score in participants with or without good self-rated health were found (all p for trend.001). In participants with poor self-rated heath, compared with the first quintile of METs, those in the fifth quintile (highest METs) had a significantly reduced risk for mild cognitive impairment by 28% (adjusted odds ratio, 0.72; 95% confidence interval, 0.58-0.89, p.01; p for trend = .006). After additional adjustment for depression, we found that the association between physical activity and DWRT score remained significant.A significant dose-response relationship between physical activity and cognitive function was found, and the association was more pronounced in participants with poor self-rated health.
Published: 2011

47. Usefulness of Physical Fitness and the Metabolic Syndrome to Predict Vascular Disease Risk in Older Chinese (from the Guangzhou Biobank Cohort Study-Cardiovascular Disease Subcohort [GBCS-CVD])

Author: Kamen A. Tsvetanov, Kar Keung Cheng, Jos A. Bosch, Bríain O'Hartaigh, Tai Hing Lam, Chaoqiang Jiang, and G. Neil Thomas
Subjects: Male, China, medicine.medical_specialty, Physical fitness, Risk Assessment, Cohort Studies, Heart Rate, Predictive Value of Tests, Internal medicine, Humans, Medicine, Pulse wave velocity, Metabolic Syndrome, Analysis of Variance, business.industry, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Plethysmography, Logistic Models, Cardiovascular Diseases, Physical Fitness, Cohort, Cardiology, Female, Metabolic syndrome, Cardiology and Cardiovascular Medicine, business, Risk assessment, Cohort study
Abstract: Physical fitness can independently lower the risk of cardiovascular disease (CVD). We explored the independent and combined associations of physical fitness, measured using the seated at rest heart rate (RHR), and the metabolic syndrome (MS), with CVD risk, as described by an elevated pulse wave velocity (PWV) in older Chinese. Data from 1,996 participants were drawn from the Guangzhou Biobank Cohort Study-Cardiovascular Disease Subcohort. Analysis of variance and logistic regression analysis were used to establish the independent and combined associations of the RHR and the MS with PWV. The RHR was independently associated with an elevated PWV (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.22 to 2.18), as was the MS (OR 2.36, 95% CI 1.76 to 3.17). The participants with a high RHR, but without the MS, had an adjusted OR of 1.63 (95% CI 1.15 to 2.30) for the presence of the CVD proxy. Those with a low RHR and the MS had an adjusted OR of 2.35 (95% CI 1.66 to 3.33). The risk of an elevated PWV increased almost fourfold with both a high RHR and a diagnosis of the MS (OR 3.87, 95% CI 2.39 to 6.28, p = 0.52 for interaction). In conclusion, physical fitness, measured using the RHR, and the MS are independently associated with an elevated PWV, a surrogate marker for CVD. The strength of this association was further increased in the presence of both. These findings confirm the beneficial effects of physical fitness on attenuating the risk of CVD among older Chinese.
Published: 2011

48. White blood cell subsets are associated with carotid intima-media thickness and pulse wave velocity in an older Chinese population: the Guangzhou Biobank Cohort Study

Author: W S Zhang, Y L Jin, Tai Hing Lam, Anna C. Phillips, Chaoqiang Jiang, Xiao Jun Yue, K.K. Cheng, J M Lin, and GN Thomas
Subjects: Carotid Artery Diseases, Male, Pathology, Lymphocyte, Carotid Intima-Media Thickness, Cohort Studies, Leukocyte Count, Risk Factors, Leukocytes, Lymphocytes, Pulse wave velocity, Age Factors, Middle Aged, Prognosis, medicine.anatomical_structure, Cardiovascular Diseases, Pulsatile Flow, Predictive value of tests, cardiovascular system, Cardiology, Female, Blood Flow Velocity, circulatory and respiratory physiology, Cohort study, China, medicine.medical_specialty, Tissue Banks, Granulocyte, Risk Assessment, Peripheral Arterial Disease, Sex Factors, Vascular Stiffness, Asian People, Predictive Value of Tests, White blood cell, Internal medicine, Internal Medicine, medicine, Humans, Ankle Brachial Index, Lymphocyte Count, cardiovascular diseases, Aged, Inflammation, business.industry, medicine.disease, Cross-Sectional Studies, Intima-media thickness, Linear Models, Arterial stiffness, business, Granulocytes
Abstract: Cross-sectional associations between white blood cell (WBC) count, lymphocyte and granulocyte numbers, and carotid intima-media thickness (IMT) and brachial-ankle pulse wave velocity (PWV) were examined in a novel older Chinese community sample. A total of 817 men and 760 women from a sub-study of the Guangzhou Biobank Cohort Study had a full blood count measured by an automated hematology analyzer, carotid IMT by B-mode ultrasonography and brachial-ankle PWV by a non-invasive automatic waveform analyzer. Following adjustment for confounders, WBC count (β=0.07, P
Published: 2011

49. Passive smoking and aortic arch calcification in older Chinese never smokers: The Guangzhou Biobank Cohort Study

Author: Lin Xu, Wei Sen Zhang, Kar Keung Cheng, Tai Hing Lam, Chaoqiang Jiang, and G. Neil Thomas
Subjects: Male, China, medicine.medical_specialty, Passive smoking, Aorta, Thoracic, medicine.disease_cause, Logistic regression, Cohort Studies, Age Distribution, Asian People, Risk Factors, Internal medicine, medicine, Humans, Sex Distribution, Risk factor, Aged, Aged, 80 and over, Aortic Arch Syndromes, business.industry, Confounding, Calcinosis, Odds ratio, Middle Aged, Confidence interval, Physical therapy, Female, Tobacco Smoke Pollution, Aortic arch calcification, Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract: Objective To study whether passive smoking is a risk factor for aortic arch calcification (AAC) among never smokers. Background We have previously reported that active smoking increases the risk of AAC, but the effect of passive smoking has not been reported. Methods We used baseline data of the Phase 1 Guangzhou Biobank Cohort Study (GBCS). 7702 older Chinese never smokers from the Phase 1 GBCS were included. Information on passive smoking and potential confounders were collected by standardized interviews and laboratory assays. AAC was diagnosed from chest X-ray by two experienced radiologists. Unconditional logistic regression was used to estimate odds ratios of AAC for passive smoking with adjustment for potential confounders. Results In women, the risk for aortic arch calcification (AAC) increased significantly with increasing duration of adulthood passive smoking exposure at home, at work and total duration of adulthood home and work exposure [adjusted odds ratio 1.24 (95% confidence interval 1.09–1.41) for high level of total exposure] ( P for trend from 0.012 to 0.001). For passive smoking at home, at work and total exposure, significant trends of increasing severity of AAC with increasing duration of exposure were observed in men and women combined ( P for trend from 0.05 to 0.002). Conclusion Passive smoking is a risk factor for aortic arch calcification. Studies of passive smoking and AAC, especially in developing countries can generate important local evidence to raise awareness and to support public health measures to protect non-smokers from second-hand smoke.
Published: 2011

50. A polymorphism in transforming growth factor-β1 is associated with carotid plaques and increased carotid intima–media thickness in older Chinese men: The Guangzhou Biobank Cohort Study-Cardiovascular Disease Subcohort

Author: Brian Tomlinson, JM Lin, Tai Hing Lam, Chaoqiang Jiang, G. Neil Thomas, Bin Liu, Ka Sing Wong, Bernard M.Y. Cheung, and Han-Bing Deng
Subjects: Carotid Artery Diseases, Male, Gastroenterology, Linkage Disequilibrium, Gene Frequency, Risk Factors, Odds Ratio, Common carotid artery, Ultrasonography, Aged, 80 and over, medicine.diagnostic_test, Homozygote, Age Factors, Middle Aged, Carotid Arteries, Phenotype, Cohort, cardiovascular system, Female, medicine.symptom, Tunica Media, Cardiology and Cardiovascular Medicine, Cohort study, China, medicine.medical_specialty, Single-nucleotide polymorphism, Polymorphism, Single Nucleotide, Risk Assessment, Asymptomatic, Transforming Growth Factor beta1, Sex Factors, Asian People, Internal medicine, medicine.artery, medicine, Humans, Genetic Predisposition to Disease, cardiovascular diseases, Aged, Chi-Square Distribution, business.industry, Introns, Logistic Models, Endocrinology, Intima-media thickness, Linear Models, Tunica Intima, business, Lipid profile, Body mass index
Abstract: Objective Polymorphisms of the transforming growth factor-β1 ( TGFB1 ) gene have not been associated with asymptomatic atherosclerosis previously. We investigated the relationship between a single nucleotide polymorphism (SNP) rs4803455 in TGFB1 and atherosclerosis identified by the presence of carotid plaque and increased intima–media thickness (IMT) in an older Chinese population. Methods 1996 subjects (992 (49.7%) men aged 50–85 years) from the Guangzhou Biobank Cohort Study-Cardiovascular Subcohort (GBCS-CVD) were genotyped. Carotid plaque and IMT were assessed by B-mode ultrasonography. Results In male subjects, the C allele of TGFB1 rs4803455 was significantly associated with prevalence of carotid plaque (adjusted OR: 2.49, 95% CI: 1.16–5.36, P =0.03). The C allele was related to increased number of common carotid artery (CCA) plaques ( P =0.03) and larger carotid plaque area ( P =0.02) in men. The homozygous carriers of allele C in male subjects also had a higher risk of having carotid IMT ≥1mm (adjusted OR: 1.75, 95% CI: 1.05–2.93, P =0.03). These associations were independent of age, smoking, physical activity, body mass index, blood pressure, lipid profile, fasting glucose and high sensitivity C-reactive protein. Conclusion This is the first study to show that the C allele in TGFB1 was associated with increased risk of atherosclerosis in older Chinese men. Further investigations on the linkage between the TGFB1 gene and progression of atherosclerosis in asymptomatic populations are warranted.
Published: 2011

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