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以重疊病例研究方式,探討飲食與血漿中葉酸與中風及不同形式中風間的相關性 PowerPoint PPT Presentation


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以重疊病例研究方式,探討飲食與血漿中葉酸與中風及不同形式中風間的相關性. 翁履珍. Introduction. Stroke (World Health Organization). A focal ( or at times global) neurological impairment sudden onset, and lasting more than 24 hrs (or leading to death) and of presumed vascular origin.

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以重疊病例研究方式,探討飲食與血漿中葉酸與中風及不同形式中風間的相關性

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Introduction

Introduction


Stroke world health organization

Stroke(World Health Organization)

  • A focal ( or at times global) neurological impairment sudden onset, and lasting more than 24 hrs (or leading to death) and of presumed vascular origin.

  • 5.5 million deaths that occur every year world wide is due to stroke.

  • Stroke is the second leading cause of death after ischemic heart disease.


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  • Ischemic stroke

    Caused by a blood clot that blocks a blood vessel or artery in the brain

  • Hemorrhagic stroke

    A blood vessel in the brain ruptures and spills blood into the surrounding tissue

    (National Institute of Neurological disorder and stroke,

    http://www.ninds.nih.gov/index.htm)


Treatable risk factors

Treatable Risk Factors

  • High blood pressure

  • Heart disease

  • Cigarette smoking

  • Diabetes

  • Warning signs or history of stroke

    TIAs( Transient ischemic attacks )

    (National Institute of Neurological disorder and stroke,

    http://www.ninds.nih.gov/index.htm)


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  • Difference of stroke mortality in Japanese emigration

    (SYME , 1975)

  • -3 fatty acid ( Iso et al.2001 )

  • Antioxidants

    Vitamin C ( Vok et al.2003) Vitamin E (Yochum et al.2000)

    Carotenoids (Hirvonen et al.2000)

    Flavonoids (Keli et al.1996)

  • Minerals

    Potassium Magnesium (Ascherio et al.1998)

  • Others

    Cereal fiber(Ascherio et al.1998)

    Folate (He et al.2004) Vitamin B6 (Kelly et al.2003)

    Vitamin B12 (He et al.2004)


Folate folic acid

Folate (Folic acid)

  • Water Soluble

  • Functions i. Red blood cell formation

    ii. New cell division

    iii. Protein metabolism

  • Deficiencies Anemia, diarrhea, depression, heartburn

  • Toxicity Insomnia, irritability, diarrhea, may mask B12 deficiency

  • Recommended Intakes (RDA):400 g/day for adults

  • Food Sources Green leafy vegetables, liver, legumes, seeds, and enriched breads, cereals, rice, and pasta.

http://nutrition.about.com/cs/supplements/l/blvitbfolate.htm


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Folate metabolism

http://www.snof.org/maladies/homocystinurie.html


Homocysteine

Homocysteine

  • Homocysteine & CVD

  • Homocysteine level CVD(Bautista et al.2002)

  • Homocysteine level stroke(Brattstrom, et al.1992)

  • Elevated homocysteine level

  • Genetic defects

    MTHFR(677C-->T)(Brattstrom, et al.1998)

  • Low intake

    Folate, vitamin B6 vitamin B12(Verhoef, et al.1996)


Folate

Folate

  • Folate and CVD

  • Folate and stroke

    Serum folate stroke (Wayne H. et al)

    >9.2mmol/L vs. 9.2mmol/L

    RBC folate stroke ( Killian Robinson )

    Folate intake & stroke

    Inverse correlation

    NHEFS (Lydia A. Bazzano et al.)

    Ischemic stroke in men(Ka He ,et al.)

    No significant association

    women (QAael K, et al.)


Folate1

Folate

  • (93-96)

  • 2003()


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Subjects and methods

Subjects and Methods


Study population

Study population

  • CVDFACTS (CardioVascular Disease risk Factor Two-township Study)

    () ()

  • 5cycle

    1989-1991

    1991-1993

    1993-1997

    1997-1999

    1999-2002

  • cyclecycle2.cycle3

  • 2cycle

  • Until cycle 4

    8011

    age 1-90

    men 3727 women 4284


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  • Ischemic stroke

    433,434,435,436,A292,A293

  • Hemorrhagic stroke

    431,432,A291

  • Subarachnoid hemorrahage

    430,A290

  • ischemic stroke

    Aspirin, ticlopin, heparin, warfarin, piracetam,

    pentoxifylline


Case control

Case & control

  • Case CVDFACTS

  • Control

    matching factors

    control


Match relation risk 2

MatchRelation risk=2


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  • : 1991-1993

  • 1234

    5678

    9B10

  • : 6+/+

  • >13


Biochemistry analysis

Biochemistry analysis

heparin

15min3000rpm;4000rpm

-70


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  • Plasma Folate

    Immunoassay

  • Plasma vitamin B6

    HPLC

  • Plasma vitamin B12

    Immunoassay


Risk factor

Risk factor

  • Age

  • Sex

  • ()

  • Smoking

    (neverpast smokercurrent smoker[1-10,10-20,>20/])

  • Hypertension (yes, no)

  • BMI (25, >25)

  • Alcohol intake (yes, no)

  • Physical activity

  • Education ( 12>12)

  • Total energy

  • Hypercholesterolemia (<240mg/dl, 240mg/dl)

  • Plasma vitamin B6

  • Plasma vitamin B12


Statistics

Statistics

  • Mean SD

  • t-test

    Difference of variables between case and control

  • Cox proportional hazard model

    RR and 95%CI

    Stratifying sex,

    (folate vs. stroke & subtype of stroke)

  • SAS v8.1


Thank you

Thank you


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