The Association of Smoking Status and Clustering of Obesity and Depression on the Risk of Early–Onset Cardiovascular Disease in Young Adults: A Nationwide Cohort Study

Background and Objectives@#To evaluate the impact of smoking in young adults on the risk of cardiovascular disease (CVD) and the clustering effect of behavioral risk factors such as smoking, obesity, and depression. @*Methods@#A Korean nationwide population-based cohort of a total of 3,280,826 participants aged 20–39 years old who underwent 2 consecutive health examinations were included. They were followed up until the date of CVD (myocardial infarction [MI] or stroke), or December 2018 (median, 6 years). @*Results@#Current smoking, early age of smoking initiation, and smoking intensity were associated with an increased risk of CVD incidence. Even after quitting smoking, the risk of MI was still high in quitters compared with non-smokers. Cigarette smoking, obesity, and depression were independently associated with a 1.3–1.7 times increased risk of CVD, and clustering of 2 or more of these behavioral risk factors was associated with a 2–3 times increased risk of CVD in young adults. @*Conclusions@#In young adults, cigarette smoking was associated with the risk of CVD, and the clustering of 2 or more behavioral risk factors showed an additive risk of CVD.

Nicotine Dependence Evaluated by Urinary Cotinine and Heaviness of Smoking Index among Smokers, Vapers, and Dual Users: A Cross-Sectional Study Using the Korea National Health and Nutrition Examination Survey Data / 가정의학회지

Background@#Many people use both combustible cigarette (CC) and electronic cigarette (EC). We compared nicotine dependence among CC, EC, and dual users using questionnaires and urinary cotinine levels. @*Methods@#Data from the Korea National Health and Nutrition Examination Survey (2014–2017) databases were analyzed; 3,917 CC, EC, and dual users were administered the urinary cotinine test, and 1,045 current CC and dual users completed the Heaviness of Smoking Index (HSI) questionnaires. Weighted geometric means of urine cotinine levels were compared between exclusive CC, exclusive EC, and dual users. The distribution rate, based on time to first cigarette (TTFC), cigarettes per day (CPD), and the HSI was analyzed in two weighted groups, exclusive CC and dual users. @*Results@#Among those who currently use any type of cigarette, 89.4%, 1.4%, and 9.2% were exclusive CC, exclusive EC, and dual users, respectively. Weighted geometric means of urine cotinine were highest in dual users (1,356.4 ng/mL), followed by exclusive CC (1,270.3 ng/mL), and exclusive EC (867.7 ng/mL) with significant differences between all three groups (P<0.05). There were no statistically significant differences in CPD between exclusive CC and dual users (P=0.626). The proportion of TTFC ≤5 minutes was 21.5% and 29.5% in the two groups, respectively (P=0.010); however, HSI differences in the two groups was marginal (P=0.557). @*Conclusion@#In this study, the urinary cotinine value could distinguish the three groups, CC, EC, and dual users, but the questionnaire using HSI could not distinguish the three groups.

Nicotine Dependence Evaluated by Urinary Cotinine and Heaviness of Smoking Index among Smokers, Vapers, and Dual Users: A Cross-Sectional Study Using the Korea National Health and Nutrition Examination Survey Data / 가정의학회지

Background@#Many people use both combustible cigarette (CC) and electronic cigarette (EC). We compared nicotine dependence among CC, EC, and dual users using questionnaires and urinary cotinine levels. @*Methods@#Data from the Korea National Health and Nutrition Examination Survey (2014–2017) databases were analyzed; 3,917 CC, EC, and dual users were administered the urinary cotinine test, and 1,045 current CC and dual users completed the Heaviness of Smoking Index (HSI) questionnaires. Weighted geometric means of urine cotinine levels were compared between exclusive CC, exclusive EC, and dual users. The distribution rate, based on time to first cigarette (TTFC), cigarettes per day (CPD), and the HSI was analyzed in two weighted groups, exclusive CC and dual users. @*Results@#Among those who currently use any type of cigarette, 89.4%, 1.4%, and 9.2% were exclusive CC, exclusive EC, and dual users, respectively. Weighted geometric means of urine cotinine were highest in dual users (1,356.4 ng/mL), followed by exclusive CC (1,270.3 ng/mL), and exclusive EC (867.7 ng/mL) with significant differences between all three groups (P<0.05). There were no statistically significant differences in CPD between exclusive CC and dual users (P=0.626). The proportion of TTFC ≤5 minutes was 21.5% and 29.5% in the two groups, respectively (P=0.010); however, HSI differences in the two groups was marginal (P=0.557). @*Conclusion@#In this study, the urinary cotinine value could distinguish the three groups, CC, EC, and dual users, but the questionnaire using HSI could not distinguish the three groups.

Association between Hypothyroidism and Chronic Kidney Disease in Korean Adults: A Study Based on the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI), 2013–2015

Background@#Previous studies suggested the correlation between thyroid and kidney functions, especially the high prevalence of hypothyroidism in chronic kidney disease. This study aimed to evaluate the influence of hypothyroidism on kidney function in Korean adults by using data from a representative nationwide survey. @*Methods@#This was a cross-sectional study composed of 5,250 individuals aged ≥19 years who were enrolled in the sixth Korea National Health and Nutrition Examination Survey. The participants were classified into three groups of patients with euthyroidism, subclinical hypothyroidism, and overt hypothyroidism according to thyroid function. Chronic kidney disease was defined as having a decreased estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Univariate and multivariate logistic regression analyses were used to evaluate the prevalence and adjusted odds ratio (aOR) of chronic kidney disease. @*Results@#Compared with the euthyroidism group, the subclinical and overt hypothyroidism groups showed higher prevalence rates of chronic kidney disease in both sexes. This tendency was significant in the elderly people aged ≥65 years. In the multivariate logistic regression analysis, the subclinical hypothyroidism group did not show a significant difference (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 0.82–3.87) from the euthyroidism group. In the overt hypothyroidism group, the aOR of chronic kidney disease was significantly higher (aOR, 5.90; 95% CI, 1.73– 20.15) than that in the euthyroidism group. @*Conclusion@#Overt hypothyroidism was associated with decreased eGFR and may be considered as an independent risk factor of chronic kidney disease.

The Association between Low Vitamin D Status and Autoimmune Thyroid Disease in Korean Premenopausal Women: The 6th Korea National Health and Nutrition Examination Survey, 2013–2014 / 가정의학회지

BACKGROUND: This study aimed to analyze the association of low vitamin D status with thyroid autoimmunity and dysfunction in the Korean population according to sex and menopausal status in women. METHODS: This study was based on the data acquired from the 6th Korea National Health and Nutrition Examination Survey. We enrolled 4,356 subjects who had data of thyroid function, antithyroid peroxidase antibody (TPOAb), and serum 25-hydroxyvitamin D (25[OH]D) levels. We excluded subjects who were pregnant and who had a history of thyroid disease or thyroid cancer, and those with transient thyroid dysfunction who tested negative for TPOAb (TPOAb[−]). RESULTS: TPOAb positivity (TPOAb[+]) with thyroid dysfunction (subclinical and overt hypothyroidism) was more prevalent in the vitamin D deficient group than in the vitamin D insufficient and sufficient groups including premenopausal (P=0.046) and postmenopausal women (P=0.032), although no significant differences were observed in men. The mean serum 25(OH)D level was significantly lower in the TPOAb(+) with thyroid dysfunction group than in the TPOAb(+) with euthyroidism and TPOAb(−) groups of premenopausal women (P=0.001), although no significant differences were observed in men and postmenopausal women. Multivariate binary logistic regression analysis, adjusted for age, body mass index, and current smoking status, showed that vitamin D insufficiency and deficiency were significantly associated with TPOAb(+) with thyroid dysfunction in premenopausal women (P<0.001), although no significant associations were observed in men and postmenopausal women. CONCLUSION: Low vitamin D status was significantly associated with thyroid autoimmunity and dysfunction in the Korean population, especially in premenopausal women.

Association between Alcohol Consumption and Mental Health (Perceived Stress, Depressive Mood, Suicidal Ideation, Quality of Life) in Koreans: The Sixth Korean National Health and Nutrition Examination Survey in 2015

BACKGROUND: Causal hypotheses suggest that alcohol-related disorders may also cause psychiatric disorders and problems, or vice versa. The association between alcohol consumption and mental health is important from both research and therapeutic viewpoints. Therefore, we aimed to analyze the association between alcohol consumption and mental health (perceived stress, depressive mood, suicidal ideation, quality of life) in Korean adults over 19 years old.METHODS: We finally included 5,399 adults who had participated in the Korean National Health and Nutrition Examination Survey in 2015, and analyzed the association between alcohol consumption and mental health, using logistic regression.RESULTS: Perceived stress was associated with alcohol consumption in problem drinkers (odds ratio [OR]=1.35, 95% confidence interval [CI]=1.13–1.61). Depressive mood was associated with alcohol consumption in moderate and problem drinkers (OR=0.90, 95% CI=0.71–1.11 and OR=1.35, 95% CI=1.06–1.70, respectively). Suicidal ideation was not associated with alcohol consumption in moderate and problem drinkers (P=0.063 and P=0.068, respectively). Quality of life was associated with alcohol consumption in moderate and problem drinkers (OR=0.48, 95% CI=0.41–0.57 and OR=0.77, 95% CI=0.66–0.92, respectively).CONCLUSION: We found that moderate drinkers have a lower risk of depressive mood and a higher quality of life as compared to low drinkers. However, problem drinkers have a higher quality of life but a higher risk of perceived stress and depressive mood as compared to low drinkers.

The Association between Low Back Pain and Mental Health in Korean Adults Over the Age of 50: Korean National Health and Nutrition Examination Survey, 2013

BACKGROUND: Lower back pain (LBP) is the most common musculoskeletal disease in adults over the age of 50. LBP is associated with physical activity and mental health such as depression or suicidal thoughts. We aimed to analyze the association between LBP and mental health and that between physical activity and depressive mood in LBP patients among Korean adults over the age of 50.METHODS: We included 2,681 adults in the analysis, who participated in the 2013 Korean National Health and Nutrition Examination Survey, and used a t-test, logistic regression analysis, and chi-squared test via complex sampling. We analyzed the association between LBP and mental health, various kinds of physical activity, and depressive mood after adjusting for confounding factors.RESULTS: Poor mental health (perception of stress, diagnosis of depression, depressive mood, suicidal thoughts, and suicide attempts) were significantly associated with LBP. The LBP group was 2.077 times more likely to be diagnosed with depression and was 4.666 times more likely to have suicidal thoughts than the control group. Exercise, such as walking, was associated with a reduced risk of depressive mood in subjects with LBP.CONCLUSION: LBP patients were at high risk of being diagnosed with depression, experiencing suicidal thoughts and depressive mood, and attempting suicide. In LBP patients, walking was associated with a reduced depressive mood.

Effect of Dietitian's Perceived Organizational Culture on Organizational Commitment at Hospital Foodservices

This study was conducted to investigate the effect dietitians' perceived organizational culture has on organizational commitment at hospital foodservices. A total of 382 dietitians working at general hospitals with 500 beds or more participated in the survey from January 16 to February 8, 2017. The result of perceived organizational culture showed hierarchical culture, rational culture, development culture, and group culture scored to be 5.29, 5.25, 5.15, and 4.97 out of 7, respectively. Differences in the perception of organizational culture and organizational commitment were observed according to the general demographics of subjects, but no significant differences were shown according to the general characteristics of hospitals. For organizational commitment perception, affective commitment (5.14), normative commitment (4.41), and continuance commitment (4.21) were identified. There were differences according to age, work experience at the present job, position, and education level by type of organizational culture. In terms of organizational commitment, there were significant differences in age, work experience at the present job, employment status, and possession of clinical dietitian certificate, position by type of commitment. A positive correlation between dietitians' perceived organizational culture and organizational commitment such as overall organizational commitment, affective commitment, and normative commitment was observed (P<0.01). Group culture, development culture, and hierarchical culture positively affected overall organizational commitment (P<0.001). Development culture, group culture, and hierarchical culture had positive effects on affective commitment, whereas rational culture had a negative influence. Development culture (P<0.05), group culture (P<0.001), and hierarchical culture (P<0.01) positively influenced normative commitment. Results suggest that it is necessary to develop plans for the improvement of rational culture, group culture, and development culture at hospital foodservice organizations.

Consideration of Serum Thyrotropin When Interpreting Serum Thyroglobulin Level in Patients with Differentiated Thyroid Cancer

BACKGROUND AND OBJECTIVES: The level of thyroid-stimulating hormone (TSH)-stimulated thyroglobulin (Tg) after thyroid hormone withdrawal (THW) is the most sensitive marker for detecting recurrence of differentiated thyroid cancer (DTC). In DTC, Tg production is regulated by TSH; however, TSH values after THW are never identical, even in the same patient. The objective of this study was to evaluate the influence of TSH on Tg levels after THW. MATERIALS AND METHODS: TSH and Tg concentrations were measured twice at 2 and 3 weeks after THW in 309 patients with DTC. TSH and Tg levels at these time points were compared. The percent change in TSH (ΔTSH) and change in Tg level (%ΔTg) from 2 to 3 weeks after THW were calculated, and Pearson's correlation coefficients were calculated to determine whether ΔTSH could affect %ΔTg. Tg cutoff value for diagnostic imaging was 2 ng/mL. RESULTS: The TSH and Tg values at 3 weeks were significantly higher than those at 2 weeks after THW. Tg values increased significantly to >2 ng/mL after 1 week in 38.5% of the patients with Tg values of 0.2-2 ng/mL at 2 weeks after THW. In patients with Tg values ≥2 ng/mL at 2 weeks after THW, Tg values increased significantly after an additional week of THW. ΔTSH correlated significantly with %ΔTg. CONCLUSION: TSH values differed according to time after THW, and Tg values differed significantly according to TSH values. Therefore, TSH values should be considered carefully when interpreting the meaning of Tg levels in patients with DTC.

Cook Supervisors' Perceived Performance of Safety Management for Vegetables at Korean Food Restaurants in Daegu

This study was conducted to identify risk factors to ensure food safety by evaluating cook supervisors' perceived performance of vegetable safety management at Korean food restaurants in Daegu. Recognition of the potential foodborne illness caused by vegetables was 2.60/5 on average. Inspection items with low scores by respondents during food safety inspection by government agencies were "Wash and sanitize vegetables" and "Keep washed and cut vegetables in the refrigerator". As for storage, perceived performance of "Store vegetable in the refrigerator less than 70% of the refrigerator capacity" scored less than 4 out of 5. About 86% of respondents answered "Water-only washing" for vegetable washing. For perceived performance of vegetable cooking, service, and leftover handling, 11 and three items out of 13 were significantly different depending on the size of restaurants and possession of culinary arts certificates, respectively. Based on results, it is necessary to provide food safety training programs for handling vegetables in order to increase knowledge of cook supervisors. In addition, intensive on-site guidance for safety management of vegetables is needed.

Pathological N1b Node Metastasis Itself Can Be Still a Valid Prognostic Factor in PTC after High Dose RAI Therapy

BACKGROUND AND OBJECTIVES: The aim of this study was to determine whether pathologically proven central or lateral lymph node (LN) metastasis (pN1a or pN1b) could affect ablation success and recurrence after high-dose radioactive iodine (RAI) ablation. We also sought to identify the risk factors for long-term recurrence in patients with papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: A total of 277 patients with pN1 disease who had undergone high-dose RAI ablation (5.55 GBq) between 2000 and 2006 were included in this retrospective study. We compared the ablation success rate and the recurrence rate between patients with pN1a and pN1b disease. Univariate and multivariate analyses were performed to identify the risk factors for recurrence. RESULTS: The median duration of follow-up was 10.2 years. The overall ablation success rate was 64%, and the ablation success rate in the pN1b group (49%) was lower than in the pN1a group (74%). The overall recurrence rate was 23%, and the recurrence rate in the pN1b group (30%) was higher than in pN1a group (18%). A higher ratio of metastatic LNs, a higher level of pre-ablation thyroglobulin, and ablation failure were significant risk factors for recurrence by multivariate analysis. CONCLUSION: Patients with pN1b disease experienced a lower ablation success rate and a higher recurrence rate than patients with pN1a disease. However, a higher ratio of metastatic LNs, a higher level of pre-ablation thyroglobulin, and ablation failure were stronger risk factors than the pathological N stage for long term recurrence in patients with node-positive PTC.

Pathological N1b Node Metastasis Itself Can Be Still a Valid Prognostic Factor in PTC after High Dose RAI Therapy

BACKGROUND AND OBJECTIVES: The aim of this study was to determine whether pathologically proven central or lateral lymph node (LN) metastasis (pN1a or pN1b) could affect ablation success and recurrence after high-dose radioactive iodine (RAI) ablation. We also sought to identify the risk factors for long-term recurrence in patients with papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: A total of 277 patients with pN1 disease who had undergone high-dose RAI ablation (5.55 GBq) between 2000 and 2006 were included in this retrospective study. We compared the ablation success rate and the recurrence rate between patients with pN1a and pN1b disease. Univariate and multivariate analyses were performed to identify the risk factors for recurrence. RESULTS: The median duration of follow-up was 10.2 years. The overall ablation success rate was 64%, and the ablation success rate in the pN1b group (49%) was lower than in the pN1a group (74%). The overall recurrence rate was 23%, and the recurrence rate in the pN1b group (30%) was higher than in pN1a group (18%). A higher ratio of metastatic LNs, a higher level of pre-ablation thyroglobulin, and ablation failure were significant risk factors for recurrence by multivariate analysis. CONCLUSION: Patients with pN1b disease experienced a lower ablation success rate and a higher recurrence rate than patients with pN1a disease. However, a higher ratio of metastatic LNs, a higher level of pre-ablation thyroglobulin, and ablation failure were stronger risk factors than the pathological N stage for long term recurrence in patients with node-positive PTC.

Inhibition of advanced glycation end product formation by burdock root extract / 한국영양학회지

PURPOSE: Diabetic complications are a major concern to manage progression of diabetes. Production of advanced glycation end products (AGEs) due to high blood glucose is one of the mechanisms leading to diabetic complications. Multiple pharmacologic AGE inhibitory agents are currently under development, but clinical applications are still limited due to safety issues. Thus, it is necessary to identify a safe anti-glycation agent. It is known that burdock roots have antioxidant, anti-inflammatory, and anti-cancer activities. The objective of the present study was to investigate the inhibitory role of burdock roots on the formation of high glucose-induced glycation of bovine serum albumin (BSA). METHODS: In this study, glycation of BSA by glucose, galactose, or fructose at 37℃ for 3 weeks was assessed based on levels of α-dicarbonyl compounds (early-stage glycation products), fructosamine (intermediate products of glycation), and fluorescent AGEs (late-stage glycation products). In order to compare the inhibitory actions of burdock root extract in AGE formation, aminoguanidine (AG), a pharmacological AGE inhibitor, was used as a positive control. RESULTS: BSA glycation by glucose, fructose, and galatose was dose- and time-dependently produced. Burdock root extract at a concentration of 4 mg/mL almost completely inhibited glucose-induced BSA glycation. The results demonstrate that burdock root extract inhibited AGE formation with an IC₅₀ value of 1.534 mg/mL, and inhibitory activity was found to be more effective than the standard anti-glycation agent aminoguanidine. This study identified a novel function of burdock root as a potential anti-glycation agent. CONCLUSION: Our findings suggest that burdock root could be beneficial for preventing diabetic complications.