Don't Miss the Golden Period for Your Health

Dr. CHEUNG Yu, Vincent

Resident Medical Officer

Specialist in Family Medicine

Are you bored with the annual body check routine items of fasting glucose and lipid profile? Are there any item that is important but usually not included in ordinary body check package?

After knowing that you have "borderline elevated glucose/cholesterol/fatty liver/blood pressure", have you seriously taken action to rectify the problems and improve your health accordingly? Do you know how serious your "borderline" fasting blood glucose/cholesterol/fatty liver/blood pressure is?

Tailor-made Body Check with Pre-and Post-test Counselling

Regular health check-up is crucial to identifying potential health problems and ensuring overall wellness. When it comes to “what to check” and “how to check”, there is simply no one-size-fits-all solution. As a Family Physician, I treasure the importance of knowing the medical history of my patients and their families, the patients’ past physical examination results, occupations, lifestyles and medication in use before providing tailored advice and ordering a targeted body check.

Tailor-made body check and pre-test counselling make screening tests meaningful. Also it is essential to have post-test follow-up counselling and an action plan. It is far from satisfactory that people simply shop for screening packages and interpret the results by merely comparing the reference range themselves! Worst of all, many people only care about annual body check but take no corresponding actions for abnormal readings.

Fasting Blood Glucose is Not Enough

Fasting glucose is affected by stress and recent illness. Furthermore, checking fasting blood glucose alone is not sensitive enough for diagnosis, as it can miss up to one-third of diabetes cases.

On the other hand, HbA1c can reflect your glucose control over the recent 2 to 3 months’ time. It also better predicts your cardio-metabolic risks than fasting blood glucose. 

Family Physicians will order further HbA1c, even 75g Oral Glucose Tolerance Test if you have the following high risk factors, such as:

• For Asian population, BMI over 23
• A waist circumference over 90cm/36 inches for male, or over 80cm/ 32 inches for female;
• 35 years old or above;
• A history of diabetes in direct relatives;
• Fewer than 3 sessions of exercise per week;
• A history of gestational diabetes, or having giving birth to a baby weighing over 9 pounds/4kg;
• A history of polycystic ovary syndrome or sleep apnea;
• A history of high blood pressure, high lipid, heart disease or stroke; and
• Ethnicity, e.g. Asian, African, Latin American, Indian, etc.

A study of 2,285 participants aged 30 or above from the National Health and Nutrition Examination Survey found that trouble maintaining sleep over 5 times per month, waking up too early more than 5 times per month, and sleeping less than 5 hours per night would increase the risk of pre-diabetes by 3.5, 2.7 and 2.1 times respectively. Either insomnia or inadequate sleep can increase stress hormones and lead to elevated blood glucose levels. 

Often adopted by laboratories, the so-called “normal reference levels” only refer to diabetes, not pre-diabetes. Do not take the readings of fasting glucose below 7 mmol/L and HbA1c below 6.5% as normal. Instead, try to keep in mind the following figures, i.e. fasting glucose at or below 5.5, HbA1c at 5.6 or below, and 7.7 or below on a 75g Oral Glucose Tolerance Test. 

For more information, please see the YouTube video entitled “Pre-diabetes” at https://www.youtube.com/watch?v=361LV-6D2lk.

"My home blood pressure is 136/88mmHg. Is it Normal? But my clinic blood pressure is 156/94 mmHg…I hope it is nothing but white coat syndrome, as I don’t want to take medication…”

In countries like China, Korea, Japan, the US and even Europe, normal blood pressure is usually defined as below 120/80mmHg.

According to the Systolic Blood Pressure Intervention Trial (SPRINT) Study, if we treat systolic blood pressure to lower than 120mmHg, we can reduce cardiovascular events by 25% and reduce the overall risk of death by 27%.

Do the Elderly Deserve Higher Blood Pressure?

According to the STEP Trial 2021, old people aged from 60 to 80 actually have 26% less cardiovascular events if their blood pressure treatment target is systolic 110 - 130mmHg as compared with the "conventional" 130 – 150mmHg.

Beware of Fatty Liver

Don't mistakenly think that fatty liver just means obesity. Actually fatty liver is associated with chronic necro-inflammation of the liver, which can increase the risk of liver cirrhosis and liver cancer by 2 to 3 folds. Fatty liver can also increase the risk of heart failure by 3.5 folds.

If diagnosed with fatty liver by ultrasound, one should resort to the more accurate and sensitive FibroScan test. As a new type of ultrasound that is non-invasive and without radiation, FibroScan can quantify one’s severity of fatty liver/ fibrosis severity.

Keep an Eye on Cardiovascular Health

For those who have hypercholesterolemia/high ASCVD (Atherosclerotic Cardiovascular Disease) risks, how about Doppler ultrasound for carotid arteries, hs-CRP or Lp(a)?

Doppler ultrasound can detect plaques (stenosis) in carotid arteries, making it especially important for patients with Transient Ischemic Attack (TIA, or "minor stroke"), diabetes and hypercholesterolemia.

The hsCRP test can reflect the level of inflammation, and is associated with increased risk of heart attack if greater than 2mg/L.

With consensus, the European Atherosclerosis Society 2022 advocated that Lp(a) be tested at least once in adult life, for Lp(a) has a linear relationship with ASCVD risks.

In conclusion, Doppler ultrasound for carotid arteries, hsCRP and Lp(a) can provide doctors with a clearer picture of one’s cardiovascular risks, which in turn helps us decide whether one needs drug treatment for hypercholesterolemia and at what LDL-cholesterol level one’s treatment should target.

More than Just Price

Package prices vary with the number and type of tests included. And the discrepancy could be significant for the same test item, depending on the accuracy, sensitivity, specificity and negative predictive value of the test(s) provided. Other factors include service and equipment accreditation of related international authorities, provision of pre-test counselling by a related specialist as well as result interpretation and follow-up by medical professionals.

Generally speaking, the issues of “what to check” and “how to check” have to do with the needs and condition of each patient. It makes pre-test discussion with doctors crucial, as they are trained to see each patient as a separate individual and gain insights from his/her medical history and his/her family’s, use of medication and clinical observation before providing tailored check-up.

For example, a positive BRCA test result suggests a 87% lifetime risk for breast cancer. However, despite its high accuracy, the more expensive BRCA test is not necessarily recommended for high-risk individuals as it might bring no benefits other than unwarranted fear and stress in those who simply decide not to take action after checking. As for lung cancer, due to its failure in detecting abnormalty in the respiratory tract, a “normal” X-ray chest result may lead to a sense of false security in longtime smokers, seniors and high-risk patients and thus missed treatment opportunities. By comparsion, a low-dose CT thorax is clinically proven to be more effective in prevention with a 20% decrease in lung cancer mortality.

In detecing nasopharyngeal cancer, Family Physicans prefer the more expensive but more reliable EBV DNA tests to EBV IgA tests, which are commonly used in most laboratories. With lower sensitivity and specificity, EBV IgA tests tend to produce more false positives and false negatives.

For patients with hypertension or diabetes, due to the limits of urine routine in detecting proteinuria at above 300mg/d (the normal range is below 30mg/d), morning spot urine microalbumin/creatinine ratio is usually recommended for early detection of microalbuminuria, i.e. 30-300mg/d, and prescription of medication for kidney protection.

In short, the higher the risk, the more detailed and thorough the check-ups. And sometimes blood tests are complemented by structural imaging examinations to ensure a full, comprehensive picture of a patient’s condition during assessment.