Deep Learning Techniques for Ear Diseases Based on Segmentation of the Normal Tympanic Membrane

Objectives@#. Otitis media is a common infection worldwide. Owing to the limited number of ear specialists and rapid development of telemedicine, several trials have been conducted to develop novel diagnostic strategies to improve the diagnostic accuracy and screening of patients with otologic diseases based on abnormal otoscopic findings. Although these strategies have demonstrated high diagnostic accuracy for the tympanic membrane (TM), the insufficient explainability of these techniques limits their deployment in clinical practice. @*Methods@#. We used a deep convolutional neural network (CNN) model based on the segmentation of a normal TM into five substructures (malleus, umbo, cone of light, pars flaccida, and annulus) to identify abnormalities in otoscopic ear images. The mask R-CNN algorithm learned the labeled images. Subsequently, we evaluated the diagnostic performance of combinations of the five substructures using a three-layer fully connected neural network to determine whether ear disease was present. @*Results@#. We obtained the receiver operating characteristic (ROC) curve of the optimal conditions for the presence or absence of eardrum diseases according to each substructure separately or combinations of substructures. The highest area under the curve (0.911) was found for a combination of the malleus, cone of light, and umbo, compared with the corresponding areas under the curve of 0.737–0.873 for each substructure. Thus, an algorithm using these five important normal anatomical structures could prove to be explainable and effective in screening abnormal TMs. @*Conclusion@#. This automated algorithm can improve diagnostic accuracy by discriminating between normal and abnormal TMs and can facilitate appropriate and timely referral consultations to improve patients’ quality of life in the context of primary care.

Job Analysis of Nurse Care Coordinators for Chronic Illness Management in Primary Care Settings: Using Developing a Curriculum Process

Purpose@#This study aimed to conduct a job analysis of nurse carecoordinators and to identify the frequency, importance and difficulty of each task of their job. @*Methods@#A committee for developing a curriculum (DACUM) was formed and members of the committee defined nurse care coordinators’ jobs and enumerated the duties, tasks and task elements by applying the DACUM technique. Then nurse care coordinators enrolled in the pilot project evaluated the frequency, importance and difficulty of each task. @*Results@#From the job descriptions of nurse care coordinators, we identified 12 duties and 42 tasks. Each task comprised 1~5 task elements. Among tasks, ‘assess the patient’s general health status’ was carried out most frequently. Nurse care coordinators perceived that ‘check vital signs’ and ‘strengthen patient competence to promote health behaviors’ were more important than all other tasks. The most difficult task was ‘develop professionalism as a nurse care coordinator’. @*Conclusion@#The nurse care coordinators' roles developed in this study will serve as the key guidelines for human resource management of care coordinators. Further, job specifications for nurse care coordinators need to be developed, which is necessary for designing education and training programs. We also need to integrate primary health care as an essential component in nursing education.

Factors that Predict Smoking Cessation among Older Koreans: Based on the Korea National Health and Nutrition Examination Survey 2016–2018 / 가정의학회지

Background@#Tobacco smoking is associated with several diseases and deaths in older Koreans. This study aimed to evaluate the factors associated with smoking cessation in older Koreans. @*Methods@#We selected 579 subjects who started smoking before the age of 65 years from the Korea National Health and Nutrition Examination Survey 2016–2018. We excluded the subjects who quit smoking before the age of 65 years, and then categorized the rest of subjects into those who stopped smoking after the age of 65 years and those who are constant smokers. Multivariable logistic analysis was performed to evaluate the factors related to smoking cessation among older Koreans. @*Results@#Among the participants, 66.1% were persistent smokers. After multivariable analysis, the factors significantly associated with smoking cessation were as follows: being in the age group of 75–79 years (adjusted odds ratio [aOR], 4.07; 95% confidence interval [CI], 2.12–7.83), being in the age group of 70–74 years (aOR, 3.10; 95% CI, 1.72–5.61), a family history of ischemic heart disease (aOR, 3.36; 95% CI, 1.09–10.35), and having had no cancer screening (aOR, 0.36; 95% CI, 0.18–0.70). @*Conclusion@#Further efforts to identify the factors related to smoking cessation will help formulate a smoking cessation policy.

Factors that Predict Smoking Cessation among Older Koreans: Based on the Korea National Health and Nutrition Examination Survey 2016–2018 / 가정의학회지

Background@#Tobacco smoking is associated with several diseases and deaths in older Koreans. This study aimed to evaluate the factors associated with smoking cessation in older Koreans. @*Methods@#We selected 579 subjects who started smoking before the age of 65 years from the Korea National Health and Nutrition Examination Survey 2016–2018. We excluded the subjects who quit smoking before the age of 65 years, and then categorized the rest of subjects into those who stopped smoking after the age of 65 years and those who are constant smokers. Multivariable logistic analysis was performed to evaluate the factors related to smoking cessation among older Koreans. @*Results@#Among the participants, 66.1% were persistent smokers. After multivariable analysis, the factors significantly associated with smoking cessation were as follows: being in the age group of 75–79 years (adjusted odds ratio [aOR], 4.07; 95% confidence interval [CI], 2.12–7.83), being in the age group of 70–74 years (aOR, 3.10; 95% CI, 1.72–5.61), a family history of ischemic heart disease (aOR, 3.36; 95% CI, 1.09–10.35), and having had no cancer screening (aOR, 0.36; 95% CI, 0.18–0.70). @*Conclusion@#Further efforts to identify the factors related to smoking cessation will help formulate a smoking cessation policy.

Factors Associated with the Intention to Quit Smoking in Elderly Korean Men: The Korea National Health and Nutrition Examination Survey 2010-2015 / 가정의학회지

Background@#Tobacco smoking is the most preventable cause of diseases and death in older adults. This study aimed to evaluate the factors associated with the intention to quit smoking in elderly Korean men. @*Methods@#We investigated 813 male smokers aged 65 years or more from the 5th and 6th Korea National Health and Nutrition Examination Survey 2010–2015. Multiple logistic regression analysis was performed to identify factors related with smoking cessation intention. @*Results@#Of the respondents, 26.3% had the intention to quit smoking. After adjustment for confounding factors, the intention to quit smoking was significantly associated with a history of ischemic heart disease (adjusted odds ratio, 1.88; 95% confidence interval, 1.02–3.48). @*Conclusion@#Identifying the factors related to the intention to quit smoking among older adults can help in developing effective smoking cessation strategies for this section of the population.

Factors Associated with Persistent Smoking in Diabetic Patients: The Seventh Korea National Health and Nutrition Examination Survey

Background@#Smoking increases total mortality and the risk of complications in patients with diabetes; however, smokers tend to smoke persistently even after the diagnosis of diabetes mellitus. The purpose of this study was to analyze risk factors predicting persistent smoking in Korean adults with diabetes. @*Methods@#This study included 265 persistent-smokers and 146 quit-smokers among the participants with diabetes from the seventh Korea National Health and Nutrition Examination Survey. The subjects were smokers at the time of diagnosis of diabetes and were categorized into two groups according to the change in smoking status between the time of diabetes diagnosis and survey. Factors associated with persistent smoking were evaluated using multiple logistic regression analysis. @*Results@#The prevalence of persistent-smokers with diabetes in this study was 65.3%. After adjusting for covariates, persistent smoking in Korean adults with diabetes was significantly associated with a history of cancer (adjusted odds ratio [aOR], 0.322; 95% confidence interval [CI], 0.116–0.889), strength exercise (aOR, 2.753; 95% CI, 1.361–5.566), stress (aOR, 2.036; 95% CI, 1.046–3.950), non-medical treatment for diabetes (aOR, 6.814; 95% CI, 1.661–27.957), and duration of diabetes (aOR, 0.952; 95% CI, 0.919–0.987). @*Conclusion@#Identifying the risk factors related to persistent smoking among Korean adults with diabetes can help in developing effective smoking cessation strategies.

Relationship between Obesity and Lifestyle Factors in Young Korean Women: the Seventh Korea National Health and Nutrition Examination Survey 2016

BACKGROUND@#The purpose of this study was to examine whether lifestyle-related factors are associated with obesity in a selected sample of young Korean women.@*METHODS@#This cross-sectional study involved 822 women aged 19–39 years who participated in the Seventh Korea National Health and Nutrition Examination Survey conducted in 2016. Obesity status was defined as general and abdominal obesity. Multiple logistic regression analyses were used to evaluate the association between lifestyle-related factors and obesity status.@*RESULTS@#The prevalence of obesity was 20.3% for general obesity and 17.4% for abdominal obesity. There were negative associations between the energy intake/body weight ratio and general and abdominal obesity. High-risk drinking was significantly associated with general obesity (adjusted odds ratio, 1.747; 95% confidence interval, 1.112–2.745), but was not associated with abdominal obesity.@*CONCLUSIONS@#Among young Korean women aged 19–39 years, high-risk drinking may be a risk factor for general obesity.

Factors Associated with Unmet Healthcare Needs of the Older Korean Population: The Seventh Korea National Health and Nutrition Examination Survey 2017

BACKGROUND@#South Korea has the fastest growing aging population in the world, and older people require more healthcare services. Unmet healthcare needs still exist in Korea due to several complex reasons. This study aimed to evaluate the factors associated with unmet healthcare needs of the older Korean population.@*METHODS@#This cross-sectional study included 1,194 older adults, aged 65 years and older, who participated in the Seventh Korea National Health and Nutrition Examination Survey conducted in 2017. Sociodemographic factors, lifestyle and health status, comorbidity, and unmet healthcare needs were included in this study's analysis. Multiple logistic regression analysis was used to evaluate the association between unmet healthcare needs and other factors.@*RESULTS@#The prevalence of unmet healthcare needs in this study population was 7.8%. After adjusting for age, sex, education level, household income, living alone, private health insurance, regular walking, body mass index, unintended weight loss, and osteoarthritis, women (adjusted odds ratio [aOR], 1.921; 95% confidence interval [CI], 1.061–3.479) and unintended weight loss (aOR, 2.218; 95% CI, 1.105–4.453) were more likely to have unmet healthcare needs than their counterparts. The group with general obesity (aOR, 1.691; 95% CI, 1.015–2.816) was more likely to have unmet healthcare needs than the group with normal body mass index.@*CONCLUSIONS@#Among the older Korean population, being a woman, general obesity, and unintended weight loss may be risk factors for unmet healthcare needs.

Factors Associated with Dry Eye Symptoms in Elderly Koreans: The Fifth Korea National Health and Nutrition Examination Survey 2010–2012 / 가정의학회지

BACKGROUND: Dry eye disease is an aging-related ophthalmic disease that not only affects the daily activities but also causes deterioration in the quality of life. This study aimed to evaluate the factors associated with dry eye symptoms in elderly Koreans. METHODS: We investigated 4,185 subjects (men=1,787 and women=2,398) aged ≥65 years from the fifth Korea National Health and Nutrition Examination Survey 2010–2012. Data were analyzed using multiple logistic regressions to identify the relationships between dry eye symptoms and other factors. RESULTS: The prevalence of dry eye symptoms was 17.9%. After adjustment for confounding factors, dry eye symptoms were significantly associated with female sex (adjusted odds ratio [aOR], 1.806; 95% confidence interval [CI], 1.410–2.313), a history of cataract (aOR, 1.683; 95% CI, 1.255–2.255), suicidal ideation (aOR, 1.414; 95% CI, 1.070–1.870), hypercholesterolemia (aOR, 1.289; 95% CI, 1.025–1.621), age ≥80 years (aOR, 0.538; 95% CI, 0.337–0.859), and sleep duration ≥9 h/d (aOR, 0.524; 95% CI, 0.330–0.834). CONCLUSION: Among elderly Koreans, female sex, a history of cataract, suicidal ideation, and hypercholesterolemia may be the risk factors for dry eye symptoms, whereas sleep duration ≥9 h/d can be a protective factor against dry eye symptoms.

Relationship between Obesity and Lifestyle Factors in Young Korean Women: the Seventh Korea National Health and Nutrition Examination Survey 2016

BACKGROUND: The purpose of this study was to examine whether lifestyle-related factors are associated with obesity in a selected sample of young Korean women. METHODS: This cross-sectional study involved 822 women aged 19–39 years who participated in the Seventh Korea National Health and Nutrition Examination Survey conducted in 2016. Obesity status was defined as general and abdominal obesity. Multiple logistic regression analyses were used to evaluate the association between lifestyle-related factors and obesity status. RESULTS: The prevalence of obesity was 20.3% for general obesity and 17.4% for abdominal obesity. There were negative associations between the energy intake/body weight ratio and general and abdominal obesity. High-risk drinking was significantly associated with general obesity (adjusted odds ratio, 1.747; 95% confidence interval, 1.112–2.745), but was not associated with abdominal obesity. CONCLUSIONS: Among young Korean women aged 19–39 years, high-risk drinking may be a risk factor for general obesity.

Factors Associated with Unmet Healthcare Needs of the Older Korean Population: The Seventh Korea National Health and Nutrition Examination Survey 2017

BACKGROUND: South Korea has the fastest growing aging population in the world, and older people require more healthcare services. Unmet healthcare needs still exist in Korea due to several complex reasons. This study aimed to evaluate the factors associated with unmet healthcare needs of the older Korean population. METHODS: This cross-sectional study included 1,194 older adults, aged 65 years and older, who participated in the Seventh Korea National Health and Nutrition Examination Survey conducted in 2017. Sociodemographic factors, lifestyle and health status, comorbidity, and unmet healthcare needs were included in this study's analysis. Multiple logistic regression analysis was used to evaluate the association between unmet healthcare needs and other factors. RESULTS: The prevalence of unmet healthcare needs in this study population was 7.8%. After adjusting for age, sex, education level, household income, living alone, private health insurance, regular walking, body mass index, unintended weight loss, and osteoarthritis, women (adjusted odds ratio [aOR], 1.921; 95% confidence interval [CI], 1.061–3.479) and unintended weight loss (aOR, 2.218; 95% CI, 1.105–4.453) were more likely to have unmet healthcare needs than their counterparts. The group with general obesity (aOR, 1.691; 95% CI, 1.015–2.816) was more likely to have unmet healthcare needs than the group with normal body mass index. CONCLUSIONS: Among the older Korean population, being a woman, general obesity, and unintended weight loss may be risk factors for unmet healthcare needs.

Factors Associated with Screening for Diabetic Retinopathy in Elderly Diabetic Patients: The Sixth Korea National Health and Nutrition Examination Survey

BACKGROUND: The purpose of this study was to analyze factors related to screening for diabetic retinopathy in elderly diabetic patients.METHODS: This study included 682 elderly diabetic patients aged older than 65 years who answered the question “Have you undergone an eye examination in the last year?” from the Sixth Korea National Health and Nutrition Examination Survey 2013–2015. Data were analyzed using multiple logistic regression to identify the relationship between screening for diabetic retinopathy in elderly diabetic patients and related factors.RESULTS: Among the study population, 493 patients (73.3%) did not undergo eye examinations in the last year. Age ≥80 years (odds ratio [OR], 2.250; 95% confidence interval [CI], 1.014–4.992), current smoking (OR, 2.006; 95% CI, 1.018–3.953), poor subjective health status (OR, 0.457; 95% CI, 0.242–0.863), history of stroke (OR, 0.479; 95% CI, 0.246–0.933), and history of hypertension (OR, 1.674; 95% CI, 1.114–2.516) were significantly associated with not undergoing eye examinations for diabetic retinopathy in elderly diabetic patients aged older than 65 years.CONCLUSION: In elderly diabetic patients aged older than 65 years living in Korea, those aged older than 80 years, who are current smokers, and with a history of hypertension showed low rates of undergoing eye examinations for diabetic retinopathy, while those with poor subjective health status and a history of stroke had high rates of undergoing eye examinations.

Association between Sleep Duration and Body Composition Measures in Korean Adults: The Korea National Health and Nutrition Examination Survey 2010 / 가정의학회지

BACKGROUND: The association between sleep duration and body composition measures in Korean adults remains unclear. METHODS: This cross-sectional study included 3,532 subjects aged ≥40 years (1,542 men and 1,990 women) who participated in the 2010 Korea National Health and Nutrition Examination Survey V-1. Self-reported sleep duration and anthropometric data were collected. Appendicular skeletal muscle mass (ASM) was quantified via dual-energy X-ray absorptiometry. Obesity was defined according to the body mass index and waist circumference. Sarcopenia was defined as the muscle mass percentage (ASM/weight) below the lowest quintile computed for the study population. Multivariate logistic regressions with or without adjustment for sociodemographic and lifestyle factors were used to evaluate the association of sleep duration with obesity and sarcopenia for participants who slept ≤5, 6–8, and ≥9 h/d. The results were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: In women, the association between sleep duration and sarcopenia was stronger for individuals who slept ≥9 h/d than for those who slept 6–8 h/d (unadjusted OR, 1.99; 95% CI, 1.19–3.34; adjusted OR, 1.77; 95% CI, 1.06–2.96). CONCLUSION: Longer sleep duration is associated with a significantly higher incidence of sarcopenia in Korean women aged ≥40 years.

Body Composition, Sarcopenia, and Suicidal Ideation in Elderly Koreans: Hallym Aging Study

This study was conducted to assess the relationship between body composition and suicidal ideation among the Korean elderly population (n = 302; ≥ 65 years) who participated in the Hallym Aging Study in 2010. Body composition was measured using dual-energy X-ray absorptiometry, and obesity was measured by the indices of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body fat percentage. Sarcopenia was defined as presence of both low muscle mass and low muscle function. Suicidal ideation was assessed using the Beck Scale for Suicide Ideation. We found no differences in body composition measures between subjects with suicidal ideation and those without. In the logistic regression analyses, there were no significant relationships for suicidal ideation according to body composition measures, including BMI, WC, WHR, WHtR, and body fat percentage in both sexes. After adjusting for age, smoking status, alcohol drinking, regular exercise, medical comorbidities, monthly income, education level, and presence of depressive symptoms, the odds ratio (OR) of suicidal ideation was higher in elderly men with sarcopenia compared to those without, whereas no significant relationships were observed in elderly women (OR 8.28, 95% confidence interval [CI] 1.20-61.34 in men; OR 0.79, 95% CI 0.07-8.43 in women). Sarcopenia is closely associated with an increased risk of suicidal ideation in elderly men.

Dietary Analysis of Kidney Transplant Patients Who Eat Korean Foods: Single Center Study / 대한이식학회지

BACKGROUND: Although nutritional problems associated with dialysis are well described, nutritional problems after renal transplantation have received little attention. Nutrition interventions play an important role in prevention and management of common health problems associated with renal transplantation such as obesity, hypertension, diabetes, and cardiovascular disease. METHODS: Sixty-four kidney transplant recipients who received post-transplant management at our hospital replied to the questionnaire. The questionnaire included 102 questions on the amount and types of Korean foods that they consumed last week. Nutritional elements of diet in renal transplant patients who consume Korean food were analyzed on the basis of the survey. RESULTS: The mean energy and protein of daily intake were 2,088+/-1,016 kcal and 75.5+/-38.2 g. Patients' diets were generally sufficient, but characterized by deficiencies in vitamin B2, vitamin D, niacin, calcium, and magnesium intake. CONCLUSIONS: Dietary advice is required with regard to intake of some nutritional elements for kidney transplant recipients who consume Korean foods. Their main nutritional problem is obesity after transplantation. Attention should be paid to prevention of nutritional imbalance.

Factors That Predict Persistent Smoking of Cancer Survivors

We conducted this cross-sectional study to elucidate factors that predict persistent smoking of the Korean cancer survivors. The subjects were 130 adult (> or =19 yr old) cancer survivors who were smokers at the diagnosis of cancer and have participated in the Korean National Health and Nutrition Examination Surveys conducted from 2007 to 2011. We categorized them into the persistent smokers and the quitters, according to change in smoking status between the time of cancer diagnosis and the time of the survey. Factors associated with persistent smoking were evaluated using the multiple logistic regression analysis. During 7.52 yr (standard deviation = 0.34) after the cancer diagnosis, 59.6% of the 130 cancer survivors have continued to smoke. After adjusting for covariates, following factors were independently associated with the risk of persistent smoking: female, low income, high-risk alcohol use, high body mass index (> or = 25 kg/m2), presence of household members who smoke, and longer duration of smoking. Alcohol Use Disorders Identification Test showed a positive association with the risk of persistent smoking (P for trend = 0.012). In conclusion, more efforts for smoking cessation should be in place for the cancer survivors with those risk factors associated with the persistent smoking.

Relationship between Sarcopenic Obesity and Cardiovascular Disease Risk as Estimated by the Framingham Risk Score

This study was conducted to assess the association between sarcopenic obesity and cardiovascular disease (CVD) risk in Korean adults (n=3,320; > or =40 yr) who participated in the 5th Korean National Health and Nutrition Examination Survey in 2010. The appendicular skeletal muscle mass divided by body weight was calculated for each participant; participants with values or =25 kg/m2) and sarcopenic status. Individuals' 10-yr CVD risk was determined using the Framingham risk model. The sarcopenic obese group had more participants (43.8% men, 14.6% women) with a high risk of CVD (> or =20%). The sarcopenic obese group was associated with an increased 10-yr CVD risk than the non-sarcopenic, non-obese group (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.53-4.06, P<0.001 in men; OR, 1.87; 95% CI, 1.02-3.41, P=0.041 in women). Sarcopenic non-obese and non-sarcopenic obese subjects were not associated with an increased 10-yr CVD risk. Sarcopenic obesity, but not non-sarcopenic obesity, was closely associated with an increased CVD risk in Korean adults.

Diagnostic Performance of Body Mass Index Using the Western Pacific Regional Office of World Health Organization Reference Standards for Body Fat Percentage

Associations between body mass index (BMI), body fat percentage (BF%), and health risks differ between Asian and European populations. BMI is commonly used to diagnose obesity; however, its accuracy in detecting adiposity in Koreans is unknown. The present cross-sectional study aimed at assessing the accuracy of BMI in determining BF%-defined obesity in 6,017 subjects (age 20-69 yr, 43.6% men) from the 2009 Korean National Health and Nutrition Examination Survey. We assessed the diagnostic performance of BMI using the Western Pacific Regional Office of World Health Organization reference standard for BF%-defined obesity by sex and age and identified the optimal BMI cut-off for BF%-defined obesity using receiver operating characteristic curve analysis. BMI-defined obesity (> or =25 kg/m2) was observed in 38.7% of men and 28.1% of women, with a high specificity (89%, men; 84%, women) but poor sensitivity (56%, men; 72% women) for BF%-defined obesity (25.2%, men; 31.1%, women). The optimal BMI cut-off (24.2 kg/m2) had 78% sensitivity and 71% specificity. BMI demonstrated limited diagnostic accuracy for adiposity in Korea. There was a -1.3 kg/m2 difference in optimal BMI cut-offs between Korea and America, smaller than the 5-unit difference between the Western Pacific Regional Office and global World Health Organization obesity criteria.

Diagnostic Performance of Body Mass Index Using the Western Pacific Regional Office of World Health Organization Reference Standards for Body Fat Percentage

Associations between body mass index (BMI), body fat percentage (BF%), and health risks differ between Asian and European populations. BMI is commonly used to diagnose obesity; however, its accuracy in detecting adiposity in Koreans is unknown. The present cross-sectional study aimed at assessing the accuracy of BMI in determining BF%-defined obesity in 6,017 subjects (age 20-69 yr, 43.6% men) from the 2009 Korean National Health and Nutrition Examination Survey. We assessed the diagnostic performance of BMI using the Western Pacific Regional Office of World Health Organization reference standard for BF%-defined obesity by sex and age and identified the optimal BMI cut-off for BF%-defined obesity using receiver operating characteristic curve analysis. BMI-defined obesity (> or =25 kg/m2) was observed in 38.7% of men and 28.1% of women, with a high specificity (89%, men; 84%, women) but poor sensitivity (56%, men; 72% women) for BF%-defined obesity (25.2%, men; 31.1%, women). The optimal BMI cut-off (24.2 kg/m2) had 78% sensitivity and 71% specificity. BMI demonstrated limited diagnostic accuracy for adiposity in Korea. There was a -1.3 kg/m2 difference in optimal BMI cut-offs between Korea and America, smaller than the 5-unit difference between the Western Pacific Regional Office and global World Health Organization obesity criteria.

Association between Coffee Consumption and Renal Impairment in Korean Women with and without Diabetes: Analysis of the Fourth Korea National Health and Nutrition Examination Survey in 2008 / 가정의학회지

BACKGROUND: Recent studies suggest that coffee consumption has an influence on kidney function. This study investigated the relationship between habitual coffee consumption and renal impairment in Korean women, in consideration of diabetic status. METHODS: This study involved 2,673 women aged 35 to 84 years who had participated in the Fourth Korea National Health and Nutrition Examination Surveys, conducted in 2008. Habitual coffee consumption was classified into three categories: less than 1 cup per day, 1 cup per day, and 2 or more cups per day. Renal function impairment was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 by the Modification of Diet in Renal Disease equation. RESULTS: The prevalence of diabetes and renal function impairment was higher in women who drank or = 2 cups per day after adjusting for multiple confounding factors. When data were stratified according to the presence of diabetes, coffee consumption > or = 2 cups of coffee per day showed an inverse association with renal function impairment in only diabetic women (OR, 0.14; 95% CI, 0.02 to 0.88; P = 0.04), compared with consumption < 1 cup of coffee per day. CONCLUSION: In a representative sample of Korean women, coffee consumption was significantly associated with a decreased risk of renal impairment especially in middle and elderly-aged diabetic women.