Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES)

Association of early-onset diabetes with socioeconomic, and health factors: a matched case-control study controlling for age, gender, and BMI

Objectives

This study examines the link between early-onset diabetes and health factors in South Korean young adults (20-39) using data from the Korea National Health and Nutrition Examination Survey (2010-2020).

Methods

A matched case-control study was conducted in 2022 with 103 patients with diabetes and 103 controls, matched by age, gender, and BMI. All data, including socioeconomic status (income, education, occupation), health behaviors (smoking, alcohol consumption, physical activity), and medical histories, were extracted from the KNHANES database. We analyzed socioeconomic status, health behaviors, and medical histories using descriptive statistics, chi-square tests, and binary logistic regression.

Results

The study revealed that educational attainment and economic status are substantial predictors of diabetes, with those holding only a high school diploma showing a nearly threefold increased risk compared to college graduates (OR = 2.986; 95% CI = 1.334-6.687). Additionally, participants with a higher number of chronic diseases (OR = 3.534; 95% CI: 1.547-8.073) and those who felt unwell in the past two weeks (OR = 4.010; 95% CI: 1.388-11.585) also demonstrated significantly increased odds of diabetes. And having a parent with diabetes was an exceptionally strong predictor, with these participants having a significantly increased risk of diabetes (OR = 47.022; 95% CI = 4.206-525.704).

Conclusion

The study emphasizes that improving educational and economic conditions, coupled with targeted screening programs for individuals with a family history of diabetes, may be effective in curbing the tide of early-onset diabetes in South Korea. These strategies may have profound implications for public health policies aimed at mitigating the risk in this increasingly vulnerable group.

National Trends of Vascular Risk Factor Control Among Stroke Survivors in Korea: From the National Health and Nutrition Examination Survey 2010 to 2021

BACKGROUND

To prevent stroke recurrence in stroke survivors, effective management of vascular risk factors (VRFs), including hypertension, diabetes, hyperlipidemia, and smoking, is essential. This study aimed to assess the VRF control status and trends among stroke survivors in Korea.

METHODS

This cross-sectional study analyzed data from 1,261 stroke survivors aged ≥ 19 years (mean age: 65.2 years; 43.1% female) who were part of the Korea National Health and Nutrition Examination Survey from 2010 to 2021. The control status of VRFs was evaluated using standardized criteria: hypertension (blood pressure < 140/90 mmHg), diabetes (hemoglobin A1c < 7%), hyperlipidemia (low-density lipoprotein cholesterol [LDL-C] < 70 mg/dL), and smoking status. Multivariate logistic regression analysis was conducted to identify factors associated with uncontrolled VRFs.

RESULTS

The rates of age-adjusted hypertension, diabetes, and smoking control remained consistent throughout the observation period. However, overall LDL-C control improved from 30.1% in 2010-2012 to 40.4% in 2019-2021 (P = 0.015), particularly in those aged ≥ 65 years. However, in the 19-49 age group, the control rate decreased from 47.0% to 15.8% (P = 0.048). Smoking rates showed no significant improvement (70.2% in 2019-2021 compared to 69.6% in 2010-2012), particularly among men. Living alone (adjusted odds ratio [aOR], 1.85; 95% confidence interval [CI], 1.03-3.32) was significantly associated with uncontrolled hypertension, whereas living in urban areas was linked to uncontrolled diabetes (aOR, 2.75; 95% CI, 1.06-7.17). Non-health screening was significantly associated with uncontrolled hyperlipidemia (aOR, 2.28; 95% CI, 1.25-4.14), and men were more likely to continue smoking (aOR, 4.47; 95% CI, 3.12-6.72).

CONCLUSION

These findings highlight the need for targeted health strategies to enhance risk-factor management and reduce stroke recurrence.

Association of Sleep Duration, Bedtime Regularity, and Weekend Catch-Up Sleep with Age-Related Hearing Loss: A Population-Based Cross-Sectional Study

PURPOSE

Age-related hearing loss (ARHL) impacts quality of life and cognition in older adults, but its link to sleep patterns remains unclear. This study explores associations between ARHL and sleep duration, weekend catch-up sleep (WCS), and bedtime regularity in a Korean population.

METHODS

Data from 6,797 adults aged ≥40 years were analyzed using the Korea National Health and Nutrition Examination Survey (KNHANES, 2021-2022). Sleep patterns were assessed via self-reported questionnaires. ARHL was classified as mild (26-41 dB) or moderate and above (>41 dB) using audiometry. Poisson regression models examined associations between sleep characteristics and ARHL, adjusting for confounders.

RESULTS

WCS (≥1h) was significantly associated with a lower prevalence of both mild (adjusted prevalence ratio = 0.58, 95% CI: 0.44-0.76) and moderate ARHL (aPR = 0.79, 95% CI: 0.63-0.98). These associations remained robust in stratified analyses among middle-aged adults and men (p-interaction < 0.01). In contrast, sleep duration and bedtime regularity showed no significant associations with ARHL after adjustment.

CONCLUSION

Our findings indicate that WCS may be associated with a lower prevalence of ARHL, particularly in middle-aged adults and men, highlighting the potential role of sleep behavior in auditory health promotion.

Association of whole-body and regional body fat mass indexes with depressive symptoms and suicidal behaviors in Korean adults: The moderating role of age

BACKGROUND

The coexistence of obesity and mental health problems has been widely reported; however, the moderating role of age in these associations has been scarcely examined. We explored age-specific variations in the association of fat mass indexes (FMIs) with depressive symptoms and suicidal behaviors.

METHODS

This study included a nationwide sample of 4185 Korean adults. Whole-body and regional body fat mass were measured using bioelectrical impedance analysis. Depressive symptoms were determined based on the Patient Health Questionnaire-9, and suicidal ideation and planning over the past year were evaluated. Logistic regression was employed to assess the relationship between FMIs and mental health outcomes, and stratified analyses were conducted to assess age-specific variations in these associations.

RESULTS

In the younger age group (<45 years), a 1-standard deviation increase in the whole-body FMI was associated with 1.38 (95 % CI: 1.18-1.61) and 1.48 (95 % CI: 1.50-2.08) times higher odds of depressive symptoms and suicidal planning, respectively. Similar positive associations between FMIs and depressive symptoms and suicidal planning were observed for regional FMIs, including trunk, arm, and leg fat mass. However, no clear associations were observed among individuals aged ≥45 years between whole-body or regional FMIs and mental health problems.

LIMITATIONS

The cross-sectional design hinders causal interpretation.

CONCLUSION

This study observed significant age-specific variations in the relationship between FMIs and depressive symptoms and suicidal behaviors.

Deep learning health space model for ordered responses

BACKGROUND

As personalized medicine becomes more prevalent, the objective measurement and visualization of an individual's health status are becoming increasingly crucial. However, as the dimensions of data collected from each individual increase, this task becomes more challenging. The Health Space (HS) model provides a statistical framework for visualizing an individual's health status on biologically meaningful axes. In our previous study, we developed HS models using statistical models such as logistic regression model (LRM) and the proportional odds model (POM). However, these statistical HS models are limited in their ability to accommodate complex non-linear biological relationships.

METHODS

In order to model complex non-linear biological relationship, we developed deep learning HS models. Specifically, we formulated five distinct deep learning HS models: four standard binary deep neural networks (DNNs) for binary outcomes and one deep ordinal neural network (DONN) that accounts for the ordinality of the dependent variable. We trained these models using 32,140 samples from the Korea National Health and Nutrition Examination Survey (KNHANES) and validated them with data from the Ewha-Boramae cohort (862 samples) and the Korea Association Resource (KARE) project (3,199 samples).

RESULTS

The proposed deep learning HS models were compared with the existing statistical HS model based on the POM. Deep learning HS model using DONN demonstrated the best performance in discriminating health status in both the training and external datasets.

CONCLUSION

We developed deep learning HS models to capture complex non-linear biological relationships in HS and compared their performance with our previously best-performing statistical HS model. The deep learning HS models show promise as effective tools for objectively and meaningfully visualizing an individual's health status.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of diabetes duration and hyperglycemia on the progression of diabetic kidney disease: Insights from the KNHANES 2019-2021

BACKGROUND

Diabetes is a significant risk factor for chronic kidney disease, and diabetic kidney disease (DKD) is prevalent among patients with diabetes. Previous studies have indicated that the duration of diabetes and poor glycemic control are associated with an increased risk of DKD, but data on how the duration and severity of hyperglycemia specifically relate to DKD progression are limited.

AIM

To investigate the relationship between diabetes duration and glycemic control, and DKD progression in South Korea.

METHODS

We included 2303 patients with diabetes using the 2019-2021 Korea National Health and Nutrition Examination Surveys data. DKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m², urinary albumin-to-creatinine ratio ≥ 30 mg/g, or both. Diabetes duration and severity were classified into six categories each.

RESULTS

DKD prevalence was 25.5%. The DKD risk significantly increased in diabetes lasting 10-15 years or hemoglobin A1C (HbA1c) ≥ 8% compared to patients with newly diagnosed diabetes or HbA1c < 6.5%. Albuminuria developed with shorter diabetes duration and lower HbA1c than eGFR decline. The adjusted odds ratios for DKD were 3.77 [95% confidence interval (95%CI): 2.60-5.45] and 4.91 (95%CI: 2.80-8.63) in patients with diabetes lasting ≥ 20 years and HbA1c ≥ 10%, respectively, compared to those with new-onset diabetes and HgA1c < 6.5%.

CONCLUSION

Patients with diabetes lasting > 10 years or HbA1c > 8% had a higher risk of DKD, emphasizing the importance of early monitoring and management is crucial to prevent DKD progression.

Sleep duration modifies the association between obstructive sleep apnea risk and glaucoma: evidence from the Korea National Health and Nutrition Examination Survey

BACKGROUND

This study aimed to investigate the combined effects of obstructive sleep apnea (OSA) risk and short sleep duration on glaucoma prevalence and intraocular pressure (IOP) using data from the 2019 to 2021 Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

This cross-sectional study analyzed data from 7,732 KNHANES participants aged ≥ 40 years. OSA risk was assessed using the STOP-BANG questionnaire, with a high risk defined as a score ≥ 3. The diagnosis of glaucoma was based on the criteria of the International Society of Geographical and Epidemiological Ophthalmology. Multivariate logistic regression models were used to evaluate the associations among glaucoma prevalence, OSA risk, and sleep duration, adjusting for demographic and health-related variables. The interaction effects of OSA risk and sleep duration on glaucoma and IOP were also assessed.

RESULTS

Among the 7,732 participants, 5.28% (n = 408) were diagnosed with glaucoma. Individuals with a high risk of OSA had significantly higher odds of glaucoma compared to those with a low risk (odds ratio: 1.34, 95% confidence interval: 1.02-1.77; P < 0.05), with the STOP-BANG components "snoring", "pressure", and "age" being most associated with increased glaucoma risk. No significant association was observed between abnormal sleep duration (< 7 h or ≥ 9 h) alone and glaucoma prevalence (P > 0.05). Individuals with a high risk of OSA with a sleep duration < 9 h showed a significantly higher glaucoma prevalence than those with ≥ 9 h of sleep (P < 0.05), suggesting that sleep duration modifies the association between OSA risk and glaucoma. Similar trends were observed for IOP, with significant interaction effects between OSA risk and sleep duration.

CONCLUSIONS

Our findings suggest that sleep duration modulates the association between OSA risk and both glaucoma prevalence and higher IOP, highlighting the importance of including sleep duration in glaucoma risk assessments for patients with OSA. Further research is required to clarify the mechanisms underlying the association between OSA, sleep duration, and glaucoma.

Exploration of the relationship between gastric cancer and nutritional risk factors: insights from the Korea National Health Insurance Database

Background/Objectives

Gastric cancer is the third most common cause of cancer-related deaths. Gastric cancer rates vary across regions, which may be attributable to factors such as Helicobacter pylori infection, environmental factors, and genetic predispositions. We examined the association between gastric cancer, nutrient intake, and lifestyle parameters in Korean adults.

Methods

This study utilized the KNHANES dataset (2012-2016) to explore the nutritional risk factors associated with gastric cancer. Multivariable analysis was conducted to confirm the association between micronutrients and specific food items using questionnaires designed to collect data on individuals' consumption frequency and nutrient intake.

Results

This study enrolled 18,894 participants, including 229 diagnosed with gastric cancer. Factors associated with gastric cancer included male sex, older age, low body-mass index, and frequent consumption of food outside the home. Multivariate analysis indicated that a lower intake of protein (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99, p < 0.001), fat (OR 0.99, 95% CI 0.98-0.99, p < 0.004), and thiamine (OR 0.59, 95% CI 0.45-0.76, p < 0.001) and a higher intake of niacin (OR 1.05, 95% CI 1.02-1.08, p < 0.001) were correlated with an increased risk of gastric cancer. Additionally, specific dietary items, such as tteok (rice cake) and soju, contributed to an elevated gastric cancer risk (OR 1.21, 95% CI, 1.01-1.40; OR 1.14, 95% CI, 1.03-1.25; p < 0.001).

Conclusion

We found an association between gastric cancer and various nutritional and lifestyle parameters. Nutrient intake and lifestyle-related factors significantly influence the prevalence of gastric cancer, suggesting that tailored interventions could mitigate this risk in specific populations.

Long-term joint exposure of outdoor air pollutants and impaired kidney function in Korean adults: A mixture analysis based on a nationwide sample (2007-2019)

We explored the association between exposure to air pollutant mixture and renal function. A nationwide sample of 69,066 Korean adults was analyzed. The 1-year moving averages of the concentrations of PM10, PM2.5, SO₂, NO₂, CO, and O₃ were estimated using the air pollution modeling. The outcome was estimated glomerular filtration rate (eGFR) value. Quantile-based G-computation analyses were performed to determine how a simultaneous increase in the air pollutant mixture by one quartile was associated with changes in eGFR levels. The mean of eGFR was 88.9 among the sample. In the quantile-based G-computation model, one-quartile increase in the levels of air pollutant mixture was linked to a decrease in eGFR by -0.85 (95 % CI: -1.14, -0.57), with CO and PM2.5 contributing 52.3 % and 37.3 %, respectively, to the negative association between the pollutant mixture and eGFR. Our results suggest that long-term exposure to air pollutant mixtures is linked to impaired renal function.

Association of objective body shape and perceived body image with depressive symptoms in men and women

AIMS

Mental health issues related to negative body image are growing concerns. We explored the association between objectively and subjectively measured body shape and depressive symptoms.

METHOD

A nationwide sample of 26,204 Korean adults was analyzed. Objective body shape was measured using the A Body Shape Index (ABSI), where a higher score indicates greater central obesity. ABSI scores were categorized into three groups: low, medium, and high. Perceived body image was classified into five categories: (i) very thin, (ii) slightly thin, (iii) normal, (iv) slightly fat, and (v) very fat. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Logistic regressions were employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

An increase in ABSI score was positively associated with depressive symptoms in men (OR = 1.27; 95% CI = 1.09-1.49) but not in women. Among men, those who perceived their body shape as very thin or very fat had 2.62-fold (95% CI = 1.70-4.05) and 2.34-fold (95% CI = 1.57-3.47) higher odds of having depressive symptoms, respectively, compared with those who perceived their body shape as normal. Among women, those who perceived their body shape as very thin or very fat had 2.73-fold (95% CI = 1.92-3.86) and 2.48-fold (95% CI = 1.97-3.14) increased odds of having depressive symptoms, respectively. The association between perceived body image and depressive symptoms manifested differently depending on ABSI group and gender.

CONCLUSION

Negative body image was associated with depressive symptoms, and this relation was differently observed across genders and different categories of actual body shape.

Association Between Dietary Monounsaturated Fatty Acid Intake and Metabolic Syndrome Among Korean Adults: A Cross-Sectional Analysis of Korea National Health and Examination Survey

INTRODUCTION/OBJECTIVES

Although monounsaturated fatty acids (MUFAs) are known as a healthy nutrient, their impact on the risk of metabolic syndrome (MetS) in the Asian population is not fully understood. This study aimed to determine the association between dietary MUFA intake and the prevalence of MetS among Korean adults.

MATERIALS AND METHODS

The 7th Korea National Health and Examination Survey (2016-2018) was analyzed. MetS was defined based on the guideline of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria, and MUFA intake was calculated using a single 24 h dietary recall. Data from 3932 younger adults (19-39 years), 6943 middle-aged adults (40-64 years), and 3942 older adults (≥65 years) were included and multivariable logistic regression models were applied to estimate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Approximately 25.8% of Korean adults showed signs of MetS, and the average MUFA intake was 13.70 g/day. Middle-aged adults with a higher MUFA intake had a lower risk of MetS (OR 0.52, 95% CI 0.35-0.78 for men; OR 0.66, 95% CI 0.43-0.99 for women) compared to those with a lower MUFA intake after the adjustment of possible confounding variables, including age, body mass index, total energy intake, household income, alcohol consumption, smoking, aerobic exercise, and energy intake from carbohydrates. No significant associations were observed in younger and older adults.

CONCLUSIONS

These results suggest that higher dietary MUFA consumption is associated with a lower risk of MetS in middle-aged Korean adults. These findings suggest that including MUFA-rich foods in the diet could be a practical strategy to reduce the burden of MetS in clinical and public heath settings.

Socioeconomic Inequalities in Intention to Quit Smoking Plan Among Korean Adults, 2016-2021

Objective: Smoking is the largest preventable cause of cancer morbidity and mortality; however, the smoking prevalence in Korea remains high. Several studies have shown that health behaviors vary by socioeconomic status, indicating that similar inequalities would be found in smoking behavior. Therefore, the aim of this study was to investigate the disparities in smoking cessation intention according to socioeconomic status. Methods: Data from the Korean National Health and Nutrition Examination Survey VII-VIII (2016-2021). We analyzed the answers of 4596 smokers who were asked "Do you have a plan to quit smoking within 6 months?" Regarding their socioeconomic status; education, income, and occupation level. We performed logistic regression and measured health inequality using the slope index of inequality (SII) and the relative index of inequality (RII). Results: In this sample, the prevalence of having a plan to quit smoking was 30.5%, whereas 69.5% had no plan. After adjusting for covariates, the odds ratio for intending to quit smoking within 6 months was higher among those living with a cohabitant compared to those living alone. Intention to quit did not differ significantly by income level; however, education level and occupation level were significantly associated with having a plan to quit smoking. To analyze the disparities, we observed the index SII and RII values. In the SII and RII values, which represent the absolute and relative inequalities, there was a significant difference in the level of education and occupation, but not in the level of income. Conclusion: There were inequalities in the intention to quit smoking plan depending on socioeconomic status, including education, household income, and occupational levels.

Assessment of cardiovascular disease risk factors in Korean children: impact of various pediatric hypertension guidelines and application of the Korean blood pressure reference

BACKGROUND

The global rise in pediatric hypertension (HTN) is a significant concern as it serves as a precursor to cardiovascular disease (CVD). To address this, we performed a comparative analysis of two guidelines for pediatric HTN: the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH), applying the Korean blood pressure (BP) reference specifically to the Korean pediatric population.

METHODS

Data from 2,060 children and adolescents aged 10-18 years from the Korean National Health and Nutrition Examination Survey (2016-2018) were analyzed. BP was classified according to the AAP, the ESH, and the Korea Regional BP Classification (KRC). High BP was defined as BP exceeding the normotensive range.

RESULTS

The prevalence of high BP in Korean youth was significantly higher according to the AAP group than that in the ESH group (19.5% vs. 10.6%, P < 0.0001). Variations in prevalence were noted based on age, sex, and obesity. No significant differences were observed between the AAP and KRC groups in terms of high BP prevalence. The application of the AAP and KRC provided a more comprehensive reflection of CVD risk factors, including obesity and metabolic profiles, compared to the ESH. The KRC showed a tendency to classify more non-obese individuals as having elevated BP, although this difference was not statistically significant.

CONCLUSIONS

In comparing the AAP, ESH, and KRC criteria in the Korean pediatric population, the KRC demonstrated a tendency to identify individuals with CVD risk factors as having high BP. This finding suggests that using the KRC as the criterion for high BP may facilitate earlier intervention in the management of CVD risk.

Association Between Healthy Dietary Patterns and Chronic Kidney Disease in Patients with Diabetes: Findings from Korean National Health and Nutrition Examination Survey 2019-2021

Background/Objectives: Although a healthy dietary pattern is a modifiable lifestyle factor in the prevention of chronic kidney disease (CKD), studies that investigate the association between a healthy diet and prevalent CKD in patients with diabetes, using the Korean Healthy Eating Index (KHEI), are lacking. Methods: This cross-sectional study included 1991 patients with diabetes from the eighth Korean National Health and Nutrition Examination Survey 2019-2021. A higher KHEI indicated healthier eating habits. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 or urine albumin-creatinine ratio ≥ 30 mg/g. The risk of prevalent CKD was evaluated according to the median KHEI value using logistic regression analysis adjusted for various clinicodemographic characteristics. Each KHEI component score was compared between those with and those without CKD, using the Student's t-test. Results: Participants with a higher KHEI were older, with higher proportions of women, non-smokers, and non-alcoholics. A higher KHEI was significantly associated with a lower risk of prevalent CKD (adjusted odds ratio [aOR], 0.73 [0.58-0.93]). Subgroup analysis revealed stronger associations in those without hypertension status (aOR, 0.57 [0.37-0.87]) with at least high school education (aOR, 0.56 [0.38-0.81]). Moreover, patients with diabetes and CKD had significantly lower KHEI, particularly in the adequacy category components, including breakfast consumption, total fruit intake, and dairy product intake. Conclusions: A healthier dietary pattern was associated with a lower risk of prevalent CKD in patients with diabetes. Dietary intervention, which recommends the intake of breakfast, fruits, and dairy products, may be an effective strategy for CKD prevention.

Towards Precision in Sarcopenia Assessment: The Challenges of Multimodal Data Analysis in the Era of AI

Sarcopenia, a condition characterised by the progressive decline in skeletal muscle mass and function, presents significant challenges in geriatric healthcare. Despite advances in its management, complex etiopathogenesis and the heterogeneity of diagnostic criteria underlie the limited precision of existing assessment methods. Therefore, efforts are needed to improve the knowledge and pave the way for more effective management and a more precise diagnosis. To this purpose, emerging technologies such as artificial intelligence (AI) can facilitate the identification of novel and accurate biomarkers by modelling complex data resulting from high-throughput technologies, fostering the setting up of a more precise approach. Based on such considerations, this review explores AI's transformative potential, illustrating studies that integrate AI, especially machine learning and deep learning, with heterogeneous data such as clinical, anthropometric and molecular data. Overall, the present review will highlight the relevance of large-scale, standardised studies to validate biomarker signatures using AI-driven approaches.

Development of a Predictive Model for Metabolic Syndrome Using Noninvasive Data and its Cardiovascular Disease Risk Assessments: Multicohort Validation Study

BACKGROUND

Metabolic syndrome is a cluster of metabolic abnormalities, including obesity, hypertension, dyslipidemia, and insulin resistance, that significantly increase the risk of cardiovascular disease (CVD) and other chronic conditions. Its global prevalence is rising, particularly in aging and urban populations. Traditional screening methods rely on laboratory tests and specialized assessments, which may not be readily accessible in routine primary care and community settings. Limited resources, time constraints, and inconsistent screening practices hinder early identification and intervention. Developing a noninvasive and scalable predictive model could enhance accessibility and improve early detection.

OBJECTIVE

This study aimed to develop and validate a predictive model for metabolic syndrome using noninvasive body composition data. Additionally, we evaluated the model's ability to predict long-term CVD risk, supporting its application in clinical and public health settings for early intervention and preventive strategies.

METHODS

We developed a machine learning-based predictive model using noninvasive data from two nationally representative cohorts: the Korea National Health and Nutrition Examination Survey (KNHANES) and the Korean Genome and Epidemiology Study. The model was trained using dual-energy x-ray absorptiometry data from KNHANES (2008-2011) and validated internally with bioelectrical impedance analysis data from KNHANES 2022. External validation was conducted using Korean Genome and Epidemiology Study follow-up datasets. Five machine learning algorithms were compared, and the best-performing model was selected based on the area under the receiver operating characteristic curve. Cox proportional hazards regression was used to assess the model's ability to predict long-term CVD risk.

RESULTS

The model demonstrated strong predictive performance across validation cohorts. Area under the receiver operating characteristic curve values for metabolic syndrome prediction ranged from 0.8338 to 0.8447 in internal validation, 0.8066 to 0.8138 in external validation 1, and 0.8039 to 0.8123 in external validation 2. The model's predictions were significantly associated with future cardiovascular risk, with Cox regression analysis indicating that individuals classified as having metabolic syndrome had a 1.51-fold higher risk of developing CVD (hazard ratio 1.51, 95% CI 1.32-1.73; P<.001). The ability to predict long-term CVD risk highlights the potential utility of this model for guiding early interventions.

CONCLUSIONS

This study developed a noninvasive predictive model for metabolic syndrome with strong performance across diverse validation cohorts. By enabling early risk identification without laboratory tests, the model enhances accessibility in primary care and large-scale screenings. Its ability to predict long-term CVD risk supports proactive intervention strategies, potentially reducing the burden of cardiometabolic diseases. Further research should refine the model with additional clinical factors and broader population validation to maximize its clinical impact.

Association between normal tension glaucoma and the risk of obstructive sleep apnoea using the STOP-Bang questionnaire

BACKGROUND

To assess the association between patients with normal tension glaucoma (NTG) and the risk of obstructive sleep apnoea (OSA) using the STOP-Bang questionnaire.

METHODS

A population-based cross-sectional analysis was performed using data from the Korean National Health and Nutrition Examination Survey from 2019 to 2021. An overall of 8832 subjects ≥ 40 years of age were investigated. Patients with NTG and controls completed the STOP-Bang questionnaire, a validated tool for identifying high-risk patients for OSA. The patients were divided into low-, intermediate-, and high-risk groups based on their scores.

RESULTS

The mean STOP-Bang scores were 2.04 ± 0.02 in the control group and 2.42 ± 0.10 in the NTG group, with significant differences between groups (p < 0.001). In univariate logistic regression models, both intermediate-risk (Odds ratio (OR), 1.42; 95% Confidence intervals (CI), 1.05-1.91) and high-risk (OR, 1.71; 95% CI, 1.22-2.40) for OSA groups revealed a significant relationship regarding NTG compared to low-risk for OSA group. When adjusted for all confounding factors, the high risk for the OSA group was significantly associated with NTG (OR, 1.54; 95% CI, 1.06-2.24).

CONCLUSIONS

Our results indicate that high-risk OSA, as measured using the STOP-Bang questionnaire, correlates with NTG. Therefore, patients who scored two or more on the STOP-Bang questionnaire and were male, had a BMI > 35 or a neck circumference > 40 cm, or those who scored five or more and were classified as high risk should be carefully monitored because of the significantly higher likelihood of an association with NTG.

Projection of the Prevalence and Economic Burden of Chronic Kidney Disease in Taiwan From 2022 to 2027 (Inside CKD): A Microsimulation Study

AIM

This study aimed to project the epidemiology of chronic kidney disease (CKD) and its economic impact in Taiwan from 2022 to 2027 using a microsimulation model.

METHODS

A virtual representative population of Taiwan was generated using demographic data. The cohort then underwent annual progression using a validated patient-level microsimulation technique, projecting CKD onset and progression based on various factors, including age, sex, eGFR, and urine albumin level. The model also incorporated associated comorbidities like type 2 diabetes mellitus and hypertension and complications such as heart failure, myocardial infarction, and stroke. Healthcare costs associated with diagnosed CKD and kidney replacement therapy (KRT) were also projected.

RESULTS

In 2022, an estimated 10.6% of the total population (2.5 million individuals) in Taiwan were affected by documented or undiagnosed CKD. Without changes in care standards, this prevalence is projected to rise to 12.4% (3.0 million individuals) by 2027, a relative increase of 17.1%. The prevalence of KRT is expected to grow by 7.0% from 2022 to 2027. Complications related to CKD, including heart failure, myocardial infarction, and stroke, are also projected to increase. The annual healthcare costs for diagnosed CKD and KRT are anticipated to rise by 19.7% from TWD $51.96 billion in 2022 to TWD $62.18 billion in 2027.

CONCLUSION

The projections underscore the escalating burden of CKD in Taiwan, emphasising the need for proactive strategies focusing on early diagnosis, effective management, and public awareness to mitigate the disease's socioeconomic impact.

The mediating role of food insecurity in the relationship between income poverty and depressive symptoms and suicidal ideation: A nationwide study of Korean adults

BACKGROUND

Income poverty has been linked to poor mental health. Food insecurity, a consequence of poverty, has been identified as a determinant of mental health. We explored the mediating role of food insecurity in the relationship between income poverty and mental health problems.

METHODS

This study utilized a nationally representative sample of 12,918 adults from the 2019-2021 Korea National Health and Nutrition Examination Survey, among whom 3,896 were included in the depressive symptom analysis and 9,022 in the suicidal ideation analysis. Income poverty was defined as having a household income below 50 % of the median. Food insecurity was assessed using the Korean version of the 18-item Household Food Security Survey Module and was dichotomized as the presence of food insecurity if three or more items received affirmative responses. Logistic regression and mediation analyses were conducted, with odds ratios (ORs) and 95 % confidence intervals (CIs) computed. Models were adjusted for gender, region, education, employment status, marital status, presence of a child, smoking, physical exercise, and alcohol use.

RESULTS

Among the sample, the prevalence was 15.1 % for income poverty, 3.8 % for food insecurity, 3.9 % for depressive symptoms, and 3.2 % for suicidal ideation. Poverty was associated with a 1.5 % (95 % CI: 1.3 %-1.6 %) increase in the likelihood of depressive symptoms compared to non-poverty conditions, with food insecurity accounting for 52.7 % (95 % CI: 46.8-58.2 %) of this effect (average causal mediating effect [ACME]: 0.008, 95 % CI: 0.006-0.009). Additionally, income poverty was associated with a 2.0 % (95 % CI: 1.9 %-2.1 %) increase in the likelihood of suicidal ideation compared to non-poverty conditions, with food insecurity accounting for 17.7 % (95 % CI: 15.7-19.8 %) of this effect (ACME: 0.004, 95 % CI: 0.003-0.004).

CONCLUSION

Food insecurity can mediate a meaningful portion of the relationship between poverty and mental health problems, highlighting the importance of targeted public health to address food access.

Baseline lung function and risk of incident tuberculosis: a nationwide population-based cohort study

BACKGROUND

While lung function is known to decrease after suffering from pulmonary tuberculosis (TB), little is known about whether baseline lung function is associated with the occurrence of TB in the general population. This study aimed to evaluate the risk of incident TB according to baseline lung function.

METHODS

A nationwide population-based cohort study was conducted using a database derived by cross-referencing Korea National Health and Nutrition Examination Survey and National Health Insurance Service between 2010 and 2016. Of 29,524 subjects, 16,594 participants aged over 40 years who had spirometry results without a previous TB history were enrolled. The primary endpoint was newly developed TB.

RESULTS

Among 16,457 participants, 72 were newly diagnosed with TB during the follow-up period (median: 5.5 years). TB risk was higher in participants with obstructive lung function impairment (aHR: 2.033, 95% CI: 1.123-3.679) or restrictive lung function impairment (aHR: 2.193, 95% CI: 1.120-4.294) than in those with normal lung function. Low forced expiratory volume in one second (FEV1) was associated with increased TB risk (aHR [lowest quartile vs. highest quartile]: 1.91, 95% CI: 1.05-3.50; aHR [lowest decile vs. highest decile]: 2.76, 95% CI: 1.14-6.70; both p for trends < 0.0001).

CONCLUSION

Our findings suggest that impaired lung function might increase TB risk and that TB risk might be inversely associated with FEV1.

Longitudinal Income Dynamics and Risk of End-Stage Kidney Disease in Type 2 Diabetes: A South Korean Population-Based Cohort Study

RATIONALE & OBJECTIVE

The prevalence of end-stage kidney disease (ESKD) continues to rise, with socioeconomic status (SES), particularly income, having associations with ESKD risk among individuals with type 2 diabetes (T2D). This study examined the longitudinal association of income changes with ESKD risk among non-elderly adults with T2D in South Korea.

STUDY DESIGN

Population-based retrospective cohort study.

SETTING & PARTICIPANTS

1,481,371 adults aged 30 to 64 years with T2D represented in the South Korean National Health Insurance Service (NHIS) database in 2015 and 2016, followed to 2020.

EXPOSURE

Sustained income levels, income variability, and income changes over five years prior to entry into the study cohort.

OUTCOMES

Primary outcome was progression to ESKD, defined as initiation of dialysis or kidney transplantation.

ANALYTICAL APPROACH

Cox proportional hazards models were used to assess the risk of ESKD, adjusting for demographic, behavioral, and clinical variables.

RESULTS

Compared with those who never reached the lowest income quartile, individuals who spent any time (1-5 years) in the lowest quartile had a higher risk of ESKD (P for trend < 0.001). Conversely, spending 2-5 years in the highest quartile was significantly associated with a lower ESKD risk (P for trend < 0.001), whereas spending only 1 year in the highest quartile was not associated with ESKD risk. Income that dropped from a higher quartile to the lowest quartile was associated with higher risk, and even those moving from the lowest to the highest quartile had a higher ESKD risk than those who remained consistently in the highest quartile. Individuals with the highest income variability exhibited an increased risk of ESKD (hazard ratio 1.14, 95% confidence interval 1.01-1.29, P for trend = 0.02).

LIMITATIONS

Residual confounding, lack of data on medication adherence, and missing laboratory results.

CONCLUSIONS

Dynamic changes in income were associated with ESKD risk among adults with T2D, findings that may inform healthcare policies that address the economic factors potentially contributing to kidney disease progression in South Korean adults with diabetes.

Association of Handgrip Strength with Diabetes, Hypertension, and Comorbidities in a Korean Population: A Large-Scale Cross-Sectional Study

Background: Handgrip strength (HGS) is strongly associated with hypertension (HTN), diabetes mellitus (DM), and HTN and DM comorbidity (HDC). However, no studies have simultaneously examined anthropometric and absolute/relative HGS indices among HTN, DM, and HDC patients. The objective of this study was to examine the associations of anthropometric and HGS indices with HTN, DM, and HDC. Methods: For this large-scale cross-sectional study, we used a dataset from the Korea National Health and Nutrition Examination Survey. The study population included 15,343 participants aged 50 years and older. Complex sample binary logistic regression was used to examine the associations of each disease with the anthropometric and HGS indices in crude and adjusted models. Results: The prevalence of HTN, DM, and HDC in the study population was 35.1%, 8.6%, and 14.4% in men and 34.7%, 5%, and 11.8% in women, respectively. In men, the indices with the strongest associations with HTN, DM, and HDC were body mass index, waist circumference, and waist-to-height ratio. Among women, body mass index and waist-to-height ratio had the strongest associations with HTN. Waist circumference and waist-to-height ratio had the strongest associations with DM. Waist-to-height ratio had the strongest associations with HDC. Additionally, the relative HGS indices were more strongly associated with these diseases than the absolute HGS indices. Conclusions: HGS indices were associated with HTN, DM, and HDC, but compared with the absolute HGS index and relative HGS indices, anthropometric indices were more strongly associated with these diseases in the Korean population.

Association of atherogenic index of plasma with kidney dysfunction in diabetic individuals: findings from two national population-based studies

BACKGROUND

Extensive evidence suggests that dyslipidemia is associated with endothelial dysfunction, oxidative stress, and inflammation, all of which can contribute to kidney dysfunction. The atherogenic index of plasma (AIP) is a novel marker of lipid metabolism disorder, but its role in kidney dysfunction in diabetic individuals remains controversial. This study aims to clarify the association of AIP with kidney dysfunction in diabetic individuals.

METHODS

This cross-sectional study analyzed a representative sample of participants aged 20 years and older from the United States (n = 2,386, NHANES 2007-2018) and Korea (n = 698, KNHANES 2012). Weighted multivariate logistic regression analyses and smoothed curve fitting were conducted to investigate the relationship between logarithmically transformed AIP (lgAIP) and multiple kidney dysfunction, including albuminuria and low estimated glomerular filtration rate (eGFR) in diabetic individuals. Additionally, we conducted interaction analyses and subgroup analyses to assess whether this relationship remained consistent across different populations. We utilized receiver operating characteristic (ROC) curves to assess and compare the diagnostic performance of AIP and other lipid indices for kidney dysfunction.

RESULTS

In both databases, higher lgAIP was significantly associated with the occurrence of albuminuria in diabetic individuals (NHANES: OR = 7.69, 95%CI: 2.90-20.40; KNHANES: OR = 6.00, 95%CI: 1.05-34.36) in the fully adjusted model. However, the OR (95% CI) for the association between lgAIP and low-eGFR was 1.22 (0.33, 4.53) in the NHANES database and 2.50 (0.16, 38.62) in the KNHANES database, indicating no statistically significant association. Subgroup analysis revealed that the association between lgAIP and albuminuria in diabetic individuals was influenced by age and BMI stratification in the NHANES database, and by BMI stratification in the KNHANES database (p for interaction < 0.05). Compared to other lipid indicators, AIP appears to be more precise and discriminatory in predicting albuminuria in diabetic individuals.

CONCLUSION

Our findings highlight a strong association between lgAIP and albuminuria in diabetic individuals. Future research should explore the mechanisms that underlying this relationship.

CLINICAL TRIAL NUMBER

Not applicable.

Is air pollution a risk factor for early menopause?

BACKGROUND

Ambient air pollution is a serious public health issue that may influence reproductive health, including fertility and menopause onset in women worldwide. Thus, understanding the risk factors associated with early menopause is crucial to inform women about potential health risks and guide public health interventions.

METHODS

We collected data from KHANES (The Korea National Health and Nutrition Examination Survey) at the Korean Center for Disease Control and Prevention, Ministry of Health and Welfare between 2010 and 2020. These data were linked with summary pollution data from AiMS-CREATE (AI-Machine Learning and Statistics Collaborative Research Ensemble for Air Pollution, Temperature, and All Types of Environmental Exposures) from 2002 to 2020. These summary data encapsulate the monthly average air pollution predictions for 226 si-gun-gu (cities, counties, and districts) in Korea. A total of 8506 participants who had experienced menopause (early menopause: 40-44 years, N = 341; normal menopause: ≥ 45 years, N = 8165) between 2002 and 2020 were included in the analysis. We employed survey logistic regression analyses to determine the associations between ambient air pollution and menopause after adjusting for covariates.

RESULTS

An association was observed between particulate matter 2.5 (PM2.5) and early menopause (adjusted survey logistic regression (aOR): 1.26, 95% confidence interval (CI): 1.21-1.31), between particulate matter 10 (PM10) and early menopause (aOR: 1.17, 95% CI: 1.14-1.20).

CONCLUSION

Our findings suggest that exposure to ambient air pollution may contribute to the onset of menopause, emphasizing the importance of addressing air quality as a public health priority. This study highlights the need for further research to explore the underlying mechanisms and long-term health impacts of environmental factors associated with early menopause.

Relationship between dietary protein and amino acid intake and handgrip strength in Korean adults: data from the 2014-2019 Korea National Health and Nutrition Examination Survey

BACKGROUND

Sarcopenia contributes to an increased risk of falls and fractures, and reduced mobility, and mortality. Supplementation with dietary protein and amino acids has been suggested as a potential strategy to slow or prevent the associated loss of muscle mass and strength. However, most previous studies have focused on dietary protein or limited populations, such as older adults. Therefore, this study aimed to investigate the relationship between dietary protein and amino acid intake and handgrip strength (HG) in Korean adults.

METHODS

This study used data from the 2014-2019 Korea National Health and Nutrition Examination Survey. A total of 18,565 adults who participated in a 1-day 24-hour recall method were included. Protein intake was calculated as a percentage of total energy intake from food sources (animal and plant). Amino acid intake (g/day), including essential amino acids (EAAs), branched-chain amino acids (BCAAs), and non essential amino acids (NEAAs), was assessed using a database expanded based on amino acid composition databases constructed by national institutions. Low HG was diagnosed based on the 2019 guidelines of the Asian Working Group on Sarcopenia.

RESULTS

In the fully adjusted model, total and plant protein intakes were positively associated with HG levels (kg) (β = 0.04 and 0.07 per 1% increase, respectively; p < 0.05 for both). Participants aged ≥ 65 years in the highest NEAA intake group had a 42% lower risk of low HG compared to those in the lowest intake group (odds ratio 0.58; 95% confidence interval 0.35-0.97; p for trend = 0.1026). A lower risk of HG was observed in older participants whose plant protein intake ranged from 8 to 10% of energy, compared to those consuming less than 7%. However, no association was found when intake exceeded 10% of energy.

CONCLUSIONS

These findings suggest that a high intake of NEAAs and a moderately high intake of plant protein may be associated with a lower risk of low HG among Korean older adults. Further prospective studies are needed to explore the effects of protein and amino acid intake on muscle mass and strength.

Possible association between metabolic dysfunction-associated steatotic liver disease predictors and hand grip strength

Both Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and sarcopenia are associated with numerous chronic diseases, and the link between the two broad-spectrum phenotypes has been extensively researched. We focused on the relationship between the hepatic steatosis index (HSI) and hand grip strength (HGS). The Korean National Health and Nutrition Examination Surveys (2014-2019) were utilized to identify the association between estimated MASLD (eMASLD) and muscle strength. HSI determined eMASLD status, and HGS evaluated muscle strength. The HSI demonstrated a positive correlation with HGS. The alanine transaminase (ALT)/aspartate aminotransferase (AST) ratio and diabetes among the five components of HSI exhibited significant relationships with HGS in men and women. The robust linearity between HSI and HGS was observed in multivariate models and stratified analyses, particularly in older non-diabetic men with a higher body mass index (BMI) and young women without diabetes. However, younger men and older women exhibited nonlinear associations influenced by the ALT/AST ratio, BMI, and diabetes. After adjusting HGS with BMI, a significant negative association between HSI and muscle strength was observed, particularly in women. The disruption in linearity was influenced by the ALT/AST ratio, particularly in men with diabetes. Our findings highlight the complex interplay between HSI and HGS. The relationship between the two broad-range phenotypes was observed, and liver profiles influenced the linearity.

Associations of low-carbohydrate diets patterns with the risk of hyperuricemia: a national representative cross-sectional study in Korea

BACKGROUND

The association between low-carbohydrate diets and hyperuricemia risk, a significant risk factor for gout and cardiometabolic morbidities, remains inconclusive, partly due to differing effects of replacing carbohydrates with animal- or plant-based macronutrients. This study examined associations between low-carbohydrate diet patterns and hyperuricemia risk in 39,880 adults in the Korea National Health and Nutritional Examination Study 2016-2022.

METHODS

Diet was assessed via a 24-hour dietary recall. The overall, animal-rich, and plant-rich low-carbohydrate diet score (LCDS) was calculated based on percent energy derived from protein and fat in animal and plant food sources. Hyperuricemia was defined as serum uric acid levels > 7.0 mg/dL for men and > 6.0 mg/dL for women. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models to estimate the risk of hyperuricemia across quintiles of LCDS.

RESULTS

A significantly greater risk of hyperuricemia was observed among individuals with higher overall LCDS (OR for quintile 5 vs. quintile 1 [Q5vs.Q1]: 1.41, 95%CI:1.22-1.63, P-trend: <0.001) and animal-rich LCDS (ORQ5vs.Q1: 1.28, 95%CI:1.12-1.47, P-trend: <0.001), but not with plant-rich LCDS (ORQ5vs.Q1: 1.00, 95%CI: 0.87-1.16). These positive associations for overall LCDS and animal-rich LCDS were evident in overweight individuals (ORQ5vsQ1: 1.53, 95%CI: 1.29-1.82 for overall LCDS; and 1.39, 95%CI: 1.19-1.63 for animal-rich LCDS; all P-trends < 0.001), but not in non-overweight individuals (all P-interactions: <0.001).

CONCLUSIONS

In our study, animal-based low-carbohydrate diets were associated with a greater risk of hyperuricemia, while no association was observed for plant-based low-carbohydrate diets. Larger cohort studies are warranted to replicate these findings.

Sufficient Magnesium Intake Reduces Retinal Vein Occlusion Risk: National Health and Nutrition Examination Survey Analysis

Background/Objectives: Retinal vein occlusion (RVO) is a major cause of vision loss globally. Although magnesium (Mg) is crucial for vascular health, its association with RVO risk is unknown. Thus, we aimed to further examine this association. Methods: This cross-sectional study included participants of the Korean National Health and Nutrition Examination Survey 2017-2021 aged ≥19 years (n = 16,358). RVO diagnosis was based on fundus imaging or was self-reported. Based on their daily Mg intake, we categorized participants into low (<120 mg), intermediate (men: 120-300 mg; women: 120-400 mg), and sufficient (men: ≥300 mg; women: ≥400 mg) intake groups and compared their characteristics across groups. Results: RVO prevalence was 0.7%. Compared to the non-RVO group, the RVO group was characterized by older individuals, fewer current alcohol consumers, a higher prevalence of hypertension and chronic kidney disease, and a lower intake of fiber, iron, calcium, vitamin E, and Mg. After full adjustment, sufficient Mg intake was significantly associated with a 64% reduced risk of RVO (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18-0.71, p = 0.003). This association was particularly notable among individuals aged 19-59 years (OR 0.18, 95% CI 0.04-0.82, p = 0.027), those with hypertension (OR 0.29, 95% CI 0.13-0.67, p = 0.003), and those without glaucoma (OR 0.33, 95% CI 0.15-0.71, p = 0.004). Conclusions: Sufficient Mg intake may reduce RVO risk among adults aged <60 years, individuals with hypertension, and those without glaucoma. Further research should validate the benefits of Mg supplementation in preventing RVO.

Association between vitamin A, E, and folate levels and risk of non-alcoholic fatty liver disease in adults with diabetes mellitus

Antioxidant vitamin deficiency may contribute to the development of metabolic diseases, such as non-alcoholic fatty liver disease (NAFLD). This study aimed to analyze the association between serum vitamin A, E, and folate levels and NAFLD in adults with diabetes mellitus. Using data from the Korean National Health and Nutrition Examination Survey (2016-2018), we conducted a cross-sectional analysis of adults over 19 with diabetes. NAFLD was identified through three prediction tools. Of 589 participants, 326, 445, and 527 had NAFLD according to the hepatic steatosis index, Framingham steatosis index (FSI), and comprehensive NAFLD score (CNS), respectively. Serum vitamin E levels were consistently higher in the NAFLD group across all diagnostic tools. Similarly, vitamin A levels were elevated in those with NAFLD as per the CNS. Folate levels were higher in the obese group according to the FSI. After adjusting for covariates, both vitamin A and E levels were positively associated with NAFLD. This suggests that higher serum levels of vitamins A and E may increase the risk of NAFLD in the Korean diabetic population. These findings highlight the importance of monitoring micronutrient levels in managing NAFLD in patients with diabetes.

Physical activity levels among long-term cancer survivors of more than 5 years: a propensity score matching analysis

PURPOSE

As both the number of long-term cancer survivors and cases of late cancer recurrence increased, understanding aspects of lifestyle, such as participation in physical activity (PA), is of importance among long-term cancer survivors. This study aimed to investigate PA levels among long-term cancer survivors compared with age-, sex-, and body mass index (BMI)-matched non-cancer participants.

METHODS

The study analyzed data from 648 cancer survivors (66% female, average age of 60.0 ± 10.9 years) who visited the Cancer Prevention Center, Yonsei Cancer Center, between 2015 and 2022. A total of 3240 participants were randomly selected from the Korea National Health and Nutrition Examination Survey (2000-2020) using propensity score matching based on age, sex, and BMI.

RESULTS

Among long-term cancer survivors, the majority of participants were survivors of colorectal (43.1%), gastric (23.8%), and breast cancer (24.1%). Long-term cancer survivors participated more in moderate-to-vigorous leisure-time PA (106.2 ± 244.3 vs. 47.3 ± 135.8 min/week, P < 0.05), transportation PA (130.3 ± 231.8 vs. 101.2 ± 174.9 min/week, P < 0.05), and total walking time (311.4 ± 380.1 vs. 227.6 ± 347.7 min/week, P < 0.05) compared with matched non-cancer participants. However, long-term cancer survivors were less likely to participate in less resistance exercises (0.7 ± 1.8 vs. 1.5 ± 1.5 day/week, P < 0.05) compared with the non-cancer matched participants. Although long-term cancer survivors are generally more physically active, a significant proportion of long-term cancer survivors (76.1%) still did not meet the PA guidelines for moderate-intensity aerobic exercise.

CONCLUSION

Although long-term cancer survivors participated in more PA compared to the matched non-cancer participants, the majority of long-term cancer survivors still do not meet the PA guidelines, suggesting that further strategies to increase PA are required.

Relationship Between Sedentary Lifestyle and Handgrip Strength Among Korean Workers

OBJECTIVE

This study examined the relationship between sedentary time and handgrip strength with age-group stratification.

METHODS

This study used 11,295 Korean workers. Participants were divided into two age groups: ≤39 and ≥40 years. Handgrip strength was measured, and sedentary time was self-reported. Multiple logistic and linear regression models were used to examine the association between sedentary time and handgrip strength.

RESULTS

Those with ≥6 hours of daily sedentary time had slightly higher odds of low handgrip strength, though not significant overall (odds ratio 1.09, 95% confidence interval 0.95-1.26). However, younger adults with high sedentary time showed significantly higher odds (odds ratio 1.55, 95% confidence interval 1.13-2.12). Linear regression also indicated a stronger negative association in younger adults.

CONCLUSIONS

Interventions to reduce sedentary time could help maintain muscle strength, especially in younger populations.

Impact of energy intake on the association between protein intake and the prevalence of frailty in older Korean adults: The Korea National Health and Nutrition Examination Survey, 2014-2018

OBJECTIVES

Findings regarding dietary protein and frailty are inconsistent. This inconsistency may be attributed to variations in energy intake adequacy. We hypothesized that the prevalence of frailty in older adults with sufficient energy intake is inversely associated with the intake of total, animal, and plant proteins; however, in those with deficient energy intake, this association may not be observed.

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS

This cross-sectional study included data of 5,768 adults aged ≥65 years from the Korea National Health and Nutrition Examination Survey 2014-2018. Frailty was assessed using a modified Cardiovascular Health Study frailty index. Protein intake was measured via a 24-h recall and analyzed using multivariable logistic regression.

RESULTS

In older adults with sufficient energy intake, frailty was inversely associated with the intake of total (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.46-0.97; p = 0.032), animal (OR, 0.59; 95% CI, 0.43-0.82; p = 0.001), and plant proteins (OR, 0.68; 95% CI, 0.50-0.92; p = 0.043). In those with deficient energy intake, total and animal protein intake showed no significant associations with frailty, whereas plant protein intake was inversely associated with frailty.

CONCLUSION

Adequate energy intake appears essential for the protective effects of total and animal protein against frailty. Higher plant protein intake appears to confer benefits regardless of energy intake, highlighting its potential role in frailty prevention.

Relationship between menopausal status and suicidal behavior among the Korean population

OBJECTIVE

We investigated whether, in the Korean population, the risk of suicidal behavior is associated with menopausal status and especially age at menopause. For a deeper understanding of suicidal behavior, participants were asked about suicidal ideation and plans, and actual suicide attempts.

METHODS

This cross-sectional, population-based study involved 27,524 women for analyzing suicidal ideation, 26,893 women for suicidal plans, 28,682 women for suicide attempts, registered in the Korea National Health and Nutrition Examination Survey (2010-2022). Data on menopausal status, including age at menopause, and suicidal behavior were obtained from a self-reported questionnaire. A logistic regression model was applied to examine whether premature ovarian insufficiency, early menopause, and normal menopause significantly impact rates of suicidal behavior, which was further stratified by depression. Weighted prevalence of suicidal behavior according to age at menopause was also analyzed.

RESULTS

Compared with premenopausal status, the risk of suicidal ideation was increased in women with premature ovarian insufficiency by an odds ratio (95 % confidence interval) of 1.53 (1.17-2.01), in women with early menopause by 1.57 (1.28-1.92), and in women with clinically normal menopause by 1.17 (1.00-1.37). The risk of suicidal planning was also increased in women in each of these three respective menopausal groups: 1.92 (1.06-3.47), 1.55 (0.96-2.51), and 1.61 (1.13-2.30). The risk of suicide attempt was also increased in women with premature ovarian insufficiency, by an odds ratio of 2.01 (0.91-4.44), and in women with a clinically normal menopause, by 1.97 (1.22-3.18). The weighted prevalence of suicidal ideation decreased with age at menopause, grouped as ≤30 (21.5 %), 31-40 (14.8 %), 41-50 (11.1 %), and ≥50 (9.4 %).

CONCLUSION

The risks of suicidal ideation and planning were higher in women with premature ovarian insufficiency, early menopause, and clinically normal menopause. The risk of suicide attempt was also higher in women with premature ovarian insufficiency and normal menopause, compared with premenopausal women. Younger age at menopause led to a higher risk of suicidal ideation and planning in general. Due to the limitations of this study's cross-sectional design, longitudinal studies must be conducted to establish more strongly this relationship between menopause and suicidal behavior.

Health-related quality of life in long-term early-stage breast cancer survivors compared to general population in Korea

PURPOSE

This study assessed health-related quality of life (HRQoL) of long-term breast cancer (BC) survivors diagnosed at early stages and compare with cancer-free, age-matched women.

METHODS

The study population included BC survivors diagnosed with ductal carcinoma in situ (DCIS) or breast cancer stages I-II, who had undergone lumpectomy/mastectomy, with time since diagnosis ranging from 9 to 16 years. Survey was conducted at two tertiary hospitals in 2020. Data for cancer-free female controls was randomly drawn from a population-based survey and age-, education-matched with 1 case: 3 controls ratio. Self-reported HRQoL was assessed using EQ-5D with five dimentions. EQ-5D utility index score was calculated. Difference in EQ-5D score was evaluated using the Tobit regression model with adjustment for other covariates.

RESULTS

Of 273 survivors. 88% and 12% underwent mastectomy and lumpectomy, respectively. The mean (standard deviation, SD) age at survey was 57.3 (8.5) years old. BC survivors reported significantly more problems performing daily activities (11% vs. 5%, p < 0.001), pain/discomfort (46% vs. 23%, p < 0.001), and anxious/depressed feelings (44% vs. 8%, p < 0.001) relative to the controls. Difference in EQ-5D score between BC survivors and the general population was higher in older age groups. The overall EQ-5D score of BC survivors was statistically lower than that of the control subjects (adjusted β =0.117, p < 0.001).

CONCLUSION

Long-term BC survivors who survived beyond ten years post-diagnosis experience more pain, anxiety, and distress, leading to an overall poorer HRQoL.

IMPLICATIONS FOR CANCER SURVIVORS

This study suggest the importance of follow-up care, particularly focusing on pain, anxiety, and distress management to enhance the HRQoL of long-term BC survivors.

Prevalence and Current Status of Cardiometabolic Risk Factors in Korean Adults Based on Fact Sheets 2024

Korea has entered 'super-aged' society in 2025 with the proportion of people 65 years or older exceeding 20% as of the end of the year 2024. The health burden of cardiovascular diseases increases with age, and the increasing prevalence of cardiovascular risk factors, such as obesity, hypertension, diabetes mellitus, and dyslipidemia, may be linked to increased population-level cardiovascular risk. According to data from 2022, the overall prevalence of obesity reached 38.4%, marking a continued upward trend, based on National Health Insurance medical checkup data. In the combined data of 2021 to 2022, the prevalence of diabetes was 15.5% in Koreans older than 30 years according to the Diabetes Fact Sheet 2024 published by the Korean Diabetes Association, based on data from the Korean National Health and Nutrition Examination Survey. The prevalence of hypertension in the total population of Korea in 2022 was 30% according to the Korean Hypertension Fact Sheet produced by the Korean Society of Hypertension. Lastly, the prevalence of dyslipidemia in 2022 was 40.9% according to the Dyslipidemia Fact Sheet published by the Korean Society of Lipid and Atherosclerosis. In this article, I would like to review the prevalence and current management of cardiovascular risk factors in Korea according to the fact sheets released by various associations in 2024.

The association between noodle consumption and metabolic syndrome in Korean adults

BACKGROUND AND OBJECTIVES

The proportion of noodles in the Korean diet is increasing, but the effect of noodle intake on metabolic syndrome has not been sufficiently investigated. Therefore, we investigated noodle consumption and its relation to metabolic syndrome in Korean adults.

METHODS AND STUDY DESIGN

This study was conducted on 10,505 adults using the combined data of the 2012-2016 Korea National Health and Nutrition Examination Survey (KNHANES). Noodle intake was evaluated with a food frequency question-naire (FFQ) based on 112 food items. To compute odds ratios (ORs) and their 95% confidence intervals (CIs) controlled for confounders, multivariable logistic regression models were used.

RESULTS

Compared to people in the lowest levels of noodle intake, the OR of the metabolic syndrome of those in the highest levels was 1.48 (95% CI, 1.16-1.90; p-trend = 0.002). This positive association was also found for hypertriglyceridemia and abdominal obesity, which were metabolic syndrome components. Specifically, the odds of having hypertriglyceridemia were 38% (OR, 1.38; 95% CI, 1.14-1.66; p-trend < 0.001) higher for people with high noodle consumption compared to those with low noodle consumption in the overall population. The tendency for people who consume a lot of noodles to have raised odds of metabolic syndrome was observed when analyzed by the type of noodles.

CONCLUSIONS

This study suggested noodle intake was positively related to met-abolic syndrome and its components in Korean adults. Further clinical trials and prospective cohort studies are required to identify a causal relationship between noodle intake and metabolic syndrome in Koreans.

Interaction of sexual violence perpetration and victimization on suicide attempts in Korean adolescents on additive and multiplicative scales: a population-based cross-sectional study

PURPOSE

To evaluate the associations and interaction between sexual violence perpetration and victimization on suicide attempts using a large representative sample of adolescents from South Korea.

METHODS

Based on data from 515,247 adolescents aged 12-18 years from the Korea Youth Risk Behavior Web-Based Survey (2006-2012), a nationally representative repeated cross-sectional survey, we obtained self-reports of suicide attempts over the past year and of lifetime sexual violence perpetration and victimization. Using complex survey weights, weighted logistic regression models were employed to estimate the odds ratios (ORs). The interaction analyses were conducted on both additive and multiplicative scales. All analyses were conducted separately for boys and girls.

RESULTS

Lifetime prevalence of sexual violence perpetration were 1.3% for boys and 0.4% for girls, and about 40% of those perpetrating sexual violence were also victims. After adjusting for several covariates, sexual violence perpetration was independently associated with suicide attempts in boys (ORadjusted for boys 1.80 [95% confidence intervals: 1.53, 2.11]), whereas in girls, the association was only marginally significant (ORadjusted for girls 1.27 [1.00, 1.63]). We found the negative multiplicative and additive interaction between the sexual violence perpetration and victimization on suicide attempts for both boys and girls (the ratio of ORs 0.30 [0.23, 0.39] for boys and 0.20 [0.12, 0.31] for girls; relative excess risk due to interaction - 1.20 [-1.91, - 0.50] for boys and - 2.33 [-3.00, - 1.66] for girls).

CONCLUSION

Sexual violence perpetration and victimization were independently and interactively associated with suicide attempts in adolescents, with a sub-additive interaction found between these two variables. Public mental health services and policies should recognize the importance of actively involving adolescents who had sexually perpetrated others as key intervention targets.

Association between Near Work, Physical Activities and Myopia in Korean Adults During COVID-19 Outbreak

PURPOSE

This study investigated the relationship between near work hours and myopia in Korean adults.

METHODS

We used data from the 2021 Korean National Health and Nutrition Examination Survey. Associations between near work time, physical activity, and myopia were assessed using chi-square tests and multiple logistic regression analyses.

RESULTS

The overall prevalence of myopia was 60.2% in adults aged 19-59 years. The prevalence of myopia was 46.2% for individuals who used smart devices for less than one hour per day, while it was 68.0% for those who used smart devices for more than four hours. In the multiple logistic regression analysis, the odds ratio (OR) for myopia was significantly higher among individuals using smart devices for 3 hours (OR = 1.55, 95% CI = 1.08-2.23) or more than 4 hours (OR = 1.75, 95% CI = 1.27-2.42), compared to users with less than 1 hour of usage. Regarding sitting time, the OR for myopia was significantly higher in individuals who sat for more than 12 hours (OR = 1.66, 95% CI = 1.05-2.61) compared to those who sat less than 4 hours.

CONCLUSION

This study found that near work and sitting times were positively associated with myopia. Given the high prevalence of myopia and its implications for serious eye diseases, it is essential to implement measures to manage myopia. Considering the increased near work hours resulting from the COVID-19 pandemic, it is necessary to adopt supplementary measures, such as ensuring sufficient rest time for the eyes and adjusting the brightness of lights, to improve eye health.

Spatio-temporal Dynamics of Water Footprints of Food Consumption in South Korea: A Decomposition Analysis

South Korea faces severe water stress, as classified by the OECD, with changing dietary patterns significantly impacting water resources. To ensure water conservation and food security, it is crucial to understand the driving factors of the water footprint of food consumption (WFC). This study examined the WFC in South Korea from 2007 to 2023, focusing on how dietary choices impact water use and sustainability, and identified the key driving factors of changes in WFC. Using the logarithmic mean Divisia index (LMDI), this study decomposed these drivers into water footprint intensity, dietary structure, average dietary intake per person, and population effect. Additionally, global and local spatial autocorrelation analyses were used to measure the degree of spatial aggregation and distribution of WFC across administrative units. Results revealed a significant increase in WFC, from 27.6 km3 in 2007 to 34.7 km3 in 2023, with an average annual growth of 2%. Among the drivers, water footprint intensity contributed most to the increase in WFC, while average dietary intake per person led to a decrease. Cereals, meats and fish collectively account for more than 76% of the total WFC during the study period. The findings suggest that the drivers influencing the changes in WFC vary across administrative units, underscoring the need for tailored policies and strategies to promote sustainable food consumption practices that could conserve water resources in each administrative unit.

Epidemiological insights into complication and outcomes in corneal refractive surgery population: findings from KNHANES 2010-2012

PURPOSE

Epidemiological studies on corneal refractive surgery remain limited, particularly regarding complications such as dry eye disease and refractive error regression, which impact long-term visual outcomes and patient satisfaction. This study aimed to evaluate the demographic and clinical characteristics of individuals with a history of corneal refractive surgery using data from the Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2012.

METHODS

This cross-sectional study included 595 participants with a self-reported history of corneal refractive surgery. Data on diagnosed dry eye disease, dry eye symptoms, and previous ocular surgeries were collected through structured questionnaires, while ophthalmologic examinations provided information on refractive errors, intraocular pressure, and other ocular conditions. Logistic regression analysis identified factors associated with dry eye disease and symptoms.

RESULTS

Dry eye disease and refractive error regression were frequently reported among individuals with a history of corneal refractive surgery. Among participants, 24.2% reported diagnosed dry eye disease, and 33.1% reported dry eye symptoms. Significant myopia (≤ -0.75 D) and significant astigmatism (≤ -0.75 D) were present in 49.4% and 39.7%, respectively. Using the timing of the last ophthalmologic examination as a proxy for time since surgery, results showed a progressive myopic shift in spherical refractive error over time, while the prevalence of dry eye disease and symptoms gradually declined. Female sex (OR = 1.76, 95% CI = 1.05-2.96) and prolonged sun exposure (> 5 h/day, OR = 2.47, 95% CI = 0.96-6.36) were associated with a higher likelihood of diagnosed dry eye disease, while a longer time since surgery was associated with decreased dry eye symptoms. Severe diseases such as cataracts (0.3%), glaucoma (0.5%), and surgically treated retinal disorders (0.2%) were rare.

CONCLUSIONS

This study provides epidemiological insights into associations between corneal refractive surgery and postoperative outcomes, highlighting dry eye disease and refractive error regression as prevalent findings, while observing that severe complications were rarely reported. Sex and sun exposure were identified as important risk factors for dry eye disease, warranting attention in preoperative counseling and postoperative care. These findings support the need for procedure-specific, longitudinal research to optimize patient outcomes and satisfaction.

Association between compound dietary antioxidant index and all-cause and cancer mortality in patients with chronic obstructive pulmonary disease: results from NHANES 1999-2018

Objective

Chronic obstructive pulmonary disease (COPD) is one of the most important causes of death in the world, and its core is chronic inflammation. Antioxidants play a positive role in the onset and prognosis of chronic respiratory diseases. In maintaining human health, the composite dietary antioxidant index (CDAI) plays an important function. Therefore, the purpose of the current study was to investigate the relationship between CDAI and all-cause and cancer mortality in individuals with COPD.

Methods

A prospective cohort study was conducted by investigating NHANES data between 1999-2018. The study included people who satisfied the inclusion and exclusion criteria. In this study, the association between CDAI and all-cause and cancer mortality was investigated using weighted Cox regression. The relationship between them is illustrated by drawing constrained cubic spline curves (RCS). Finally, subgroup analysis is used to further verify.

Results

The study included 1,534 participants. CDAI was associated with COPD patients mortality, and after adjusting for multiple factors, we observed a 5% reduction in the risk of all-cause mortality (HR = 0.95, 95% CI: 0.92-0.97) was associated with a 9% lower risk of cancer mortality for each one-unit increase in CDAI (HR = 0.91, 95% CI: 0.85-0.98). After adjusting for multiple factors, high CDAI was associated with a reduced risk of mortality, with patients in the high CDAI group having 35% lower all-cause mortality than those in the low CDAI group (HR = 0.65, 95% CI: 0.50-0.85), the high CDAI group had a 61% lower risk of cancer mortality (HR = 0.39,95% CI: 0.23-0.68). Subgroup analysis and sensitivity analysis showed a consistent association between CDAI and COPD mortality.

Conclusion

Our study highlights the inverse association between CDAI and all-cause and cancer mortality in patients with COPD. Further prospective studies are needed to confirm the role of CDAI in mortality risk in patients with COPD.

Association Between Suicidal Ideation and Cancer Screening Uptake: Results from Middle-Aged and Older Adults in Korea

BACKGROUND

Compliance with cancer screening guidelines is crucial for the early diagnosis and prevention of cancer. We explored the association of suicidal ideation with participation in cancer screening programs.

METHODS

This cross-sectional analysis included a nationwide sample consisting of 22,554 Korean adults (9667 men and 12,887 women). Suicidal ideation in the past year was self-reported (yes or no). Participation in gastric, colorectal, cervical, and breast cancer screening within the past 2 years was assessed. Logistic regression models were employed to determine the association of suicidal ideation with participation in each cancer screening test. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.

RESULTS

Among men, the participation rates in gastric and colorectal cancer screening were 47.6% and 39.7%, respectively. Among women, the participation rates in gastric, colorectal, cervical, and breast cancer screening were 47.1%, 34.8%, 44.3%, and 50.8%, respectively. In the male sample, suicidal ideation was associated with reduced participation in gastric cancer screening (OR: 0.83, 95% CI: 0.69-0.99) and colorectal cancer screening (OR: 0.82, 95% CI: 0.67-1.00). Similarly, in the female sample, suicidal ideation was inversely associated with participation in gastric (OR: 0.74, 95% CI: 0.67-0.82), colorectal (OR: 0.71, 95% CI: 0.62-0.81), cervical (OR: 0.75, 95% CI: 0.68-0.84), and breast cancer screening (OR: 0.76, 95% CI: 0.68-0.84).

CONCLUSIONS

This study suggests that individuals with suicidal ideation demonstrated reduced participation in cancer screening tests. This study highlights the need for targeted support to improve access to cancer screening programs for individuals with mental health problems.

Association between depression and perceived health status in Korean adult women: a nationwide cross-sectional study

BACKGROUND

Perceived health status (PHS) can be influenced by mental health. A negative correlation between high levels of depression and self-evaluation of health has been reported, but research focusing on depression as a risk factor for poor PHS has been limited in Asia. This study aimed to analyse the association between depression and PHS in Korean adult women and explore the degree of depression's association on poor PHS.

METHODS

We conducted a cross-sectional study for adult women in Korea using data from the Korean National Health and Nutrition Examination Survey from 2014, 2016, 2018, 2020 and 2022. Depression was assessed using the nine-item Patient Health Questionnaire, and PHS was evaluated through a self-report questionnaire. Multivariate logistic regression analyses were used to identify the association between depression and PHS after adjusting for various covariates.

RESULTS

A total of 15,082 Korean adult women were included. A significant inverse relationship was found between depression and PHS across all adjusted models, with an odds ratio of 3.18 (95% confidence interval 2.37-4.27; P < 0.01). Poor PHS had a stronger association with depression than with chronic diseases such as hypertension, diabetes, and dyslipidemia.

CONCLUSIONS

Depression was strongly associated with poor PHS among Korean adult women. These findings highlight the importance of the implementation of mental health policies and programs to improve PHS. Future longitudinal studies are required to further validate these findings and explore causal relationships.

Dietary patterns and all-cause and cardiovascular disease, and cancer mortality in Korean adults

BACKGROUND

Examining dietary patterns in relation to mortality offers a more comprehensive view of food and nutrient intake. However, to our knowledge, the association of the Korean population's dietary patterns with mortality remains scarce and unclear. We aim to investigate the association between dietary patterns and all-cause, cardiovascular disease (CVD), and cancer mortality in the Korean population.

METHODS

This prospective cohort study included 18,019 men and 26,604 women aged ≥ 19 years who participated in the Korea National Health and Nutrition Examination Surveys 2007-2015. Dietary data were collected from a 24-hour dietary recall. Mortality from all causes, CVD, and cancer were ascertained from linkage to Statistics Korea. We identified dietary patterns through factor analysis. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of the all-cause, CVD, and cancer mortality according to diet pattern scores.

RESULTS

During a mean follow-up of 8.19 person-years, 2,622 deaths were identified, with 595 due to CVD and 827 due to cancer. Factor analysis based on 22 food groups, three dietary patterns were obtained: (1) "animal food and condiment pattern," (2) "seafood and vegetable pattern," and (3) "dairy products and processed meat pattern." After multivariable adjustment, the "seafood and vegetable pattern" score was associated with a lower risk of all-cause and CVD mortality. HRs (95% CIs) for all-cause mortality for the second to the highest quintile of "seafood and vegetable pattern", compared with the first quintile were 0.86 (0.75-0.99), 0.75 (0.65-0.87), 0.81 (0.69-0.94), and 0.87 (0.73-1.05), respectively (P for trend = 0.191). For CVD mortality, the HRs were 0.82 (0.62-1.07), 0.80 (0.58-1.08), 0.70 (0.50-0.99), and 0.63 (0.42-0.96), respectively (P for trend = 0.027). No statistically significant associations were found in "animal food and condiment pattern" or "dairy products and processed meat pattern" for all-cause, CVD, and cancer mortality.

CONCLUSIONS

We observed that the "seafood and vegetable" dietary pattern decreased the risk of all-cause and CVD mortality in Korean adults.

Electronic cigarette use and heavy metal exposure: Evidence from the Korea National Health and Nutrition Examination Survey

PURPOSE

This study investigated the association between electronic cigarette (e-cigarette) use and serum concentrations of heavy metals (lead, mercury, and cadmium) in the Korean population, utilizing data from the Korea National Health and Nutrition Examination Survey (KNHANES), a nationally representative cross-sectional survey.

METHODS

Data from KNHANES 2013, 2016, and 2017 were analyzed. Participants were classified as e-cigarette users (individuals who had ever used e-cigarettes, including dual users who had also used conventional cigarettes), conventional smokers (individuals who had smoked at least 100 conventional cigarettes [5 packs], but not e-cigarettes, in their lifetime), and non-smokers (individuals who had never used e-cigarettes and either never smoked conventional cigarettes or smoked fewer than 100 cigarettes). Linear regression models were employed to evaluate the association between smoking status and heavy metal concentrations, adjusting for covariates including age, sex, income, education, and health behaviors. Subgroup analyses were performed based on sex, age, and obesity status.

RESULTS

E-cigarette users exhibited significantly higher serum concentrations of heavy metals than non-smokers. Lead levels were 10.0 % higher (exponentiated β = 1.100; p < 0.001), mercury levels were 13.7 % higher (β = 1.137; p < 0.001), and cadmium levels were 61.4 % higher (β = 1.614; p < 0.001). Conventional smokers demonstrated elevated levels of these metals compared to non-smokers, but generally lower levels than e-cigarette users. Subgroup analyses revealed stronger associations among younger participants, males, and individuals with obesity, particularly for cadmium.

CONCLUSIONS

Dual use of e-cigarettes and conventional cigarettes is associated with elevated exposure to heavy metals compared to exclusive smoking cigarettes. These findings highlight the need for targeted public health interventions and stricter regulatory standards to address the risks associated with e-cigarette use.

Comparison of SPISE and METS-IR and Other Markers to Predict Insulin Resistance and Elevated Liver Transaminases in Children and Adolescents

BACKGRUOUND

Studies on predictive markers of insulin resistance (IR) and elevated liver transaminases in children and adolescents are limited. We evaluated the predictive capabilities of the single-point insulin sensitivity estimator (SPISE) index, metabolic score for insulin resistance (METS-IR), homeostasis model assessment of insulin resistance (HOMA-IR), the triglyceride (TG)/ high-density lipoprotein cholesterol (HDL-C) ratio, and the triglyceride-glucose index (TyG) for IR and alanine aminotransferase (ALT) elevation in this population.

METHODS

Data from 1,593 participants aged 10 to 18 years were analyzed using a nationwide survey. Logistic regression analysis was performed with IR and ALT elevation as dependent variables. Receiver operating characteristic (ROC) curves were generated to assess predictive capability. Proportions of IR and ALT elevation were compared after dividing participants based on parameter cutoff points.

RESULTS

All parameters were significantly associated with IR and ALT elevation, even after adjusting for age and sex, and predicted IR and ALT elevation in ROC curves (all P<0.001). The areas under the ROC curve of SPISE and METS-IR were higher than those of TyG and TG/HDL-C for predicting IR and were higher than those of HOMA-IR, TyG, and TG/HDL-C for predicting ALT elevation. The proportions of individuals with IR and ALT elevation were higher among those with METS-IR, TyG, and TG/ HDL-C values higher than the cutoff points, whereas they were lower among those with SPISE higher than the cutoff point.

CONCLUSION

SPISE and METS-IR are superior to TG/HDL-C and TyG in predicting IR and ALT elevation. Thus, this study identified valuable predictive markers for young individuals.

Older Adults with Diabetes in Korea: Latest Clinical and Epidemiologic Trends

BACKGRUOUND

Diabetes in older adults is becoming a significant public burden to South Korea. However, a comprehensive understanding of epidemiologic trends and the detailed clinical characteristics of older adults with diabetes is lacking. Therefore, we evaluated epidemiologic trends and the metabolic and lifestyle characteristics of diabetes in Korean older adults.

METHODS

We analyzed data from the Korea National Health and Nutrition Examination Survey to assess diabetes prevalence according to diabetes duration and lifestyle behaviors. In addition, we drew upon the National Health Information Database of the National Health Insurance System to assess physical activity levels, antidiabetic medication use, polypharmacy, medication adherence, and major comorbidities.

RESULTS

The absolute number of newly diagnosed cases of diabetes among older adults doubled over the past decade. Management rates of metabolic indicators were higher in older adults with diabetes compared to those without diabetes. The proportion of older adults with diabetes meeting the minimum recommended physical activity increased over the years. Compared to 10 years before, the use of dipeptidyl peptidase-4 inhibitor or sodium-glucose cotransporter-2 inhibitor had increased, as had comorbidities such as dyslipidemia, dementia, cancer, heart failure, atrial fibrillation, and chronic kidney disease. Initial medication adherence was significantly lower in those with end-stage kidney disease or dementia, insulin use, high-risk alcohol use, and living alone. Continuing insulin use 1 year after diagnosis of diabetes was significantly higher in those who initiated insulin therapy at diagnosis, had retinopathy, were on triple antidiabetic medications, and had a history of cancer.

CONCLUSION

Comprehensive management of metabolic indicators and physical activity is essential for older adults with diabetes. Improvements in prescribing guidelines, personalized management of age-related comorbidities, and individualized approaches that consider the heterogeneous nature of older adults with diabetes are desirable. Further research, such as high-quality cohort and intervention studies specific to older adults, is needed to establish evidence-based management for older adults with diabetes.

Association between menopausal age and smoking status defined using urinary cotinine or tobacco-specific nitrosamine metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol: The Korea National Health and Nutrition Examination Survey 2016-2018

This study aimed to establish the optimal cut-off values for urinary cotinine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL)to determine smoking status in Korean women over 20 years of age and to assess the correlation of these biomarkers with reproductive health, particularly menopausal age, in postmenopausal women. Utilizing data from the 7th edition of the Korea National Health and Nutrition Examination Survey (2016-2018), researchers included postmenopausal women aged 40-60 years who were within 5 years of menopause. Self-reported smoking status was aligned with biomarkers levels to calculate optimal cut-off values, classifying a total of 503 postmenopausal women into four groups: never smokers (cotinine <0.738 ng/mL, NNAL <1.595 pg/mL), secondhand smokers (SHSrs; cotinine 0.738-37.7 ng/mL, NNAL 1.595-12.35 pg/mL), light current smokers (cotinine 37.7-837 ng/mL, NNAL 12.35-91.55 pg/mg), and heavy current smokers (cotinine >837 ng/mL, NNAL >91.55 pg/mL). Differences in menopausal age were analyzed using Kaplan-Meier curves and log-rank tests. The results indicated significant differences in menopausal age between never smokers and heavy smokers (51.4 ± 3.9 vs. 49.6 ± 3.0 years, p = 0.001) as well as SHSrs and heavy smokers (51.4 ± 3.3 vs. 49.6 ± 3.0 years, p = 0.001) when applying urinary cotinine cutoff values. However, no significant differences in menopausal age were observed based on NNAL cutoffs. These findings suggest urinary cotinine levels correlated more strongly with menopausal age than using urine NNAL levels for defining smoking status among postmenopausal Korean women. Heavy current smokers, as identified by urinary cotinine levels, experienced menopause at an earlier age compared to never smokers and SHSrs.

Associations of leisure-time and occupational physical activity with allergic rhinitis and chronic sinusitis in middle-aged adults: a population-based study

OBJECTIVE

To explore the links of leisure-time physical activity (LTPA), and occupational physical activity (OPA) with allergic rhinitis (AR) and chronic rhinosinusitis (CRS) in a nationally representative sample of the Korean population.

METHODS

10,346 participants aged 40-60 years old were obtained from the KNHANES 2014-2018 database. Physical activity levels were assessed using questions adapted from the Korean version of the Global Physical Activity Questionnaire. Participants were categorized as having high or low LTPA or OPA. AR and CRS statuses were determined based on participants' medical histories. Univariate and multivariate logistic regression analyses were conducted to uncover the associations between AR/CRS and LTPA/OPA. Subgroup analysis was performed considering various clinical characteristics.

RESULTS

The multivariate regression analysis revealed high OPA as a risk factor for AR in middle-aged adults (odds ratio [OR] = 1.474, 95% confidence interval [CI]: 1.130, 1.924), especially among males (OR = 1.665, 95% CI: 1.147, 2.417), individuals with BMI ≥ 25 (OR = 1.717, 95% CI: 1.124, 2.623), blue-collar workers (OR = 1.686, 95% CI: 1.074, 2.642), and green-collar workers (OR = 4.178, 95% CI: 1.642, 11.319). However, no notable correlation was revealed between LTPA and AR prevalence (P > 0.5), nor between OPA or LTPA and CRS prevalence (P > 0.5).

CONCLUSIONS

LTPA and OPA exhibit different links with AR, suggesting that high levels of OPA in AR individuals should be addressed. However, neither LTPA nor OPA shows a significant correlation with CRS.