ABSTRACT
Background@#Recent studies have indicated that vitamin D deficiency is associated with diabetes and hypertension in adults. However, this association has not been sufficiently studied in cases of prediabetes and prehypertension. Thus, this study aimed to clarify the relationship between vitamin D levels and prediabetes and prehypertension in Korean adults. @*Methods@#Data from 1,808 adults aged ≥19 years who participated in the 2013–2015 Korea National Health and Nutrition Examination Survey were included in this study. The odds ratio of prediabetes and prehypertension according to the 25-hydroxyvitamin D (25[OH]D) status was calculated using multivariable logistic regression analysis. @*Results@#Mean serum 25(OH)D levels were significantly different among females with normal glucose levels, prediabetes, and diabetes mellitus. Further, the mean levels were not significantly different in both males and females of all ages with normal blood pressure, prehypertension, and hypertension. In addition, logistic regression analysis showed that serum 25(OH)D levels were not significantly associated with the odds ratio of prediabetes and prehypertension after adjusting for age, sex, smoking, alcohol consumption, physical activity, calcium supplement intake, income, body mass index, systolic blood pressure, and fasting glucose. @*Conclusion@#Serum vitamin D status was not independently associated with the risks of prediabetes and prehypertension in Korean adults.
ABSTRACT
Background@#Recent evidence has reported the relationships between 25-hydroxyvitamin D (25[OH]D) insufficiency and chronic diseases. This study examined the association of physical activity and sitting time with vitamin D status. @*Methods@#This study analyzed the data of 1,598 adults aged ≥19 who participated in the 2014 Korea National Health and Nutrition Examination Survey. Vitamin D insufficiency was defined as a serum 25(OH)D level of ≤20 ng/mL. The odds ratios and 95% confidence intervals of vitamin D insufficiency according to physical activity and sitting time were calculated using a multivariable logistic regression analysis. @*Results@#The mean levels of serum 25(OH)D were 16.5 ng/mL in males and 15.2 ng/mL in females, respectively and was significantly higher in the participants with sitting times of <5 hours/day than those with sitting times of ≥5 hours/day. After adjusting for confounding variables, sitting time of <5 hours/day was associated with decreased odds of vitamin D insufficiency as compared with sitting time of ≥5 hours/day in the total participants and females. In addition, the odds ratio for vitamin D insufficiency was significantly lower in the group with sitting times of <5 hours/ day than in the group with sitting times of ≥5 hours/day even among people with low physical activity in the total participants and females. @*Conclusion@#Serum 25(OH)D level was insufficient in the Korean adults and shorter sitting time was related to lower odds ratio of vitamin D insufficiency. Our findings suggest that sitting time is an independent factor of serum vitamin D status.
ABSTRACT
PURPOSE: Early arteriovenous fistula (AVF) failure especially during the first several months after fistula creation makes the patient, physician and surgeon frustrated. To evaluate the patency rate of arteriovenous fistulas which were made for hemodialysis, we analyzed three different protocols pre- and peri-operatively in our hospital. METHOD: From January 1983 through December 1998, total 2,078 cases of AVF were done in 1,711 patients. During the first period (from 1983 to 1988, n=280), all of the AVFs were performed with naked eyes but during the second period (from 1989 to 1993, n=770), we used surgical loupe and microvascular anastomosing technique. During the third period (from 1994 to 1998, n=1,028), besides using surgical loupe, patients were treated peri-operatively with certain volumes of fluid to maintain the systolic blood pressure above 100 mmHg, venogram and duplex sonogram to identify an available vein before AVF creation, aggressive salvage procedures and use of aspirin after fistula creation. RESULT: There were no differences between each periods in their age distribution, sex ratio, serum creatinine level, associated diabetes mellitus and hemoglobin level except significantly low incidence of hypotension at the time of operation in period 3. The early fistula failure rate at 3 months decreased in period 2, 3 than period 1 (6.9%, 6.7% vs 12.7%) and showed statistical significance (p<0.05). The rate of fistulas that is patent more than 3 months and continued at the end of 12 months were no difference between the periods. Frequency of re-AVF within 3 months in period 1 was significantly higher than period 2, 3 which suggested improved early patency in later periods. The center ability to manage the created AVF checked by rate of re-AVF showed significant difference between our hospital and other local dialysis centers. The patency of primary AVF in each period was 69.7%, 75.2%, 77.5% at one year but that of re-AVF were 77.7%, 86.3% and 80.2%. CONCLLUSION: Microsurgical technic under surgical loupe improved primary AVF patency and decreased early failure rate. Also a protocoled perioperative management, improved management skill and experiences of dialysis center might decrease the re-AVF rate.