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PubMed1997

Cognitive testing of elderly Chinese people in Singapore: influence of education and age on normative scores.

AIM: to establish age- and education-adjusted mean psychometric test scores of cognitively normal elderly Chinese people in Singapore. METHOD: 155 community-living, cognitively intact elderly Chinese subjects, stratified according to age and education, were selected from the membership lists of senior citizens' clubs and were administered a neuropsychological assessment battery. The mean test scores were then analysed for correlations with demographic characteristics. RESULTS: only education and age were independent variables; gender and language spoken were strongly correlated with education by the chi2 method (P < 10[-5]). Subsequent statistical analysis of education and age on the psychological test scores by the general linear model procedure enabled the formulation of a table of age- and education-adjusted normative cognitive scores. CONCLUSION: the derivation of age- and education-adjusted normative scores of a selected neuropsychological assessment battery on elderly Chinese people enables a more accurate diagnosis of dementia to be made and may facilitate better international comparisons of this condition. As our subjects are representative of many others from China, these results may serve not only as a local, but also as a regional, reference source.

Age Factors↗
PubMed2003

Associations of diabetes mellitus and ethnicity with mortality in a multiethnic Asian population: data from the 1992 Singapore National Health Survey.

Despite the high prevalence of diabetes mellitus, little is known about mortality associated with diabetes in Asia. Therefore, the authors followed 3,492 Chinese, Malay, and Asian Indian adults randomly selected from the general population in Singapore. Data on glucose tolerance, demographic characteristics, and other cardiovascular disease risk factors (lipid profile, blood pressure, smoking status, alcohol consumption, and obesity) were obtained in 1992. Vital status was determined as of December 31, 2001. There were 108 deaths over a period of 9 years. Impaired fasting glycemia or impaired glucose tolerance (IFG/IGT) (hazard ratio (HR)=1.39, 95% confidence interval (CI): 0.84, 2.31) and diabetes mellitus (HR=2.49, 95% CI: 1.58, 3.94) were associated with increased mortality after adjustment for age, gender, ethnic group, and educational level. Compared with Chinese with diabetes, Indians with diabetes experienced significantly greater mortality (HR=3.86, 95% CI: 1.76, 8.44) after adjustment for gender, age, educational level, smoking, hypertension, alcohol intake, and obesity. Undiagnosed diabetes and IFG/IGT were more common than known diabetes and also were associated with increased mortality. For reduction of mortality associated with IFG/IGT and diabetes, the authors recommend a screening program to detect undiagnosed diabetes and IFG/IGT along with aggressive treatment of diabetes after diagnosis.

Adolescent↗
PubMed2002

Dietary isothiocyanates, glutathione S-transferase polymorphisms and colorectal cancer risk in the Singapore Chinese Health Study.

Dietary intake of cruciferous vegetables (Brassica spp.) has been inversely related to colorectal cancer risk, and this has been attributed to their high content of glucosinolate degradation products such as isothiocyanates (ITCs). These compounds act as anticarcinogens by inducing phase II conjugating enzymes, in particular glutathione S-transferases (GSTs). These enzymes also metabolize ITCs, such that the protective effect of cruciferous vegetables may predicate on GST genotype. The Singapore Chinese Health Study is a prospective investigation among 63 257 middle-aged men and women, who were enrolled between April 1993 and December 1998. In this nested case-control analysis, we compared 213 incident cases of colorectal cancer with 1194 controls. Information on dietary ITC intake from cruciferous vegetables, collected at recruitment via a semi-quantitative food frequency questionnaire, was combined with GSTM1, T1 and P1 genotype from peripheral blood lymphocytes or buccal mucosa. When categorized into high (greater than median) and low (less than/equal to median) intake, dietary ITC was slightly lower in cases than controls but the difference was not significant [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.59-1.12]. There were no overall associations between GSTM1, T1 or P1 genotypes and colorectal cancer risk. However, among individuals with both GSTM1 and T1 null genotypes, we observed a 57% reduction in risk among high versus low consumers of ITC (OR 0.43, 95% CI 0.20-0.96), in particular for colon cancer (OR 0.31, 0.12-0.84). Our results are compatible with the hypothesis that ITCs from cruciferous vegetables modify risk of colorectal cancer in individuals with low GST activity. Further, this gene-diet interaction may be important in studies evaluating the effect of risk-enhancing compounds in the colorectum.

Case-Control Studies↗
PubMed2003

Vitamin D receptor start codon polymorphism and colorectal cancer risk: effect modification by dietary calcium and fat in Singapore Chinese.

Vitamin D has been implicated as a protective agent against colorectal cancer. We hypothesized that a functional start codon polymorphism in the vitamin D receptor (VDR) influences the risk of colorectal carcinoma. We conducted a case-control study nested within a large cohort of Singapore Chinese. VDR genotypes, determined by FokI restriction endonuclease digestion of PCR-amplified DNA, were performed on 217 colorectal cancer cases and 890 controls. We found that compared with individuals carrying the FF genotype, those with Ff genotype had a 51% increase in risk of colorectal cancer and those with the ff genotype, an 84% increase in risk (P for trend = 0.01). The effect of the VDR genotype on risk appeared to be modified by both dietary calcium and fat. Among those with either low calcium or low fat intake (below the median values in controls), the risk for colorectal cancer increased in a gene-dose-dependent manner such that individuals possessing the ff genotype displayed an approximately 2.5-fold increased risk that was statistically significant. There was little evidence of a VDR genotype-colorectal cancer association among subjects with higher than median values of either dietary fat or calcium.

Aged↗
PubMed2004

Polymorphisms in angiotensin II type 1 receptor and angiotensin I-converting enzyme genes and breast cancer risk among Chinese women in Singapore.

Angiotensin II is converted from its precursor by angiotensin I-converting enzyme (ACE) and has been shown to mediate growth in breast cancer cell lines via ligand-induced activity through the angiotensin II type 1 receptor (AGTR1). Earlier we showed that women with the low activity genotype of the ACE gene have a statistically significantly ( approximately 50%) reduced breast cancer risk compared with those possessing the high activity ACE genotype. To further test the hypothesis that angiotensin II participates in breast carcinogenesis through AGTR1, we examined genetic polymorphisms in the 5'-region of the AGTR1 gene (A-168G, C-535T and T-825A) in relation to risk of breast cancer in 258 breast cancer cases and 670 female controls within the Singapore Chinese Health Study. Relative to the homozygotes, individual genotypes with one or two copies of the respective allelic variants (putative low risk genotypes) were each associated with an approximately 30% reduction in risk of breast cancer. Risk of breast cancer decreased with increasing number of low risk AGTR1 genotypes after adjustment for potential confounders. Relative to those carrying no low risk genotypes (homozygous for A, C and T alleles for the three polymorphisms, respectively), the odds ratios (95% confidence intervals) were 0.84 (0.51-1.37) for women possessing one low risk genotype and 0.68 (0.46-1.01) for women possessing two or three low risk genotypes (P for trend = 0.05). When both AGTR1 and ACE gene polymorphisms were examined simultaneously, women possessing at least one AGTR1 low risk genotype in combination with the ACE low activity genotype had an odds ratio of 0.35 (95% confidence interval, 0.20-0.62) compared with those possessing the ACE high activity genotype and no AGTR1 low risk genotype. Our findings suggest that pharmacological inhibition of the angiotensin II effect by blockade of ACE and/or AGTR1 could be potential targets for the prevention and treatment of breast cancer.

Aged↗
PubMed2005

Tea and circulating estrogen levels in postmenopausal Chinese women in Singapore.

The role of tea in the etiology of breast cancer is controversial. We recently provided the first set of human evidence that breast cancer risk is significantly inversely associated with tea intake, largely confined to intake of green tea. Since black tea and green tea possess comparable levels of the total tea polyphenols that possess antioxidative activities, reasons for the paradoxical effects of green tea and black tea on breast cancer protection are not apparent. Some limited evidence suggests that green tea may have downregulatory effects on circulating sex-steroid hormones, whereas black tea may have upregulatory effects. We therefore, investigated the relationship between tea intake, and plasma estrogen and androstenedione levels in a cross-sectional study of healthy postmenopausal Chinese women in Singapore. In this group of 130 women, 84 were non or irregular (less than once a week) tea drinkers, 27 were regular (weekly/daily) green tea drinkers and 19 were regular (weekly/daily) black tea drinkers. Relative to plasma estrone levels in non- or irregular tea drinkers (29.5 pg/ml) the levels were 13% lower in regular green tea drinkers (25.8 pg/ml) and 19% higher in regular black tea drinkers (35.0 pg/ml). These differences in estrone levels were statistically significant (P = 0.03) inspite of adjusting for age, body mass index, intake of soy, and other covariates. A similar pattern of differences between tea intake, and plasma levels of estradiol (P = 0.08) and androstenedione (P = 0.14) were found. In addition, the tea-estrogen associations were observed irrespective of the genotype of catechol-O-methyltransferase (COMT), a major enzyme that aids in the excretion of tea polyphenols in humans. Larger studies are needed to confirm results from this cross-sectional study and to better understand the potentially differing effect of black and green tea on circulating estrogen levels and ultimately on the risk of breast cancer.

Aged↗
PubMed2005

Green tea intake, ACE gene polymorphism and breast cancer risk among Chinese women in Singapore.

Experimental and epidemiological data have implicated a potential chemoprotective role of green tea polyphenols and a potential enhancing role of angiotensin II in the development of breast cancer in humans. Angiotensin II is converted from its precursor by angiotensin-converting enzyme (ACE). Women with low-activity genotype of the ACE gene had a reduced risk of breast cancer compared with those possessing high-activity ACE genotype. Experimental data showed that green tea polyphenols could inhibit angiotensin II-induced reactive oxygen species production. We reasoned that if this is one of the mechanisms by which green tea polyphenols protect against human breast cancer, then their effect should be more prominent among women possessing high-activity ACE genotype than women with low-activity ACE genotype. In other words, we predict a stronger inverse green tea-breast cancer association among the former versus the latter subgroup of women. To test this hypothesis, we conducted a nested case-control study involving 297 incident breast cancer cases and 665 control subjects within the Singapore Chinese Health Study. There was no association between intake frequencies of green tea and risk of breast cancer among all women or those with low-activity ACE genotype. Among women with high-activity ACE genotype, however, intake frequency of green tea was associated with a statistically significant decrease in risk of breast cancer (P for trend=0.039); the odds ratio (95% confidence interval) was 0.33 (0.13-0.82) for women drinking green tea at least monthly and 0.29 (0.10-0.79) for those drinking green tea at least weekly compared with non-drinkers. There was a statistically significant interaction effect between green tea intake and ACE genotype on risk of breast cancer (P for interaction=0.01). Black tea intake was unrelated to breast cancer risk irrespective of the ACE genotype. The findings of the present study highlight the importance of genetically determined factors in evaluating the role of green tea intake in the development of breast cancer.

Adult↗
PubMed2005

The effect of cyclin D1 (CCND1) G870A-polymorphism on breast cancer risk is modified by oxidative stress among Chinese women in Singapore.

Cyclin D1 (CCND1), an intracellular cell-cycle regulatory protein with checkpoint function, can promote cell proliferation or induce growth arrest and apoptosis depending on the cellular context. We hypothesized that the direction of the association between the (CCND1) G870A-polymorphism and breast cancer risk may be modified by dietary and genetic factors influencing the oxidant-antioxidant balance, such as a dietary pattern with a high intake of n-6 fatty acids and a low intake of n-3 fatty acids, or a genetic profile that is deficient in glutathione S-transferases. We tested our hypothesis in a case-control study nested into the Singapore Chinese Health Study, a prospective investigation of diet and cancer in 63,000 Chinese men and women. Genomic DNA collected from 258 incident cases of breast cancer and 670 female cohort controls was examined for CCND1, GSTM1, GSTT1 and GSTP1 genes using fluorogenic 5'-nuclease assay. Unconditional logistic regression models were used to assess the effects with adjustment for potential confounders. All statistical tests were two-sided. The heterozygous CCND1 GA genotype significantly reduced the breast cancer risk in all subjects (OR=0.67, 95% CI 0.45-0.99) when compared with the GG genotype. The association was restricted to women with a high (above median value) intake level of n-6 fatty acids (OR=0.51, 95% CI 0.30-0.87), a low (below median value) intake level of the antagonistic marine n-3 fatty acids (OR=0.54, 95% CI 0.32-0.93) or a total lack of the antioxidative GSTM1 (OR=0.44, 95% CI 0.25-0.80) or GSTT1 genes (OR=0.46, 95% CI 0.24-0.87). The effects were consistently stronger in cases with advanced disease. The AA genotype did not affect breast cancer risk. The results of this study are compatible with the hypothesis that the oxidant-antioxidant balance in cells is an important determinant of the direction of the cyclin D1 effect, leading either to cell proliferation or cell death.

Adult↗
PubMed2006

Peroxisome proliferator-activated receptor (PPAR) gamma gene polymorphisms and colorectal cancer risk among Chinese in Singapore.

Peroxisome proliferator-activated receptor (PPAR) gamma is a ligand-activated nuclear receptor that plays a key role in adipogenesis and adipocyte gene expression, and has recently been linked with possible antineoplastic effects in colonic carcinogenesis. PPARgamma2 and gamma3 are two transcripts arising from the PPARgamma gene through differential promoter usage and alternative splicing. We investigated the associations between PPARgamma2 Pro12Ala and PPARgamma3 C-681G gene polymorphisms and colorectal cancer (CRC) risk in a case-control study nested within the Singapore Chinese Health Study. Genotypes for the PPARgamma2 and PPARgamma3 polymorphisms were determined on 362 incident CRC cases and 1164 cohort controls by direct sequencing and by fluorogenic 5'-nuclease assay. Unconditional logistic regression models were used for statistical analyses. With adjustment for CRC risk factors, subjects with one or two copies of the G allele of the PPARgamma2 Pro12Ala polymorphism showed a statistically significant reduction in risk compared to those with the CC genotype [odds ratio (OR)=0.53, 95% confidence interval (CI)=0.30-0.92]. For the PPARgamma3 C-681G polymorphism, subjects with one or two copies of the C allele showed a reduction in risk compared to those with the GG genotype (OR=0.72, 95% CI=0.51-1.04). When PPARgamma2 and PPARgamma3 genotypes were considered simultaneously, the number of putative low-risk genotypes was significantly associated with reduced risk of CRC in a gene-dose-dependent manner; the OR (95% CI) was 0.72 (0.49-1.07) among subjects possessing one low-risk genotype (either PPARgamma2 or PPARgamma3), and the comparable figure among subjects possessing both low-risk genotypes was 0.19 (0.07-0.51).

Aged↗
PubMed2003

Tobacco control and gender in south-east Asia. Part II: Singapore and Vietnam.

In the World Health Organization's Western Pacific Region, being born male is the single greatest risk marker for tobacco use. While the literature demonstrates that risks associated with tobacco use may vary according to sex, gender refers to the socially determined roles and responsibilities of men and women, who initiate, continue and quit using tobacco for complex and often different reasons. Cigarette advertising frequently appeals to gender roles. Yet tobacco control policy tends to be gender-blind. Using a broad, gender-sensitivity framework, this contradiction is explored in four Western Pacific countries. Part I of the study presented the rationale, methodology and design of the study, discussed issues surrounding gender and tobacco, and analysed developments in Malaysia and the Philippines (see the previous issue of this journal). Part II deals with Singapore and Vietnam. In all four countries gender was salient for the initiation and maintenance of smoking. Yet, with a few exceptions, gender was largely unrecognized in control policy. Suggestions for overcoming this weakness in order to enhance tobacco control are made.

Adolescent↗
PubMed1994

Condom use negotiation among sex workers in Singapore: findings from qualitative research.

Following an earlier study of 806 sex workers in Singapore in which they were found to succeed only half the time in getting clients to use condoms, a qualitative investigation was conducted on 40 sex workers to explore their perceived barriers and approaches in negotiating condom use with clients. Five different patterns of condom use were identified: successful, unsuccessful, misinformed, passive and uninterested. The successful negotiators used several practical approaches to secure clients' compliance. Unsuccessful negotiators experienced problems such as inability to resist clients' pressure or respond to their queries. The misinformed group believed that regular clients were safe. The passive group did not negotiate condom use due to their perceptions of lack of support from peers and brothel keepers, and the uninterested group was apathetic with fatalistic perceptions of AIDS. The in-depth interviews with successful negotiators provided relevant, specific and practical information which could be disseminated to their peers to develop their negotiation skills. This qualitative study also provided useful insights on condom use negotiation and highlighted the need for comprehensive interventions which should not only aim at developing sex workers' negotiation skills but also at gathering support from brothel keepers to facilitate behaviour change, and public education directed at clients to increase condom use.

Adult↗
PubMed1984

Low birthweight of live singletons in Singapore, 1967-1974.

A random sample of 23 591 single livebirths was drawn from the Singapore Registry for 1967-1974, and information extracted from the birth certificates. The proportion of low birthweight infants (2500 g or less) fell markedly from 9.1% in 1967 to 5.7% in 1974, which has not been the finding in other studies. Variation in the proportions of low birthweight infants by sex, maternal age, parity, and social class, are broadly in agreement with other studies. Indians were found to have significantly smaller babies (mean weight of 3020 g) with a higher proportion of low birthweight ones (11.5%) than the Malays (3080 g and 8.1%) and the Chinese (3130 g and 6.1%). This is despite similar distributions of gestational age, and for term babies the differences in low birthweight proportions are highly significant with Chinese 5.0%, Malays 6.5%, and Indians 9.8%. The reasons for this are discussed with the implication that lower birthweights in Indians are to some extent of ethnic/genetic origin.

Adult↗
PubMed1985

Maternal-child hepatitis B virus transmission in Singapore.

A study of maternal-infant transmission of hepatitis B virus (HBV) was conducted in Singapore between June 1980 and June 1982. HBsAg carrier rate was highest among Chinese (6.2%) followed by Malay (2.3%) and Indian (0.6%) mothers. The presence of HBeAg in maternal sera correlated well with high titre HBsAg (p = 7.34 X 10(-5)). Overall HBV transmission occurred in 27/56 (48.2%) infants from carrier mothers. The majority of the transmission was perinatal. There was a very strong correlation between transmission and HBeAg status of the mother (p = 1.85 X 10(-9); odds ratio = 68.44) and to a lesser extent with high titre HBsAg (p = 0.002; odds ratio = 6.38). A strong negative correlation was seen between transmission and anti-HBeAg (p = 8.19 X 10(-7); odds ratio = 0.04). At one year 19 (70.4%) infants were still HBsAg positive while seven (25.9%) lost the antigenemia and acquired anti-HBsAg and one developed HBsAg after one year. It could be calculated that perinatal HBV transmission contributed about 18% to the total pool of HBsAg positive infants of one year of age.

Carrier State↗
PubMed1986

Trends in mortality from ischaemic heart disease in Singapore, 1959 to 1983.

Mortality from ischaemic heart disease in Singapore has been studied from vital statistics for the 25 years from 1959 to 1983. The age-standardized rates for ages 30 to 69 years increased in men from 106.8 per 100 000 in 1959-1963 to 204.5 in 1979-1983, while for women they increased from 30.7 to 72.0 per 100 000. The male to female ratios in the age-standardized rates for ischaemic heart disease fell from 3.5 to 2.8 in the period, while remaining steady for all causes. However, while mortality rates for ischaemic heart disease have increased steadily over the period in the older age groups, they have recently declined in the younger ages with a birth cohort effect. For males the decline started with the 1932-1936 birth cohort (men now aged around 50 years), while for females it was the 1937-1941 birth cohort (women now aged around 45 years). The reasons for this decline are discussed but no clear explanation is at present apparent and it would be useful to have future monitoring of lifestyles and coronary risk factors.

Adult↗
PubMed1987

Trends in mortality from hypertensive and cerebrovascular diseases in Singapore, 1959 to 1983.

Secular trends in mortality from hypertensive and cerebrovascular diseases have been studied in Singapore from vital statistics for the years from 1959 to 1983. Males were found to have higher mortality than females from hypertensive disease (by about 25%) and cerebrovascular disease (by about 20%). After an initial slight rise mortality from hypertensive disease fell markedly from the mid-1960s (slightly more in males than females) but the rate of decline has levelled off in the last few years. A more modest decline in cerebrovascular disease mortality started in the early 1970s in males and the mid-1970s in females, with the decline to date being slightly more in males. These declines started at the same point in time in both sexes and in all age groups, with the rate of decline falling with age. The timing and patterns of these declines are consistent with the theory that treatment of hypertension has played a significant role.

Adult↗
PubMed1987

A study on the prevalence of hepatitis B surface antigen among Chinese adult males in Singapore.

A study was conducted in Singapore on 8829 Chinese men aged 35 years or more to determine whether the prevalence of hepatitis B surface antigen (HBsAg) positivity is associated with the source from which the subjects were recruited, or with occupation as an indicator of socioeconomic status. The HBsAg prevalence rates were significantly different (p less than 0.0001) among the five source groups: 8.3% in healthy blood donors, 7.8 in other healthy subjects, 9.2 in non-hepatic outpatients, 10.3 in hospital non-hepatic patients who were not gravely ill, and 11.2 in hospital non-hepatic patients who were gravely ill. After statistical adjustment by multiple logistic regression for age and occupation, the odds ratio (using 'other healthy subjects' as the reference group) ranged from 0.98 (95% CL = 0.65-1.47) for healthy blood donors to 1.42 (95% CL = 0.95-2.12) for hospital non-hepatic patients who were gravely ill. The HBsAg prevalence rates were also significantly different (p less than 0.0001) among occupations: 8.5% in professional, technical and administrative personnel, 9.7 in clerical, sales and services personnel, 10.3 in agricultural and factory workers and unskilled labourers, and 10.5 among the unemployed and retired. After statistical adjustment for age and source groups, the odds ratio (using professional, technical and administrative subjects as the reference group) ranged from 1.07 (95% CL = 0.99-1.17) for the unemployed and retired subjects, to 1.19 (95% CL = 0.93-1.53) for agricultural and factory workers and unskilled labourers.

Adult↗
PubMed1992

Corneal arcus and cardiovascular risk factors in Asians in Singapore.

This study was a cross-sectional random survey of the whole of Singapore, based on 2143 subjects (aged 18-69 years, response rate 60.3%). The presence of corneal arcus was determined by a doctor using the naked eye in good light. Cardiovascular risk factors were measured by standardized techniques. The prevalence rates overall of corneal arcus were: 18-29 years (males 0.5%, females 0.3%), 30-49 years (males 18.1%, females 13.3%) and 50-69 years (males 70.7%, females 55.3%). In the 30-49 age group, people with arcus had higher serum low density lipoprotein (LDL) cholesterol concentrations than people without arcus, the mean differences being, males 0.31 mmol/l (P = 0.040) and females 0.62 mmol/l (P less than 0.001) with an increased likelihood of having values greater than 5.5.mmol/l of males 1.8 (95% confidence interval (95% CI): 1.0-3.4) and females 2.6 (95% CI: 1.4-4.8). There were no significant differences for LDL-cholesterol in the 50-69 age group. Arcus was weakly associated with fasting plasma glucose in the 30-49 age group. Arcus was not associated with serum high density lipoprotein (HDL) cholesterol, serum fasting triglyceride, blood pressure and cigarette smoking. It is concluded that while corneal arcus is primarily an age-related change, its formation is accelerated by high serum LDL-cholesterol so that in people under 50 years it is a marker for the condition.

Adolescent↗
PubMed1993

Epidemiology of sudden unexpected death syndrome among Thai migrant workers in Singapore.

A total of 235 cases of sudden unexpected death syndrome (SUDS) among apparently healthy male Thai migrant workers in Singapore were reported between 1982 and 1990. Most of the deaths occurred during sleep and 13% were not sleep-related. The median age at the time of death was 33 years and the median interval between arrival and death was 8 months. These deaths occurred singly and sporadically throughout the year. Post-mortem examination revealed few abnormal findings except for haemorrhagic congestion or oedema of the lungs. There were moderate to severe intra-alveolar haemorrhages with some evidence of myocarditis or pneumonitis. Preliminary findings of serial sections of the hearts indicate evidence of anomalies in the cardiac conduction system. Epidemiological investigations showed that a family history of similar deaths and serological evidence of current or recent infection with Pseudomonas pseudomallei were significantly associated with SUDS. Extensive biochemical and toxicological investigations were inconclusive. There was no evidence of chronic deficiency in thiamine or potassium among the healthy Thai workers living and working in the same conditions as the cases, and no significant abnormalities were detected on electrocardiographic examination. As these migrant workers experienced various psychosocial problems which could stem from maladjustment to an urban environment, separation from the family, burden of debts and long hours of work, stress could be a precipitating factor for SUDS.

Adult↗