Guangzhou Number 12 Hospital

Guangzhou, China

Guangzhou Number 12 Hospital

Guangzhou, China

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Yeung S.L.A.,University of Hong Kong | Jiang C.Q.,Guangzhou Number 12 Hospital | Zhang W.S.,Guangzhou Number 12 Hospital | Lam T.H.,University of Hong Kong | And 2 more authors.
Journal of Epidemiology and Community Health | Year: 2013

Background Western observational studies show moderate alcohol use, compared with never use, positively associated with health. Moderate users differ systematically from others, making these observations vulnerable to confounding. Observations from other contexts may help distinguish whether these associations are confounded. To assess whether southern Chinese would provide a more suitable setting to examine the association of moderate alcohol use with health, we compared never alcohol users with moderate alcohol users and occasional users in this setting. Methods We used age-adjusted multinomial regression to assess sex-stratified associations of alcohol use (never, occasional (<1 occasion/week), moderate (≤140 g ethanol/week for women and ≤210 g for men)) with health attributes and indicators in the Guangzhou Biobank Cohort Study (2003-2008) (n=26 361). Results Among men, moderate alcohol users, when compared with never users, had slightly lower socioeconomic position and unhealthier lifestyle. Conversely, occasional alcohol users, when compared with never users, had higher socioeconomic position and healthier lifestyle. Among women, when compared with never users, both occasional and moderate users had higher socioeconomic position and healthier lifestyle. However, all alcohol users for both sexes, when compared with never users, were more likely to be ever smokers and to be exposed to secondhand smoke. Conclusions Observations in alcohol epidemiology may be affected by confounding due to contextually specific systematic differences. Results from a particular setting should not be interpreted as causal unless they are verified in different populations and, preferably, in nonobservational studies.


Zhao J.,University of Hong Kong | Jiang C.,Guangzhou Number 12 Hospital | Lam T.H.,University of Hong Kong | Liu B.,Guangzhou Number 12 Hospital | And 7 more authors.
International Journal of Epidemiology | Year: 2014

Accepted 22 October 2013 Background Observationally lower testosterone is associated with an unhealthier cardiovascular (CVD) risk profile, but this association is open to confounding and reverse causality. The authors examined the association of testosterone with well-established cardiovascular disease (CVD) risk factors (blood pressure, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL)cholesterol and fasting glucose) and the Framingham score using a Mendelian randomization analysis with a separate-sample instrumental variable estimator. Methods To minimize reverse causality, a genetic score predicting testosterone was developed in 289 young Chinese men from Hong Kong, based on three selected testosterone-related single nucleotide polymorphisms (rs10046, rs1008805 and rs1256031). Multivariable censored and linear regressions were used to examine the association of genetically predicted testosterone levels with CVD risk factors and Framingham score among 4212 older Chinese men from the Guangzhou Biobank Cohort Study. Results Predicted testosterone was unrelated to systolic blood pressure [-0.11 mmHg, 95% confidence interval (CI) -0.70 to 0.48], diastolic blood pressure (0.04 mmHg, 95% CI -0.27 to 0.36), fasting glucose (0.02 mmol/l, 95% CI -0.02 to 0.06) or Framingham score (0.02, 95% CI -0.0001 to 0.03) but associated with higher LDLcholesterol (0.02 mmol/l, 95% CI 0.01 to 0.04) and lower HDL-cholesterol (-0.01 mmol/l, 95% CI -0.02 to -0.001), after adjustment for potential confounders (age, education, smoking status, use of alcohol and body mass index). Conclusions Our findings did not corroborate observed protective effects of testosterone on cardiovascular risk factors or risk of ischaemic heart disease among men, but raises the possibility that higher testosterone may be associated with an unhealthier lipid profile. © The Author 2013.


Zhao J.,University of Hong Kong | Jiang C.,Guangzhou Number 12 Hospital | Lam T.H.,University of Hong Kong | Liu B.,Guangzhou Number 12 Hospital | And 7 more authors.
International Journal of Epidemiology | Year: 2015

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 (50+ years) Chinese men from the Guangzhou Biobank Cohort Study. Results Predicted testosterone was not associated with QT interval [-0.08 ms per nmol/l testosterone, 95% confidence interval (CI) -0.81 to 0.65], QTf interval (0.40 ms 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 (0.66 ms 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. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.


Heys M.,University of Hong Kong | Jiang C.,Guangzhou Number 12 Hospital | Schooling C.M.,University of Hong Kong | Zhang W.,Guangzhou Number 12 Hospital | And 3 more authors.
European Journal of Epidemiology | Year: 2010

Inadequate childhood nutrition is associated with poor short-term academic and cognitive outcomes. Dietary supplementation with meat is associated with better cognitive outcome in children. Whether childhood nutrition has life long effects on cognitive function is unclear. We examined the association of childhood meat eating with adulthood cognitive function in southern China where the older population lived through significant hardship during their early years. Multivariable linear regression was used in a cross-sectional study of 20,086 Chinese men and women aged iobank Cohort Study (phases 2 and 3) 2005-8. We assessed the association of childhood meat eating with delayed 10-word and immediate recall score. Adjusted for age, sex, education, childhood and adulthood socio-economic position and current physical activity, childhood meat eating almost daily, when compared to yearly or never childhood meat eating, was positively associated with delayed recall score (additional number of words recalled out of 10 = 0.22 [95% confidence interval = 0.11-0.31]). Similarly adjusted, childhood meat eating about once a month, about once a week and almost daily were positively associated with immediate recall score (additional number of words recalled out of 30 = 0.38 [0.23-0.54], 0.73 [0.56-0.89] and 0.76 [0.55-0.98] respectively). More frequent childhood meat eating was associated with better cognition through to old age. If confirmed, these results highlight the importance of adequate childhood nutrition and they also emphasise the childhood and adolescent antecedents of adult disease, with corresponding public health implications for healthy aging. © 2010 The Author(s).


Heys M.,University of Hong Kong | Jiang C.,Guangzhou Number 12 Hospital | Cheng K.K.,University of Birmingham | Zhang W.,Guangzhou Number 12 Hospital | And 4 more authors.
Psychoneuroendocrinology | Year: 2011

Background: Estrogen has neurotrophic and neuroprotective properties in animal and in vitro studies. Epidemiological studies are inconclusive, but suggest a positive association between endogenous estrogen exposure (measured by reproductive period, the number of years between menarche and menopause) and later life cognitive function. Methods: Structural equation modeling was used in a cross-sectional study of 11,094 naturally postmenopausal multiparous Chinese older (≥50 years) women from the Guangzhou Biobank Cohort Study (phases 2 and 3) to assess the interrelationship of four proxies of higher endogenous estrogen exposure (longer reproductive period, older age of first pregnancy, lower parity and shorter average duration of breast feeding per child) with immediate and the delayed 10-word recall score in phases 2 and 3, and with the mini-mental state examination (MMSE) score in phase 3 (5641 women). Results: Adjusted for age, education, childhood and adulthood socio-economic position and physical activity, longer reproductive period was associated with higher scores (0.02 words per year, 95% confidence interval (CI) 0.008-0.02 for delayed recall and 0.05 MMSE score, 95%CI 0.04-0.07, respectively). Lower parity and shorter average duration of breast-feeding per child were also associated with better cognitive function. Conclusions: In a large cohort of naturally postmenopausal Chinese women proxies of greater endogenous estrogen exposure were associated with better cognitive function. These findings support biological evidence for a cognitively protective role of endogenous estrogen. © 2010 Elsevier Ltd.


Jiang C.Q.,Guangzhou Number 12 Hospital | Xu L.,Guangzhou Number 12 Hospital | Xu L.,University of Hong Kong | Lam T.H.,University of Hong Kong | And 3 more authors.
Journal of Epidemiology and Community Health | Year: 2010

Introduction Smoking has been shown to be associated with carotid atherosclerosis in cross-sectional and prospective studies in Western populations. However, few studies have examined the reversal of risk resulting from quitting smoking, and the results are conflicting. Methods 959 men aged 50e85 years were randomly selected from phase III (2006e2007) of the Guangzhou Biobank Cohort Study into this cross-sectional study. Common carotid artery intima-media thickness (CCAIMT) was measured by B-mode ultrasonography, and carotid artery plaques were identified. Major cardiovascular risk factors, including fasting triglyceride, low-density and high-density lipoprotein (LDL and HDL) cholesterol and glucose, and systolic and diastolic blood pressure, were assessed. Results CCA-IMT and the number of carotid plaque increased from never to former to current smokers (both p≤0.001). Among former smokers compared to current smokers, after adjustment for cigarette pack-years and other potential confounders, the adjusted ORs (95% CI) for quitting for 1-9, 10-19 and 20+ years were 0.77 (0.47 to 1.26), 0.45 (0.26 to 0.79) and 0.37 (0.17 to 0.77) for the presence of CCA atherosclerosis, and 0.69 (0.43 to 1.12), 0.47 (0.27 to 0.82) and 0.45 (0.23 to 0.96) for the presence of carotid plaques, respectively. Longer duration of quitting smoking was also significantly associated with decreasing risk of the severity of CCA atherosclerosis and carotid plaques (all p≤0.001). Conclusion Smoking cessation was beneficial in attenuating the risk of carotid atherosclerosis associated with cigarette smoking. The short duration of cessation in earlier studies is a likely explanation for the inconsistent results.


Schooling C.M.,University of Hong Kong | Jiang C.,Guangzhou Number 12 Hospital | Zhang W.,Guangzhou Number 12 Hospital | Lam T.H.,University of Hong Kong | And 2 more authors.
Annals of Epidemiology | Year: 2011

Purpose: Women usually report attributes of masculinity as attractive. These are attributes are metabolically expensive. We examined the trade off of a key attribute of masculinity, muscularity, proxied by recalled adolescence build, with lifetime reproductive success in the developing country setting of Southern China. Methods: We used poisson multivariable regression in 19,168 older (≥50 years) Chinese from the Guangzhou Biobank Cohort Study (phases 2 and 3) to examine the sex-stratified, adjusted associations of recalled adolescent relative weight (light (n = 6730), average (n = 9344), and heavy (n = 3094)) with number of offspring. Results: Among men, recalled heavy adolescent weight compared with light was associated with an incident rate ratio for offspring of 1.08 (95% confidence interval [CI] 1.04-1.13) adjusted for age. This estimate was unchanged by adjustment for life course socio-economic position. There was no such association in women. Conclusions: Male physical attractiveness, possibly representing levels of testosterone, was rewarded by lifetime reproductive success, despite potential costs. Socio-economic development may facilitate an inevitable move toward environmentally driven higher levels of testosterone with corresponding public health implications for any conditions or societal attributes driven by testosterone. Further investigation is warranted. © 2011 Elsevier Inc.


Schooling C.M.,University of Hong Kong | Schooling C.M.,City University of New York | Jiang C.,Guangzhou Number 12 Hospital | Lam T.H.,University of Hong Kong | And 3 more authors.
PLoS ONE | Year: 2011

Background: In observational studies from western countries childhood emotional adversity is usually associated with adult cardiovascular disease. These findings are open to contextual biases making evidence from other settings valuable. We examined the association of a potential marker of childhood emotional adversity with cardiovascular disease risk factors in a developing country. Methods: We used multivariable regression in cross-sectional analysis of older (≥50 years) men (n = 7,885) and women (n = 20,886) from the Guangzhou Biobank Cohort Study (2003-8) to examine the adjusted association of early life (<18 years) parental death (none, one or two deaths) with blood pressure, fasting glucose, LDL-cholesterol, HDL-cholesterol, triglycerides, body mass index (BMI), waist-hip ratio (WHR) and white blood cell count (WBC). We used seated height and delayed 10-word recall to assess content validity of parental death as a measure of childhood emotional adversity. We also examined whether associations varied by sex. Results: Early life parental death was associated with shorter age- and sex-adjusted seated height. It was also associated with lower 10-word recall score adjusted for age, sex, socio-economic position, leg length and lifestyle. Similarly, adjusted early life parental death was not associated with blood pressure, fasting glucose, LDL-cholesterol or HDL-cholesterol but was associated with lower BMI (-0.40, 95% confidence interval (CI) -0.62 to -0.19 for 2 compared with no early life parental deaths) and triglycerides. Associations varied by sex for WHR and WBC. Among men only, early life parental death was associated with lower WHR (-0.008, 95% CI -0.015 to -0.001) and WBC (-0.35 109/L, 95% CI -0.56 to -0.13). Conclusions: In a non-western population from a developing country, childhood emotional adversity was negatively associated with some cardiovascular risk factors, particularly among men. Our study suggests that some of the observed associations in western populations may be socially rather than biologically based or may be population specific. © 2011 Schooling et al.


Schooling C.M.,University of Hong Kong | Jiang C.,Guangzhou Number 12 Hospital | Zhang W.,Guangzhou Number 12 Hospital | Lam T.H.,University of Hong Kong | And 2 more authors.
Annals of Epidemiology | Year: 2011

Purpose: With economic development, there is an emerging epidemic of diabetes in China despite relatively low levels of obesity. Muscle mass, for which adolescence is a key developmental window, may reduce vulnerability to diabetes. We examined the association of recalled adolescent build with diabetes in a large sample from the developing country setting of southern China. Methods: We used multivariable regression in cross-sectional data (2005-2008), from the Guangzhou Biobank Cohort Study (phases 2 and 3) for 19,524 older (≥50 years) Chinese to examine the adjusted associations of recalled adolescent relative weight (light [. n = 6843], average [. n = 9529], and heavy [. n = 3152]) with clinically measured diabetes. Results: As older adults, heavy adolescents had a lower risk of diabetes (odds ratio = 0.86, 95% confidence interval: 0.75-0.99) than light adolescents adjusted for age, sex, education, smoking, leg length, and seated height. This association was stronger after additional adjustment for waist/hip ratio and body mass index. Conclusions: Poor living conditions during adolescence, resulting in low muscle mass, could contribute to vulnerability to diabetes, which, if confirmed, could be relevant to the emerging epidemic of diabetes in the developing world, as well as to minorities and migrants elsewhere. © 2011 Elsevier Inc.


Elwell-Sutton T.M.,University of Hong Kong | Jiang C.Q.,Guangzhou Number 12 Hospital | Zhang W.S.,Guangzhou Number 12 Hospital | Cheng K.K.,University of Birmingham | And 3 more authors.
Health Policy and Planning | Year: 2013

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. © The Author 2012; all rights reserved.

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