Singaporean Chinese Adults Research Articles

Comparison of race- and ethnicity-specific BMI cutoffs for categorizing obesity severity: a multicountry prospective cohort study.

The objective of this study was to compare race- and ethnicity-specific BMI cutoffs for the three classes of obesity based on equivalent risk of type 2 diabetes (T2D). Participants without T2D were included from the UK Biobank, the China Health and Nutrition Survey, and the Singapore Chinese Health Study. Poisson regressions with restricted cubic splines were applied to determine BMI cutoffs for each non-White race and ethnicity for equivalent incidence rates of T2D at BMI values of 30.0, 35.0, and 40.0 kg/m2 in White adults. During a median follow-up of 13.8 years among 507,763 individuals, 5.2% developed T2D. In women, BMI cutoffs for an equivalent incidence rate of T2D as observed at 40.0 kg/m2 in White adults were 31.6 kg/m2 in Black, 29.2 kg/m2 in British Chinese, 27.3 kg/m2 in South Asian, 26.9 kg/m2 in Native Chinese, and 25.1 kg/m2 in Singapore Chinese adults. In men, the corresponding BMI cutoffs were 31.9 kg/m2 in Black, 30.6 kg/m2 in British Chinese, 29.0 kg/m2 in South Asian, 29.6 kg/m2 in Native Chinese, and 27.6 kg/m2 in Singapore Chinese adults. The race and ethnicity order was consistent when equivalent BMI cutoffs were estimated for class I and II obesity. Establishing a race- and ethnicity-tailored classification of the three classes of obesity is urgently needed.

APOE Genotype Modifies the Association between Midlife Adherence to the Planetary Healthy Diet and Cognitive Function in Later Life among Chinese Adults in Singapore

BackgroundIt remains unclear if adherence to the planetary healthy diet (PHD), designed to improve human and environmental health, is associated with better cognitive function in aging, and if this association differs by apolipoprotein E (APOE) genotype. ObjectivesWe aimed to examine the association between the PHD pattern and risk of poor cognitive function, and to further assess whether the APOE ε4 allele could modify this association. MethodsThe study included 16,736 participants from the Singapore Chinese Health Study. The PHD score was calculated using data from a validated 165-item food frequency questionnaire at baseline (1993–1998), with higher scores indicating greater adherence to the PHD. Cognitive function was assessed by the Singapore-modified Mini-Mental State Examination at follow-up 3 visits (2014–2016). A subset of 9313 participants had APOE genotype data. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for potential confounders. ResultsWe identified 2397 (14.3%) cases of poor cognitive function. In the total population, OR (95% CI) of poor cognitive function for each one-SD increment in the PHD score was 0.89 (0.85, 0.93). Carriers of APOE ε4 allele had increased risk of poor cognitive function (OR: 1.36, 95% CI: 1.15, 1.61). There was a significant interaction between the PHD score and the APOE ε4 allele (P-interaction = 0.042). Each one-SD increment in the PHD score was significantly associated with lower risk of poor cognitive function (OR: 0.89; 95% CI: 0.83, 0.96) in non-carriers of APOE ε4 allele, but not in APOE ε4 allele carriers (OR: 1.04, 95% CI: 0.89, 1.23). ConclusionsMidlife adherence to the PHD was associated with reduced risk of poor cognitive function in later life. However, this was not observed in carriers of APOE ε4 allele who had higher risk of poor cognitive function.

Adherence to a Planetary Health Diet, Environmental Impacts, and Mortality in Chinese Adults

Although the EAT-Lancet Commission has recently proposed a planetary health diet (PHD) to promote human and environmental health, little is known about how PHD affects environment and mortality risk among an Asian population. To investigate whether a PHD score is associated with environmental impacts and mortality outcomes in a Chinese cohort living in Singapore. This cohort study used data from the Singapore Chinese Health Study. Eligible participants were without known cardiovascular disease and cancer at baseline; they were recruited between 1993 and 1998 and followed up using record linkage data until 2020. Data were analyzed from September 2022 to April 2023. PHD score was calculated based on the reference consumption of 14 dietary components in PHD and individual energy intake assessed using a validated food frequency questionnaire in this cohort. Diet-related environmental impacts were estimated using a food frequency questionnaire. Mortality outcomes (all-cause, cardiovascular disease, cancer, and respiratory disease) were identified via linkage with a nationwide registry. A total of 57 078 participants were included in this study (mean [SD] age, 56.1 (7.9) years; 31 958 women [56.0%]). During a median (IQR) follow-up of 23.4 (18.7-26.2) years, 22 599 deaths occurred. Comparing the highest and lowest quintiles, higher PHD scores were associated with lower greenhouse gas emissions (β = -0.13 kg CO2 equivalent; 95% CI, -0.14 to -0.12 kg CO2 equivalent), but with higher total water footprint (β = 0.12 m3; 95% CI, 0.11-0.13 m3) and land use (β = 0.29 m2; 95% CI, 0.28-0.31 m2). In the adjusted multivariable model, compared with the lowest quintile, participants in the highest quintile of PHD score had lower risk of all-cause mortality (hazard ratio [HR], 0.85; 95% CI, 0.81-0.89), cardiovascular disease mortality (HR, 0.79; 95% CI, 0.73-0.85), cancer mortality (HR, 0.93; 95% CI, 0.86-1.00), and respiratory disease mortality (HR, 0.81; 95% CI, 0.74-0.89). In this study of Singapore Chinese adults, higher adherence to PHD was associated with reduced risk of chronic disease mortality. However, environmental impacts were uncertain, as higher adherence was associated with lower greenhouse gas emissions but higher total water footprint and land use.

A Dietary Pattern for High Estimated Total Fat Amount Is Associated with Enhanced Allergy Sensitization and Atopic Diseases among Singapore/Malaysia Young Chinese Adults

Introduction: Frequent dietary patterns for fast food diets are suggested to be a risk factor for atopic disease development. Excessive dietary fats in fast foods are postulated to promote low-grade chronic inflammation. However, no studies in Asia have yet to characterize the dietary pattern for high-fat foods with atopic diseases. Thus, this study aims to assess the association between dietary fats with the prevalence of atopic diseases in an allergic cohort. Methods: Through an investigator-administered questionnaire that follows the International Study of Asthma and Allergies in Childhood (ISAAC) protocol, we evaluated the eating habits, lifestyle behaviours, sociodemographics, and atopic symptoms, and history among 11,494 young Chinese adults in Singapore and Malaysia. A skin prick test (SPT) for common house dust mites was also conducted to determine the atopic (allergic) status. We identified 1,550 atopic dermatitis (AD), 1,301 allergic asthma (AS), and 3,757 allergic rhinitis (AR) atopic cases. We derived a novel dietary index, Diet Quality based on Total Fat Amount (DQTFA), to examine the association between eating patterns for estimated total fat amount with various atopic outcomes. Results: There was a preponderance of subjects having positive SPT reaction (69.0%) with the prevalence of AR being the highest (32.7%), then AD (13.5%), and AS (11.3%). Additionally, there is a significantly higher proportion of subjects with an atopy background and atopic diseases consume diets with a high estimated mean fat amount. The adherence to a dietary pattern of the higher estimated total fat amount was shown to be strongly associated with all atopic diseases and exhibited dose-dependent responses in the univariate analysis. These associations remained significant even with the adjustments for age, gender, body mass index, use of alcohol, sedentary lifestyles, and physical activity. A dietary pattern for high-fat amount is more strongly associated with AS (adjusted odds ratio [AOR]: 1.524; 95% confidence interval [CI]: 1.216–1.725; p < 0.001) and AR (AOR: 1.294; 95% CI: 1.107–1.512; p < 0.001) compared to AD (AOR: 1.278; 95% CI: 1.049–1.559; p < 0.05). Finally, it was shown that having either one of the atopic comorbidities was strongly associated with a dietary pattern of high-fat amounts (AOR: 1.360; 95% CI: 1.161–1.594; p < 0.001). Conclusion: Our findings altogether provide initial evidence that the dietary pattern of a diet high in fat amount is associated with an increased risk of atopy and atopic diseases in young Chinese adults in Singapore and Malaysia. Balancing the consumption of dietary fats and changing personal dietary habits by choosing foods of the lower fat amount may reduce the associated odds of atopic diseases.

Widowhood and Mortality Among Chinese Older Adults in Singapore: The Roles of Gender and Perceived Social Support.

Although the association between widowhood and mortality is well established, the impact of widowhood on mortality could differ by social support, gender, and widowhood duration. We studied the association between widowhood and mortality among older Chinese adults in Singapore and analyzed how social support, gender, and widowhood duration may modify this association. We used data from 15,858 participants aged 61-96 years from the third follow-up of the population-based Singapore Chinese Health Study in 2014-2016. Mortality data were obtained through linkage with the national death registry through 31st December 2018, and social support was measured with the Duke Social Support Scale. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between widowhood and mortality risk. Compared with those married, widowed adults had a higher mortality risk (HR = 1.18, 95% CI = 1.01-1.38), and this risk was higher for those who were either recently widowed (<5 years; HR = 1.28, 95% CI = 1.00-1.63) or long-term widowed (>10 years; HR = 1.27, 95% CI = 1.07-1.54). Among men, those recently widowed had the highest mortality risk (HR = 1.50, 95% CI = 1.06-2.13), whereas, among women, those long-term widowed had the highest mortality risk (HR = 1.26, 95% CI = 0.99-1.60). In the analysis stratified by social support, widowhood was associated with mortality among those with low social support (HR = 1.27, 95% CI = 1.05-1.54), but not among those with high social support (HR = 1.01, 95% CI = 0.76-1.33). Widowhood was associated with increased mortality risk, particularly among recently widowed men and long-term widowed women. Having adequate social support could attenuate the adverse effects of widowhood among older adults.

Prevalence, risk and protective factors for mild cognitive impairment in a population-based study of Singaporean elderly

The prevalence of dementia has been widely reported, and its potential risk and protective factors are well-characterized. However, there is a scarcity of related information regarding mild cognitive impairment (MCI). Thus this population-based study aimed to determine the prevalences of MCI and its subtypes, as well as to identify the risk and protective factors for MCI in the Chinese elderly population of Singapore. Results showed that the overall prevalence of MCI was 12.5%, while the gender-adjusted prevalence of MCI was 12.3%. Gender was found to be significantly associated with the subtypes of MCI, with males more likely to have amnestic MCI and females more likely to have non-amnestic MCI. Older age, lower educational levels, lower social activity levels, depression, hypertension, hyperlipidemia, diabetes and stroke were found to be risk factors for MCI in univariate analysis. However, multivariable analysis showed that only hypertension and stroke were the significant risk factors for MCI. Higher educational levels and active social engagements were significant protective factors for MCI in multivariable analysis. Age and depression had boundary significant associations with the prevalence of MCI. After adjusting for gender, the influence of hypertension, stroke, social engagement, age and depression on MCI remained unchanged, except that education became a boundary significant lower risk factor of MCI development. In conclusion, this study presented the prevalence, risk and protective factors for MCI among Singaporean Chinese older adults, which facilitates the screening of vulnerable groups for MCI.

O22‐3: Cohort differences in spirometry indices in healthy Singapore Chinese adults

O22‐3: Cohort differences in spirometry indices in healthy Singapore Chinese adults

Midlife Dietary Intakes of Monounsaturated Acids, n–6 Polyunsaturated Acids, and Plant-Based Fat Are Inversely Associated with Risk of Cognitive Impairment in Older Singapore Chinese Adults

Previous studies have shown inconsistent results for the relation between dietary fat intake and cognitive function in the elderly. Furthermore, prospective studies on this topic among the Chinese population are scarce. We aimed to examine the association between midlife dietary fat intake and risk of cognitive impairment in the elderly. Prospective cohort analysis was conducted among 16,736 participants from the Singapore Chinese Health Study. Dietary information was assessed by a validated FFQ at baseline (1993-1998) when participants aged 45-74 y (mean: 53.5; SD: 6.22). Cognitive impairment was identified using the Singapore modified Mini-Mental State Examination at the third follow-up visit (2014-2016) when participants aged 61-96 y (mean: 73.2; SD: 6.41). Multivariable logistic regression models were used to calculate ORs and 95% CIs. Cognitive impairment was presented in 2397 participants. When substituted for total carbohydrate, dietary fat intake was inversely related to cognitive impairment (OR comparing extreme quartiles: 0.80; 95% CI: 0.67, 0.94; P-trend=0.003). The OR (95% CI) comparing extreme quartiles of specific dietary fats was 1.08 (0.89, 1.31; P-trend=0.51) for SFAs, 0.80 (0.64, 0.99; P-trend=0.02) for MUFAs, 0.84 (0.72, 0.99; P-trend=0.02) for PUFAs, 0.92 (0.77, 1.09; P-trend=0.49) for n-3 PUFAs, and 0.83 (0.70, 0.98; P-trend=0.01) for n-6 PUFAs. An inverse association was found for plant-based fat (OR: 0.84; 95% CI: 0.72, 0.98; P-trend=0.02), but not for animal-based fat (OR: 0.96; 95% CI: 0.81, 1.15; P-trend=0.76). When substituted for SFAs, the OR (95% CI) was 0.77 (0.61, 0.97; P-trend=0.02) for MUFAs and 0.82 (0.70, 0.95; P-trend=0.003) for PUFAs. We found that substitution of total carbohydrate or SFAs with MUFAs and PUFAs, particularly n-6 PUFAs, was related to a lower risk of cognitive impairment in elderly Chinese participants. In addition, an inverse association with cognitive impairment was found for plant-based fat.

Effects of Mindfulness-Based Stress Reduction on Psychological Symptoms and Telomere Length: A Randomized Active-Controlled Trial

Much research has demonstrated the beneficial effects of mindfulness-based stress reduction (MBSR) on psychological and physical health, but it is not known whether MBSR may impact cellular aging in healthy populations. Further, little research has evaluated MBSR against an active control condition, which precludes strong conclusions regarding the unique effects of mindfulness on psychological functioning. The present study examined the effects of MBSR versus music therapy–based stress reduction (MTSR) on trait mindfulness, self-compassion, and several psychological health outcomes, as well as leukocyte telomere length (LTL). One hundred and fifty eight Singaporean Chinese adults were recruited and randomly assigned to an eight-week MBSR or MTSR course. Participants provided blood samples and completed a battery of self-report measures pre- and post-intervention. Analyses showed that participants in the MBSR condition demonstrated significantly greater improvements in depressive symptoms, trait mindfulness, and self-compassion compared to the control condition. Treatment condition did not predict changes in LTL, anxiety, stress, or happiness, though there was a trend for duration of home mindfulness practice to predict increases in LTL. Overall, the study demonstrated MBSR’s unique effects in reducing depressive symptoms. Improvements in trait mindfulness and self-compassion correspond with theorized mechanisms of change underlying mindfulness training. The lack of intervention effect with regards to LTL suggests that a more intensive intervention may be required for mindfulness to exert noticeable impact on aging at the cellular level, or that the effect may only emerge over a longer term.

Sugar-sweetened beverages consumption in midlife and risk of late-life cognitive impairment in Chinese adults

Objective: To evaluate whether midlife consumption of sugar-sweetened beverages (SSBs), including juices and soft drinks, were associated with late-life cognitive impairment in Chinese adults. Methods: Follow up was conducted for participants from Singapore Chinese Health Study, a population-based prospective cohort, for 16-23 (mean 20) years. The information about their SSBs consumption were collected at baseline survey from 1993 to 1998 by using a validated food frequency questionnaire and their cognition status were evaluated by using a Singapore-modified Mini-Mental State Examination Scale in the 3(rd) follow-up visit during 2014- 2016. Multivariable logistic regression models were used to estimate the ORs and 95%CIs. Results: A total of 16 948 participants were included in the analysis and 2 443 of them were identified as cognitive impairment using education-specific cutoffs. Sex, age, ancestral home, education level, physical activity level, total diet fiber intake level, BMI, alcohol drinking were significantly associated with cognitive impairment (P<0.05). After adjusted the above variables, potential dietary variables and disease status, no significant association was observed between SSBs consumption and cognitive impairment (P>0.05). Compared with those who never or hardly ever drank soft drinks, no significant differences in cognitive impairment risk were observed for those who drank soft drinks 2 or more times a week (OR=0.91, 95%CI: 0.77-1.08), those who drank 1 time a week (OR=1.00, 95%CI:0.82-1.23) and those who drank 1-3 times a month (OR=0.94, 95%CI: 0.80-1.09) (trend P=0.306). Compared with those who never or hardly ever drank juices, no significant differences in cognitive impairment risk were observed for those who drank juices 2 or more times a week (OR=1.03, 95%CI:0.88-1.20), those who drank 1 time a week (OR=0.96, 95%CI: 0.82-1.12) and those who drank 1-3 times a month (OR=0.94, 95%CI: 0.82-1.08) (trend P=0.930). No significant interactions were found with age, sex, and BMI status. Conclusion: SSBs consumption in midlife was not significantly associated with risk of late-life cognitive impairment in Singaporean Chinese adults with relatively low consumption levels. Further researches are needed to verify the results.

Diet, Secondhand Smoke, and Glycated Hemoglobin (HbA1c) Levels among Singapore Chinese Adults.

The combination of poor diet and exposure to secondhand smoke may increase hemoglobin A1c (HbA1c) levels, but few studies have explored this interaction. We explored an interaction among 574 never-smoking adults from the Singapore Chinese Health Study. At baseline (age 59 ± 8 years), intakes of omega-3 polyunsaturated fatty acids, vitamin C, vitamin E and fiber were estimated using a modified food frequency questionnaire. At follow-up (age 64 ± 9 years), HbA1c and cotinine were measured. A product term between cotinine (above or below the median value) and each nutrient (high or low intake) was included in separate linear regression models with HbA1c as the outcome. HbA1c among those with high cotinine and low omega-3 polyunsaturated fatty acids intakes were higher than would be expected due to the individual effects alone (p-for-interaction = 0.05). Among those with lower intakes of omega-3 polyunsaturated fatty acids, high cotinine levels were associated with 0.54% higher HbA1c levels (95% confidence interval [CI]: 0.02, 1.06). Conversely, among those with higher intakes of omega-3 polyunsaturated fatty acids, HbA1c differ not differ by exposure (−0.09%; 95% CI: −0.45, 0.30). No evidence of interaction was observed for other nutrients. Diets high in omega-3 polyunsaturated fatty acids may ameliorate secondhand smoke-induced increases in HbA1c.

Pulse Pressure and the Risk of End-Stage Renal Disease Among Chinese Adults in Singapore: The Singapore Chinese Health Study.

BackgroundAlthough hypertension is an established risk factor for chronic kidney disease, less is known about the relationship of pulse pressure (PP), a measure of arterial stiffness, with chronic kidney disease. We investigated the association of systolic blood pressure (BP), diastolic BP, PP, and mean arterial pressure with the risk of end‐stage renal disease (ESRD) in the prospective population‐based Singapore Chinese Health Study.Methods and ResultsWe used data from 30 636 participants who had BP measured at ages 46 to 85 years during follow‐up I interviews between 1999 and 2004. Information on lifestyle factors was collected at recruitment from 1993 to 1998, and selected factors were updated at follow‐up I. We identified 463 ESRD cases over an average 11.3 years of follow‐up I by linkage with the nationwide Singapore Renal Registry. Cox proportional hazards regression models were used to assess the relations between different BP indexes and ESRD risk. Each BP index was positively associated with ESRD when studied individually. However, when PP was included as a covariate, systolic and diastolic BP and mean arterial pressure were no longer associated with ESRD. Conversely, PP remained significantly associated with ESRD risk in a dose‐dependent manner (P trend<0.001) after adjusting for systolic or diastolic BP. Compared with the lowest group (<45 mm Hg) of PP, the hazard ratio was 5.25 (95% CI, 3.52–7.84) for the highest group (≥85 mm Hg). The association between hypertension and ESRD risk was attenuated and no longer significant after adjusting for PP.ConclusionsOur findings provide a basis for targeting reduction of arterial stiffness to decrease ESRD risk.

Level of tear cytokines in population-level participants and correlation with clinical features

AimsTear cytokine levels indicate severity of ocular surface inflammation. Previous reports of cytokine concentrations were based on hospital-based studies or non-Chinese populations. We determine the range of tear concentration of cytokines in a representative adult Chinese population. MethodsThirty-nine participants were recruited from a population-based study of Chinese adults in Singapore, and standardized clinical ocular surface/eyelid features evaluated. Tear was extracted from Schirmer strips and analysed using a multiplex bead-based assay. ResultsTear concentrations of 14 cytokines were investigated and quantifiable in each participant. Eight cytokines increased with increasing age, and 4 cytokines (IL-4, IL-12, IL-10 and IFN-γ) were increased in people with increased frequency of ocular discomfort. Three cytokines (MCP-1, IP-10 and IL-13) had increased levels in people with lower Schirmer tests, while 9 other cytokines were increased in patients with eyelid crusting (TNF-α, IL-1β, IL-17α, IL-2, IL-4, IL-6, IL-12, IL-10 and IFN-γ). Twelve percent of participants had eyelid crusting. ConclusionUsing a convenient collection technique that is a routine clinical test, 14 tear cytokines could be quantifiable even in Singapore Chinese adults without a dry eye diagnosis. Elevation of different tear cytokines may be linked to subclinical aqueous tear deficiency or eyelid inflammation even in asymptomatic people.

An Ecologic Study of Trends in the Prevalence of Myopia in Chinese Adults in Singapore Born from the 1920s to 1980s

This study aimed to investigate secular trends in the prevalence of myopia over 6 decades (from the 1920s to 1980s) in Chinese adults in Singapore. Parental myopia prevalence was estimated using a parent-completed questionnaire in paediatric cohorts that included: 1) The Singapore Cohort Of Risk factors for Myopia (SCORM), 2) The Strabismus, Amblyopia and Refractive Error in Singaporean Children (STARS), and 3) The Growing Up in Singapore Towards healthy Outcomes (GUSTO). Published estimates for myopia prevalence from 5 adult studies in Singapore were reviewed. Secular trends in the prevalence of myopia were correlated with changes in the education system. The prevalence of parental myopia in SCORM (n = 2943), STARS (n = 4938), and GUSTO (n = 1072) was 47.8%, 53.4%, and 73.4%, respectively; corresponding calendar years these parents might have started schooling were 1966, 1973, and 1983 (born in 1960, 1967, and 1977), respectively. Mean age of parents was 41.3, 40.1, and 33.4 years, respectively. Prevalence of myopia in adult studies in persons who started elementary school in 1928, 1934, 1938, 1939, 1942, 1948, 1952, 1958, 1962, 1972, 1982, and 1995 were 36.4%, 39.7%, 30.0%, 31.5%, 33.0%, 26.4%, 32.5%, 48.7%, 39.4%, 52.0%, 82.2%, and 85.9%, respectively. During the past few decades, the prevalence of myopia increased rapidly, especially in persons who started elementary school after the 1980s (born after 1970). The education system was expanded after Singapore's independence in 1965, and the new education system was introduced in 1978. These changes, together with increasing intensive schooling, may have contributed to the increase in myopia prevalence.

Abstract P205: Meat Intake and Risk of Coronary Heart Disease Mortality in Singapore Chinese Adults

Introduction: Epidemiological studies have reported inconsistent association between meat intake and coronary heart disease (CHD) mortality. We aimed to evaluate this association in a Chinese population with high fish intake and consumption of pork as red meat. Hypothesis: We assessed the hypothesis that intake of red meat, poultry, and fish/shellfish is associated with CHD mortality risk in an Asian population. Methods: The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998 in Singapore. A validated 165-item semi-quantitative food-frequency questionnaire was used to assess usual diet at recruitment, and mortality information was identified via registry linkage up to December 31, 2014. Cox proportional hazard models were used to calculate HRs (95% CI) with adjustment for potential confounders in 60,298 eligible participants free of self-reported CHD and stroke at baseline. Results: Median intake of total meat in this population was 95.9 g/d (interquartile range: 66.5-133), averagely comprised of 27.9% red meat, 18.3% poultry, and 53.6% fish/shellfish.During 981,983 person-years of follow-up, we identified 2,610 CHD deaths among 57,078 subjects who were free of cardiovascular disease at baseline. After controlling for socio-demographic, lifestyle and dietary factors including intakes of poultry and fish/shellfish, red meat intake was associated with increased CHD mortality risk (HR comparing highest vs. lowest quartiles 1.17; 95% CI 1.04-1.32; P-trend=0.005), which became insignificant after adjusting for cholesterol intake (1.11; 0.97-1.26; P-trend=0.11). Conversely, an inverse association was observed for poultry intake (0.88; 0.78-0.99; P-trend=0.03) which remained significant when adjusted for dietary cholesterol (0.85; 0.75-0.96; P-trend=0.007). Fish/shellfish intake was marginally associated with decreased risk of CHD mortality after adjusting for cholesterol (0.91; 0.80-1.03; P-trend=0.045). Dietary cholesterol was associated with an increased risk even after adjusting for intake of red meat, poultry, and fish/shellfish (1.22; 1.07-1.39; P-trend=0.002) or dietary saturated fatty acids, monounsaturated fatty acids, n-3, and n-6 (1.23; 1.07-1.42; P-trend=0.003). Conclusions: In this large cohort study of Chinese adults, red meat intake was associated with a higher risk of CHD mortality that was partly mediated by its cholesterol content. Conversely, poultry was related to a lower risk of CHD mortality.

Consumption of Red Meat, but Not Cooking Oils High in Polyunsaturated Fat, Is Associated with Higher Arachidonic Acid Status in Singapore Chinese Adults.

High arachidonic acid (AA; 20:4n-6) status may have adverse effects on inflammation and risk of cardiovascular diseases. Concerns about high intake of n-6 polyunsaturated fatty acids (PUFAs) are based on the premise that endogenous conversion from linoleic acid (LA; 18:2n-6) is an important source of AA, but few population-based studies have investigated dietary determinants of AA status. In this study, we examined habitual food consumption in relation to plasma concentrations of AA and other PUFAs in population-based studies. We used cross-sectional data from 269 healthy, ethnic Chinese participants (25–80 years old) with contrasting intakes of fish and red meat from the Singapore Prospective Study Program and 769 healthy participants (44–74 years old) from the Singapore Chinese Health Study as a validation set. Multivariable linear regression was used to examine PUFA intake (% energy) and food sources of PUFA (fish, red meat, poultry, soy and cooking oils) in relation to plasma PUFAs (AA, LA, dihomo-gamma-linolenic acid (DGLA; 20:3n-6), alpha-linolenic acid (ALA; 18:3n-3), eicosapentaenoic acid (EPA; 20:5n-3), and docosahexaenoic acid (DHA; 22:6n-3)) concentrations. Higher intake of red meat was associated with higher plasma AA concentrations. High intake of PUFA or PUFA-rich oils was associated with higher plasma ALA but not with plasma AA. Higher intakes of soy were associated with higher ALA and fish with higher DHA and EPA concentrations. These associations were statistically significant (p < 0.05) in both studies. Red meat consumption, but not PUFA or PUFA-rich cooking oil, was associated with circulating AA suggesting that intake of pre-formed AA rather than LA is an important determinant of AA status. A diet high in fish, soy products and polyunsaturated cooking oil, and low in red meat may be associated with an optimal plasma profile of PUFA in this Chinese population.

The Construct of Change in Close Relationships

Relationship beliefs are individual’s cognitive representations of interpersonal relationships found to contribute to the functioning, development and resolution of close relationships. The present study extends Rogge and Bradbury’s (2002) multidimensional approach to the understanding of relationship change by exploring the construct of change that involves both intentional interventions and naturally occurring changes. We conducted two studies on Singaporean Chinese adults, aged 18 to 29 years old. Study 1 explored the laypeople’s construct of relationship change through qualitative interviews. The responses were utilized to develop the Relationship Beliefs about Change (RBC) scale. Study 2 aimed to validate the RBC scale and found three dimensions: Agent of Change (AGC), Inevitable Change (IC), and Managing Change (MC). The RBC demonstrated adequate psychometric properties as an assessment of change beliefs in relationship. The scale revealed a multifaceted system of beliefs consisting of the constantly changing nature of relationship: AGC—who or what changes; IC—the belief system about change, and MC—the need for intervention to curb changes in relationships.

Plasma α-Linolenic and Long-Chain ω-3 Fatty Acids Are Associated with a Lower Risk of Acute Myocardial Infarction in Singapore Chinese Adults

Background: Long-chain marine omega-3 polyunsaturated fatty acids (n–3 PUFAs) are associated with a lower risk of acute myocardial infarction (AMI), but results for plant-derived α-linolenic acid (ALA; 18:3n–3) are inconsistent.Objective: We aimed to examine the association between plasma n–3 PUFAs and AMI risk and to explore potential mediation by cardiovascular disease risk factors.Methods: A nested case-control study with 744 incident AMI cases and 744 matched controls was conducted within the Singapore Chinese Health Study for participants aged 47–83 y. Conditional logistic regression was used to calculate the multivariable ORs for AMI with and without adjustment for cardiovascular disease risk factors, including blood lipids, blood pressure, C-reactive protein, serum creatinine, and glycated hemoglobin.Results: Plasma long-chain n–3 PUFAs were associated with lower AMI risk (multivariable OR: 0.62; 95% CI: 0.41, 0.94; for the highest compared with the lowest quartile; P-trend = 0.03). This association was not substantially changed after adjustment for cardiovascular disease risk factors. Dietary intakes of fish and long-chain n–3 PUFAs were similarly inversely associated with AMI risk. Plasma ALA was marginally associated with a lower risk of AMI (multivariable OR: 0.73; 95% CI: 0.51, 1.05; P-trend = 0.07) even in persons with high plasma concentrations of long-chain n–3 PUFAs. This association became significantly weaker after adjustment for blood pressure and LDL cholesterol.Conclusions: Plasma long-chain n–3 PUFAs are associated with a lower risk of AMI in this Asian population. Plasma ALA may be marginally associated with reduced AMI risk, even in persons with high concentrations of long-chain n–3 PUFAs, and this association may be partially mediated by lower blood pressure and LDL cholesterol.

Abstract 15307: Dairy Intake and Risk of Cardiovascular Mortality in Singapore Chinese Adults

Introduction: Studies have suggested that dairy foods may be associated with lower risk of metabolic syndrome, HTN, and T2D. However, the relation of dairy products with CVD risk has been less clear, with mixed findings from various epidemiological studies. So far, few reports are from Chinese populations where the consumption levels are generally low. Methods: The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45-74 years from 1993 to 1998 in Singapore. A validated 165-item semi-quantitative food-frequency questionnaire was used to assess usual diet at recruitment, and mortality information was identified via registry linkage up to December 31, 2013. Cox proportional hazard models were used to calculate HRs (95% CI) with adjustment for potential confounders. Results: The median total dairy intake was 20.1 g/d (ranged 0-1084 g/d). During 981,480 person-years of follow-up, we identified 5,484 CVD deaths. After controlling for socio-demographic, lifestyle and other dietary factors, marginally inverse association was observed, and the HRs (95% CI) for CVD mortality were 1.00, 0.95 (0.88-1.02), 0.96 (0.89-1.04), and 0.91 (0.84-0.99) for increasing quartiles of total dairy intake (P-trend=0.08). No significant association was observed for CHD deaths (n=3,033), and the HR comparing extreme quartiles was 0.93 (95% CI: 0.84-1.04; P-trend=0.27). Although the trend was not significant (P-trend=0.15) for stroke mortality (n=1544), the HRs were 1.00, 0.88 (0.77-1.02), 0.88 (0.76-1.01), and 0.84 (0.72-0.98) for increasing quartiles of total dairy intake. In men, higher total dairy intake was inversely associated with risk of CVD mortality [HR comparing extreme quartiles 0.89 (0.80-0.99); P-trend=0.02] and stroke mortality [0.72 (0.58-0.89); P-trend=0.005], but no significant association was observed in women [CVD mortality 0.99 (0.88-1.12); P-trend=0.41; and stroke mortality 0.93 (0.75-1.15); P-trend=0.97]. Conclusions: In this large cohort study of Chinese adults with generally low dairy consumption, high intake of total dairy products was associated with a modestly decreased risk of total CVD mortality, and this association was mainly observed for stroke mortality and only evident in men.

Bidirectional Association between Self-Reported Hypertension and Gout: The Singapore Chinese Health Study

It has been hypothesized that the association between hypertension and gout is bidirectional, however, few studies have examined this in a prospective cohort. We analyzed data from the Singapore Chinese Health Study (SCHS) follow-up I (1999–2004) and II (2006–2010) interviews, when both physician-diagnosed hypertension and gout were self-reported. We included participants with data for both follow-up interviews and who were free of heart disease, stroke and cancer at follow-up I. The analysis of hypertension and risk of gout included 31,137 participants when prevalent gout cases were excluded, while the analysis of gout and risk of hypertension included 20,369 participants when prevalent hypertension cases were excluded. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The mean age at follow-up I was 60.1 (SD 7.3) years, and the average follow-up was 6.8 (SD 1.4) years. In the analysis of hypertension and risk of gout, 682 incident cases were identified. Compared to normotensive participants, hypertensive patients had an88% increased risk of developing gout (HR 1.88; 95% CI 1.61–2.21). In the parallel analysis, 5,450 participants reported to have newly diagnosed hypertension during follow-up. Compared to participants without gout, those with gout had an18% increased risk of developing hypertension (HR 1.18; 95% CI 1.02–1.37). The bidirectional association was stronger in normal weight adults compared to overweight/obese individuals (P interaction = 0.06 and 0.04, respectively). The hypertension to gout association was stronger in women compared to men (P interaction = 0.04), while the gout to hypertension association was evident in women but not in men (P interaction = 0.02). In conclusion, our results suggest that the hypertension-gout association is bidirectional in this cohort of Singapore Chinese adults. The potential interactions of the bidirectional association with obesity and sex deserve further investigations.