Mercury exposure is associated with obesity: a systematic review and meta-analysis / 대한지역사회영양학회지

Objectives@# Previous studies have evaluated the association between mercury exposure and obesity but have yielded mixed conclusions. The aim of this study was to systematically review and summarize scientific evidence regarding the association between mercury exposure and obesity in the human population. @*Methods@# We conducted a systematic search of PubMed, Web of Science, Scopus, and Science Direct for articles related to mercury exposure and obesity. Meta-analyses of the highest and lowest categories of mercury levels were evaluated using a random effects model. Begg’s test was used to detect publication bias. @*Results@# A total of 9 articles were included. The pooled random effects odds ratio (OR) for mercury exposure and obesity of all 9 studies was 1.66 (95% confidence interval [CI]: 1.16-2.38). This positive association was evident in adults (OR: 1.61, 95% CI: 1.02-2.54) and among studies with Asian populations (OR: 2.00, 95% CI: 1.53-2.59), but not among those with North America/African populations (OR: 0.90, 95% CI: 0.50-1.65). @*Conclusions@# The present meta-analysis identified a positive association between mercury exposure and obesity. These findings suggest that toxic environmental metals such as mercury may be an important risk factor for obesity along with dietary habits and lifestyles.

Association between dietary omega-3 fatty acid intake and depression in postmenopausal women

BACKGROUND/OBJECTIVES@#This study aimed to analyze the association between dietary omega-3 fatty acid intake and depression in postmenopausal women using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI. @*SUBJECTS/METHODS@#The KNHANES is a cross-sectional nationwide health and nutrition survey. Dietary data, including omega-3 fatty acids, were assessed using the 24-h recall method. Depression was evaluated using a survey questionnaire. The association between dietary omega-3 fatty acids and depression was evaluated using multivariate logistic regression analysis. Depression, according to the dietary omega-3 fatty acid intake, was expressed as the odds ratio (OR) with a 95% confidence interval (CI). A total of 4,150 postmenopausal women were included in the analysis. @*RESULTS@#In the fully-adjusted model, the group with the highest dietary omega-3 fatty acid intake significantly showed lower prevalence of depression than the group with the lowest intake (OR, 0.52; 95% CI, 0.33–0.83); a significant linear trend was detected (P for trend = 0.04). According to the dose-response analysis using cubic restricted spline regression, this association was linear and monotonic (P for non-linearity = 0.32). @*CONCLUSIONS@#In this study, the dietary omega-3 fatty acid intake in postmenopausal women was inversely proportional to depression in a dose-response manner. Large cohort studies are needed to verify the causality between omega-3 fatty acids and depression in Korean postmenopausal women.

Association between dietary branchedchain amino acid intake and skeletal muscle mass index among Korean adults: Interaction with obesity

BACKGROUND/OBJECTIVES@#The branched-chain amino acids (BCAA), including isoleucine, leucine, and valine, promote muscle protein synthesis. However, obesity may interfere with protein synthesis by dysregulating mitochondrial function in the muscles.This study aimed to examine the association between dietary intake levels of BCAA and skeletal muscle mass index (SMI) in middle-aged participants, and the effect of obesity/ abdominal obesity on this association. @*SUBJECTS/METHODS@#The data of 3,966 men and women aged 50–64 years who participated in the 2008–2011 Korea National Health and Nutrition Examination Survey were analyzed.Intake levels of energy-adjusted dietary amino acids were obtained using a 24-hour dietary recall. SMI was calculated by dividing the appendicular skeletal muscle mass by body weight (kg) and multiplying the result by 100%. Multivariable general linear models were used to analyze the association of dietary BCAA intake levels with SMI. @*RESULTS@#The beneficial effects of energy-adjusted dietary BCAA intakes on SMI were greater in the non-obesityon-abdominal obesity groups; however, no significant associations were observed in the obesity/abdominal obesity groups (P > 0.05). @*CONCLUSIONS@#Healthy weight and sufficient intake of dietary BCAA are recommended to maintain muscle mass.

Association between dietary omega-3 fatty acid intake and depression in postmenopausal women

BACKGROUND/OBJECTIVES@#This study aimed to analyze the association between dietary omega-3 fatty acid intake and depression in postmenopausal women using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI. @*SUBJECTS/METHODS@#The KNHANES is a cross-sectional nationwide health and nutrition survey. Dietary data, including omega-3 fatty acids, were assessed using the 24-h recall method. Depression was evaluated using a survey questionnaire. The association between dietary omega-3 fatty acids and depression was evaluated using multivariate logistic regression analysis. Depression, according to the dietary omega-3 fatty acid intake, was expressed as the odds ratio (OR) with a 95% confidence interval (CI). A total of 4,150 postmenopausal women were included in the analysis. @*RESULTS@#In the fully-adjusted model, the group with the highest dietary omega-3 fatty acid intake significantly showed lower prevalence of depression than the group with the lowest intake (OR, 0.52; 95% CI, 0.33–0.83); a significant linear trend was detected (P for trend = 0.04). According to the dose-response analysis using cubic restricted spline regression, this association was linear and monotonic (P for non-linearity = 0.32). @*CONCLUSIONS@#In this study, the dietary omega-3 fatty acid intake in postmenopausal women was inversely proportional to depression in a dose-response manner. Large cohort studies are needed to verify the causality between omega-3 fatty acids and depression in Korean postmenopausal women.

Association between dietary branchedchain amino acid intake and skeletal muscle mass index among Korean adults: Interaction with obesity

BACKGROUND/OBJECTIVES@#The branched-chain amino acids (BCAA), including isoleucine, leucine, and valine, promote muscle protein synthesis. However, obesity may interfere with protein synthesis by dysregulating mitochondrial function in the muscles.This study aimed to examine the association between dietary intake levels of BCAA and skeletal muscle mass index (SMI) in middle-aged participants, and the effect of obesity/ abdominal obesity on this association. @*SUBJECTS/METHODS@#The data of 3,966 men and women aged 50–64 years who participated in the 2008–2011 Korea National Health and Nutrition Examination Survey were analyzed.Intake levels of energy-adjusted dietary amino acids were obtained using a 24-hour dietary recall. SMI was calculated by dividing the appendicular skeletal muscle mass by body weight (kg) and multiplying the result by 100%. Multivariable general linear models were used to analyze the association of dietary BCAA intake levels with SMI. @*RESULTS@#The beneficial effects of energy-adjusted dietary BCAA intakes on SMI were greater in the non-obesityon-abdominal obesity groups; however, no significant associations were observed in the obesity/abdominal obesity groups (P > 0.05). @*CONCLUSIONS@#Healthy weight and sufficient intake of dietary BCAA are recommended to maintain muscle mass.

Health-related quality of life in elderly patients with diabetes mellitus according to age: based on Korea National Health and Nutrition Examination Survey / 한국영양학회지

Purpose@#Although the importance of life satisfaction in patients with chronic diseases has been emphasized, limited studies have been performed on the health-related quality of life (HRQoL) among elderly patients with chronic diseases. This study examined the HRQoL among Korean patients with diabetes aged 65 years or older. @*Methods@#This study used data from the Korea National Health and Nutrition Examination Survey 2008–2016. The analysis included data of 2,353 elderly patients with diabetes aged 65 years or older who were aware that they had type 2 diabetes. Each participant was categorized into one of three age groups (65–69 years, 70–74 years, and ≥ 75 years). The EuroQol-5 Dimensions (EQ-5D) scale was computed to estimate the HRQoL. Multivariate linear regression analysis was used to compare the demographic characteristics, lifestyle characteristics, nutrient intake, and EQ-5D scores between the age groups. @*Results@#The intake levels of most nutrients were similar in the three age groups, but the total energy intake levels were significantly lower, and the sodium intake levels were significantly higher in the older age groups (p < 0.001). In addition, all items of the EQ-5D index, except for anxiety/depression, tended to decrease with age. In particular, the oldest age group (≥ 75 years) showed significantly lower levels on most items and the EQ-5D index than those in the other age groups (p < 0.001). @*Conclusion@#Elderly patients with type 2 diabetes may have low levels of life satisfaction, which worsens with increasing age. Therefore, it is important to develop and manage personalized guidelines and medical systems so that elderly patients have a higher quality of life for the remainder of their lives. The results of this study are expected to be used as basic data for the systematic management of diabetes in elderly Korean patients.

Association between phytochemical index and metabolic syndrome

BACKGROUND/OBJECTIVES@#Although previous experimental studies reported the health benefits of foods rich in phytochemicals, few epidemiologic studies have investigated the associations between phytochemicals and metabolic disorders. This study aimed to calculate a phytochemical index (PI) and examine its association with metabolic syndrome in the Korean population. @*SUBJECTS/METHODS@#Data of Korean adults aged ≥ 19 years who participated in the 2008–2016 Korea National Health and Nutrition Examination Surveys were analyzed. The PI was calculated using 24-hour intake recall data regarding whole grains, vegetables, fruits, legumes, nuts and seeds, and soybeans and soy products. Demographic and lifestyle data were obtained using self-administered questionnaires. A multivariable logistic regression was performed to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of metabolic syndrome and its components according to PI quintiles. @*RESULTS@#Overall, 31,319 adults were evaluated. Compared with men, women had a higher median PI level (9.96 vs. 13.63) and significantly higher caloric intake levels from most PI components (P < 0.05), except for soy products. After adjusting for multiple confounding variables, participants in the highest PI quintile had significantly lower prevalences of abdominal obesity (OR: 0.90, 95% CI: 0.81–0.99), hyperglycemia (OR: 0.83, 95% CI: 0.74– 0.94), high blood pressure (OR: 0.82, 95% CI: 0.73–0.93), hypertriglyceridemia (OR: 0.84, 95% CI: 0.75–0.94), and metabolic syndrome (OR: 0.78, 95% CI: 0.69–0.88). @*CONCLUSIONS@#Higher intakes of phytochemical-rich foods are associated with a lower prevalence of metabolic dysregulation and consequently, cardiometabolic diseases.

Trends in metabolic risk factors among patients with diabetes mellitus according to income levels: the Korea National Health and Nutrition Examination Surveys 1998 ~ 2014 / 한국영양학회지

PURPOSE: Management of the metabolic risk factors in diabetes patients is essential for preventing or delaying diabetic complications. This study compared the levels of the metabolic risk factors in diabetes patients according to the income levels, and examined the secular trends in recent decades. METHODS: The data from the Korea National Health and Nutrition Examination Survey 1998 ~ 2014 were used. The diabetes patients were divided into three groups based on their household income levels. General information was obtained through self-administered questionnaires, and the blood biomarkers and blood pressure data were obtained from a health examination. Multivariable linear regression models were used to compare the metabolic biomarker levels according to the household income levels, adjusting for potential confounding factors. RESULTS: The fasting blood glucose, hemoglobin A1c, and blood lipid (total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride) levels were similar in the three groups. During the survey period of 16 years, the blood pressure showed a significant decreasing trend with time in all groups (p < 0.001). In contrast, the fasting blood glucose (p = 0.004), total cholesterol (p < 0.001), and LDL-cholesterol levels (p = 0.007) decreased significantly, and the HDL-cholesterol level (p < 0.001) increased significantly in the highest-income groups. In the lowest-income group, the fasting blood glucose (p = 0.02), total cholesterol (p < 0.001), and triglyceride (p = 0.003) levels showed a significant decreasing trend over time. On the other hand, the middle-income group showed no significant change in any of the metabolic risk factors except for blood pressure. CONCLUSION: The level of management of metabolic risk factors according to the income level of Korean diabetes patients was similar. On the other hand, the highest- and lowest-income groups showed positive trends of management of these factors during 16 years of observation, whereas the middle-income group did not show any improvement.

Association between vitamin D deficiency and anemia among Korean adolescent girls and young women / 한국영양학회지

PURPOSE: Although vitamin D deficiency is common among Korean adolescent girls and young women, few studies have explored the potential health effects of vitamin D deficiency in this vulnerable population. This study examined the association between vitamin D deficiency and anemia in Korean adolescent girls and young women.METHODS: The data from the Korea National Health and Nutrition Examination Survey 2008 ~ 2014 were used. A total of 3,643 girls and adult women aged 12 to 29 who provided all the information (including serum 25-hydroxy vitamin D, hemoglobin, and/or serum ferritin) needed for the analysis were included in the analysis. Demographic, lifestyle, and health data were obtained through survey questionnaires. Anemia and iron deficiency anemia were defined according to the World Health Organization cut-offs. Multivariable logistic regression, and restricted cubic spline regression were used in the analysis.RESULTS: In fully adjusted logistic regression models, the vitamin D deficiency was significantly associated with higher prevalences of anemia (odds ratio (OR): 1.61, 95% confidence interval (CI): 1.04 ~ 2.49) and iron deficiency anemia (OR: 1.43, 95% CI: 1.01 ~ 2.03). In a cubic spline regression model, we observed a dose-response relationship between serum 25(OH)D concentration and anemia, and this linear relationship was also clearly observed between serum 25(OH)D concentration and iron deficiency anemia.CONCLUSION: Vitamin D deficiency may be associated with a higher prevalence of iron deficiency anemia and anemia in adolescent girls and young women. Alternatively, vitamin D deficiency may be a concurrent event for patients with anemia, which we cannot distinguish in this cross-sectional study. Further studies are needed to verify the causality in this population of low vitamin D levels.

Self-management levels of diet and metabolic risk factors according to disease duration in patients with type 2 diabetes

BACKGROUND/OBJECTIVES: Metabolic risk factors should be managed effectively in patients with type 2 diabetes mellitus (T2DM) to prevent or delay diabetic complications. This study aimed to compare the self-management levels of diet and metabolic risk factors in patients with T2DM, according to the duration of illness, and to examine the trends in self-management levels during the recent decades. SUBJECTS/METHODS: Data were collected from the Korea National Health and Nutrition Examination Surveys (KNHANES, 1998–2014). In our analysis, 4,148 patients with T2DM, aged ≥ 30 years, were categorized according to the duration of their illness (< 5 years, 5–9 years, and ≥ 10 years). Demographic and lifestyle information was assessed through self-administered questionnaires, and biomarker levels (e.g., fasting glucose level, blood pressure, or lipid level) were obtained from a health examination. Dietary intake was assessed by a 24-recall, and adherence level to dietary guidelines (meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol) were assessed. Multivariable generalized linear regression and unconditional logistic regression models were used to compare the prevalence rates of hyperglycemia, dyslipidemia, and hypertension according to the duration of patients' illness, accounting for the complex survey design of the KNHANES. RESULTS: In the multivariable adjusted models, patients with a longer duration (≥ 10 years) of T2DM had a higher prevalence of hyperglycemia than those with a shorter duration of T2DM (< 5 years) (odds ratio 2.20, 95% confidence interval 1.61–3.01, P for trend < 0.001). We did not observe any associations of disease duration with the prevalence of hypertension and dyslipidemia. In addition, the adherence levels to dietary recommendations did not significantly differ according to disease duration, except adherence to moderate alcohol consumption. There were significant decreasing trends in the prevalence of hyperglycemia in patients with a duration of illness ≥ 10 years (P for trend = 0.004). CONCLUSION: Although the proportion of patients with adequate control of glucose levels has improved in recent decades, poorer self-management has been found in those with a longer disease duration. These findings suggest the need for well-planned and individualized patient education programs to improve self-management levels and quality of life by preventing or delaying diabetic complications.

A Preliminary Study to Determine Comprehensive Research and Development Plans for Promoting Mental Health Services

OBJECTIVES: The aim of this study was to analyze research and development projects in mental health services in Korea, using priority evaluation of mental health promotion policies to determine direction of the service. METHODS: An online survey was conducted that targeted experts in the mental health service regarding promotion of mental health in Korea in 2016. The survey was based on 32 policy projects that resulted from 12 strategies according to 4 policy objectives. RESULTS: Analysis of 32 mental health projects were assessed regarding the possibility of technology development success, magnitude of the ripple effect, and necessity of a national response. It was observed that 3 policy projects relevant to suicide, had a high relative priority. This was followed by policies for improvement of health insurance and the medical benefit cost system, and policies for reinforcement of crisis psychological support such as those for disaster victims. CONCLUSION: The prioritization of mental health services should place an emphasis on promotion of a healthy mental lifestyle, rehabilitation support for patients with serious mental illness, and reinforcement of social safety networks for suicide prevention.

Independent correlates of the toenail chromium level and the association between the chromium level and dyslipidemia / 한국영양학회지

PURPOSE: The number of patients with dyslipidemia have been increasing steadily over the past few decades in South Korea. The association between the chromium level and chronic disease has attracted considerable interest, but few studies have been conducted on the Korean population. The aim of this study was to identify the dietary and non-dietary correlates of the toenail chromium level, and evaluate the association between the toenail chromium level and dyslipidemia. METHODS: The baseline data of an ongoing prospective cohort study in Yeungnam area in South Korea were analyzed. A total of 500 participants aged 35 years or older who completed questionnaires on their demographics, lifestyle characteristics, and medical information were included. The toenail chromium level was analyzed by neutron activation analysis. The dietary intake was assessed using a validated 146-item semi-quantitative food frequency questionnaire. The blood lipid profiles were obtained from medical examinations conducted by the Korean National Health Insurance Service or medical institutions. RESULTS: Higher chromium levels were associated with the residential area (urban), higher education level, higher intakes of noodles and vegetables, and lower intake of fruits. Multiple logistic regression analysis showed that the toenail chromium levels were not associated significantly with the prevalence of dyslipidemia (odds ratio: 0.99, 95% confidence interval: 0.61 ~ 1.60). CONCLUSION: This study is the first study in Korea to determine the independent correlates of the toenail chromium levels and the association between chromium exposure and dyslipidemia. These findings provide useful scientific evidence for the development of chromium intake guidelines for the Korean population.

Dietary Issues and Challenges on Cardiometabolic Health in Korea: From a Viewpoint of a National Nutrition Surveillance System

A national nutrition surveillance system is an essential instrument for the detection of nutrition and nutrition-related health problems that can assist on policy implementation. The role of nutritional surveillance in detecting trends of nutritional problems and predicting their risks has become more important as its strong scientifically based method and evidences may provide insights on chronic disease risks. In this review, we attempted to identify dietary issues of Korean cardiometabolic disease (CMD) based on the national nutrition surveillance system and addressed gaps and limitations in the system. In addition, an alternative way on how the system can overcome these problems with the view of ultimately improving public health in Korea was discussed.

Coffee and metabolic syndrome: A systematic review and meta-analysis / 한국영양학회지

PURPOSE: Coffee is the most frequently consumed food item in South Korea after rice and cabbage. Coffee contains various substances, including caffeine, cafestol, kahweol, chlorogenic acid, and many other known and unknown ingredients with some health benefits. Especially, cumulative evidence has shown that regular coffee use is associated with lower risk of type 2 diabetes, although limited and inconsistent data are available regarding metabolic syndrome. METHODS: This study reviewed all available scientific and epidemiologic evidence on coffee consumption, metabolic syndrome, and the association between them. Most epidemiologic research regarding this association was of a cross-sectional design, and a few case-control and cohort studies were available. We conducted meta-analysis with 11 observational studies investigated in Europe, America, and Asia. Summary odds ratios (OR) were calculated using a random-effects model. RESULTS: The overall OR of metabolic syndrome was 0.90 (95% Confidence Interval (CI), 0.81-0.99) for the highest category of coffee intake compared with the lowest intake category. These associations were stronger in populations of US and Europe (OR 0.84, 95% CI 0.76-0.94), whereas no association was observed in the Asian population (OR 1.00, 95% CI 0.81-1.23). CONCLUSION: The review results indicate that frequent coffee consumption may be beneficial to metabolic syndrome, but the association between coffee consumption and metabolic syndrome may differ by nations or continents.

Evaluation of dietary behavior and nutritional status of elementary school students in Jeju using nutrition quotient / 한국영양학회지

PURPOSE: The aim of this study was to evaluate the food behavior and nutritional status of elementary school students in the Jeju area using Nutrition Quotient (NQ). METHODS: The subjects were 440 students (235 boys and 205 girls) in the fifth and sixth grade at four elementary schools located in Jeju. Demographic, lifestyle, and environmental information was collected using a self-reported questionnaire. The food behavior checklist for children's Nutrition Quotient (NQ), consisting of 19 items, and nutrition education related information were also obtained. RESULTS: The mean score of the children's NQ was poor, reaching 60.3 points. The percentage distribution of NQ grade was 19.8% (lowest), 18.6% (low), 45.0% (medium), 10.7% (high), and 5.9% (highest) and the factor scores for balance, diversity, abstinence, regularity, and practice were 56.6, 68.4, 71.3, 57.4, and 54.8 points, respectively. Compared with the NQ cut-off points for defining malnutrition (balance; 57, diversity; 87, abstinence; 66, regularity; 69, and practice; 67 point), average score of abstinence factor was only above the cut-off point and scores of the other factors were below the cut-off point. Subjects with higher NQ scores tended to have higher levels of exercise activity (p < 0.001), frequency of family meals (p < 0.01), and father's educational levels (p < 0.01) compared to those with lower NQ score. NQ score showed positive association with nutrition education experience and practice (p < 0.001) CONCLUSION: NQ score of elementary school students residing in Jeju was lower than the national average. More opportunities should be provided for participation in nutrition education, which incorporates a range of program strategies, as well as communication and education activities.

Determinants of age at menarche in Korean elementary school girls / 한국영양학회지

PURPOSE: During the recent decades, the age at menarche continued to decline in Korea and worldwide. Prior studies have suggested that early menarche may increase the risk of various social, psychological, and physical health problems in young adolescent girls, but little is known about the determinants associated with early menarche. The purpose of this study is to evaluate independent determinants of early menarche among 5th~6th female graders in South Korea. METHODS: Our analysis was conducted in 95 menarcheal girls and 95 age-matched pre-menarcheal girls residing in Daegu, South Korea. Demographic and lifestyle characteristics were collected using survey questionnaires for children and parents. Dietary information was assessed by 2 day~24 hour food records and survey questionnaires, which were completed by both children and their parents. Anthropometric data were obtained from the student health check-ups at the school. RESULTS: A multiple logistic regression analysis using a conditional likelihood method was performed for simultaneous evaluation of several risk factors. There were significant differences in that higher proportion of obesity (OR, odds ratio = 5.60, 95% CI, confidence interval = 1.34~23.42), shorter sleep duration (OR = 0.45, 95% CI = 0.23~0.87), and younger mother's age at menarche (OR = 0.64, 95% CI = 0.44~0.93) were observed in the menarcheal group compared to the premenarcheal group. CONCLUSION: These findings indicate a possible association of sleep duration, mother's menarcheal age, and obesity with age at menarche. A well-planned, prospective cohort study is warranted to examine causal relationship.

Trends in adherence to dietary recommendations among Korean type 2 diabetes mellitus patients

BACKGROUND/OBJECTIVES: The current study examined trends in adherence to dietary recommendations and compared the levels of adherence between diagnosed and undiagnosed subjects with type 2 diabetes mellitus (T2DM) in Korea over the past 14 years. SUBJECTS/METHODS: Data were collected from the 1998-2012 Korea National Health and Nutrition Examination Surveys (KNHANES). Diagnosed diabetes was defined as giving a positive response to questions about awareness of the disease, a physician's diagnosis of diabetes, or medical treatment for diabetes, whereas undiagnosed diabetes was defined as having a fasting glucose level > or = 126 mg/dl. Assessment of adherence level was based on 6 components of dietary guidelines, considering meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol. The participants received 1 point if they met the criteria for each of the 6 components, and the total possible score ranged from 0 to 6 points. Multivariate generalized linear regression was performed, taking into account the complex survey design. RESULTS: Among all diabetic patients aged 30 years or older, the proportion of diagnosed diabetes increased dramatically, from 40.9% in 1998 to 75.9% in 2012 (P for trend < 0.001). The overall adherence levels to dietary recommendations were low and did not significantly differ between diagnosed and undiagnosed subjects with T2DM for all survey years. Several improvements were observed, including increased adherence to maintaining sufficient vegetable/seaweed consumption (increased from 0.12 to 0.16 points) and limiting sodium intake (increased from 0.12-0.13 points to 0.19-0.24 points; P for trend < 0.001), while adherence to maintaining moderate alcohol consumption decreased. CONCLUSIONS: Analysis of data collected by the KNHANES indicates that Korean T2DM patients have poor adherence to dietary recommendations and maintenance of a healthy lifestyle, regardless of disease awareness. This finding suggests that development of practical, evidence-based guidelines is necessary and that provision and expansion of educational programs for T2DM patients is critical after diagnosis.

Associations of serum 25(OH)D levels with depression and depressed condition in Korean adults: results from KNHANES 2008-2010 / 한국영양학회지

PURPOSE: Vitamin D has been known to play an important role in the central nervous system and brain functions in the human body, and cumulative evidence has shown that vitamin D deficiency might be linked with various mental health conditions. Epidemiologic studies have shown that vitamin D deficiency may be associated with higher risk of depression in the US and European populations. However, limited information is available regarding the association between vitamin D status and depression in the Korean population. The objective of this study was to examine the associations between vitamin D levels and prevalence of depression. METHODS: We conducted a cross-sectional analysis using nationally representative data from the 2008-2010 Korean National Health and Nutrition Examination Survey from which serum 25-hydroxyvitamin D concentrations were available. A total of 18,735 adults who had available demographic, dietary, and lifestyle information were included in our analysis. We defined "depression" with a diagnosis by a physician. "Depressed condition" was defined as having feelings of sadness or depression without diagnosis by a physician. RESULTS: The prevalence of depression was 1.63% and 5.43% in Korean men and women, respectively; 12.5% of men and 26.1% of women were defined as the group having depressed conditions. In multivariate logistic regression models, no significant associations were observed between vitamin D status and prevalence of depression or depressed conditions in Korean men and women. CONCLUSION: We found no association between vitamin D insufficiency and depression/depressed conditions in Korean adults. Future large prospective studies and randomized controlled trials are needed to confirm this relationship.

Nutritional Evaluation and Its Relation to the Risk of Metabolic Syndrome according to the Consumption of Cooked Rice and Cooked Rice with Multi-grains in Korean Adults: Based on 2007-2008 Korean National Health and Nutrition Examination Survey / 대한지역사회영양학회지

This study was conducted to investigate the nutrient intakes of subjects by quartile of percent energy intake from cooked rice, consumption of cooked rice mixed with multi-grains and to evaluate rice consumption in relation to the risk of metabolic syndrome. The subjects were 5,830 males and females aged between 20~64 years based on 2007-2008 KNHNES data. Levels of percent energy intake from cooked rice were classified into 4 groups (Q1, Q2, Q3, Q4 groups: 25% of each) using data of 24-hour recall method from KNHNES. Using medical examination and questionnaire, subjects were classified according to diagnostic criteria of metabolic syndrome. The subjects with higher age, being married, lower education, lower economic level were more likely to take higher percent energy intake from cooked rice. Quartile Q3 of percent energy intake from cooked rice tended to show higher Index of Nutritional Quality (INQ) for fiber, calcium, iron, potassium and vitamin A. INQ of protein, dietary fiber, calcium, thiamin, phosphorus, potassium, riboflavin, niacin and vitamin C by consumption of cooked rice mixed with multi-grains was higher than that by consumption of cooked white rice when adjusted for age. No association with a risk for metabolic syndrome was found for quartile of percent energy intake from cooked rice or cooked rice mixed with multi-grains compared to cooked white rice after adjusting for energy, gender, age, BMI, alcohol, smoking, income and physical activity. In conclusion, consumption of over 54% energy intake from cooked rice or only cooked white rice showed relatively low INQs, but was not associated with a higher risk for metabolic syndrome.

A Case of Warfarin-Induced Bleeding in a Patient with CYP2C9 and VKORC1 Gene Polymorphism, Detected by a Point-of-Care Gene Test Device / 대한내과학회지

A 69-year-old female Korean patient was initially prescribed warfarin for the prevention of systemic thromboembolism due to atrial fibrillation. One month later, multiple bruises and subcutaneous hematomas were evident, and laboratory testing revealed a prolonged prothrombin time (PT) of > 106s. After admission, the PT was corrected via fresh frozen plasma transfusion and intravenous vitamin K infusion. We sought to determine the cause of the PT prolongation, suspecting that genetic cause may have had an effect on the variation in the warfarin dose requirement. A point-of-care gene test device (Verigene(R) system; Nanosphere, Northbrook, IL) revealed CYP2C9*1/*3 heterozygosity and a VKORC1 A/A single nucleotide polymorphism. Although it is well established that CYP2C9 or VKORC1 gene polymorphisms can influence warfarin dose requirements, they can be easily neglected, with detrimental outcomes. Through our experience with CYP2C9 and VKORC1 polymorphism causing bleeding complications during warfarin treatment, we aim to emphasize the importance of pharmacogenetic testing to avoid this potential oversight.