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Ahn J, Park HS, Cho SJ, Baek S, Rhee Y, Hong N. Association of secondhand smoke with fracture risk in community-dwelling nonsmoking adults in Korea. JBMR Plus 2024; 8:ziae010. [PMID: 38505531 PMCID: PMC10945720 DOI: 10.1093/jbmrpl/ziae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/01/2024] [Accepted: 01/07/2024] [Indexed: 03/21/2024] Open
Abstract
Although the detrimental effects of active smoking on bone health have been widely recognized, the impact of secondhand smoke exposure on fracture risk in non-smokers remains less understood. A total of 4843 nonsmokers aged 40-69 yr, who participated in the Korean Genome and Epidemiology Study from 2001 to 2018, were analyzed. The participants were categorized into two groups based on their exposure status to secondhand smoke: currently exposed and unexposed. The exposure group was subsequently divided into two subgroups based on the median weekly exposure time (high vs low). The incidence of new fractures was determined using self-reported questionnaires. The identified fractures were categorized according to the fracture site: overall, vertebral, hip, non-vertebral, and non-vertebral non-hip fractures. The mean age of the participants was 52.4 yr (84.1% women). Exposure to secondhand smoke was associated with an increased risk of fracture (adjusted hazard ratio [aHR]: 1.27, P = 0.028) after adjusting for multiple covariates including age, sex, BMI, household income, bone density of mid-shaft tibia, C-reactive protein, alcohol consumption, and fracture history. Secondhand smoke remained as a significant risk factor for fracture, independent of the major osteoporotic fracture probabilities estimated using a fracture risk assessment tool (aHR: 1.24, P = 0.038). The high exposure group had higher risk of fracture than that of the unexposed group (aHR: 1.33, P = 0.025), whereas the fracture risk did not differ significantly between low exposure and unexposed groups (aHR: 1.18, P = 0.253), suggesting a potential dose-response relationship. Secondhand smoke showed robust association with increased risk of non-vertebral (aHR: 1.37, P = 0.008) or non-vertebral non-hip fractures (aHR: 1.36, P = 0.013), while its association with vertebral fracture was attenuated (aHR: 1.03, P = 0.908). Secondhand smoke was associated with an elevated risk of fracture in nonsmokers, independent of clinical risk factors.
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Affiliation(s)
- Junyeong Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hye-Sun Park
- Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 03722, Republic of Korea
| | - Sung Joon Cho
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Seungjin Baek
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul 03722, Republic of Korea
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Association between blood cadmium levels and the risk of osteopenia and osteoporosis in Korean post-menopausal women. Arch Osteoporos 2021; 16:22. [PMID: 33527234 PMCID: PMC7850996 DOI: 10.1007/s11657-021-00887-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/06/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED We aimed to investigate the association between cadmium levels and the risk of osteopenia and osteoporosis in Korean post-menopausal women. There was a significant positive association between cadmium levels and the risk of osteopenia and osteoporosis, but further studies for dose response are required. PURPOSE Cadmium exposure can exert detrimental effects on bone health, particularly in post-menopausal women. However, previous studies have failed to report an association in Korean post-menopausal women. We aimed to investigate the association between cadmium levels and the risk of osteopenia and osteoporosis in Korean post-menopausal women. METHODS In total, 5432 participants from the 4th and 5th Korean National Health and Nutrition Examination Survey (KNHANES) were randomly sampled for measurements of heavy metal concentrations in the blood, bone mass density (BMD), and nutrient intake. We analyzed data for 1031 post-menopausal women ≥50 years of age. Blood cadmium levels were categorized into quartiles, and a multinomial logistic regression model was used for analysis. RESULTS There was a significant positive association between cadmium levels and the risk of osteopenia and osteoporosis, but the odds ratio (OR) at the 4th level was lower than that at the 3rd level (OR and 95% confidence interval (CI) for osteopenia: 2nd quartile: 1.24, 0.88-1.74; 3rd quartile: 3.22, 2.24-4.64; 4th quartile: 1.27, 0.87-1.85; P for trend <0.001; OR and 95% CI for osteoporosis: 2nd quartile: 1.54, 1.05-2.25; 3rd quartile: 3.63, 2.31-5.69; 4th quartile: 1.70, 1.03-2.81; P for trend <0.001). This trend was consistent in the sensitivity analysis. CONCLUSION Our findings suggest that there is an association between blood cadmium levels and the risk of osteopenia and osteoporosis in Korean post-menopausal women. However, further prospective studies are required to determine whether there is a dose-response relationship and address potential selection bias, especially in patients with femoral neck osteoporosis.
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Kiyota Y, Muramatsu H, Sato Y, Kobayashi T, Miyamoto K, Iwamoto T, Matsumoto M, Nakamura M, Tateno H, Sato K, Miyamoto T. Smoking cessation increases levels of osteocalcin and uncarboxylated osteocalcin in human sera. Sci Rep 2020; 10:16845. [PMID: 33033284 PMCID: PMC7546721 DOI: 10.1038/s41598-020-73789-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/16/2020] [Indexed: 12/14/2022] Open
Abstract
Smoking is thought to be a risk factor for osteoporosis development; however, the consequences of stopping smoking for bone homeostasis remain unknown. Here we conducted two separate human studies and show that bone mineral density was significantly lower in smokers than in non-smokers. The first was an observational study of pre- and post-menopausal healthy female smokers and non-smokers; the second included 139 current smokers determined to stop smoking. In the second study, levels of bone formation markers such as osteocalcin and uncarboxylated osteocalcin significantly increased after successful smoking cessation, as verified by significantly reduced levels of serum cotinine, a nicotine metabolite. Moreover, nicotine administration to mice reduced bone mineral density and significantly increased the number of osteoclasts in bone. Reduced bone mass phenotypes seen in nicotine-treated mice were significantly increased following nicotine withdrawal, an outcome accompanied by significantly reduced serum levels of tartrate-resistant acid phosphatase, a bone resorption marker. Taken together, our findings suggest that bone homeostasis is perturbed but can be rescued by smoking cessation.
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Affiliation(s)
- Yasuhiro Kiyota
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroyasu Muramatsu
- Chuo Naika Clinic, 2-7-8 Nihon-bashi Ningyou-chou, Chuo-ku, Tokyo, 103-0013, Japan
| | - Yuiko Sato
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tami Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kana Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroki Tateno
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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Kim H, Beom SH, Lee SH, Koh JM, Kim BJ, Kim TH. Differential association of dietary fat intake with DXA-based estimates of bone strength according to sex in the KNHANES IV population. Arch Osteoporos 2020; 15:62. [PMID: 32333189 DOI: 10.1007/s11657-020-00737-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/13/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED The higher the dietary fat intake is in men, the worse their bone strength. By contrast, in women, both low and high fat intakes have negative impacts on bone strength. Dietary fat intake may be a modifiable factor affecting bone health, but this needs to be reconfirmed in further studies. PURPOSE Despite the general belief that higher fat intake may be harmful for bone health, its impact on bone strength has not been thoroughly studied. METHODS We conducted a population-based cross-sectional study derived from the Korea National Health and Nutrition Examination Surveys, including 2590 participants. Composite indices of femoral neck strength, such as the compression strength index (CSI), bending strength index (BSI), and impact strength index (ISI), were generated by combining bone mineral density, weight, and height with the femoral axis length and width. Nutritional status was assessed using a 24-h dietary recall questionnaire. RESULTS Dietary fat intake (%: energy from fat intake/total energy intake × 100) was inversely related to CSI and ISI in men, but not in women. Men in the highest three fat intake quintiles had lower CSI, BSI, and/or ISI than those in the lowest quintile (P = 0.003-0.041). In women, compared with participants in the third fat intake quintile, those in the other four quintiles had lower CSI, BSI, and/or ISI (P = 0.004-0.049). When participants were allocated to three groups according to the dietary reference intake of fat in Koreans [low (< 15%), moderate (15-30%), or high (≥ 30%)], men with a moderate or high fat intake had significantly lower ISIs than those with a low fat intake (P = 0.045 and 0.040, respectively). By contrast, compared with women consuming a moderate amount of fat, those with a high intake had lower CSI, BSI, and ISI (P = 0.024-0.048). CONCLUSION Higher fat intake in men may contribute to deteriorations in bone strength. However, this finding and the observed sex differences need to be reconfirmed using established methods for assessment of dietary intake other than the 24-h dietary recall method employed in this study.
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Affiliation(s)
- Hyeonmok Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, 02053, South Korea
| | - Sun Hee Beom
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, 02053, South Korea
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Tae Ho Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, 02053, South Korea.
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Cho YM, Kim HR, Kang MY, Myong JP, Koo JW. Fixed night workers and failed smoking cessation. J Occup Med Toxicol 2019; 14:23. [PMID: 31404360 PMCID: PMC6683487 DOI: 10.1186/s12995-019-0243-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background The objective of this study was to examine the relationship between employee work schedule and failure in smoking cessation. Methods Logistic regression was used to estimate the association between work schedule and failed smoking cessation rate among 4927 male workers who had attempted smoking cessation. The data was obtained from the annual Korean National Health and Nutrition Examination Survey from 2007 to 2015 (excluding data from 2013). An adjusted model, including demographic and occupational variables, was constructed after stratifying the data into two subgroups by age (the 19- to 40-year-old group and the 41- to 60-year-old group). Results The percentage of smoking-cessation failure varied according to work schedule and age. The failure rate in the 19- to 40-year-old group was generally higher for all work schedule categories than in the 41- to 60-year-old group. In particular, the highest percentage (90.9%) of smoking-cessation failure was in the fixed overnight work group. After adjusting for demographic characteristics and work organization variables, the odds ratio for failed smoking cessation across all ages was 3.30 (95%CI 2.23–4.86) among the fixed overnight workers compared to the daytime workers. Both of the age-stratified subgroups maintained this relationship, with a notably higher OR in the 19- to 40-year-old group (OR 3.74, 95% CI 1.80–7.77). Conclusions Fixed overnight work is likely to negatively affect smoking cessation compared to other work schedules. Tailored anti-smoking intervention programs are required based on work schedule.
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Affiliation(s)
- Youn-Mo Cho
- Department of Occupational & Environmental Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Seoul Republic of Korea
| | - Hyoung-Ryoul Kim
- Department of Occupational & Environmental Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Seoul Republic of Korea
| | - Mo-Yeol Kang
- Department of Occupational & Environmental Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Seoul Republic of Korea
| | - Jun-Pyo Myong
- Department of Occupational & Environmental Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Seoul Republic of Korea
| | - Jung Wan Koo
- Department of Occupational & Environmental Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Seoul Republic of Korea
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Kim SJ, Kim MJ, Yoon SG, Myong JP, Yu HW, Chai YJ, Choi JY, Lee KE. Impact of smoking on thyroid gland: dose-related effect of urinary cotinine levels on thyroid function and thyroid autoimmunity. Sci Rep 2019; 9:4213. [PMID: 30862792 PMCID: PMC6414657 DOI: 10.1038/s41598-019-40708-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/19/2019] [Indexed: 11/20/2022] Open
Abstract
Cigarette smoking is believed to affect thyroid function and autoimmune thyroid disease. However, there is little information to analyze their association using objective biomarkers. The aim of this study was to investigate the dose-related effect of smoking on thyroid hormones and thyroid peroxidase antibody (TPO Ab) using urinary cotinine levels and a population-based cohort. The present study used the thyroid hormone and urinary cotinine dataset from sixth Korean National Health and Nutrition Examination Survey in 2014 and 2015, and a total of 4249 participants were included. Dose-response relationships between thyroid hormone (free T4, TSH, and TPO Ab) and urinary cotinine levels were estimated using ANCOVA after adjustment for all variables (age, height, weight, alcohol, exercise, and log- transformed iodine in urine). Urinary cotinine level was negatively correlated with TSH. The estimated coefficients were −0.0711 in males and −0.0941 in females (p < 0.0001). TPO Ab titer was positively correlated with cotinine levels in males (p < 0.0001). Our findings indicated a significant dose-related effect of urinary cotinine level on thyroid function, and thyroid autoimmunity.
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Affiliation(s)
- Su-Jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea
| | - Min Joo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Gab Yoon
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea
| | - Jun Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Hyeong Won Yu
- Department of Surgery, Bundang Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - June Young Choi
- Department of Surgery, Bundang Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Republic of Korea.
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AL-Bashaireh AM, Haddad LG, Weaver M, Kelly DL, Chengguo X, Yoon S. The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:4184190. [PMID: 30112011 PMCID: PMC6077562 DOI: 10.1155/2018/4184190] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
This systematic review explored associations between smoking and health outcomes involving the musculoskeletal system. AMSTAR criteria were followed. A comprehensive search of PubMed, Web of Science, and Science Direct returned 243 articles meeting inclusion criteria. A majority of studies found smoking has negative effects on the musculoskeletal system. In research on bones, smoking was associated with lower BMD, increased fracture risk, periodontitis, alveolar bone loss, and dental implant failure. In research on joints, smoking was associated with increased joint disease activity, poor functional outcomes, and poor therapeutic response. There was also evidence of adverse effects on muscles, tendons, cartilage, and ligaments. There were few studies on the musculoskeletal health outcomes of secondhand smoke, smoking cessation, or other modes of smoking, such as waterpipes or electronic cigarettes. This review found evidence that suggests tobacco smoking has negative effects on the health outcomes of the musculoskeletal system. There is a need for further research to understand mechanisms of action for the effects of smoking on the musculoskeletal system and to increase awareness of healthcare providers and community members of the adverse effects of smoking on the musculoskeletal system.
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Affiliation(s)
| | - Linda G. Haddad
- College of Health and Human Services, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Michael Weaver
- College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Xing Chengguo
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Saunjoo Yoon
- College of Nursing, University of Florida, Gainesville, FL, USA
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Kim BJ, Lee SH, Isales CM, Koh JM, Hamrick MW. The positive association of total protein intake with femoral neck strength (KNHANES IV). Osteoporos Int 2018; 29:1397-1405. [PMID: 29511792 PMCID: PMC6014874 DOI: 10.1007/s00198-018-4451-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/15/2018] [Indexed: 12/22/2022]
Abstract
UNLABELLED Data gathered from a nationally representative cohort demonstrate that higher dietary protein intake was positively associated with the composite indices of femoral neck strength in both men and women, suggesting that higher protein intake may contribute to lower risk of hip fracture through the improvement of bone strength. INTRODUCTION Despite the general belief that higher protein intake may be helpful for bone homeostasis, its impact on human bone health is still debated. Furthermore, the association of dietary protein intake with femoral neck (FN) strength, which can predict fracture risk independently of bone mineral density (BMD), has not been thoroughly studied. METHODS This is a population-based, cross-sectional study from Korea National Health and Nutrition Examination Surveys, including 592 men aged 50 years or older and 590 postmenopausal women. The composite indices of FN strength, such as the compression strength index (CSI), bending strength index (BSI), and impact strength index (ISI), were generated by combining BMD, body weight, and height with the femoral axis length and width, which were measured by dual-energy X-ray absorptiometry. RESULTS After adjustment for confounders, total protein intake (g/kg/day) positively correlated with all three FN composite indices in both genders (P = 0.006 to 0.035), except for BSI showing marginal significance in postmenopausal women (P = 0.093). Consistently, compared with subjects in lowest total protein intake quartile, those in the highest quartile showed markedly higher CSI, BSI, and ISI values (P = 0.043 to < 0.001), with a dose-response manner across increasing total protein intake quartile categories in both men and women (P for trend = 0.028 to < 0.001). CONCLUSIONS These findings provide the clinical evidence that higher dietary protein intake can play a beneficial role on bone health through the increase of FN strength relative to load in adults.
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Affiliation(s)
- B-J Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Laney Walker Blvd. CB2915, Augusta, GA, 30912, USA
| | - S H Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - C M Isales
- Departments of Orthopaedic Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - J-M Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - M W Hamrick
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Laney Walker Blvd. CB2915, Augusta, GA, 30912, USA.
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Strozyk D, Gress TM, Breitling LP. Smoking and bone mineral density: comprehensive analyses of the third National Health and Nutrition Examination Survey (NHANES III). Arch Osteoporos 2018; 13:16. [PMID: 29502242 DOI: 10.1007/s11657-018-0426-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 01/17/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Some questions remain on the relationship between smoking and bone health. Detailed analyses of the relationship between smoking and BMD are presented, essentially ruling out non-linear associations as an explanation for inconsistent results in the literature. INTRODUCTION To provide comprehensive multiple regression and dose-response analyses of the association between smoking behavior variables and bone health as assessed by radiologically determined bone mineral density in NHANES III. METHODS Analyzes of a representative cross-sectional survey of the noninstitutionalized population of the USA. Self-reported smoking behavior and bone mineral density of 14,510 participants were analyzed using survey design-based multiple linear regression modeling. Dose-response patterns were analyzed using restricted cubic spline regression. RESULTS Femoral neck bone mineral density in current smokers was numerically lower than in never smokers, but this was not statistically significant after controlling for confounders. In former smokers, bone mineral density T scores were 0.064 units higher for every 10 years of abstinence, with little impact of confounder adjustment. Spline regression revealed no relevant non-linearity in the associations studied. CONCLUSIONS Non-linearity is an unlikely explanation for inconsistent results in the literature on smoking and bone mineral density. Further and especially longitudinal studies of the complex relationship smoking with bone health would be particularly important given the still substantial prevalence of smoking in an aging global population.
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Affiliation(s)
- Dominik Strozyk
- Department of Internal Medicine, GRN Hospital Sinsheim, Sinsheim, Germany
| | - Thomas M Gress
- Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, Philipps University of Marburg, Marburg, Germany
| | - Lutz P Breitling
- Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, Philipps University of Marburg, Marburg, Germany. .,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
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Abstract
Background: We evaluated the relationship between secondhand smoke (SHS) inhalation, as verified by urinary cotinine levels, and bone health. Methods: We analyzed the nationwide, population-based, cross-sectional health survey. We included 1936 men aged 50 years or older who checked bone mineral density (BMD) from the Korean National Health and Nutrition Examination Survey (2008–2010). Current smokers assessed by urinary cotinine levels higher than 500 ng/mL were excluded (n = 616). Exposure to SHS was determined using a 50 ng/mL urinary cotinine threshold. Results: The estimated prevalence of SHS exposure in our cohort was 13.9%. After adjusting for age and body mass index (BMI), T-scores at total femur (P < 0.001), femoral neck (P < 0.001), and lumbar spine (P = 0.004) were lower in SHS exposure versus nonexposure groups. Impaired bone health (osteopenia or osteoporosis) at femoral neck or lumbar spine was evident in 61.7% and 48.6% of SHS exposure and nonexposure cases, respectively (P = 0.004). Moreover, after adjusting for age, BMI, and health habits, the odds ratio for impaired bone health in the SHS exposure group was 1.89 (95% confidence interval: 1.31–2.74). Conclusions: Our findings suggest that SHS exposure, determined by urinary cotinine levels, is negatively associated with BMD and is a leading cause of impaired bone health in Korean men.
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Affiliation(s)
- Ji Hyun Moon
- Department of Family Medicine, Jeju National University Hospital, Jeju Self-governing Province, Republic of Korea.,Department of Medicine, Graduate School of Jeju National University, Jeju Self-governing Province, Republic of Korea
| | - Mi Hee Kong
- Department of Family Medicine, Jeju National University Hospital, Jeju Self-governing Province, Republic of Korea.,Department of Family Medicine, School of Medicine, Jeju National University, Jeju Self-governing Province, Republic of Korea
| | - Hyeon Ju Kim
- Department of Family Medicine, Jeju National University Hospital, Jeju Self-governing Province, Republic of Korea.,Department of Family Medicine, School of Medicine, Jeju National University, Jeju Self-governing Province, Republic of Korea
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11
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Lee JH, Hong AR, Kim JH, Kim KM, Koo BK, Shin CS, Kim SW. Amount of smoking, pulmonary function, and bone mineral density in middle-aged Korean men: KNHANES 2008-2011. J Bone Miner Metab 2018; 36:95-102. [PMID: 28144749 DOI: 10.1007/s00774-017-0811-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/15/2016] [Indexed: 01/21/2023]
Abstract
Smoking induces bone loss; however, data on the relationship between smoking history and bone mineral density (BMD) are lacking. Age and pulmonary function can affect BMD. We investigated the relationships among pack-years (PYs) of smoking, pulmonary function, and BMD in middle-aged Korean men (50-64 years old). This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey, 2008-2011. All participants underwent BMD measurements using dual energy X-ray absorptiometry and pulmonary function tests using standardized spirometry. In total, 388 never-smokers and 1088 ever-smokers were analyzed. The number of PYs of smoking was negatively correlated with total hip BMD (r = -0.088; P = 0.004) after adjusting for age, height, and weight. Ever-smokers were classified into 3 groups according to PYs of smoking. The highest tertile (n = 482) exhibited significantly lower total hip bone mass than the lowest tertile (n = 214) after adjusting for confounding factors (age, height, weight, forced expiratory volume in 1 s (FEV1), alcohol consumption, physical activity, and vitamin D levels) that could affect bone metabolism (P = 0.003). In conclusion, smoking for >30 PYs was significantly associated with low hip BMD after adjusting for pulmonary function in middle-aged Korean men. Long-term smoking may be a risk factor for bone loss in middle-aged men independent of age, height, weight, and pulmonary function.
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Affiliation(s)
- Ji Hyun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - A Ram Hong
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 156-707, South Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
- Department of Internal Medicine, Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 156-707, South Korea.
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12
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Ahn SH, Seo DH, Kim SH, Nam MS, Hong S. The relationship between fatty liver index and bone mineral density in Koreans: KNHANES 2010-2011. Osteoporos Int 2018; 29:181-190. [PMID: 29051986 DOI: 10.1007/s00198-017-4257-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/05/2017] [Indexed: 12/28/2022]
Abstract
UNLABELLED Analyses using a nationally representative cohort have revealed that high fatty liver index (FLI) is associated with low bone mineral density (BMD) regardless of insulin resistance in men, thereby supporting the deteriorated bone metabolism in nonalcoholic fatty liver disease (NAFLD). INTRODUCTION NAFLD is linked to deteriorated bone health. We investigated the association of FLI, a scoring model for NAFLD, with BMD. METHODS This was a population-based, cross-sectional study from the Korea National Health and Nutrition Examination Surveys including 4264 Koreans (1908 men and 2356 women). FLI was calculated using body mass index, waist circumference, serum triglyceride, and gamma-glutamyltranspeptidase level. Insulin resistance was evaluated using the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. BMD was measured using dual-energy X-ray absorptiometry at the lumbar spine, total hip, femoral neck, and whole body. RESULTS Men had a higher FLI than women, while the HOMA-IR index was similar between men and women. The significant association between FLI and BMD was observed only in men, but not in women. FLI was negatively correlated with total hip, femoral neck, and whole body BMD in men after adjusting for all potential confounders, including HOMA-IR (P < 0.001 to 0.010). Lumbar spine, total hip, femoral neck, and whole body BMD in men showed a decreasing trend as the FLI tertile increased after adjusting for all potential confounders, including HOMA-IR (P for trends < 0.001 to 0.034). In men aged 50 years or older, odds ratios for combined osteopenia and osteoporosis increased across increasing FLI tertiles after adjusting for confounders (P for trends < 0.011 to 0.029). CONCLUSION NAFLD is associated with low bone density regardless of insulin resistance in men. These findings suggest an undiscovered direct link between liver and bone that increases the risk of osteoporosis in men with NAFLD.
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Affiliation(s)
- S H Ahn
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea
| | - D H Seo
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea
| | - S H Kim
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea
| | - M-S Nam
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea
| | - S Hong
- Division of Endocrinology and Metabolism, Inha University Hospital, Inha University School of Medicine, Incheon, 22332, Republic of Korea.
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13
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Kwak J, Jeong H, Chun S, Bahk JH, Park M, Byun Y, Lee J, Yim HW. Effectiveness of government anti-smoking policy on non-smoking youth in Korea: a 4-year trend analysis of national survey data. BMJ Open 2017; 7:e013984. [PMID: 28706085 PMCID: PMC5577913 DOI: 10.1136/bmjopen-2016-013984] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Since the Health Promotion Act was introduced in Korea in 1995, anti-smoking policies and regulations have undergone numerous revisions, and non-smoking areas have gradually been expanded. The purpose of this study was to examine the impact of a partial legislative ban on adolescent exposure to secondhand smoke using objective urinary cotinine levels in a nationwide representative sample. METHODS Urine cotinine levels were measured in the Korea National Health and Nutrition Examination Survey from 2008 to 2011. This study was a trend analysis of 4 years of national survey data from 2197 Korean youth aged 10-18 years. Among non-smokers, the 75th percentile urinary cotinine level was estimated. We also considered the number of household smokers. RESULTS The 75th percentile urine cotinine level of non-smokers showed a significant decreasing trend from 2008 to 2011, from 15.47 to 5.37 ng/mL, respectively. Urine cotinine did not decline significantly in non-smokers living with smokers during the study period. The results did not show a statistically significant reduction in smoking rate in adolescents from 2008 to 2011, although there was a trend towards a decrease (p=0.081). CONCLUSIONS Based on urine cotinine levels, government-initiated anti-smoking policies have only been effective among highly exposed non-smoking adolescents during the study period. Further study needs to evaluate whether or not the legislative ban affects domestic smoking exposure.
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Affiliation(s)
- Jueun Kwak
- Catholic Medical Center, Seoul, Republic of Korea
| | - Hyunsuk Jeong
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungha Chun
- College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hoon Bahk
- Catholic Medical Center, Seoul, Republic of Korea
| | - Misun Park
- Clinical Research Coordinating Center, Catholic Medical Center, Republic of Korea
| | | | - Jina Lee
- Catholic Medical Center, Seoul, Republic of Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Clinical Research Coordinating Center, Catholic Medical Center, Republic of Korea
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14
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Kim H, Lee SH, Kim BJ, Koh JM. Association between obesity and femoral neck strength according to age, sex, and fat distribution. Osteoporos Int 2017; 28:2137-2146. [PMID: 28352995 DOI: 10.1007/s00198-017-4015-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 03/17/2017] [Indexed: 01/22/2023]
Abstract
UNLABELLED Indicators of total and abdominal obesity were negatively associated with femoral neck strength indices. There are age-, sex-, and fat distribution-specific differences in the magnitude of these associations. These suggested that indicators of obesity with different magnitude according to age, sex, and fat distribution associated with poor bone health. INTRODUCTION Fat regulates bone metabolism, but the associations of total and abdominal obesity with bone health are inconsistent. We investigated the association between indicators of obesity and composite indices of femoral neck (FN) strength reflecting the risk of hip fracture. METHODS This population-based cross-sectional study examined data from the Korea National Health and Nutrition Examination Surveys. Participants were divided into groups according to age (25-49/≥50 years) and sex. We examined total fat mass (TFM) and percentage fat mass (pFM) as indicators of total obesity and truncal fat mass (TrFM) as an indicator of abdominal obesity. We calculated the composite indices of FN strength and anthropometric clinical indicators of abdominal obesity. RESULTS TFM, pFM, and TrFM were negatively associated with the composite indices, irrespective of age and sex (P < 0.001-0.005). Most anthropometric clinical indicators of abdominal obesity showed negative associations with the composite indices regardless of age and sex (P < 0.001-0.048), except for women aged 25-49 years. In men, magnitudes of the negative contributions of TFM to the composite indices were significantly stronger at age 25-49 years than at age ≥50 years. Magnitudes of negative associations of TFM with the composite indices were greater in men than in women. TrFM had a more detrimental effect than TFM on FN strength in men aged 25-49 years and in women of both ages. CONCLUSION Indicators of total and abdominal obesity negatively associated with FN strength, and magnitudes of their effects on bone health differed according to age, sex, and fat distribution.
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Affiliation(s)
- H Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea
| | - S H Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea.
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea.
| | - B J Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea
| | - J M Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea
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15
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Chang HK, Chang DG, Myong JP, Kim JH, Lee SJ, Lee YS, Lee HN, Lee KH, Park DC, Kim CJ, Hur SY, Park JS, Park TC. Bone mineral density among Korean females aged 20-50 years: influence of age at menarche (The Korea National Health and Nutrition Examination Survey 2008-2011). Osteoporos Int 2017; 28:2129-2136. [PMID: 28293690 DOI: 10.1007/s00198-017-3997-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 03/01/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED To evaluate a possible correlation between bone mineral density (BMD) and age at menarche, the present study used the BMD dataset of the Korea National Health and Nutrition Examination Survey IV-V (KNHANES IV-V). Age at menarche had a small but significant association with BMD of the lumbar spine in premenopausal Korean females, aged 20-50 years. INTRODUCTION To investigate any correlation between bone mineral density (BMD) and age at menarche in Korean females using data from the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V; 2008-2011). METHODS In total, 37,753 individuals participated in health examination surveys between 2008 and 2011. A total of 5032 premenopausal females aged 20-50 years were eligible. Age, height, weight, and age at menarche were assessed. RESULTS Results from the univariate linear regression and analysis of covariance (ANCOVA) indicated that age (per 1 year), height (per 1 cm), weight (per 1 kg), exercise (per 1 day/week), familial osteoporosis history (yes), parity (n = 0 to ≥4), and menarche age distribution were associated with BMD of the total femur, femur neck, and lumbar spine. After stratifying the bone area and adjusting for age, parity, alcohol intake, smoking, exercise, and familial osteoporosis history, no effect was seen for the total femur or femur neck. Age at menarche 16~17 and ≥18 years groups were associated with BMD of the lumbar spine only. CONCLUSIONS Age at menarche had a small but significant association with BMD of the lumbar spine in premenopausal Korean females, aged 20-50 years. Females with late menarche may achieve lower peak bone mass at some skeletal sites, which may put them at greater risk for osteoporosis in later life.
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Affiliation(s)
- H K Chang
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - D-G Chang
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - J-P Myong
- Department of Occupational & Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - J-H Kim
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea
| | - S-J Lee
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Y S Lee
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H-N Lee
- Department of Obstetrics and Gynecology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K H Lee
- Department of Obstetrics and Gynecology, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - D C Park
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - C J Kim
- Department of Obstetrics and Gynecology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S Y Hur
- Department of Obstetrics and Gynecology, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - J S Park
- Department of Obstetrics and Gynecology, Seoul St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - T C Park
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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16
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Lim HS, Lee HH, Kim TH, Lee BR. Relationship between Heavy Metal Exposure and Bone Mineral Density in Korean Adult. J Bone Metab 2016; 23:223-231. [PMID: 27965944 PMCID: PMC5153379 DOI: 10.11005/jbm.2016.23.4.223] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 11/16/2022] Open
Abstract
Background Exposure to heavy metals from environmental and industrial sources remains a concern of serious public health risk. This study was conducted to analysis the relationship between heavy metal concentrations and bone density. Methods This study used data from a nation-based sample of Koreans (n=2,429) from 2008 to 2011 Korea National Health and Nutrition Examination Survey. We were obtained heavy metals (lead, mercury and cadmium), socioeconomic and demographic factors and bone mineral density (BMD) measured by T-score. Results Menopausal women, current smoker or the frequent alcohol drinking, low educational level and low family income were greater in the osteopenia or osteoporosis groups than normal group, and were associated with an increased blood heavy metal concentration levels. The highest quartile group in blood lead had a 1.47 times (95% confidence interval [CI] 1.16-1.87) risk of osteopenia or osteoporosis. In case of blood cadmium, the risk for osteopenia or osteoporosis increased 2.1 times (95% CI 1.64-2.68). Conclusions We observed a significant association between blood heavy metals (lead and cadmium) levels and low BMD. Our findings suggest that heavy metal exposure may be a risk factor for osteoporosis.
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Affiliation(s)
- Hee-Sook Lim
- Department of Clinical Nutrition, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.; Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hae-Hyeog Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bo-Ra Lee
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang Unversity Bucheon Hospital, Bucheon, Korea
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17
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Ahn SH, Kim H, Kim BJ, Lee SH, Koh JM. Insulin resistance and composite indices of femoral neck strength in Asians: the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). Clin Endocrinol (Oxf) 2016; 84:185-193. [PMID: 26426810 DOI: 10.1111/cen.12958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/19/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Fracture risk in type 2 diabetes mellitus with insulin resistance is increased, despite relatively preserved bone mineral density (BMD). In this study, we investigated the relationship between insulin resistance and composite indices of femoral neck strength in Koreans. DESIGN A population-based, cross-sectional study from the Korea National Health and Nutrition Examination Survey PARTICIPANTS: About 1243 men and 1433 women MEASUREMENTS: Insulin resistance was evaluated using the homoeostasis model assessment-estimated insulin resistance (HOMA-IR) index. Femoral neck width and axis length were measured from hip dual-energy X-ray absorptiometry scans and combined with BMD, weight and height to calculate composite indices of femoral neck strength relative to load: compression (CSI), bending (BSI) and impact strength indices (ISI). RESULTS HOMA-IR showed an inverse relationship with CSI, BSI and ISI in both genders before and after adjusting for confounders (P < 0·001-0·029). CSI was more strongly associated with HOMA-IR than BSI and/or ISI in both genders (P < 0·001-0·013). When men were stratified according to HOMA-IR quartiles, all strength indices decreased as the quartile increased, after adjusting for all potential confounders (P for trend <0·001-0·001), whereas CSI and ISI did in women (P for trend = 0·012 and 0·002, respectively). Fasting insulin levels, but not glucose levels, were negatively associated with all strength indices regardless of confounders (P < 0·001-0·044). CONCLUSIONS Insulin resistance is associated with low femoral neck strength, particularly against the compressive load. These findings suggest a better approach to evaluate bone health in insulin-resistant individuals.
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Affiliation(s)
- Seong Hee Ahn
- Division of Endocrinology and Metabolism, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeonmok Kim
- Division of Endocrinology and Metabolism, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
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Fucic A, Plavec D, Casteleyn L, Aerts D, Biot P, Katsonouri A, Cerna M, Knudsen LE, Castano A, Rudnai P, Gutleb A, Ligocka D, Lupsa IR, Berglund M, Horvat M, Halzlova K, Schoeters G, Koppen G, Hadjipanayis A, Krskova A, Középesy S, Arendt M, Fischer ME, Janasik B, Gurzau AE, Gurzau ES, Grandér M, Larsson K, Jajcaj M, Kolossa-Gehring M, Sepai O, Exley K, Bartolome M, Cutanda F, Mazej D, Nielsen JKS, Snoj-Tratnik J, Schwedler G, Fiddicke U, Seiwert M, Govarts E, Den Hond E, Koch HM, Lopez A, Joas A, Joas R. Gender differences in cadmium and cotinine levels in prepubertal children. ENVIRONMENTAL RESEARCH 2015; 141:125-131. [PMID: 25529752 DOI: 10.1016/j.envres.2014.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 08/27/2014] [Accepted: 10/01/2014] [Indexed: 06/04/2023]
Abstract
Susceptibility to environmental stressors has been described for fetal and early childhood development. However, the possible susceptibility of the prepubertal period, characterized by the orchestration of the organism towards sexual maturation and adulthood has been poorly investigated and exposure data are scarce. In the current study levels of cadmium (Cd), cotinine and creatinine in urine were analyzed in a subsample 216 children from 12 European countries within the DEMOCOPHES project. The children were divided into six age-sex groups: boys (6-8 years, 9-10 years and 11 years old), and girls (6-7 years, 8-9 years, 10-11 years). The number of subjects per group was between 23 and 53. The cut off values were set at 0.1 µg/L for Cd, and 0.8 µg/L for cotinine defined according to the highest limit of quantification. The levels of Cd and cotinine were adjusted for creatinine level. In the total subsample group, the median level of Cd was 0.180 µg/L (range 0.10-0.69 µg/L), and for cotinine the median wet weight value was 1.50 µg/L (range 0.80-39.91 µg/L). There was no significant difference in creatinine and cotinine levels between genders and age groups. There was a significant correlation between levels of cadmium and creatinine in all children of both genders. This shows that even at such low levels the possible effect of cadmium on kidney function was present and measurable. An increase in Cd levels was evident with age. Cadmium levels were significantly different between 6-7 year old girls, 11 year old boys and 10-11 year old girls. As there was a balanced distribution in the number of subjects from countries included in the study, bias due to data clustering was not probable. The impact of low Cd levels on kidney function and gender differences in Cd levels needs further investigation.
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Affiliation(s)
- A Fucic
- Institute for Medical Research and Occupational Health, Ksaverska c 2, 10000 Zagreb, Croatia.
| | - D Plavec
- Children Hospital Srebrnjak, Croatia
| | | | - D Aerts
- Federal Public Service Health, Food Chain Safety and Environment - DG Environment, Belgium
| | - P Biot
- DG Environment, Multilateral and Strategic Affairs, Belgium
| | - A Katsonouri
- State General Laboratory, Ministry of Health, Cyprus
| | - M Cerna
- Laboratoire National de Sante, Luxembourg; National Institute of Public Health, Czech Republic
| | | | - A Castano
- Instituto de Salud Carlos III, Spain
| | - P Rudnai
- National Institute of Environmental Health, Hungary
| | - A Gutleb
- Centre de Recherche Public - Gabriel Lippmann, Luxembourg
| | - D Ligocka
- Nofer Institute of Occupational Medicine, Poland
| | - I-R Lupsa
- Environmental Health Center, Romania
| | - M Berglund
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - M Horvat
- Institute Josef Stefan, Slovenia
| | - K Halzlova
- Public Health Authority, Slovak Republic; State General Laboratory, Ministry of Health, Cyprus
| | - G Schoeters
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Netherlands
| | - G Koppen
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Netherlands
| | - A Hadjipanayis
- Larnaca General Hospital, Ministry of Health, Republic of Cyprus
| | - A Krskova
- Laboratoire National de Sante, Luxembourg; National Institute of Public Health, Czech Republic
| | - S Középesy
- National Institute of Environmental Health, Hungary
| | - M Arendt
- Initiativ Liewensufank, Luxembourg
| | - M E Fischer
- Laboratoire National de Sante, Luxembourg; National Institute of Public Health, Czech Republic
| | - B Janasik
- Nofer Institute of Occupational Medicine, Poland
| | | | | | - M Grandér
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - K Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - M Jajcaj
- Institute Josef Stefan, Slovenia
| | | | | | | | | | - F Cutanda
- Instituto de Salud Carlos III, Spain
| | - D Mazej
- Institute Josef Stefan, Slovenia
| | | | | | | | - U Fiddicke
- Federal Environment Agency (UBA), Germany
| | - M Seiwert
- Federal Environment Agency (UBA), Germany
| | - E Govarts
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Netherlands
| | - E Den Hond
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health, Netherlands
| | - H M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance - Institute of the Ruhr-Universität Bochum (IPA), Germany
| | - A Lopez
- Instituto de Salud Carlos III, Spain
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19
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Øyen J, Gram Gjesdal C, Nygård OK, Lie SA, Meyer HE, Apalset EM, Ueland PM, Pedersen ER, Midttun Ø, Vollset SE, Tell GS. Smoking and body fat mass in relation to bone mineral density and hip fracture: the Hordaland Health Study. PLoS One 2014; 9:e92882. [PMID: 24667849 PMCID: PMC3965480 DOI: 10.1371/journal.pone.0092882] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/26/2014] [Indexed: 11/23/2022] Open
Abstract
Lower bone mineral density (BMD) in smokers may be attributable to lower body weight or fat mass, rather than to a direct effect of smoking. We analyzed the effects of smoking exposure, assessed by plasma cotinine, and body fat on BMD and the risk of subsequent hip fracture. In the community-based Hordaland Health Study (HUSK), 3003 participants 46-49 years and 2091 subjects 71-74 years were included. Cotinine was measured in plasma and information on health behaviors was obtained from self-administered questionnaires. BMD and total body soft tissue composition were measured by dual X-ray absorptiometry. Information on hip fracture was obtained from computerized records containing discharge diagnoses for hospitalizations between baseline examinations 1997-2000 through December 31st, 2009. In the whole cohort, moderate and heavy smokers had stronger positive associations between fat mass and BMD compared to never smokers (differences in regression coefficient (95% CI) per % change in fat mass = 1.38 (0.24, 2.52) and 1.29 (0.17, 2.4), respectively). In moderate and heavy smokers there was a nonlinear association between BMD and fat mass with a stronger positive association at low compared to high levels of fat mass (Davies segmented test, p<0.001). In elderly women and men, heavy smokers had an increased risk of hip fracture compared to never smokers (hazard ratio = 3.31, 95% CI: 2.05, 5.35; p<0.001). In heavy smokers there was a tendency of a lower risk of hip fracture with higher percentage of fat mass. The deleterious effect of smoking on bone health is stronger in lean smokers than in smokers with high fat mass.
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Affiliation(s)
- Jannike Øyen
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Clara Gram Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ottar Kjell Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Haakon E. Meyer
- Section for Preventive Medicine and Epidemiology, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Division of Epidemiology, Oslo, Norway
| | - Ellen Margrete Apalset
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Per Magne Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | | | | | - Stein Emil Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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