Combined Effects of Depression and Chronic Disease on the Risk of Mortality: The Korean Longitudinal Study of Aging (2006-2016)

Background@#The prevalence of depression is much higher in people with chronic disease than in the general population. Depression exacerbates existing physical conditions, resulting in a higher-than-expected death rate from the physical condition itself. In our aging society, the prevalence of multimorbid patients is expected to increase; the resulting mental problems, especially depression, should be considered. Using a large-scale cohort from the Korean Longitudinal Study of Aging (KLoSA), we analyzed the combined effects of depression and chronic disease on all-cause mortality. @*Methods@#We analyzed 10-year (2006–2016) longitudinal data of 9,819 individuals who took part in the KLoSA, a nationwide survey of people aged 45–79 years. We examined the association between multimorbidity and depression using chi-square test and logistic regression. We used the Cox proportional hazard model to determine the combined effects of multimorbidity and depression on the all-cause mortality risk. @*Results@#During the 10-year follow up, 1,574 people (16.0%) died. The hazard ratio associated with mild depression increased from 1.35 (95% confidence interval [CI], 1.05–1.73) for no chronic disease to 1.25 (95% CI, 0.98–1.60) for 1 chronic disease, and to 2.00 (95% CI, 1.58–2.52) for multimorbidity. The hazard ratio associated with severe depression increased from 1.73 (95% CI, 1.33–2.24) for no chronic disease, to 2.03 (95% CI, 1.60–2.57) for 1 chronic disease, and to 2.94 (95% CI, 2.37–3.65) for multimorbidity. @*Conclusion@#Patients with coexisting multimorbidity and depression are at an increased risk of all-cause mortality than those with chronic disease or depression alone.

Combined Effects of Depression and Chronic Disease on the Risk of Mortality: The Korean Longitudinal Study of Aging (2006-2016)

Background@#The prevalence of depression is much higher in people with chronic disease than in the general population. Depression exacerbates existing physical conditions, resulting in a higher-than-expected death rate from the physical condition itself. In our aging society, the prevalence of multimorbid patients is expected to increase; the resulting mental problems, especially depression, should be considered. Using a large-scale cohort from the Korean Longitudinal Study of Aging (KLoSA), we analyzed the combined effects of depression and chronic disease on all-cause mortality. @*Methods@#We analyzed 10-year (2006–2016) longitudinal data of 9,819 individuals who took part in the KLoSA, a nationwide survey of people aged 45–79 years. We examined the association between multimorbidity and depression using chi-square test and logistic regression. We used the Cox proportional hazard model to determine the combined effects of multimorbidity and depression on the all-cause mortality risk. @*Results@#During the 10-year follow up, 1,574 people (16.0%) died. The hazard ratio associated with mild depression increased from 1.35 (95% confidence interval [CI], 1.05–1.73) for no chronic disease to 1.25 (95% CI, 0.98–1.60) for 1 chronic disease, and to 2.00 (95% CI, 1.58–2.52) for multimorbidity. The hazard ratio associated with severe depression increased from 1.73 (95% CI, 1.33–2.24) for no chronic disease, to 2.03 (95% CI, 1.60–2.57) for 1 chronic disease, and to 2.94 (95% CI, 2.37–3.65) for multimorbidity. @*Conclusion@#Patients with coexisting multimorbidity and depression are at an increased risk of all-cause mortality than those with chronic disease or depression alone.

Influence of National Health Screening Program on All-Cause Mortality in Korea Analysis of the Korean Longitudinal Study of Aging, 2006–2014

BACKGROUND: To investigate the impact of national health screening on all-cause mortality risk, aged over 45.METHODS: Data from Korean Longitudinal Study of Aging 2006–2014 were assessed. A total of 10,254 participants were included at baseline, and survival rate was assessed biennially. Using cox proportional hazards model, the effect of health screening on mortality risk was investigated. Covariates were gender, depression, education, marital status, co-habitants, house income, social engagement, economic satisfaction, private health insurance, residence location, chronic diseases, and health behaviors (smoking, alcohol intake, regular exercise).RESULTS: At baseline 2006, 54.4% of participants didn't undergo health screening. A hazard ratio (HR) for mortality risk of non-participants were 1.36 (95% confidence interval [CI], 1.21–1.53) after adjusting age and gender. Adding marital status and co-habitants to model 1 as covariates, HR was 1.34 (95% CI, 1.18–1.50) (model 2). Adding depression scores and socioeconomic vulnerabilities to model 2, HR was 1.29 s (95% CI, 1.14–1.45) (model 3). Adding chronic diseases to model 3, HR was 1.26 (95% CI, 1.14–1.48) (model 4). Finally, health behaviors have been added to model 4, HR was 1.24 (95% CI, 1.10–1.40) (model 5). In addition, the mortality risk increased as the cumulative number of missing health screenig increased accordingly.CONCLUSION: Health screening was an independent factor to reduce mortality risk. Therefore, active encouragement to participate the health screening should be implemented to reduce all-cause mortality.

The Influence of Negative Mental Health on the Health Behavior and the Mortality Risk: Analysis of Korean Longitudinal Study of Aging from 2006 to 2014 / 가정의학회지

BACKGROUND: Several studies have shown that negative mental health increases risky health behavior and mortality risk. We investigated the relationship between mental health and health behavior, and the causal association between mental health and mortality risk. METHODS: We used data from the 8-year (2006–2014) Korean Longitudinal Study of Aging with a cohort of 10,247 individuals (whom we divided into a younger group aged <65 years and an older group aged ≥65 years). Mental health was assessed with the following factors: depression, social engagement, and satisfaction of life. Health behavior was assessed with smoking, alcohol use, and regular exercise. Mortality risk was calculated using survival status and survival months as of 2014. Multiple logistic regression and Cox proportional hazard analysis were performed. RESULTS: Negative mental health was associated with current smoking and sedentary life style, but not with alcohol consumption. In addition, it was associated with an increase in all-cause mortality risk. The increase in mortality risk in the highest quartile (vs. lowest) was 1.71 times (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12–2.62) and 2.07 times (HR, 2.07; 95% CI, 1.60–2.67) for the younger and older group, respectively. CONCLUSION: Our results show that mental health affects health behavior and mortality risk. A key inference from this study is that improving mental health can lead to positive changes in health behavior and reduce the risk of mortality.

Socioeconomic Vulnerability, Mental Health, and Their Combined Effects on All-Cause Mortality in Koreans, over 45 Years: Analysis of Korean Longitudinal Study of Aging from 2006 to 2014 / 가정의학회지

BACKGROUND: We evaluated the effects of socioeconomic factors and psychosocial factors, both individually and combined, on all-cause mortality risk (mortality risk). METHODS: We conducted an 8-year (2006–2014) longitudinal analysis of 10,247 individuals who took part in the Korean Longitudinal Study of Aging, a nationwide survey of people aged 45–79 years. Socioeconomic vulnerability (SEV) was assessed with factors such as education, household income, commercial health insurance, and residential area. Mental health (MH) was assessed with factors such as depression, social engagement, and life satisfaction. The covariates were age, gender, marital status, cohabiting, number of chronic diseases, and health behaviors such as regular exercise, smoking, and alcohol intake. We used a Cox proportional hazard analysis to investigate the effects of SEV and MH on mortality risk and also to analyze the superimposed effects of SEV-MH on mortality risk. RESULTS: After the controlling for the covariates, high SEV and negative MH were found to be strong predictors of all-cause mortality. The highest quartile of SEV (vs. lowest) had a 1.70 times greater mortality risk (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.24–2.33) and the highest quartile of MH (vs. lowest) had a 2.13 times greater mortality risk (HR, 2.13; 95% CI, 1.72–2.64). Being in the highest quartile for both SEV and MH (vs. lowest) increased mortality risk more than 3 times (HR, 3.11; 95% CI, 2.20–4.40). CONCLUSION: High SEV and negative MH were independently associated with increased mortality risk, and their superimposed effects were associated with an increased risk of mortality.

Circulating folate levels and colorectal adenoma: a case-control study and a meta-analysis

BACKGROUND/OBJECTIVES: The relationship between folate and colorectal neoplasia remains controversial. We examined the association between serum folate concentrations and colorectal adenomas in a case-control study of Korean adults and conducted a meta-analysis. SUBJECTS/METHODS: Our case-control study included 113 pairs of case and control who underwent colonoscopy and provided blood samples. We used multivariable conditional logistic regression models to obtain the odds ratios and 95% confidence interval (CIs). For meta-analysis, we identified the relevant studies by searching the PubMed database up to February 2017, included our case-control study and combined the study-specific relative risks (RRs) using a random-effects model. RESULTS: In this case-control study, we included 58 men and 55 women with colorectal adenomas and sex and fasting status matched the controls. We did not find any significant association between the serum folate levels and colorectal adenomas in either men or women. For meta-analysis, a total of eleven studies were included in our analysis and classified into two groups; polyp clearance group (PC) for the studies that included participants who underwent endoscopies and had their polyps removed at baseline; and no polyp clearance group (NPC) for the studies that included participants whose histories of endoscopies were unknown or who underwent their first endoscopies. Four PC (1,311 cases and 1,672 non-cases) and eight NPC studies (3,501 cases and 11,347 non-cases) were included. The combined RRs (95% CIs) comparing the bottom with the top categories of circulating folate levels were 1.07 (0.97-1.18) for the NPC group but 1.45 (1.16-1.74) for the PC group. CONCLUSIONS: Low circulating folate levels were associated with new adenoma formation.

The Relationship between Socioeconomic Status and Metabolic Syndrome, Using Structural Equation Modelling

BACKGROUND: This study aimed to investigate the complexity of the relationships between socioeconomic status, health behaviors, stress and risks of metabolic syndrome. By applying structural equational modelling, modified generalized conceptual model had described the associations and interactions among them. METHODS: 24,210 participants (8,242 men, 15,968 women) registered with the Korean Health Examinee Cohort (KOEX) between 2004 to 2008. This study collected data on the socioeconomic status, health behaviors, and stress through individual interviews. Socioeconomic status (education, house income, occupation), health behaviors (diet, physical activity, smoking, alcohol consumption) and stress level were defined as exogenous factors. Endogenous variables were risks of metabolic syndrome based on modified National Cholesterol Education Program Adult Treatment Panel-lll (NCEP ATP-lll, 2006). RESULTS: According to model fitness test, these proposed model were acceptable in men, comparative fit index=0.877, incremental fit Index=0.877, Tucker-Lewis index=0.757, root-mean-squared error associated=0.055. These were compatible also in women as comparative fit index=0.924, incremental fit index=0.924, Tucker-Lewis index=0.851, root-mean-squared error associated=0.050. There were sex difference related to risks of metabolic syndrome: in men socioeconomic status (β=-0.08), health behaviors (β=-0.25) and stress (β=-0.25) were relevant, but in women only socioeconomic status (β=-0.25) was relevant (P<0.05). CONCLUSIONS: A conceptual model properly explains how Socioeconomic status may influence on health behaviors, stress, and risks of metabolic syndrome. Health behaviors in men and socioeconomic status in women had the strongest associations with risks of metabolic syndrome. In addition, socioeconomic status was strongly associated with health behaviors, stress and age.

Total and Dietary Calcium Intake and Colorectal Adenoma in Korean Adults

BACKGROUND: Colorectal cancer in Korea has become more prevalent over the few last decades, and calcium is considered a preventive factor for colorectal cancer development. We examined the associations between total and dietary calcium intake and the prevalence of colorectal adenoma in Korean adults. METHODS: This cross-sectional study included 112 colorectal adenoma cases and 252 adenoma-free non-cases, aged 45 to 71 years, who underwent colonoscopies at the Daegu Catholic University Medical Center from August 2011 to September 2012. Participants were asked about their diet using a validated food frequency questionnaire and about supplement use through interviews. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the association between total and dietary calcium intake and the prevalence of colorectal adenomas using multivariable logistic regression models. RESULTS: Increasing total calcium intake from foods and supplements was significantly associated with a decreased prevalence of colorectal adenoma in women; comparing the highest quartile with the lowest quartile, the OR (95% CI) was 0.35 (0.15-0.85; P for trend = 0.03). Likewise, high dietary calcium intake from foods was associated with a lower prevalence of colorectal adenoma in women; compared with the lowest quartile, the ORs (95% CIs) were 0.32 (0.13-0.82) for the 3rd quartile and 0.44 (0.19-1.03; P for trend = 0.13) for the 4th quartile. However, the association was not clear for either total or dietary calcium intake among men. CONCLUSIONS: A higher intake of calcium was associated with a reduction of colorectal adenoma prevalence in Korean women.

Circulating Concentrations of C-Peptide and Colorectal Adenoma

Hyperinsulinemia may increase the risk of colorectal neoplasia because of its mitogenic and antiapoptotic properties, which have a growth-promoting effect. We examined the association between circulating concentrations of C-peptide, a biomarker of insulin secretion, and colorectal adenoma prevalence in a case-control study of Korean adults. A total of 364 participants (112 cases and 252 controls) were included. Participants who underwent a colonoscopy completed questionnaires and provided blood samples. We used multivariate logistic regression models to obtain odds ratios (ORs) and 95% confidence intervals (CIs) for colorectal adenoma. Circulating concentrations of C-peptide were not associated with colorectal adenoma; the multivariate OR (95% CI) was 0.95 (0.51-1.75) comparing the highest tertile with the lowest tertile (p for trend = 0.91). When we used a conditional logistic regression model by fasting status and sex matching, there was still no association (OR = 0.92; 95% CI = 0.43-1.99) when comparing the highest tertile with the lowest tertile. We observed no association between circulating concentrations of C-peptide and colorectal adenoma prevalence in Korean adults.

Association of Leisure Time Physical Activity and Metabolic Syndrome over 40 Years / 가정의학회지

BACKGROUND: This study aimed to investigate the relationship between leisure time physical activities (LTPA) and metabolic syndrome (MS). METHODS: Five thousand seven hundred and thirty two adults 40 years old or older were enrolled in the study from April 2009 to December 2010. National Cholesterol Education Program's Adult Treatment Panel III was used for the criteria of MS, and Minnesota Leisure Time Physical Activity Questionnaire was used to measure LTPA. After adjusted covariates (age, hypertension, smoking, drinking, education level, household income level, work time physical activities, and menopause for females), the relationship between LTPA and MS was analyzed using logistic regression analysis. RESULTS: The prevalence of MS was 22.8% in men, and 14.1% in women. Average LTPA was 1,498 kcal/wk in men, and 1,308 kcal/wk in women. After adjustment for covariates, the odds ratios of middle and low LTPA compared with high LTPA were 1.06 (0.87-1.34), 1.54 (1.08-1.75), for women, this same association was not seen in men. The prevalence of MS was 22.8% in men and 14.1% in women, and their LTPA burned 1,498 and 1,308 kcal/wk, respectively. When the odds ratio of MS for the high LTPA group was set at 1.0, the odds ratio of MS was 1.06 (0.87-1.34) in the middle LTPA group and 1.54 (1.08-1.75) in the low LTPA group in women, which showed that the MS risk increased when the LTPA was lower. This same association was not seen in men. CONCLUSION: LTPA was independently associated with metabolic syndrome, but only for women.

The Relationship between Smoking Level and Metabolic Syndrome in Male Health Check-up Examinees over 40 Years of Age / 가정의학회지

BACKGROUND: The objective of this study was to investigate the relationship between smoking and metabolic syndrome in men. METHODS: This cross-sectional study included 1,852 men over age 40 who underwent health screening from April 2009 to December 2010. We classified them into three smoking levels as non-, intermediate-, and heavy-smoker, considering their smoking status (non, ex, current) and amount (0, 1-29, > or =30 pack year [PYR]). The relationship between smoking level and metabolic syndrome was analyzed by logistic regression analysis, after covariates (age, body mass index, education, house income, alcohol intake, and physical activity) were controlled. RESULTS: The proportions of non-, intermediate-, and heavy-smokers were 31.8%, 56.2%, and 12.0%, respectively. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for metabolic syndrome were 1.0, 1.58 (1.09-2.23), 1.92 (1.29-2.81) in non-, intermediate-, and heavy-smokers, respectively. For heavy-smokers compared with non-smokers, ORs and 95% CIs of a lower high density lipoprotein cholesterol, higher triglyceride, and higher fasting glucose were 2.47 (1.63-3.74), 1.71 (1.17-2.52), and 1.43 (1.02-2.00), respectively. In current-smokers, we divided into three subgroups according to PYR, and compared with 1-19 PYR, ORs and 95% CIs of 20-29 PYR and > or =30 PYR for metabolic syndrome were 2.07 (1.14-3.74) and 3.06 (1.66-5.62), respectively. CONCLUSION: This study showed a positive dose-response relationship between smoking level and metabolic syndrome in men.

Socioeconomic Status and Health Behaviors Associated with Metabolic Syndrome in Adults over 40 Years

BACKGROUND: The most effective means of preventing chronic disease is known to be promoting health behaviors; but this is difficult because health behaviors are associated with the socioeconomic status (SES). SES is a measure of access to material resources and social resources. This study aimed to assess the association between metabolic syndrome (MetS) and SES after controlling for health behaviors (smoking, alcohol intake, physical activity, and diet). METHODS: 24,515 participants (8,214 men, 16,301 women) older than 40 years were recruited from the 2004-2008 Korean Health Examinee Cohort. Along with MetS components, SES and health behaviors data were collected through individual interviews. SES was classified into tertiles (high, middle, and low groups) measured by education and house income levels. MetS was defined using the criteria from the modified National Cholesterol Education Program Adult Treatment Panel-lll (NCEP ATP-lll, 2007). RESULTS: Among the study subjects, the prevalences of MetS were 13.8%, 17.4%, and 25.3% in the high, middle, and low SES groups, respectively. After controlling for age and health behaviors, the odds ratios for MetS in the high, middle, and low SES were 1.0, 1.54 (95% confidence interval [95% CI]=1.34-1.76), and 2.01 (95% CI=1.72-2.36), respectively, for women. This association was not seen in men. CONCLUSION: SES was inversely associated with metabolic syndrome, as with health behaviors, but only for women.

Socioeconomic Status in Association with Metabolic Syndrome and Coronary Heart Disease Risk / 가정의학회지

BACKGROUND: The purpose of this study was to examine the association of metabolic syndrome (MS) coronary heart disease (CHD) with socioeconomic status (SES). METHODS: The participants were 2,170 (631 men and 1,539 women), aged over 40 years who had visited for health screening from April to December in 2009. We classified them into three SES levels according to their education and income levels. MS was defined using the criteria of modified National Cholesterol Education Program Adult Treatment Panel III and CHD risk was defined using Framingham risk score (FRS) > or = 10%. RESULTS: High, middle, and low SES were 12.0%, 73.7%, and 14.3%, respectively. The prevalence of MS was 18.1%. For high, middle, and low SES, after adjusted covariates (age, drinking, smoking, and exercise), odds ratios for MS in men were 1.0, 1.41 (confidence interval [CI], 0.83 to 2.38; P > 0.05), and 1.50 (CI, 0.69 to 3.27; P > 0.05), respectively and in women were 1.0, 1.74 (CI, 1.05 to 3.18; P or = 10% was 33.5% (adjusted covariates were drinking, smoking, and exercise) and odds ratios for FRS > or = 10% in men were 1.0, 2.86 (CI, 1.35 to 6.08; P or = 10% risk in men, and an inverse relationship between SES and both risk of MS and FRS > or = 10% in women.

Socioeconomic Status and Health Behaviors Associated with Metabolic Syndrome in Adults over 40 Years

BACKGROUND: The most effective means of preventing chronic disease is known to be promoting health behaviors; but this is difficult because health behaviors are associated with the socioeconomic status (SES). SES is a measure of access to material resources and social resources. This study aimed to assess the association between metabolic syndrome (MetS) and SES after controlling for health behaviors (smoking, alcohol intake, physical activity, and diet). METHODS: 24,515 participants (8,214 men, 16,301 women) older than 40 years were recruited from the 2004-2008 Korean Health Examinee Cohort. Along with MetS components, SES and health behaviors data were collected through individual interviews. SES was classified into tertiles (high, middle, and low groups) measured by education and house income levels. MetS was defined using the criteria from the modified National Cholesterol Education Program Adult Treatment Panel-lll (NCEP ATP-lll, 2007). RESULTS: Among the study subjects, the prevalences of MetS were 13.8%, 17.4%, and 25.3% in the high, middle, and low SES groups, respectively. After controlling for age and health behaviors, the odds ratios for MetS in the high, middle, and low SES were 1.0, 1.54 (95% confidence interval [95% CI]=1.34-1.76), and 2.01 (95% CI=1.72-2.36), respectively, for women. This association was not seen in men. CONCLUSION: SES was inversely associated with metabolic syndrome, as with health behaviors, but only for women.

Socioeconomic Status and Health Behaviors Associated with Metabolic Syndrome in Adults over 40 Years

BACKGROUND: The most effective means of preventing chronic disease is known to be promoting health behaviors; but this is difficult because health behaviors are associated with the socioeconomic status (SES). SES is a measure of access to material resources and social resources. This study aimed to assess the association between metabolic syndrome (MetS) and SES after controlling for health behaviors (smoking, alcohol intake, physical activity, and diet). METHODS: 24,515 participants (8,214 men, 16,301 women) older than 40 years were recruited from the 2004-2008 Korean Health Examinee Cohort. Along with MetS components, SES and health behaviors data were collected through individual interviews. SES was classified into tertiles (high, middle, and low groups) measured by education and house income levels. MetS was defined using the criteria from the modified National Cholesterol Education Program Adult Treatment Panel-lll (NCEP ATP-lll, 2007). RESULTS: Among the study subjects, the prevalences of MetS were 13.8%, 17.4%, and 25.3% in the high, middle, and low SES groups, respectively. After controlling for age and health behaviors, the odds ratios for MetS in the high, middle, and low SES were 1.0, 1.54 (95% confidence interval [95% CI]=1.34-1.76), and 2.01 (95% CI=1.72-2.36), respectively, for women. This association was not seen in men. CONCLUSION: SES was inversely associated with metabolic syndrome, as with health behaviors, but only for women.

Predictive factors for invasive intraductal papillary mucinous neoplasm of the pancreas

BACKGROUNDS/AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has malignant potential. Predicting invasive IPMN has proven difficult and controversial. We tried to identify predictive factors for invasive IPMN. METHODS: Thirty six patients underwent resection for IPMN from February 2001 to July 2011. Clinicopathological features including demographic, imaging, microscopic, and serological findings were retrospectively reviewed. Receiver operating characteristic (ROC) curve analysis was used to analyze sensitivity and specificity of all possible cut-off values for the diameter of the main pancreatic duct and mass size predicting invasive IPMN. Student t-test, chi-square test, and logistic regression were used for univariate and multivariate analysis. RESULTS: The mean age was 63.5+/-8.4 years. Males were more commonly affected (58.3% vs 41.7%). Pancreaticoduodenectomy was performed in 55.6% of patients, distal pancreatectomy in 36.1%, and central pancreatic resection in 8.3%. Non-invasive IPMNs were present in 80.6% (n=29), whereas invasive IPMNs were present in 19.4% (n=7). In univariate analysis, tumor location (p=0.036), Kuroda classification (p=0.048), mural nodule (p=0.016), and main duct dilatation (> or =8 mm) (p=0.006) were statistically significant variables. ROC curve analysis showed that a value of 8 mm for the main duct dilatation and a value of 35 mm for the size of the mass lesion have 80% sensitivity and 75% specificity and 100% sensitivity and 82.6% specificity, respectively. However, in multivariate analysis, main ductal dilatation (> or =8 mm) was identified to be the only independent factor for invasive IPMN (p=0.049). CONCLUSIONS: Main duct dilatation appears to be a useful indicator for predicting invasive IPMN.

Reference Values for the Augmentation Index and Pulse Pressure in Apparently Healthy Korean Subjects

BACKGROUND AND OBJECTIVES: Arterial stiffness is a precursor to premature cardiovascular disease. The augmentation index (AI) and pulse pressure (PP) are cardiovascular risk factors. The aim of this study was to define the diagnostic values of the AI and PP from the peripheral arterial and central aortic waveforms in healthy subjects. SUBJECTS AND METHODS: We recruited 522 consecutive subjects (mean age 46.3+/-9.6 years, 290 males) who came to our facility for a comprehensive medical testing. We measured the body mass index (BMI), blood pressure, peripheral and central PP, and a pulse wave analysis that included the central and peripheral AI. RESULTS: The peripheral and central AIs in the female subjects were significantly higher than that in the male subjects (p<0.001). The peripheral and central PPs in the subjects with hyperlipidemia were significantly higher than subjects with normal lipid profiles (p<0.001). The peripheral and central PPs and peripheral and central AIs significantly increased with age. CONCLUSION: Pending validation in prospective outcome-based studies, a peripheral PP of 70 mmHg, central PP of 50 mmHg, peripheral AI of 100%, and central AI of 40% may be preliminary values in adult subjects.

The Diagnostic Criteria of Metabolic Syndrome and the Risk of Coronary Heart Disease according to Definitions in Men / 가정의학회지

BACKGROUND: Early detection of metabolic syndrome (MS) is important to prevent complications. Yet, there is no internationally agreed definition for MS. This study was performed to compare the diagnostic criteria of MS using various definitions and agreements, and to find better definition for screening high risk group of coronary heart disease. METHODS: The participants were 426 men above forty years old who had visited to have health screening in a general hospital in Daegu from March to December in 2007. The diagnostic criteria of MS and Kappa statistic were calculated according to the following five diagnostic definitions; modified World Health Organization (WHO), National Cholesterol Education Program Third Adult Treatment Panel (NCEP-ATP III), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) and NCEP-ATP III modified waist circumference > or = 90 cm (modified NCEP-ATP III). The sensitivity and specificity of each definition of MS were calculated with respect to high risk group by Framingham risk score (FRS). RESULTS: The diagnostic criteria of MS were 6.6% by IDF, 7.7% by WHO, 10.6% by NCEP-ATP III, 18.1% by modified NCEP-ATP III and 22.3% by AHA/NHLBI. The kappa satistic ranged from 0.30 to 0.87. The sensitivity of each definition with respect to FRS was 8.3% in IDF, 13.4% in WHO, 15.3% in NCEP-ATP III, 27.4% in modified NCEP-ATP III and 32.5% in AHA/NHLBI. CONCLUSION: There was great difference in the diagnostic criteria of MS according to diagnostic definitions. The author suggests that AHA/NHLBI or modified NCEP-ATP III definition may be better for screening high risk group of coronary heart disease than others.

The Association of Central Obesity with Type 2 Diabetes among Koreans according to the Serum Gamma-Glutamyltransferase Level: Korean Genome and Epidemiology Study / 예방의학회지

OBJECTIVES: This cross-sectional study was performed to examine if the serum gamma-glutamyltransferase (GGT) level that is within its normal range is associated with the risk of type 2 diabetes and if the association between the waist hip ratio (WHR) and type 2 diabetes is different depending on the serum GGT levels. METHODS: The study subjects were 23,436 persons aged 40 years or older and who participated in regular health check-ups at 11 hospitals (males: 5,821, females: 17,615). The gender-specific quintiles of the serum GGT and WHR were used to examine the associations with type 2 diabetes. RESULTS: The serum GGT levels within their normal range were positively associated with type 2 diabetes only in women. The adjusted odds ratios (ORs) were 1.0, 1.0, 1.4, 2.1, and 2.5 according to the quintiles of the serum GGT (p(trend)<0.01). The WHR was more strongly associated with the prevalence of diabetes among the women with a high-normal serum GGT level as compared with those with a low-normal serum GGT level (p for interaction=0.02). For example, the adjusted ORs for women with a low normal serum GGT level were 1.0, 1.2, 1.5, 2.2, and 2.4 according to the quintiles of the WHR, while those figures were 1.0, 2.4, 3.6, 5.0, and 8.3 among the women with a high normal serum GGT level. However, in men, the serum GGT was very weakly associated with type 2 diabetes and the association between the WHR and type 2 diabetes was not different depending on the serum GGT level. CONCLUSIONS: Serum GGT within its normal range was positively associated with type 2 diabetes, and central obesity was more strongly associated with the prevalence of type 2 diabetes when the serum GGT level was high-normal. However, these associations were observed only in women, which is different from the previous findings. The stronger relation between central obesity and type 2 diabetes among women with a high-normal serum GGT level can be useful for selecting a group that is at high risk for type 2 diabetes irregardless of whatever the underlying mechanism is.

Associations of Non Alcoholic Fatty Liver with the Metabolic Syndrome and Serum Carotenoids / 예방의학회지

OBJECTIVES: This study was conducted to investigate the associations of non alcoholic fatty liver with metabolic syndrome and the serum carotenoids. METHODS: This study was conducted in a general hospital in South Korea from November, 2004 to August, 2005. The study subjects were 350 sampled persons who were aged from 40 years and older (males: 180, females: 170). They were grouped into the normal, mild and severe groups according to fat accumulation in their livers, as determined by ultrasonography. We analyzed the association between non alcoholic fatty liver and metabolic syndrome by multiple logistic regression analysis and we analyzed the association between non alcoholic fatty liver and the serum carotenoids by a general linear model(ANCOVA). RESULTS: After adjustment for the effect of potential covariates, the prevalence of metabolic syndrome was associated with fat accumulation in the liver (p trend <0.001). If the odds ratio of normal group is 1.00, then that of the mild group is 2.80 (95% C.I=1.17-6.71) and that of the severe group is 7.29 (95% C.I=2.76-19.30). The prevalence of metabolic alterations fitting the criteria of metabolic syndrome, according to the class of fat accumulation in the liver, was significantly increased, except for criteria of high blood pressure, a large waist circumference and low HDL (high density lipoprotein) cholesterol level (p trend <0.001). The level of serum beta-carotene was decreased according to the class of fat accumulation in the liver (p trend=0.036), but the levels of serum alpha-carotene, lycopene, bata-cryptoxanthin and lutein were not decreased. CONCLSIONS: This study shows that non alcoholic fatty liver was associated with metabolic syndrome and with the serum beta-carotene level.