Early-onset vasomotor symptoms and development of depressive symptoms among premenopausal women

BACKGROUND

We investigated the association between vasomotor symptoms (VMSs) and the onset of depressive symptoms among premenopausal women.

METHODS

This cross-sectional study included 4376 premenopausal women aged 42-52 years, and the cohort study included 2832 women without clinically relevant depressive symptoms at baseline. VMSs included the symptoms of hot flashes and night sweats. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale; a score of ≥16 was considered to define clinically relevant depressive symptoms.

RESULTS

Premenopausal Women with VMSs at baseline exhibited a higher prevalence of depressive symptoms compared with women without VMSs at baseline (multivariable-adjusted prevalence ratio 1.76, 95 % confidence interval [CI] 1.47-2.11). Among the 2832 women followed up (median, 6.1 years), 406 developed clinically relevant depressive symptoms. Women with versus without VMSs had a significantly higher risk of developing clinically relevant depressive symptoms (multivariable-adjusted hazard ratio, 1.72; 95 % CI 1.39-2.14). VMS severity exhibited a dose-response relationship with depressive symptoms (P for trend <0.05).

LIMITATIONS

Self-reported questionnaires were only used to obtain VMSs and depressive symptoms, which could have led to misclassification. We also could not directly measure sex hormone levels.

CONCLUSIONS

Even in the premenopausal stage, women who experience hot flashes or night sweats have an increased risk of present and developed clinically relevant depressive symptoms. It is important to conduct mental health screenings and provide appropriate support to middle-aged women who experience early-onset VMSs.

Baseline and change in serum uric acid level over time and resolution of nonalcoholic fatty liver disease in young adults: The Kangbuk Samsung Health Study

AIMS

To determine the association between: (i) baseline serum uric acid (SUA) level and (ii) SUA changes over time, and nonalcoholic fatty liver disease (NAFLD) resolution.

MATERIALS AND METHODS

A retrospective cohort study, comprising 38 483 subjects aged <40 years with pre-existing NAFLD, was undertaken. The effects of SUA changes over time were studied in 25 266 subjects. Participants underwent a health examination between 2011 and 2019, and at least one follow-up liver ultrasonography scan up to December 2020. Exposures included baseline SUA level and SUA changes between baseline and subsequent visits, categorized into quintiles. The reference group was the third quintile (Q3) containing zero change. The primary endpoint was resolution of NAFLD.

RESULTS

During a median follow-up of 4 years, low baseline SUA level and decreases in SUA levels over time were independently associated with NAFLD resolution (p for trend <0.001). Using SUA as a continuous variable, the likelihood of NAFLD resolution was increased by 10% and 13% in men and women, respectively, per 1-mg/dL decrease in SUA. In a time-dependent model with changes in SUA treated as a time-varying covariate, adjusted hazard ratios (95% confidence intervals) for NAFLD resolution comparing Q1 (highest decrease) and Q2 (slight decrease) to Q3 (reference) were 1.63 (1.49-1.78) and 1.23 (1.11-1.35) in men and 1.78 (1.49-2.12) and 1.18 (0.95-1.46) in women, respectively.

CONCLUSIONS

Low baseline SUA levels and a decrease in SUA levels over time were both associated with NAFLD resolution in young adults.

Gate-bias stability of triple-gated feedback field-effect transistors with silicon nanosheet channels

In this study, we investigate the gate-bias stability of triple-gated feedback field-effect transistors (FBFETs) with Si nanosheet channels. The subthreshold swing (SS) of FBFETs increases from 0.3 mV dec-1to 60 and 80 mV dec-1inp- andn-channel modes, respectively, when a positive bias stress (PBS) is applied for 1000 s. In contrast, the SS value does not change even after a negative bias stress (NBS) is applied for 1000 s. The difference in the switching characteristics under PBS and NBS is attributed to the ability of the interface traps to readily gain electrons from the inversion layer. The switching characteristics deteriorated by PBS are completely recovered after annealing at 300 °C for 10 min, and the characteristics remain stable even after PBS is applied again for 1000 s.

Screening mammography performance according to breast density: a comparison between radiologists versus standalone intelligence detection

BACKGROUND

Artificial intelligence (AI) algorithms for the independent assessment of screening mammograms have not been well established in a large screening cohort of Asian women. We compared the performance of screening digital mammography considering breast density, between radiologists and AI standalone detection among Korean women.

METHODS

We retrospectively included 89,855 Korean women who underwent their initial screening digital mammography from 2009 to 2020. Breast cancer within 12 months of the screening mammography was the reference standard, according to the National Cancer Registry. Lunit software was used to determine the probability of malignancy scores, with a cutoff of 10% for breast cancer detection. The AI's performance was compared with that of the final Breast Imaging Reporting and Data System category, as recorded by breast radiologists. Breast density was classified into four categories (A-D) based on the radiologist and AI-based assessments. The performance metrics (cancer detection rate [CDR], sensitivity, specificity, positive predictive value [PPV], recall rate, and area under the receiver operating characteristic curve [AUC]) were compared across breast density categories.

RESULTS

Mean participant age was 43.5 ± 8.7 years; 143 breast cancer cases were identified within 12 months. The CDRs (1.1/1000 examination) and sensitivity values showed no significant differences between radiologist and AI-based results (69.9% [95% confidence interval [CI], 61.7-77.3] vs. 67.1% [95% CI, 58.8-74.8]). However, the AI algorithm showed better specificity (93.0% [95% CI, 92.9-93.2] vs. 77.6% [95% CI, 61.7-77.9]), PPV (1.5% [95% CI, 1.2-1.9] vs. 0.5% [95% CI, 0.4-0.6]), recall rate (7.1% [95% CI, 6.9-7.2] vs. 22.5% [95% CI, 22.2-22.7]), and AUC values (0.8 [95% CI, 0.76-0.84] vs. 0.74 [95% CI, 0.7-0.78]) (all P < 0.05). Radiologist and AI-based results showed the best performance in the non-dense category; the CDR and sensitivity were higher for radiologists in the heterogeneously dense category (P = 0.059). However, the specificity, PPV, and recall rate consistently favored AI-based results across all categories, including the extremely dense category.

CONCLUSIONS

AI-based software showed slightly lower sensitivity, although the difference was not statistically significant. However, it outperformed radiologists in recall rate, specificity, PPV, and AUC, with disparities most prominent in extremely dense breast tissue.

The association of blood eosinophil counts and FEV1 decline: a cohort study

BACKGROUND

Accelerated lung function decline is characteristic of chronic obstructive pulmonary disease (COPD). However, the association between blood eosinophil counts and lung function decline, accounting for current smoking status, in young individuals without prevalent lung disease is not fully understood.

METHODS

This is a cohort study of 629 784 Korean adults without COPD or a history of asthma at baseline who participated in health screening examinations including spirometry and differential white blood cell counts. We used linear mixed effects model to estimate the annual change in FEV1 (mL) by baseline blood eosinophil count, adjusting for covariates including smoking status. We also performed a stratified analysis by baseline and time-varying smoking status.

RESULTS

During a mean follow-up of 6.5 years (maximum of 17.8 years), the annual change in FEV1 (95% confidence interval [CI]) in participants with eosinophil counts <100, 100-199, 200-299, 300-499, and ≥500 cells/µL in the fully adjusted model were -23.3 (-23.9, -22.7), -24.3 (-24.9, -23.7), -24.8 (-25.5, -24.2), -25.5 (-26.2, -24.8), and -26.8 (-27.7, -25.9) mL, respectively. When stratified by smoking status, participants with higher eosinophil count had a faster decline in FEV1 than those with lower eosinophil count in both never- and ever-smokers, which persisted when time-varying smoking status was used.

CONCLUSIONS

Blood eosinophil counts were associated with a faster lung function decline among healthy individuals without lung disease, independent of smoking status. The findings suggest that blood eosinophil counts contribute to the risk of faster lung function decline, particularly among younger adults without a history of lung disease.

Nightshift work and irregular menstrual cycle: 8-year follow-up cohort study

BACKGROUND

Irregular menstruation is a major health problem among women, although its association with nightshift work remains controversial.

AIMS

To study the association between nightshift work and irregular menstrual cycle among female workers and investigate any differences according to sleep quality, working hours or obesity.

METHODS

This study included female workers who underwent health examinations from 2012 to 2019. Nightshift work, working hours, sleep quality and menstrual cycles were assessed using self-administered questionnaires. Irregular menstrual cycle was defined as self-reported irregular or ≥36 days. Adjusted odds ratios and 95% confidence intervals (CIs) were calculated by multivariable logistic regression; adjusted hazard ratios (95% CIs) for incident irregular menstrual cycle were calculated by Cox proportional hazard models with time-dependent analysis.

RESULTS

The study participants were 87 147 in the cross-sectional study and 41 516 in the longitudinal study. After adjusting for all covariates in the cross-sectional analyses, the odds ratio for prevalent irregular menstrual cycle among female nightshift workers versus the reference was 1.26 (95% CI 1.2-1.33). In the cohort study, the adjusted hazard ratio for incident irregular menstrual cycle among nightshift workers was 1.95 (95% CI 1.61-2.35) in the period after 6 years. No significant differences were observed among subgroups stratified by sleep quality, working hours or obesity.

CONCLUSIONS

Nightshift work is associated with an increased risk of both prevalent and incident irregular menstrual cycle in female workers without significant interactions by sleep quality, working hours or obesity.

Risk prediction model for gastric cancer within 5 years in healthy Korean adults

BACKGROUND

Although endoscopy is commonly used for gastric cancer screening in South Korea, predictive models that integrate endoscopy results are scarce. We aimed to develop a 5-year gastric cancer risk prediction model using endoscopy results as a predictor.

METHODS

We developed a predictive model using the cohort data of the Kangbuk Samsung Health Study from 2011 to 2019. Among the 260,407 participants aged ≥20 years who did not have any previous history of cancer, 435 cases of gastric cancer were observed. A Cox proportional hazard regression model was used to evaluate the predictors and calculate the 5-year risk of gastric cancer. Harrell's C-statistics and Nam-D'Agostino χ2 test were used to measure the quality of discrimination and calibration ability, respectively.

RESULTS

We included age, sex, smoking status, alcohol consumption, family history of cancer, and previous results for endoscopy in the risk prediction model. This model showed sufficient discrimination ability [development cohort: C-Statistics: 0.800, 95% confidence interval (CI) 0.770-0.829; validation cohort: C-Statistics: 0.799, 95% CI 0.743-0.856]. It also performed well with effective calibration (development cohort: χ2 = 13.65, P = 0.135; validation cohort: χ2 = 15.57, P = 0.056).

CONCLUSION

Our prediction model, including young adults, showed good discrimination and calibration. Furthermore, this model considered a fixed time interval of 5 years to predict the risk of developing gastric cancer, considering endoscopic results. Thus, it could be clinically useful, especially for adults with endoscopic results.

Adiposity, Body Composition Measures, and Breast Cancer Risk in Korean Premenopausal Women

Objective

To investigate the association between body composition parameters and breast cancer (BC) risk in premenopausal women.

Design, Setting, and Participants

Prospective cohort study using data from the Kangbuk Samsung Cohort Study. Participants were women aged 20 to 54 years who were enrolled from 2011 to 2019 and followed up for BC development until December 31, 2020. Data were analyzed from June to August 2023.

Exposures

Trained nurses conducted anthropometric measurements and assessed body composition using segmental bioelectric impedance analysis. The analysis encompassed adiposity measures such as body mass index (BMI), waist circumference, and body composition parameters, including muscle mass, fat mass, ratio of muscle mass to weight, ratio of fat mass to weight, and fat mass index.

Main outcomes and measures

Adjusted hazard ratios (aHR) for BC during the follow-up period.

Results

Among 125 188 premenopausal women, the mean (SD) age was 34.9 (6.3) years. During a mean (range) follow-up of 6.7 (0.5-9.9) years, 1110 incident BC cases were identified. The mean (SD) BMI and waist circumference were 21.6 (3.1) and 75.3 (8.2) cm, respectively. Higher BMI and waist circumference were associated with decreased risk, with an aHR of 0.89 (95% CI, 0.84-0.95) per SD increase in BMI and 0.92 (95% CI, 0.86-0.98) per SD increase in waist circumference. A higher ratio of fat mass to weight was associated with decreased BC risk (aHR, 0.92; 95% CI, 0.86-0.99 per SD increase), whereas the opposite trend was observed for the ratio of muscle mass to weight, with an aHR of 1.08 (95% CI, 1.02-1.15) per SD increase. The results remained consistent even after additional adjustments for height in the model. The fat mass index was also inversely associated with BC risk, with an HR of 0.90 (95% CI, 0.85-0.97) per SD increase.

Conclusions and Relevance

In this cohort study of premenopausal women, a higher level of adiposity, represented by increased BMI, waist circumference, and fat mass, was consistently associated with decreased breast cancer risk. Conversely, muscle mass and its ratio to weight displayed opposite or inconsistent patterns. These findings suggest an inverse association between excess adiposity and the risk of BC in premenopausal women, confirming earlier findings that BMI is an indirect measure of adiposity.

Mammography-based deep learning model for coronary artery calcification

AIMS

Mammography, commonly used for breast cancer screening in women, can also predict cardiovascular disease. We developed mammography-based deep learning models for predicting coronary artery calcium (CAC) scores, an established predictor of coronary events.

METHODS AND RESULTS

We evaluated a subset of Korean adults who underwent image mammography and CAC computed tomography and randomly selected approximately 80% of the participants as the training dataset, used to develop a convolutional neural network (CNN) to predict detectable CAC. The sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), and overall accuracy of the model's performance were evaluated. The training and validation datasets included 5235 and 1208 women, respectively [mean age, 52.6 (±10.2) years], including non-zero cases (46.8%). The CNN-based deep learning prediction model based on the Resnet18 model showed the best performance. The model was further improved using contrastive learning strategies based on positive and negative samples: sensitivity, 0.764 (95% CI, 0.667-0.830); specificity, 0.652 (95% CI, 0.614-0.710); AUROC, 0.761 (95% CI, 0.742-0.780); and accuracy, 70.8% (95% CI, 68.8-72.4). Moreover, including age and menopausal status in the model further improved its performance (AUROC, 0.776; 95% CI, 0.762-0.790). The Framingham risk score yielded an AUROC of 0.736 (95% CI, 0.712-0.761).

CONCLUSION

Mammography-based deep learning models showed promising results for predicting CAC, performing comparably to conventional risk models. This indicates mammography's potential for dual-risk assessment in breast cancer and cardiovascular disease. Further research is necessary to validate these findings in diverse populations, with a particular focus on representation from national breast screening programmes.

Binary and ternary logic-in-memory using nanosheet feedback field-effect transistors with triple-gated structure

In this study, we demonstrate binary and ternary logic-in-memory (LIM) operations of inverters and NAND and NOR gates comprising nanosheet (NS) feedback field-effect transistors (FBFETs) with a triple-gated structure. The NS FBFETs are reconfigured in p- or n-channel modes depending on the polarity of the gate bias voltage and exhibit steep switching characteristics with an extremely low subthreshold swing of 1.08 mV dec-1 and a high ON/OFF current ratio of approximately 107. Logic circuits consisting of NS FBFETs perform binary and ternary logic operations of the inverters and NAND and NOR gates in each circuit and store their outputs under zero-bias conditions. Therefore, NS FBFETs are promising components for next-generation LIM.

Impact of metabolic unhealthiness and its changes on the risk of erosive esophagitis: a cohort study

BACKGROUND AND AIM

We aimed to compare the risk of erosive esophagitis (EE) among individuals with different phenotypes based on metabolic health status and obesity and investigate the role of changes in metabolic health in EE risk.

METHODS

A cohort of 258 892 asymptomatic adults without EE at baseline who underwent ollow-up esophagogastroduodenoscopy (EGD) were categorized into the following four groups according to metabolic health and obesity status: (i) metabolically healthy (MH) non-obese; (ii) metabolically unhealthy (MU) non-obese; (iii) MH obese; and (iv) MU obese. EE was defined as the presence of grade A or higher mucosal breaks on EGD.

RESULTS

During a median follow-up of 4.5 years, the incidence rates of EE were 0.6/103 person-years (PY), 1.7/103 PY, 1.7/103 PY, and 3.1/103 PY in the MH non-obese, MU non-obese, MH obese, and MU obese groups, respectively. The multivariable-adjusted hazard ratio (HR) (95% confidence intervals [CI]) for developing EE comparing the MH obese, MU non-obese, and MU obese groups with the MH non-obese group were 1.49 (1.29-1.71), 1.56 (1.25-1.94), and 2.18 (1.90-2.49), respectively. The multivariable-adjusted HR (95% CI) comparing the progression of MH to MU, regression of MU to MH, and persistent MU with the persistent MH group were 1.39 (1.10-1.76), 1.39 (1.09-1.77), and 1.86 (1.56-2.21), respectively. The increased risk of EE among the persistent MU group was consistently observed in individuals without obesity or abdominal obesity.

CONCLUSION

Metabolic unhealthiness and obesity were independent risk factors for the development of EE, suggesting that maintaining both normal weight and metabolic health may help reduce the risk of EE.

Human papillomavirus infection and cardiovascular mortality: a cohort study

BACKGROUND AND AIMS

High-risk human papillomavirus (HR-HPV) infection-a well-established risk factor for cervical cancer-has associations with cardiovascular disease (CVD). However, its relationship with CVD mortality remains uncertain. This study examined the associations between HR-HPV infection and CVD mortality.

METHODS

As part of a health examination, 163 250 CVD-free Korean women (mean age: 40.2 years) underwent HR-HPV screening and were tracked for up to 17 years (median: 8.6 years). National death records identified the CVD mortality cases. Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD mortality were estimated using Cox proportional hazard regression analyses.

RESULTS

During 1 380 953 person-years of follow-up, 134 CVD deaths occurred, with a mortality rate of 9.1 per 105 person-years for HR-HPV(-) women and 14.9 per 105 person-years for HR-HPV(+) women. After adjustment for traditional CVD risk factors and confounders, the HRs (95% CI) for atherosclerotic CVD (ASCVD), ischaemic heart disease (IHD), and stroke mortality in women with HR-HPV infection compared with those without infection were 3.91 (1.85-8.26), 3.74 (1.53-9.14), and 5.86 (0.86-40.11), respectively. The association between HR-HPV infection and ASCVD mortality was stronger in women with obesity than in those without (P for interaction = .006), with corresponding HRs (95% CI) of 4.81 (1.55-14.93) for obese women and 2.86 (1.04-7.88) for non-obese women.

CONCLUSIONS

In this cohort study of young and middle-aged Korean women, at low risks for CVD mortality, those with HR-HPV infection had higher death rates from CVD, specifically ASCVD and IHD, with a more pronounced trend in obese individuals.

The future of International Classification of Diseases coding in steatotic liver disease: An expert panel Delphi consensus statement

BACKGROUND

Following the adoption of new nomenclature for steatotic liver disease, we aimed to build consensus on the use of International Classification of Diseases codes and recommendations for future research and advocacy.

METHODS

Through a two-stage Delphi process, a core group (n = 20) reviewed draft statements and recommendations (n = 6), indicating levels of agreement. Following revisions, this process was repeated with a large expert panel (n = 243) from 73 countries.

RESULTS

Consensus ranged from 88.8% to 96.9% (mean = 92.3%).

CONCLUSIONS

This global consensus statement provides guidance on harmonizing the International Classification of Diseases coding for steatotic liver disease and future directions to advance the field.

Potential role of Fibrosis-4 score in hepatocellular carcinoma screening: The Kangbuk Samsung Health Study

AIM

Hepatocellular carcinoma (HCC) is a major cause of cancer-related death, with low survival rates worldwide. Fatty liver disease (FLD) significantly contributes to HCC. We studied the screening performance of different methods for identifying HCC in patients with FLD or with metabolic risk factors for FLD.

METHODS

Korean adults (n = 340 825) without a prior HCC diagnosis were categorized into four groups: normal (G1), ≥2 metabolic risk factors (G2), FLD (G3), and viral liver disease or liver cirrhosis (G4). The National Cancer Registry data were used to identify HCC cases within 12 months. We assessed the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values of individual or combined screening methods.

RESULTS

In 93 HCC cases, 71 were identified in G4, whereas 20 cases (21.5%) in G2 and G3 combined where ultrasound and Fibrosis-4 performed similarly to alpha-fetoprotein and ultrasound. In G2, Fibrosis-4 and ultrasound had the highest area under the receiver operating characteristic curve (0.93 [0.87-0.99]), whereas in G3, the combined screening methods had the highest area under the receiver operating characteristic curve (0.98 [0.95-1.00]). The positive predictive value was lower in G2 and G3 than in G4, but was >5% when restricted to a high Fibrosis-4 score.

CONCLUSIONS

More than 21% of HCC cases were observed in patients with diagnosed FLD or at risk of FLD with metabolic risk factors. Nevertheless, screening for HCC in individuals without cirrhosis or viral hepatitis yielded very low results, despite the potential value of the Fibrosis-4 score in identifying individuals at high risk of HCC.

Mammographic breast density and cardiovascular disease risk in women

AIMS

We aimed to determine the predictive role of mammographic breast density in addition to the Framingham Risk Score (FRS) on subsequent CVD events in women.

METHODS AND RESULTS

This cohort study included 4,268,579 women aged ≥40 years who underwent mammography screening between 2009 and 2010 with follow-up until 2020. Breast density was reported following the Breast Imaging Reporting and Data System. Primary outcomes included coronary heart disease, cerebrovascular disease, peripheral arterial disease, and heart failure. The incremental predictive ability of breast density added to the FRS model was assessed using the ROC and net reclassification index (NRI) among all women and strata based on FRS risk categories (<5% as low-risk, 5%-10% as moderate-risk, and ≥10% as high-risk). In total, 135,475 CVD events were recorded after a median follow-up of 10.9 years. A lower category of breast density was associated with a higher risk of CVD. Compared to the extremely dense breast group, the hazard ratios (95% CI) for CVDs were 1.12 (1.09-1.14), 1.19 (1.17-1.22), and 1.29 (1.26-1.32) in women with heterogeneously dense, scattered fibroglandular densities, and almost entirely fat breast density, respectively. Adding breast density to the FRS showed a slight improvement in AUROC but a modest improvement in NRI; the C-statistic difference was 0.083% (95% CI 0.069-0.096) with a 7.15% (6.85-7.69) increase in NRI, with the strongest improvement observed in the low-risk group.

CONCLUSIONS

Mammographic breast density is an independent predictor of incident CVD among women. The addition of mammographic breast density to FRS improves the prediction of CVDs, especially in low-risk individuals.

Metabolic-associated fatty liver disease is associated with colorectal adenomas in young and older Korean adults

BACKGROUND AND AIMS

Given that the majority of colorectal cancers (CRCs) develop from high-risk adenomas, identifying risk factors for high-risk adenomas is important. The relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and the risk of colorectal adenoma in young adults remains unclear. We aimed to evaluate this relationship in adults <50 (younger) and ≥50 (older) years of age.

METHODS

This cross-sectional study included 184 792 Korean adults (80% <50 years of age) who all underwent liver ultrasound and colonoscopy. Participants were grouped into those with and without MAFLD and classified by adenoma presence into no adenoma, low-risk adenoma, or high-risk adenoma (defined as ≥3 adenomas, any ≥10 mm, or adenoma with high-grade dysplasia/villous features).

RESULTS

The prevalence of low- and high-risk adenomas among young and older adults was 9.6% and 0.8% and 22.3% and 4.8%, respectively. MAFLD was associated with an increased prevalence of low- and high-risk adenomas in young and older adults. Young adults with MAFLD had a 1.30 (95% CIs 1.26-1.35) and 1.40 (1.23-1.59) times higher prevalence of low- and high-risk adenomas, respectively, compared to those without MAFLD. These associations were consistent even in lean adults (BMI < 23 kg/m2 ) and those without a family history of CRC.

CONCLUSIONS

MAFLD is associated with an increased prevalence of low- and high-risk adenomas in Korean adults, regardless of age or obesity status. Whether reducing metabolic risk factors, such as MAFLD, reduces the risk of precancerous lesions and ultimately reduces the risk of early-onset CRC requires further investigation.

History of Gestational Diabetes and Incident Nonalcoholic Fatty Liver Disease: The Kangbuk Samsung Health Study

INTRODUCTION

We examined the relationship between a previous history of gestational diabetes mellitus (pGDM) and risk of incident nonalcoholic fatty liver disease (NAFLD) and investigated the effect of insulin resistance or development of diabetes as mediators of any association.

METHODS

We performed a retrospective cohort study of 64,397 Korean parous women without NAFLD. The presence of and the severity of NAFLD at baseline and follow-up were assessed using liver ultrasonography. Cox proportional hazards models were used to determine adjusted hazard ratios for incident NAFLD according to a self-reported GDM history, adjusting for confounders as time-dependent variables. Mediation analyses were performed to examine whether diabetes or insulin resistance may mediate the association between pGDM and incident NAFLD.

RESULTS

During a median follow-up of 3.7 years, 6,032 women developed incident NAFLD (of whom 343 had moderate-to-severe NAFLD). Multivariable adjusted hazard ratios (95% confidence intervals) comparing women with time-dependent pGDM with the reference group (no pGDM) were 1.46 (1.33-1.59) and 1.75 (1.25-2.44) for incident overall NAFLD and moderate-to-severe NAFLD, respectively. These associations remained significant in analyses restricted to women with normal fasting glucose <100 mg/dL or that excluded women with prevalent diabetes at baseline or incident diabetes during follow-up. Diabetes and insulin resistance (Homeostatic Model Assessment for Insulin Resistance) each mediated <10% of the association between pGDM and overall NAFLD development.

DISCUSSION

A previous history of GDM is an independent risk factor for NAFLD development. Insulin resistance, measured by the Homeostatic Model Assessment for Insulin Resistance, and development of diabetes each explained only <10% of the association between GDM and incident NAFLD.

Nonalcoholic fatty liver disease without overlapping metabolic-associated fatty liver disease and the risk of incident type 2 diabetes

BACKGROUND AND AIMS

Re-classifying NAFLD as metabolic-associated fatty liver (MAFLD) has been proposed. While some people fulfil criteria for NAFLD, they do not have MAFLD; and whether NAFLD-only subjects have increased the risk of type 2 diabetes remains unknown. We compared risk of incident T2D in individuals with: (a) NAFLD-only; and (b) MAFLD, to individuals without fatty liver, considering effect modification by sex.

METHODS

246 424 Koreans without diabetes or a secondary cause of ultrasound-diagnosed hepatic steatosis were studied. Subjects were stratified into: (a) NAFLD-only status and (b) NAFLD that overlapped with MAFLD (MAFLD). Cox proportional hazards models with incident T2D as the outcome were used to estimate hazard ratios (HRs) for: (a) and (b). Models were adjusted for time-dependent covariates, and effect modification by sex was analysed in subgroups.

RESULTS

A total of 5439 participants had NAFLD-only status and 56 839 met MAFLD criteria. During a median follow-up of 5.5 years, 8402 incident cases of T2D occurred. Multivariable-adjusted HRs (95% CI) for incident T2D comparing NAFLD-only and MAFLD to the reference (neither condition) were 2.39 (1.63-3.51) and 5.75 (5.17-6.36) (women), and 1.53 (1.25-1.88) and 2.60 (2.44-2.76) (men), respectively. The increased risk of T2D in the NAFLD-only group was higher in women than in men (p for interaction by sex <0.001) and consistently observed across all subgroups. Risk of T2D was increased in lean participants regardless of metabolic dysregulation (including prediabetes).

CONCLUSIONS

NAFLD-only participants without metabolic dysregulation and the criteria for MAFLD are at increased risk of developing T2D. This association was consistently stronger in women than in men.

Diagnostic performance of screening mammography according to menstrual cycle among Asian women

PURPOSE

To investigate the performance metrics of screening mammography according to menstrual cycle week in premenopausal Asian women.

METHODS

This retrospective study included 69,556 premenopausal Asian women who underwent their first screening mammography between 2011 and 2019. The presence or absence of a breast cancer diagnosis within 12 months after the index screening mammography served as the reference standard, determined by linking the study data to the national cancer registry data. Menstrual cycles were calculated, and participants were assigned to groups according to weeks 1-4. The performance metrics included cancer detection rate (CDR), sensitivity, specificity, and positive predictive value (PPV), with comparisons across menstrual cycles.

RESULTS

Among menstrual cycles, the lowest CDR at 4.7 per 1000 women (95% confidence interval [CI], 3.8-5.8 per 1000 women) was observed in week 4 (all P < 0.05). The highest sensitivity of 72.7% (95% CI, 61.4-82.3) was observed in week 1, although the results failed to reach statistical significance. The highest specificity of 80.4% (95% CI, 79.5-81.3%) was observed in week 1 (P = 0.01). The lowest PPV of 2.2% (95% CI, 1.8-2.7) was observed in week 4 (all P < 0.05).

CONCLUSION

Screening mammography tended to show a higher performance during week 1 and a lower performance during week 4 of the menstrual cycle among Asian women. These results emphasize the importance of timing recommendations that consider menstrual cycles to optimize the effectiveness of screening mammography for breast cancer detection.

Utility of Stereotactic Body Radiation Therapy (SBRT) in Establishing Local Control for Invasive Breast Cancer Patients Not Undergoing Definitive Surgery

PURPOSE/OBJECTIVE(S)

Breast cancer (BC) treatment involves a multi-modal approach where surgical resection is the backbone of therapy. However, due to medical comorbidities precluding surgery, unresectable disease, or patient preference, some patients do not undergo surgery. In the absence of resection, it is paramount to improve local control (LC) of the primary tumor. To that end, this study explored the role of ablative RT dose delivered with SBRT.

MATERIALS/METHODS

Between 2015-2022, 21 patients (10 metastatic, 11 stage IA-IIIC) received 23 SBRT courses to primary BC lesions without planned surgery at our institution. One patient had undergone whole breast RT 20 years prior to SBRT. 7 patients were analyzed retrospectively; 15 are currently enrolled in a prospective study. SBRT dose was 40 Gy/5 fractions delivered every other day. Follow-up imaging (PET, CT, MRI, MMG/US) was reviewed to evaluate the response. CTCAE v.3 was used to document any acute (≤3 months) and late toxicities. Kaplan-Meier curves were used to estimate local control (LC) and overall survival (OS).

RESULTS

Median age was 78.4 (45.9-97.3) years. Median follow-up was 14.7 (3.3-70.3) months after RT completion. Initial post-treatment imaging was available for all cases and was performed at a median of 4.0 (0.6-11.9) months after SBRT. The median pre-SBRT index lesion size was 3.1 (0.5-14.5) cm and PTV was 32.4 (11.5-522.4) cc. At a median 4 months post-SBRT, the median decrease in index lesion size was 20.8 (0-100) % and SUV reduction was 65.2 (20.8-100) %. Further improvement was seen on the 2nd follow-up scans at a median 7.8 months post-SBRT, with 62 (0-100) % and 88 (33.3-100) % median reduction in the tumor size and SUV, respectively, compared to pre-SBRT values. The estimated LC rate was 100% at 6 months and 93.3% at 12 months. The sole case of local progression occurred 9.5 months after SBRT, after an initial interval decrease in the primary lesion. Among the patients with available systemic follow-up scans, regional progression occurred in 4 (17.4%) cases at a median 18.6 (5.2-22.7) months post-SBRT. Six (37.5%) patients developed distant progression at a median 4.8 (0.9-16.2) months, all of whom had metastatic disease at diagnosis. The estimated OS was 85.7% at 6 months and 63.8% at 12 months. Most patients tolerated the treatment well. There was no grade 4 toxicity. Complete acute toxicity data is presented in Table 1. Only one patient experienced late grade 2 breast edema.

CONCLUSION

Based on our preliminary results, definitive SBRT to the primary BC appears to have a role in providing LC in the treatment of non-surgical patients and is well-tolerated. Since the disease progression tends to occur outside the treated primary tumor, additional approaches to improve regional and distant control should be investigated.

Serum 25-Hydroxyvitamin D Levels and Risk of Colorectal Cancer: An Age-Stratified Analysis

BACKGROUND & AIMS

The role of circulating 25-hydroxyvitamin D (25(OH)D) in the prevention of early-onset colorectal cancer (CRC) in young adults aged <50 years is uncertain. We evaluated the age-stratified associations (<50 vs ≥50 years) between circulating 25(OH)D levels and the risk of CRC in a large sample of Korean adults.

METHODS

Our cohort study included 236,382 participants (mean age, 38.0 [standard deviation, 9.0] years) who underwent a comprehensive health examination, including measurement of serum 25(OH)D levels. Serum 25(OH)D levels were categorized as <10, 10 to 20, and ≥20 ng/mL. CRC, along with the histologic subtype, site, and invasiveness, was ascertained through linkage with the national cancer registry. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CRC according to the serum 25(OH)D status, with adjustment for potential confounders.

RESULTS

During the 1,393,741 person-years of follow-up (median, 6.5 years; interquartile range, 4.5-7.5 years), 341 participants developed CRC (incidence rate, 19.2 per 105 person-years). Among young individuals aged <50 years, serum 25(OH)D levels were inversely associated with the risk of incident CRC with HRs (95% CIs) of 0.61 (0.43-0.86) and 0.41 (0.27-0.63) for 25(OH)D 10 to 19 ng/mL and ≥20 ng/mL, respectively, with respect to the reference (<10 ng/mL) (P for trend <.001, time-dependent model). Significant associations were evident for adenocarcinoma, colon cancer, and invasive cancers. For those aged ≥50 years, associations were similar, although slightly attenuated compared with younger individuals.

CONCLUSIONS

Serum 25(OH)D levels may have beneficial associations with the risk of developing CRC for both early-onset and late-onset disease.

Predictive Value of Pre-Treatment MRI Radiomics for Distant Brain Metastases Following Stereotactic Radiosurgery/Radiotherapy

PURPOSE/OBJECTIVE(S)

Local intracranial therapy for brain metastases (BM) has taken on particular importance as survival among metastatic patients improves. However, the development of distant BMs (DBMs) outside the treated area remains a stubborn problem for which canonical clinical features (age, histology, ECOG PS) have limited predictive capability. In this study, we hypothesized that MRI-based "radiomic" features (sub-visual cues extracted from diagnostic images) can accurately predict the time-to-DBM development (TTDD) on a retrospectively curated dataset of patients treated with stereotactic radiosurgery/radiotherapy (SRS/SRT).

MATERIALS/METHODS

We queried our treatment planning system for patients treated with brain SRS/SRT between 2014 and 2021, and curated the incidence/timing of DBMs manually. Pre-RT MRI sequences (T1 pre, T1 post, T2, and FLAIR) and planning data were obtained for each patient. MRI and CT simulations were co-registered using affine transformations, and regions of interest (ROIs) were identified based on contoured structures (GTV) and discrete isodose ranges (0-25%, 25-50%, 50-75%, 75%+). Radiomic features were extracted from these ROIs, and clinical features (ECOG PS, tumor volume, age) were recorded for baseline comparison. Features were selected using Wald test scores from univariate Cox proportional hazard (CPH) models. Multivariate CPH models were then trained to predict TTDD using combinations of selected features. Predictive capability was evaluated using concordance index (c-index) values. A radiomic risk score (RRS) was created to discriminate patients with low and high-risk for DBMs, and evaluated using a log-rank test.

RESULTS

A total of 105 patients were selected with a median follow up of 356 days. 53 patients developed DBMs (median time 118 days). Radiomic CPH models achieved a c-index of 0.63 compared to clinical baseline of 0.49. The combination of radiomic and clinical features achieved the highest c-index of 0.69. Overall, radiomic features with and without clinical features were able to stratify patients into low and high-risk groups with statistically significant differences in TTDD development (see Table 1). Clinical features alone were not significant. The most predictive radiomic features were identified within the T1 pre-contrast MRI from the 50-75% isodose regions, followed by T2 FLAIR/GTV and T2/GTV combinations.

CONCLUSION

Radiomic features from routine MR scans were more predictive of TTDD than baseline clinical features. The contribution from the 50-75% isodose region suggests importance within the peritumoral environment in addition to the tumor itself.

Synergistic effect of non-alcoholic fatty liver disease and history of gestational diabetes to increase risk of type 2 diabetes

Whether non-alcoholic fatty liver disease (NAFLD) improves risk prediction for subsequent type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (pGDM) is uncertain. We examined the combined effects of NAFLD and pGDM on risk prediction for incident T2DM. This retrospective cohort study included 97,347 Korean parous women without diabetes mellitus at baseline whose mean (SD) age was 39.0 (7.8) years. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident T2DM according to self-reported pGDM and ultrasound-diagnosed NAFLD at baseline. When combined with conventional diabetes risk factors, the incremental predictive ability of NAFLD and pGDM to identify incident T2DM was assessed. During a median follow-up of 3.9 years, 1,515 cases of incident T2DM occurred. Multivariable-adjusted HRs (95% confidence intervals [CIs]) for incident T2DM comparing pGDM alone, NAFLD alone, and both NAFLD and pGDM to the reference (neither NAFLD nor pGDM) were 2.61 (2.06-3.31), 2.26 (1.96-2.59), and 6.45 (5.19-8.00), respectively (relative excess risk of interaction = 2.58 [95% CI, 1.21-3.95]). These associations were maintained after adjusting for insulin resistance, body mass index, and other potential confounders as time-dependent covariates. The combination of NAFLD and pGDM improved risk prediction for incident T2DM (based on Harrell's C-index, also known as the concordance index, and net reclassification improvement) compared to conventional diabetes risk factors. In conclusion, NAFLD synergistically increases the risk of subsequent T2DM in women with pGDM. The combination of NAFLD and pGDM improves risk prediction for T2DM.

Nonalcoholic fatty liver disease and risk of incident young-onset hypertension: Effect modification by sex

BACKGROUND AND AIMS

Although nonalcoholic fatty liver disease (NAFLD) and hypertension are increasingly common among young adults, it is uncertain if NAFLD affects incidence of young-onset hypertension, and if the association is modified by sex. We investigated potential effect modification by sex on the association between NAFLD and incident hypertension in young adults (<40 years).

METHOD AND RESULTS

This cohort study comprised 85,789 women and 67,553 men aged <40 years without hypertension at baseline. Hepatic steatosis was assessed by liver ultrasound and classified as mild or moderate/severe. Hypertension was defined as blood pressure (BP) ≥130/80 mmHg; self-reported history of physician-diagnosed hypertension; or current use of BP-lowering medications. Cox proportional hazard models were used to estimate hazard ratios (HRs; 95% confidence intervals [CIs]) for incident hypertension by NAFLD status (median follow-up 4.5 years). A total of 25,891 participants developed incident hypertension (incidence rates per 10³ person-years: 15.6 for women and 63.5 for men). Multivariable-adjusted HRs (95% CIs) for incident hypertension comparing no NAFLD (reference) with mild or moderate/severe NAFLD were 1.68 (1.56-1.80) and 1.83 (1.60-2.09) for women and 1.21 (1.17-1.25) and 1.23 (1.17-1.30) for men, respectively. Stronger associations were consistently observed between NAFLD and incident hypertension in women, regardless of obesity/central obesity (all p-values for interaction by sex <0.001).

CONCLUSIONS

NAFLD is a potential risk factor for young-onset hypertension with a relatively greater impact in women and in those with more severe hepatic steatosis.

Evaluating Psychometric Properties of the International Knee Documentation Committee Subjective Knee Form in a Heterogeneous Sample of Post-Operative Patients

Background

The International Knee Document Committee Subjective Knee Form (IKDC-SKF) is a patient-reported outcome measure used in orthopedics and sports medicine. Further psychometric assessment is necessary to confirm measurement properties in a large, heterogenous sample.

Purpose

The purpose of the study was to assess the psychometric properties of the IKDC-SKF in a large, heterogenous sample.

Study Design

Cross-Sectional Study.

Methods

An exploratory factor analysis (EFA) was conducted to identify a sound latent structure and to assess internal consistency in a large sample of patients who underwent knee arthroscopy. A confirmatory factor analysis (CFA) was conducted to confirm structural validity. Multi-group invariance was conducted to assess factorial stability across sex and age groups, while longitudinal invariance procedures were performed to assess stability over time.

Results

A 3-factor, 9-item IKDC-SKF short form was identified with EFA procedures. The model was confirmed with CFA (CFI = 0.983; TLI = 0.975; IFI = 0.983; RMSEA = 0.057), while a sound 2-factor, 6-item model was also identified (CFI = 1.0; TLI = 0.999; IFI = 1.0; RMSEA = 0.11). The 9-item IKDC-SKF short form was invariant across groups but not time; removal of a single item (i.e., 8-item IKDC-SKF short form) resulted in longitudinal invariance. The 6-item IKDC-SKF short form was invariant across groups and time.

Conclusion

The 6-item, 8-item, and 9-item short form versions of the IKDC-SKF exceed contemporary fit recommendations and present as plausible alternatives to the IKDC-SKF with improved measurement properties, reduced scale response burden, and evidence of multi-group and longitudinal invariance. Further, the 6- and 8-item IKDC-SKF short forms may be used to assess group differences or change across time.# Level of evidence hereLevel 3©The Author(s).

Long working hours and increased risks of lean non-alcoholic fatty liver disease among Korean men and women

Despite the increasing prevalence of lean nonalcoholic fatty liver disease (NAFLD), its risk factors are not well established. We examined the association between long working hours and incident NAFLD in lean Korean workers with emphasis on sex-based effect modification. This cohort study involved 46,113 non-overweight (BMI < 23 kg/m²) and NAFLD-free Korean workers (mean age, 35.5 years). Working hours were categorized into 35-40 (reference), 41-52, and ≥ 53 h. The presence of fatty liver and its severity were determined using ultrasonography and NAFLD fibrosis score (NFS), respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using parametric proportional hazards models. Incident cases of 5901 lean NAFLD developed over a median follow-up of 3.8 years. The incidence of lean NAFLD increased with increasing working hours with a stronger association in men than in women (P for interaction < 0.001). For men, multivariable-adjusted HRs (95% CIs) for lean NAFLD in time-dependent models comparing working hours of 41-52 and ≥ 53 h compared to the reference category were 1.17 (1.07-1.28) and 1.25 (1.12-1.39), respectively. The excess relative risk of developing lean NAFLD with intermediate/high NFS was observed in working hours of 41-52 and ≥ 53 h with a corresponding HR of 1.66 (1.13-2.43) and 1.54 (0.94-2.51), respectively. Conversely, no significant associations were found between working hours and incidence of lean NAFLD in women. In conclusion, long working hours were significantly associated with an increased incidence of lean NAFLD and its severe form in men but not in women.

Vasomotor and other menopause symptoms and the prevalence of ideal cardiovascular health metrics among premenopausal stage women

OBJECTIVE

We examined the association between menopause symptoms and the prevalence of ideal cardiovascular health (CVH) metrics among premenopausal women.

METHODS

This cross-sectional study comprised 4,611 premenopausal women aged 42 to 52 years. Data for CVH metrics were collected during health screening examinations. Menopause symptoms were measured using the Korean version of the Menopause-Specific Quality of Life questionnaire. For vasomotor, psychosocial, physical, and sexual symptoms, participants were divided into absent or symptomatic groups, further divided into tertiles (range, 0-7; 7 being the most bothersome). Ideal CVH metrics were defined according to the American Heart Association Life Simple 7 metrics, except dietary component. Cardiovascular health metrics were scored from 0 (unhealthy) to 6 (healthy) and classified as poor (0-2), intermediate (3-4), and ideal (5-6). Multinomial logistic regression models were used to estimate the prevalence ratios for intermediate and poor CVH metrics using ideal CVH as the reference.

RESULTS

The overall and 4 menopause-specific quality of life domain scores were significantly associated with poorer CVH metrics scores in a dose-response manner ( P < 0.05). After adjusting for age, parity, education level, anti-Mullerian hormone levels, and alcohol intake, women with the most bothersome degree for vasomotor, psychosocial, physical, and sexual symptoms had significantly higher prevalence of poor CVH metrics, with corresponding prevalence ratios (95% confidence interval) of 2.90 (1.95-4.31), 2.07 (1.36-3.15), 3.01 (1.19-7.65), and 1.66 (1.15-2.39), respectively, compared with those without each vasomotor, psychosocial, physical, and sexual symptom.

CONCLUSIONS

Premenopausal stage women with either vasomotor or nonvasomotor menopausal symptoms have significantly higher prevalence of poor CVH metrics, compared with those without any menopausal symptoms.

Time-resolved Coulomb collision of single electrons

A series of recent experiments have shown that collision of ballistic electrons in semiconductors can be used to probe the indistinguishability of single-electron wavepackets. Perhaps surprisingly, their Coulomb interaction has not been seen due to screening. Here we show Coulomb-dominated collision of high-energy single electrons in counter-propagating ballistic edge states, probed by measuring partition statistics while adjusting the collision timing. Although some experimental data suggest antibunching behaviour, we show that this is not due to quantum statistics but to strong repulsive Coulomb interactions. This prevents the wavepacket overlap needed for fermionic exchange statistics but suggests new ways to utilize Coulomb interactions: microscopically isolated and time-resolved interactions between ballistic electrons can enable the use of the Coulomb interaction for high-speed sensing or gate operations on flying electron qubits.

Association of changes in sleep duration and quality with incidence of depression: A cohort study

BACKGROUND

The longitudinal relationship between sleep duration, sleep quality, and their changes with the risk of depressive symptoms is unclear. We examined the association between sleep duration, sleep quality, and their changes with incident depressive symptoms.

METHODS

A total of 225,915 Korean adults without depression at baseline with a mean age of 38.5 years were followed for an average of 4.0 years. Sleep duration and quality were assessed using the Pittsburgh Sleep Quality Index. The presence of depressive symptoms was assessed using the Center for Epidemiologic Studies Depression scale. Flexible parametric proportional hazard models were used to determine hazard ratios (HRs) and 95 % confidence intervals (CIs).

RESULTS

In total, 30,104 participants with incident depressive symptoms were identified. Multivariable-adjusted HRs (95 % CIs) for incident depression comparing sleep durations of ≤5, 6, 8, and ≥9 h with 7 h were 1.15 (1.11-1.20), 1.06 (1.03-1.09), 0.99 (0.95-1.03), and 1.06 (0.98-1.14), respectively. A similar trend was observed in patients with poor sleep quality. Compared with participants with persistently good sleep quality, participants with persistently poor sleep quality or who developed poor sleep quality were associated with the risk of incident depressive symptoms [HRs (95 % CIs) of 2.13 (2.01-2.25) and 1.67 (1.58-1.77), respectively].

LIMITATIONS

Sleep duration was assessed using self-reported questionnaire and the study population may not reflect general population.

CONCLUSIONS

Sleep duration, sleep quality and their changes were independently associated with incident depressive symptoms in young adults, suggesting that inadequate sleep quantity and quality play a role in depression risk.

High-Intensity Statin Reduces the Risk of Mortality Among Chronic Liver Disease Patients With Atherosclerotic Cardiovascular Disease: A Population-Based Cohort Study

Background 2018 American Heart Association/American College of Cardiology cholesterol guideline recommends statin in patients with chronic and/or stable liver disease for secondary prevention of atherosclerotic cardiovascular disease yet remains equivocal on the adequate intensity of statin for patients with chronic liver disease (CLD). We aimed to assess the association between statin intensity and mortality among patients with CLD with atherosclerotic cardiovascular disease. Methods and Results We conducted a population-based cohort study in South Korea. We assessed the risk of survival and clinical outcomes using inverse probability of treatment-weighted Cox proportional hazards regression. We also estimated the absolute risk difference between treatment groups based on the Poisson distribution. During an average of 2.35 person-years, 10 442 patients with CLD with atherosclerotic cardiovascular disease were identified. Among those patients, 5515 (52.8%) received high-intensity statin, and 4927 (47.2%) received low/moderate-intensity statin. High-intensity statin was associated with lower risk for all-cause mortality (hazard ratio [HR], 0.83 [95% CI, 0.75-0.92]), cardiovascular-cause mortality (HR, 0.85 [0.71-1.01]), liver-cause mortality (HR, 0.72 [0.54-0.97]) compared with low/moderate-intensity statin. Although both hospitalizations for recurrent myocardial infarction and stroke were shown to be increased among high-intensity statin users, effect estimate was homogeneous in the absolute scale (myocardial infarction: HR, 1.12 [1.04-1.19], risk difference, 7.57 [-0.69 to 15.84] per 1000 person-years; stroke: HR, 1.11 [0.97 to 1.27]; risk difference, -1.70 [-5.19 to 1.78]). Conclusions Among patients with CLD with atherosclerotic cardiovascular disease, high-intensity statin was significantly associated with a lower risk of mortality. These findings herein support the guidelines for statin use in patients with CLD while demonstrating potential benefit of optimal intensity use.

Association between gut microbiota and anxiety symptoms: A large population-based study examining sex differences

BACKGROUND

This study aimed to examine the association between anxiety symptoms and gut microbial composition and to infer their functional pathways.

METHODS

In total, 605 participants were included in this study. Participants were categorized into anxious and non-anxious groups according to their Beck Anxiety Inventory scores, and their fecal microbiota was profiled using 16S ribosomal RNA gene sequencing. The microbial diversity and taxonomic profiles of the participants with anxiety symptoms were analyzed using generalized linear models. The function of the gut microbiota was inferred by comparing 16S rRNA data between the anxious and non-anxious groups.

RESULTS

The gut microbiome of the anxious group showed lower alpha diversity than that of the non-anxious group, and there were prominent differences in the community structure of the gut microbiota between the two groups. Male participants with anxiety had lower relative abundances of the family Oscillospiraceae, fibrolytic bacteria including those of the family Monoglobaceae, and short-chain fatty acid-producing bacteria such as those of the genus Lachnospiraceae_NK4A136 than those without anxiety symptoms. Female participants with anxiety symptoms had a lower relative abundance of the genus Prevotella than those without anxiety symptoms.

LIMITATION

The direction of causality between anxiety symptoms and the gut microbiota was unclear owing to the cross-sectional design of the study.

CONCLUSION

Our results elucidate the association between anxiety symptoms and gut microbiota and provide insights for developing interventions to treat anxiety symptoms.

Risk of CKD Following Detection of Microscopic Hematuria: A Retrospective Cohort Study

RATIONALE & OBJECTIVE

Microscopic hematuria is an uncertain risk factor for chronic kidney disease (CKD). We investigated the association between persistent or single episodes of microscopic hematuria and the development of incident CKD, overall and separately among men and women.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

A total of 232,220 Korean adults without CKD at baseline who underwent repeated regular health examinations at Kangbuk Samsung Health Study formed the study cohort.

EXPOSURE

Microscopic hematuria was defined by≥5 red blood cells per high-power field. Participants were categorized into 1 of 4 groups according to the presence of hematuria at 2 consecutive examinations: (1) no hematuria at both examinations (reference group); (2) hematuria followed by no hematuria (regressed hematuria group); (3) no hematuria followed by hematuria (developed hematuria group); and (4) hematuria at both examinations (persistent hematuria group).

OUTCOME

CKD was defined as an estimated glomerular filtration rate<60mL/min/1.73m² or proteinuria (1+or more on dipstick examination).

ANALYTICAL APPROACH

Semiparametric proportional hazards models were used to estimate hazard ratios.

RESULTS

During a 4.8-year median follow-up period, 2,392 participants developed CKD. Multivariable-adjusted hazard ratios for incident CKD, comparing the regressed, developed, and persistent hematuria groups to the no-hematuria group were 1.85 (95% CI, 1.35-2.53), 3.18 (95% CI, 2.54-3.98), and 5.23 (95% CI, 4.15-6.59), respectively. The association between persistent hematuria and incident CKD was stronger in men than women (P for interaction<0.001), although a statistically significant association was observed in both sexes.

LIMITATIONS

Lack of albuminuria and inability to consider specific glomerular diseases.

CONCLUSIONS

Men and women with microscopic hematuria, especially persistent hematuria, may be at increased risk of CKD.

Metabolically healthy and unhealthy obesity and the development of lung dysfunction

We investigated the association of metabolically healthy (MH) and unhealthy (MU) obesity with incident lung dysfunction. This cohort study included 253,698 Korean lung disease-free adults (mean age, 37.4 years) at baseline. Spirometry-defined lung dysfunction was classified as a restrictive pattern (RP) or obstructive pattern (OP). We defined obesity as BMI ≥ 25 kg/m² and MH as the absence of any metabolic syndrome components with a homeostasis model assessment of insulin resistance < 2.5: otherwise, participants were considered MU. During a median follow-up of 4.9 years, 10,775 RP cases and 7140 OP cases develped. Both MH and MU obesity showed a positive association with incident RP, with a stronger association in the MU than in the MH group (P_interaction = 0.001). Multivariable-adjusted hazard ratios (95% CI) for incident RP comparing obesity to the normal-weight category was 1.15 (1.05-1.25) among the MH group and 1.38 (1.30-1.47) among MU group. Conversely, obesity was inversely associated with OP because of a greater decline in forced vital capacity than forced expiratory volume in 1 s. Both MH and MU obesity were positively associated with RP. However, the associations between obesity, metabolic health, and lung functions might vary depending on the type of lung disease.

Evaluating a Project Extension for Community Health Outcomes Pediatric Behavioral Health Series in a Rural and Frontier State: An Exploratory Investigation

BACKGROUND

Idaho, a predominately rural state, has a high prevalence of mental illness with minimal access to care. Barriers in diagnosis and treatment of pediatric behavioral health disorders could be mitigated with an accessible and effective specialty training program.

METHODS

A 10-session Project Extension for Community Health Outcomes (ECHO) series was designed to expand provider knowledge about pediatric behavioral health conditions and improve perceived clinical practice skills. Pre- and postseries evaluation surveys and individual session evaluations were used to assess the program.

RESULTS

A total of 148 individuals attended at least 1 of the 10 sessions. Participants reported high satisfaction with individual sessions and indicated that attendance positively impacted their knowledge and competency. Participants also reported that the knowledge and skills gained from the series would benefit more than half of their patients or clients.

CONCLUSION

The short ECHO series appears to be a viable and valuable option to provide Idaho providers with effective specialty training that is well attended and well received.

Performance analysis of screening mammography in Asian women under 40 years

BACKGROUND

Screening mammography performance among young women remains uncertain in East Asia, where the proportion of young breast cancer patients is higher than that in Western countries. Thus, we analyzed the performance of screening mammography in women under 40 years in comparison with older age groups.

METHODS

This retrospective study comprised 95,431 Asian women with 197,525 screening mammograms. The reference standard was determined by linkage to the national cancer registry data and the 12-month follow-up outcomes after the index mammogram. The performance metrics included sensitivity, specificity, cancer detection rate (CDR), positive predictive value (PPV), recall rate, and areas under the receiver operating characteristic curve (AUCs), with comparisons across age groups (30 s, 40 s, and ≥ 50 s).

RESULTS

For young women aged < 40 years, sensitivity and AUC (95% confidence interval [CI]) of screening mammography were 60.4% (50.4-69.7) and 0.73 (0.68-0.77), respectively, with no significant difference compared to women in their 40 s (sensitivity: 64.0% [95% CI: 57.8-69.8], P = 0.52; AUC: 0.75 [95% CI: 0.73-0.78], P = 0.35). The CDR (95% CI) was 0.8 (0.6-1.1) per 1,000 mammograms for young women, poorer than 1.8 (1.6-2.1) per 1,000 mammograms for women in their 40 s (P < 0.001). The PPV and recall rate (95% CI) for young women were 0.6% (0.4-0.7) and 14.9% (14.6-15.1), poorer than 1.4% (1.2-1.6) and 13.3% (13.1-13.5) for women in their 40 s (P < 0.001), respectively.

CONCLUSION

The accuracy of screening mammography for young women in their 30 s was not significantly different from that for women in their 40 s, but the cancer detection and recall rates were poorer.

Association of Breast Cancer Family History With Breast Density Over Time in Korean Women

IMPORTANCE

Evidence suggests that women with a family history of breast cancer (FHBC) in first-degree relatives have a higher level of breast density; however, studies of premenopausal women remain limited.

OBJECTIVE

To investigate the association between FHBC and mammographic breast density and breast density changes among premenopausal women.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study used population-based data obtained from the National Health Insurance Service-National Health Information Database of Korea. We included premenopausal women aged 40 to 55 years who underwent mammography for breast cancer screening once between January 1, 2015, and December 31, 2016 (n = 1 174 214), and women who underwent mammography twice (first in 2015-2016 and again between January 1, 2017 and December 31, 2018) (n = 838 855).

EXPOSURES

Family history of breast cancer was assessed using a self-reported questionnaire, which included information on FHBC in the mother and/or sister.

MAIN OUTCOMES AND MEASURES

Breast density, based on the Breast Imaging Reporting and Data System, was categorized as dense (heterogeneously or extremely dense) and nondense (almost entirely fat or scattered fibroglandular areas). Multivariate logistic regression was used to assess the association among FHBC, breast density, and changes in breast density from the first to second screening. Data analysis was performed from June 1 to September 31, 2022.

RESULTS

Of the 1 174 214 premenopausal women, 34 003 (2.4%; mean [SD] age, 46.3 [3.2] years) reported having FHBC among their first-degree relatives, and 1 140 211 (97.1%; mean [SD] age, 46.3 [3.2] years) reported no FHBC. Odds of having dense breasts was 22% higher (adjusted odds ratio [aOR], 1.22; 95% CI, 1.19-1.26) in women with FHBC than in women without FHBC, and the association varied by affected relatives: mother alone (aOR, 1.15; 95% CI, 1.10-1.21), sister alone (aOR, 1.26; 95% CI, 1.22-1.31), and both mother and sister (aOR, 1.64; 95% CI, 1.20-2.25). Among women with fatty breasts at baseline, the odds of developing dense breasts was higher in women with FHBC than in those without FHBC (aOR, 1.19; 95% CI, 1.11-1.26), whereas among women with dense breasts, higher odds of having persistently dense breasts were observed in women with FHBC (aOR, 1.11; 95% CI, 1.05-1.16) than in those without FHBC.

CONCLUSIONS AND RELEVANCE

In this cohort study of premenopausal Korean women, FHBC was positively associated with an increased incidence of having increased or persistently dense breasts over time. These findings suggest the need for a tailored breast cancer risk assessment for women with FHBC.

Age-varying association between depression and cognitive function among a national sample of older U.S. immigrant adults: the potential moderating role of physical activity

OBJECTIVES

This study aimed to (1) investigate age-associated trends in depression and cognition, (2) determine whether the association between depression and cognition varies across age, and (3) test whether this association is moderated by different levels of physical activity among older U.S. immigrant adults aged 60 to 80 years.

METHODS

Using national data on elderly U.S. immigrants (N = 375) from the 2011-2014 NHANES, we employed weighted intercept-only linear time-varying effect modeling (TVEM) and weighted linear TVEM to address our research questions.

RESULTS

Weighted intercept-only linear TVEM indicated no trend in depression, but its mean peaked at age 67. Cognition consistently decreased with age, reaching its lowest point at age 78. Weighted linear TVEM revealed a significant inverse association between depression and cognition at some age ranges, with the strongest association at around age 66. Yet, we did not find the moderational relation of physical activity to this age-varying association.

CONCLUSIONS

Although we observed a significant inverse relationship between depression and cognition at a certain age point, physical activity did not moderate the age-varying association. Understanding of age-varying effects on the depression-cognition interaction will promote prevention efforts targeting aging immigrant populations at highest risk for these health outcomes. Further work is needed to test moderating effects of other health behaviors on this association across age.

Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2056139 .

Glycaemic status, insulin resistance, and risk of infection-related mortality: a cohort study

IMPORTANCE

The impact of non-diabetic hyperglycaemia and insulin resistance on infection-related mortality risk remains unknown.

OBJECTIVE

We investigated the association of glycaemic status and insulin resistance with infection-related mortality in individuals with and without diabetes.

DESIGN

Cohort study based on Kangbuk Samsung Health Study and national death records.

PARTICIPANTS

About 666 888 Korean adults who underwent fasting blood measurements including glucose, glycated haemoglobin (HbA1c), and insulin during health-screening examinations were followed for up to 15.8 years.

MAIN OUTCOME AND MEASURES

Infection-related mortality, therefore we used Cox proportional hazards regression analyses to estimate hazard ratios (HRs) and 95% CIs for infection-related mortality. Vital status and infection-related mortality were ascertained through national death records. Variable categories were created based on established cut-offs for glucose and HbA1c levels and homeostatic model assessment of insulin resistance (HOMA-IR) quintiles.

RESULTS

During a median follow-up of 8.3 years, 313 infectious disease deaths were dentified. The associations of glucose and HbA1c levels with infection-related mortality were J-shaped (P for quadratic trend<.05). The multivariable-adjusted HR (95% CIs) for infection-related mortality comparing glucose levels <5, 5.6-6.9, and ≥7.0 mmol/L to 5.0-5.5 mmol/L (the reference) were 2.31 (1.47-3.64), 1.65 (1.05-2.60), and 3.41 (1.66-7.00), respectively. Among individuals without diabetes, the multivariable-adjusted HR for infection-related mortality for insulin resistance (HOMA-IR ≥75th centile versus <75th centile) was 1.55 (1.04-2.32).

CONCLUSIONS AND RELEVANCE

Both low and high glycaemic levels and insulin resistance were independently associated with increased infection-related mortality risk, indicating a possible role of abnormal glucose metabolism in increased infection-related mortality.

Persistence or regression of prediabetes and coronary artery calcification among adults without diabetes

OBJECTIVE

The effect of changes in glycemic status on subclinical atherosclerosis is uncertain. We assessed the association of persistence, regression, or progression of prediabetes with coronary artery calcium score (CACS) as a measure of subclinical atherosclerosis.

DESIGN

A cross-sectional study, comprising 126 765 adults, and longitudinal sub-study, comprising 40 622 adults (with baseline and at least 1 follow-up computed tomography scan to assess changes in CACS), were undertaken.

METHODS

Changes in glycemic status over 1.5 years (interquartile range, 1.0-2.0) before the first CACS assessment were categorized according to 6 groups: persistent normoglycemia (reference), normoglycemia to prediabetes, normoglycemia to diabetes, prediabetes to normoglycemia, persistent prediabetes, and prediabetes to diabetes. Logistic regression was used to calculate the odds ratios (ORs) and 95% CIs for prevalent coronary artery calcification (CAC). Mixed models with random intercepts and random slopes were used to estimate 5-year CAC progression rates.

RESULTS

Mean (SD) age was 41.3 (7.0) years (74.7% male) (n = 126 765). Multivariable-adjusted OR for prevalent CAC was 1.13 (95% CI, 1.08-1.18) for persistent prediabetes, 1.05 (0.98-1.12) for regression to normoglycemia, and 1.46 (95% CI, 1.27-1.67) for progression from prediabetes to diabetes, compared with persistent normoglycemia. Coronary artery calcification progression increased significantly in all prediabetes groups. Multivariable-adjusted ratio of 5-year CAC progression rates was 1.19 (95% CI, 1.16-1.22) (persistent prediabetes), 1.11 (1.07-1.14) (regression to normoglycemia), and 1.63 (95% CI, 1.26-2.10) (progression from prediabetes to diabetes).

CONCLUSIONS

Unfavorable changes in glycemic status, including persistence of prediabetes or progression to diabetes from prediabetes, were associated with increased risk of CAC.

Implicating genes, pleiotropy, and sexual dimorphism at blood lipid loci through multi-ancestry meta-analysis

BACKGROUND

Genetic variants within nearly 1000 loci are known to contribute to modulation of blood lipid levels. However, the biological pathways underlying these associations are frequently unknown, limiting understanding of these findings and hindering downstream translational efforts such as drug target discovery.

RESULTS

To expand our understanding of the underlying biological pathways and mechanisms controlling blood lipid levels, we leverage a large multi-ancestry meta-analysis (N = 1,654,960) of blood lipids to prioritize putative causal genes for 2286 lipid associations using six gene prediction approaches. Using phenome-wide association (PheWAS) scans, we identify relationships of genetically predicted lipid levels to other diseases and conditions. We confirm known pleiotropic associations with cardiovascular phenotypes and determine novel associations, notably with cholelithiasis risk. We perform sex-stratified GWAS meta-analysis of lipid levels and show that 3-5% of autosomal lipid-associated loci demonstrate sex-biased effects. Finally, we report 21 novel lipid loci identified on the X chromosome. Many of the sex-biased autosomal and X chromosome lipid loci show pleiotropic associations with sex hormones, emphasizing the role of hormone regulation in lipid metabolism.

CONCLUSIONS

Taken together, our findings provide insights into the biological mechanisms through which associated variants lead to altered lipid levels and potentially cardiovascular disease risk.

Age-stratified effects of coronary artery calcification on cardiovascular and non-cardiovascular mortality in Korean adults

AIMS

The role of coronary artery calcium score (CACS) in predicting cardiovascular disease (CVD) and non-CVD mortality in young adults is unclear. We investigated the association of CACS with CVD and non-CVD mortality in young and older individuals.

METHODS AND RESULTS

CVD-free Koreans (n = 160 821; mean age, 41.4 years; 73.2% young individuals aged <45 years) who underwent cardiac tomography estimation of CACS (69.7% one-time measurement), were followed-up for a median of 5.6 years. The vital status and cause of death were ascertained from the national death records. Sub-distribution hazard ratios (SHR) and 95% confidence intervals (CIs) for cause-specific mortality were estimated using the Fine and Gray proportional hazards models. Overall, a higher CACS was strongly associated with an increased risk of CVD mortality. Among young individuals, multivariable-adjusted SHR (95% CIs) for CVD mortality comparing a CACS of 1-100, 101-300, and >300 to 0 CACS were 5.67 (2.33-13.78), 22.34 (5.72-87.19), and 74.1 (18.98-239.3), respectively, and among older individuals, corresponding SHR were 1.51 (0.60-3.84), 8.57 (3.05-24.06), and 6.41 (1.98-20.74). The addition of CACS to Framingham risk score significantly but modestly improved risk prediction for CVD mortality in young individuals. Conversely, CACS was significantly associated with non-CVD mortality only in older individuals.

CONCLUSIONS

Strong associations of CACS with CVD mortality, but not non-CVD mortality, were observed in young individuals, beginning in the low CACS category. Our findings reaffirm the need for early intervention for young adults even with low CACS to reduce CVD mortality.

Risk factors for the development of idiopathic macular hole: a nationwide population-based cohort study

This nationwide population-based cohort study searched for demographic, comorbid, behavioral, and reproductive risk factors for idiopathic macular hole (MH) development using data provided by the Korean National Health Insurance Service. A total of 4,496,867 individuals aged 50-79 years who participated in the Korean National Health Screening Program in 2013 or 2014 were included. Participants were followed up until December 2018, and incident cases of idiopathic MH were identified. Prospective associations between incident idiopathic MH and various covariates were investigated using multivariable-adjusted Cox proportional hazard models. During an average follow-up period of 4.91 years, 3054 patients were newly diagnosed with idiopathic MHs. Women showed greater risk (hazard ratio of 1.71) and earlier presentation of idiopathic MH than men. Compared to the normal body mass index group, the obese group (≥ 25 kg/m²) showed a significantly lower risk of idiopathic MH. Among postmenopausal women, those with two or more children showed a greater risk of idiopathic MH than those who had not been pregnant, with a hazard ratio of 1.80. In conclusion, idiopathic MH occurred earlier and greater in women. Childbirth were associated with an increased risk of MH development, and obesity was associated with a lower risk of MH.

NAFLD improves risk prediction of type 2 diabetes: with effect modification by sex and menopausal status

BACKGROUND AND AIMS

The effects of sex and menopausal status on the association between NAFLD and incident type 2 diabetes (T2D) remain unclear. We investigated the effect modification by sex and menopause in the association between NAFLD and T2D; also, the added predictive ability of NAFLD for the risk of T2D was assessed.

APPROACH AND RESULTS

This cohort study comprised 245,054 adults without diabetes (109,810 premenopausal women; 4958 postmenopausal women; 130,286 men). Cox proportional hazard models were used to estimate hazard ratios (HRs; 95% confidence intervals [CIs]) for incident T2D according to NAFLD status. The incremental predictive role of NAFLD for incident T2D was assessed using the area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. A total of 8381 participants developed T2D (crude incidence rate/10³ person-years: 2.9 premenopausal women; 12.2 postmenopausal women; 9.3 men) during median follow-up of 5.3 years. NAFLD was positively associated with incident T2D in all groups. After adjustment for potential confounders, the multivariable-adjusted HRs (95% CIs) for incident T2D comparing NAFLD to no NAFLD were 4.63 (4.17-5.14), 2.65 (2.02-3.48), and 2.16 (2.04-2.29) in premenopausal women, postmenopausal women, and men, respectively. The risks of T2D increased with NAFLD severity as assessed by serum fibrosis markers, and the highest relative excess risks were observed in premenopausal women. The addition of NAFLD to conventional risk factors improved risk prediction for incident T2D in both sexes, with a greater improvement in women than men.

CONCLUSIONS

NAFLD, including more severe NAFLD, is a stronger risk factor for incident T2D in premenopausal women than in postmenopausal women or men; protection against T2D is lost in premenopausal women with NAFLD.

Prediabetes diagnosis is associated with the progression of coronary artery calcification: The Kangbuk Samsung Health Study

AIM

To investigate the associations between prediabetes defined by different diagnostic criteria and coronary artery calcification (CAC) and its progression over time.

MATERIALS AND METHODS

This cross-sectional study included 146 436 Korean adults without diabetes who underwent CAC estimation computed tomography (CT) during health examinations from 2011 to 2019. We used multinomial logistic regression models. The longitudinal study comprised 41 100 participants with at least one follow-up cardiac CT and annual CAC progression rates and ratios were estimated. Prediabetes was categorized into three groups: isolated glucose prediabetes (fasting blood glucose [FBG] 100-125 mg/dl, HbA1c < 5.7%), isolated HbA1c prediabetes (FBG < 100 mg/dl, HbA1c 5.7%-6.4%) and prediabetes meeting both FBG and HbA1c criteria (FBG 100-125 mg/dl, HbA1c 5.7%-6.4%).

RESULTS

After adjusting for covariates, the prevalence ratios (95% CI) for CAC scores of more than 100 comparing isolated glucose prediabetes, isolated HbA1c prediabetes and prediabetes fulfilling both criteria with those of normoglycaemia were 1.12 (0.99-1.26), 1.24 (1.11-1.39) and 1.31 (1.18-1.45), respectively. The multivariable-adjusted ratio (CIs) of annual CAC progression rates comparing the corresponding groups with the normoglycaemia group were 1.031 (1.023-1.039), 1.025 (1.019-1.032) and 1.054 (1.047-1.062), respectively.

CONCLUSIONS

CAC risk and CAC progression were consistently highest in individuals meeting both glucose and HbA1c criteria, while all three prediabetes types showed a significantly increased risk of CAC progression. Atherosclerosis risk reduction management is necessary for prediabetes, especially in patients meeting both criteria.

Many-faceted rasch calibration of the foot function index-revised short form

Background

The Foot Function Index Revised Short version (FFI-RS) is a foot- and ankle- patient-reported outcome measure (PROM), developed from the Foot Function Index (FFI). Previous studies, estimating item parameters and multidimensional properties, have limitations properly establishing the measurement properties of the FFI-RS. A multi-faceted Rasch analysis with a larger sample would allow for a more robust validation approach to improve the clinical interpretation of the FFI-RS using a multidimensional perspective. Therefore, the purpose of this study was to assess the psychometric properties of the FFI-RS as a PROM of foot function.

Method

A total of 2184 patients with foot pathology who completed the FFI-RS were included in the data. Data were extracted from the cloud-based orthopedic and sports medicine global registry Surgical Outcome System (SOS). The psychometric properties of the FFI-RS were assessed using a many-faceted Rasch analysis that included model-data fit, rating scale function, item-person map (distribution of item difficulty and person ability), and item difficulty of the subscale.

Results

Two misfit items were discovered and deleted; 32-items from the original FFI-RS were retained. The 4-item Likert scale functioned effectively and item difficulty (-0.58 to 1.48), subscale difficulty (-0.58 to 1.15), and person’s foot function (-6.62 to 6.24) had wide distributions.

Conclusions

Many-faceted Rasch analysis revealed the FFI-RS had sound psychometric properties using the many-faceted Ranch analysis and retained 32 of the original items. Clinicians and researchers should consider weaknesses identified with items in the ‘Difficulty” subscale and future work should be conducted to modify or develop items that will more accurately evaluate a wide range of foot function levels.

The Korea Cohort Consortium: The Future of Pooling Cohort Studies

Objectives: We introduced the cohort studies included in the Korean Cohort Consortium (KCC), focusing on large-scale cohort studies established in Korea with a prolonged follow-up period. Moreover, we also provided projections of the follow-up and estimates of the sample size that would be necessary for big-data analyses based on pooling established cohort studies, including population-based genomic studies.Methods: We mainly focused on the characteristics of individual cohort studies from the KCC. We developed “PROFAN”, a Shiny application for projecting the follow-up period to achieve a certain number of cases when pooling established cohort studies. As examples, we projected the follow-up periods for 5000 cases of gastric cancer, 2500 cases of prostate and breast cancer, and 500 cases of non-Hodgkin lymphoma. The sample sizes for sequencing-based analyses based on a 1:1 case-control study were also calculated.Results: The KCC consisted of 8 individual cohort studies, of which 3 were community-based and 5 were health screening-based cohorts. The population-based cohort studies were mainly organized by Korean government agencies and research institutes. The projected follow-up period was at least 10 years to achieve 5000 cases based on a cohort of 0.5 million participants. The mean of the minimum to maximum sample sizes for performing sequencing analyses was 5917-72 102.Conclusions: We propose an approach to establish a large-scale consortium based on the standardization and harmonization of existing cohort studies to obtain adequate statistical power with a sufficient sample size to analyze high-risk groups or rare cancer subtypes.