Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings / 가정의학회지

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and “healthy aging” become more and more important, these guidelines are also expected to increase in clinical usefulness.

Association between Copper–Zinc Ratio in Hair and Neutrophil–Lymphocyte Ratio within the Context of a Normal White Blood Cell Count among Overweight or Obese Korean Individuals: A Pilot Study / 가정의학회지

Background@#Obesity is considered a state of enhanced oxidative stress as well as chronic and low-grade inflammation. The copper–zinc ratio in obese individuals has been reported to reflect systemic oxidative stress and inflammatory status. We investigated whether the neutrophil–lymphocyte ratio is related to the copper–zinc ratio in hair, within the context of a normal white blood cell count among overweight or obese Korean individuals. @*Methods@#We included 56 participants aged older than 20 years who voluntarily sought weight reduction treatment and met the inclusion criterion of body mass index of 23 kg/m2 or greater. Intra-abdominal visceral adipose tissue was measured by computed tomography imaging, while the copper and zinc levels were measured by hair mineral analysis. Using multiple linear regression analysis, we examined the associations between the neutrophil–lymphocyte ratio and the copper–zinc ratio. @*Results@#The mean age, body mass index, and visceral adipose tissue were 46.0±10.5 years, 29.0±4.1 kg/cm2 , and 142.9±68.8 cm2 , respectively. Pearson’s correlation analysis revealed the association of the neutrophil–lymphocyte ratio with copper level (r=0.475, P<0.001) and copper–zinc ratio (r=0.494, P<0.001). After adjusting for confounding variables, we found the neutrophil–lymphocyte ratio was significantly associated with the level of copper and the copper–zinc ratio in hair (regression coefficient: 0.055±0.015; P<0.001 and regression coefficient: 0.761±0.185; P<0.001, respectively). @*Conclusion@#A higher copper–zinc ratio in hair is positively and independently associated with the neutrophil–lymphocyte ratio. Thus, a high hair copper–zinc ratio could be a useful parameter for oxidative burden of individuals predisposed to obesity-related comorbidity.

Association between Copper–Zinc Ratio in Hair and Neutrophil–Lymphocyte Ratio within the Context of a Normal White Blood Cell Count among Overweight or Obese Korean Individuals: A Pilot Study / 가정의학회지

Background@#Obesity is considered a state of enhanced oxidative stress as well as chronic and low-grade inflammation. The copper–zinc ratio in obese individuals has been reported to reflect systemic oxidative stress and inflammatory status. We investigated whether the neutrophil–lymphocyte ratio is related to the copper–zinc ratio in hair, within the context of a normal white blood cell count among overweight or obese Korean individuals. @*Methods@#We included 56 participants aged older than 20 years who voluntarily sought weight reduction treatment and met the inclusion criterion of body mass index of 23 kg/m2 or greater. Intra-abdominal visceral adipose tissue was measured by computed tomography imaging, while the copper and zinc levels were measured by hair mineral analysis. Using multiple linear regression analysis, we examined the associations between the neutrophil–lymphocyte ratio and the copper–zinc ratio. @*Results@#The mean age, body mass index, and visceral adipose tissue were 46.0±10.5 years, 29.0±4.1 kg/cm2 , and 142.9±68.8 cm2 , respectively. Pearson’s correlation analysis revealed the association of the neutrophil–lymphocyte ratio with copper level (r=0.475, P<0.001) and copper–zinc ratio (r=0.494, P<0.001). After adjusting for confounding variables, we found the neutrophil–lymphocyte ratio was significantly associated with the level of copper and the copper–zinc ratio in hair (regression coefficient: 0.055±0.015; P<0.001 and regression coefficient: 0.761±0.185; P<0.001, respectively). @*Conclusion@#A higher copper–zinc ratio in hair is positively and independently associated with the neutrophil–lymphocyte ratio. Thus, a high hair copper–zinc ratio could be a useful parameter for oxidative burden of individuals predisposed to obesity-related comorbidity.

Upcoming Aging Society and Men's Health: Focus on Clinical Implications of Exercise and Lifestyle Modification

Borderline-High Mean Corpuscular Volume Levels Are Associated with Arterial Stiffness among the Apparently Healthy Korean Individuals / 가정의학회지

Background@#High mean corpuscular volume (MCV) has been implicated in various health problems, such as anemia, liver disease, and thyroid disease. However, the clinical significance of borderline-high MCV is poorly understood in the primary care setting. This study aimed to investigate whether borderline-high MCV was related to arterial stiffness in Korean adults as measured by brachial-ankle pulse wave velocity (baPWV). @*Methods@#This cross-sectional study comprised 582 participants aged >30 years who underwent routine health examinations. Borderline-high MCV was defined as over 95.0 fl (>90th percentile) after excluding participants with MCV of ≥100 fl or ≤80 fl, and high baPWV was defined as >1,600 cm/s (>90th percentile). The odds ratios (ORs) and 95% confidence intervals (CIs) for high baPWV according to borderline-high MCV were calculated using multiple logistic regression analyses after adjusting for the confounding variables. @*Results@#The mean age of the study population was 47.8±11.7 years, and 56.9% of the participants were male. Compared to that in the control group, the OR (95% CI) of high baPWV in those with a borderline-high MCV was 3.68 (1.39–9.74) after adjusting for age, sex, body mass index, alcohol intake, smoking status, regular exercise, mean blood pressure, fasting plasma glucose, triglyceride, high-density lipoprotein cholesterol, C-reactive protein, γ-glutamyltransferase, uric acid, hypertension medication, and diabetes medication. @*Conclusion@#Borderline-high MCV was independently associated with arterial stiffness among apparently healthy Korean individuals.

Association between Resting Heart Rate and Borderline Ankle-Brachial Index Among the Health Screen Examinees

BACKGROUND: The ankle-brachial index (ABI) is a simple, noninvasive clinical test that is useful in the diagnosis of peripheral artery disease (PAD). The borderline ABI value is 0.91–0.99 and has also been reported in endothelial dysfunction and preclinical PAD. We investigated the relationship between resting heart rate as a surrogate marker of autonomic balance and borderline ABI in apparently healthy individuals.METHODS: We evaluated the association between resting heart rate and borderline ABI in 618 participants (348 male and 270 female) in a health examination program. The odds ratios for borderline ABI were calculated using a multivariable logistic regression analysis after adjusting for confounding variables across heart rate quartiles (Q1≤56, Q2=57–62, Q3=63–68, and Q4≥69 beats/min).RESULTS: The overall prevalence of borderline ABI was 13.9%. The age- and sex-adjusted resting heart rate was significantly higher in the borderline ABI group than in the control group (66.9±0.9 vs. 63.0±0.4 beats/min, P < 0.001). The odds ratios (95% confidence intervals) for the borderline ABI in each heart rate quartile were 1.00, 1.04 (0.43–2.52), 1.69 (0.73–3.93), and 3.52 (1.55–7.97) after adjusting for age, sex, smoking status, alcohol intake, regular exercise, body mass index, systolic blood pressure, fasting plasma glucose level, triglyceride level, high-density lipoprotein-cholesterol level, white blood cell count, C-reactive protein level, uric acid level, γ-glutamyltransferase level, hypertension medication, diabetes medication, and dyslipidemia medication.CONCLUSION: These findings indicate that a higher resting heart rate is independently associated with borderline ABI.

Relationship of Forced Vital Capacity with Chronic Kidney Disease among Middle-Aged and Elder Korean Men

BACKGROUND: It is unclear whether impaired pulmonary function serves as a risk factor for decreased renal function. This study investigated the association between the forced vital capacity (FVC) and chronic kidney disease (CKD) in middle-aged and elderly men.METHODS: We investigated the association between FVC and CKD in 412 Korean men aged ≥50 years, without diabetes, who have not received treatment for chronic lung disease. CKD was defined based on evidence of renal tissue damage or reduced renal function indicated by estimated glomerular filtration rate < 60 mL/min/1.73 m² or proteinuria level ≥1+. We assessed the association between FVC and CKD using multivariate logistic regression analysis after adjusting for confounders.RESULTS: The overall prevalence of CKD was 29.2% in the study population. Multivariate logistic regression analysis showed that the odds ratio with a 95% confidence interval for CKD was 0.96 (0.92–0.99) with a 1% increment in FVC after adjusting for age, body mass index, smoking status, alcohol intake, regular exercise, systolic and diastolic blood pressures, fasting plasma glucose, triglyceride, and high-density lipoprotein-cholesterol levels, as well as antihypertensive and antidyslipidemic medications.CONCLUSION: We observed that FVC was independently and inversely associated with CKD. This finding suggests that careful monitoring of renal function is necessary to evaluate possible kidney dysfunction in patients with decreased FVC.

Higher Serum Calcium Levels Are Associated with Preclinical Peripheral Arterial Disease among the Apparently Healthy Individuals / 가정의학회지

BACKGROUND: Epidemiological studies suggest that serum calcium levels correlate with cardiovascular events. An ankle-brachial index (ABI) between 0.9 and 1.00 is a surrogate estimation of preclinical peripheral arterial disease (PAD). Prior studies have shown that an ABI of 0.9–1.0 is also associated with endothelial dysfunction. Therefore, we sought to investigate the relationship between serum calcium levels and preclinical PAD in apparently healthy Korean individuals. METHODS: We evaluated the association between serum calcium levels and preclinical PAD in 596 participants (334 males, 262 females) in a health examination program. Preclinical PAD was defined by an ABI of 0.9–1.0. Multiple logistic regression analysis was used to determine whether the serum calcium level was an independent determinant of preclinical PAD. RESULTS: The overall prevalence of preclinical PAD was 14.3%. The mean age was 44.0±12.5 years in the non-PAD group and 48.3±11.4 years in the preclinical PAD group (P=0.001). After adjusting for age, gender, systolic blood pressure, fasting plasma glucose, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, g-glutamyltransferase, uric acid, hypertension medication, diabetes medication, and hyperlipidemia medication, the odds ratio (95% confidence intervals) for preclinical PAD was 2.28 (1.02–5.11) with a 1-mg/dL increase in the serum calcium. CONCLUSION: These findings suggest that increased serum calcium is independently and positively associated with preclinical PAD regardless of the presence of classic cardiovascular risk factors.

Uric Acid Level Has a J-Shaped Association with Arterial Stiffness in Korean Postmenopausal Women / 가정의학회지

BACKGROUND: Uric acid has been reported to function both as an oxidant or antioxidant depending on the context. A previous study in the Korean population reported a positive linear association between serum uric acid level and arterial stiffness in men, but little is known about how serum uric acid level is related to the risk of increased arterial stiffness in Korean postmenopausal women. METHODS: We performed a cross-sectional study of 293 subjects who participated in a health examination program run by the health promotion center of Gangnam Severance Hospital between October 2007 and July 2010. High brachial-ankle pulse wave velocity was defined as a brachial-ankle pulse wave velocity of more than 1,450 cm/s. The odds ratios (ORs) for high brachial-ankle pulse wave velocity were calculated using multivariate logistic regression analysis across uric acid quartiles after adjusting for other indicators of cardiovascular risk. RESULTS: The 293 postmenopausal women were divided into quartiles according to uric acid level. The mean brachial-ankle pulse wave velocity values of each quartile were as follows: Q1, 1,474 cm/s; Q2, 1,375 cm/s; Q3, 1,422 cm/s; Q4, 1,528 cm/s. The second quartile was designated as the control group based on mean brachial-ankle pulse wave velocity value. Multivariate adjusted ORs (95% confidence intervals) for brachial-ankle pulse wave velocity across the uric acid quartiles were 2.642 (Q1, 1.095–6.3373), 1.00, 4.305 (Q3, 1.798–10.307), and 4.375 (Q4, 1.923–9.949), after adjusting for confounding variables. CONCLUSION: Serum uric acid level has a J-shaped association with arterial stiffness in Korean postmenopausal women.