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Background: Vitamin D is an important nutrient for maintaining cardiovascular, endocrine, immune, and nervous system health. Body mass index (BMI) is one of the factors influencing vitamin D levels. We aimed to study the factors that play a role in the outcomes and prognoses of critically ill patients. Method: This study was conducted at four teaching hospitals in Northern Taiwan between August 2018 and July 2020. A total of 1421 critically ill patients admitted to the intensive care units (ICUs) were eligible for assessment. Patients were classified into two groups based on serum 25(OH)D levels: sufficiency ( 20 ng/ml) and insufficiency (< 20 ng/ml); and into four groups according to BMI: underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obesity (BMI 30). Statistical analyses were performed, and a p-value < 0.05 indicated a significant difference. Results: More than half (57.9%) of the critically ill ICU patients had vitamin D deficiency (VDD); and VDD lengthened ICU stay by 2.5 days in vitamin D-deficit patients as compared to that in vitamin D-sufficient patients. Patients with obesity had a 4.2-day longer ICU stay (16.7 days) than that of the BMI < 30 group (12.5 days), which was significant (p = 0.009). They also had the lowest vitamin D levels (17.3 ng/mL) and the highest 90-day mortality rate (17.3%) compared to the other BMI groups. Conclusion: In caring for critical patients, physicians need to pay more attention to vitamin D levels and BMI factors, which may impact their outcome prediction. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between hormone replacement therapy (HRT) and the risk of bone fracture in menopausal women in Taiwan.Study Design: The longitudinal, population-based, nested case-control study in Taiwan involved 5269 women aged > 45 years with fractures and 21,076 matched randomly selected controls without fractures. A conditional logistic regression model of analysis was employed.Main Outcome Measures: The association between the risk of bone fracture and various HRT-related parameters, including the timing, dosage, and adherence, was investigated.Results: Women with menopausal syndrome were protected from fractures when they received hormone drugs at high cumulative defined daily doses (DDDs) (Cumulative DDDs≥360) (odds ratio [OR]: 0.90, 95 % confidence interval [CI]: 0.82-0.99) and when their adherence was high (over 0.5) (OR: 0.70, 95 % CI: 0.60-0.82). The risk of fracture also decreased with high cumulative DDDs and high adherence combined (OR: 0.71, 95 % CI: 058-0.86). Subgroup analyses suggested that estrogen-containing regimens showed a protective effect against fractures at high cumulative DDDs or when adherence was high. Similar results were also observed with progestogen-containing regimens. Past exposure to an estrogen-containing regimen showed a protective effect against fractures when adherence was high. Past exposure to a progestogen-containing regimen showed a protective effect against fractures at high cumulative DDDs and when adherence was high.Conclusions: The results indicate that past exposure to estrogen-containing or progestogen-containing regimens exerts protective effects against bone fracture. These effects increased with higher cumulative DDDs and with adherence in a dose-dependent manner. [ABSTRACT FROM AUTHOR]

Abstract: Circulating levels of inflammatory and prothrombotic factors are elevated in the metabolic syndrome (MS) and linked with the occurrence of cardiovascular events. The aim of our study was to investigate the relationship between inflammatory and prothrombotic markers and the MS in elderly institutionalized residents. A total of 326 non-diabetic residents of Chuang-Hua Veterans Care Home (age: 79.9±4.1 years; 100% males) were enrolled. MS was diagnosed according to the AHA/NHLBI Scientific Statement criteria. Body fat percentage was measured by bioelectrical impedance analysis. Insulin resistance was calculated by homeostasis model assessment for insulin resistance (HOMA-IR). Inflammatory markers, including tumor necrosis factor-a (TNF-α), high sensitivity C-reactive protein (hsCRP), and plasminogen activator inhibitor-1 (PAI-1), were determined using ELISA. Elderly residents with the MS had higher systolic and diastolic blood pressures (both p < 0.001) and higher HOMA-IR (p < 0.001), hsCRP (p = 0.008), and PAI-1 levels (p < 0.001) than those without the MS. On multivariate logistic regression analysis, PAI-1 was an independent risk factor for the MS. Of the MS components, elderly residents with higher waist circumferences and higher levels of plasma fasting glucose, and triglyceride (TG), and lower levels of high density lipoprotein (HDL) had higher PAI-1 levels than those without the above components. [Copyright &y& Elsevier]