Association between Falls and Nutritional Status of Community-Dwelling Elderly People in Korea / 가정의학회지

Background@#Malnutrition is a well-known risk factor of falls, although studies examining the association between nutritional status and falls are rare. We aimed to investigate the association between nutritional status and falls according to gender among Korean older adults. @*Methods@#The study included 10,675 participants (4,605 men and 6,070 women) aged 65 years and older and used data from the 2011 Survey of Living Conditions and Welfare Needs of Korean Older Persons. Nutritional status of the participants was assessed using the Nutritional Screening Initiative checklist, and the participants were categorized into the following groups: “good,” “moderate nutritional risk,” and “high nutritional risk.” Odds ratios (OR) of fall risk in the above groups based on gender were evaluated using multivariate logistic regression analyses. @*Results@#Fallers in both genders showed significant association with older age, lower household income, inadequate exercise, and poor nutritional status compared with non-fallers. Considering the good nutritional status group as the reference group, the high nutritional risk group showed a higher risk of falls in men (OR, 1.59; 95% confidence interval [CI], 1.26–1.99); both moderate and high nutritional risk groups showed a higher risk of falls after adjusting for confounding factors in women (OR, 1.39; 95% CI, 1.19–1.62 and OR, 1.90; 95% CI, 1.61–2.24, respectively). @*Conclusion@#The risk of falls was associated with poor nutritional status, and statistical significance of the association between nutritional status and falls was stronger in women than in men.

Insulin Resistance and Obesity according to Degree of Acanthosis Nigricans in Obese Korean Children and Adolescents

Background@#Recent studies suggest that acanthosis nigricans (AN) is associated with insulin resistance in obese children. However, very few studies have assessed insulin resistance and obesity according to the degree of AN. Therefore, this study aimed to investigate the correlation between the degree of obesity and insulin resistance according to the severity of AN. @*Methods@#A total of 141 participants (83 boys and 58 girls) aged 6−17 years were recruited for the Intervention for Childhood and Adolescents obesity via Activity and Nutrition study between 2016 and 2017. The participants were categorized into four groups according to the severity of AN: grade 0 (n=69), grade 1 (n=19), grade 2–3 (n=35), and grade 4 (n=18). All participants underwent physical examination and blood tests. We compared the mean homeostatic model assessment (HOMA-IR) and body mass index Z score (BMI Z-score) in each group using ANCOVA and linear regression model. @*Results@#The HOMA-IR, which represents insulin resistance, increased with increasing AN severity (grade 0 group: 3.25±0.070; grade 1 group: 3.97±0.103; grade 2–3 group: 4.76±0.079; AN grade 4: 6.40±0.107; P for trend<0.001). Similarly, the BMI Z-score, which represents the degree of obesity, increased with increasing AN severity (grade 0 group: 2.29±0.052; grade 1 group: 2.42±0.080; grade 2–3 group: 2.44±0.062, grade 4: 2.67±0.089; P for trend<0.001). @*Conclusion@#Insulin resistance and the degree of obesity increase with the severity of AN in Korean obese children.

Tobacco control policy on the electronic cigarette

E-cigarettes, or electronic nicotine delivery systems, are popular among smokers who are looking for a less harmful alternative to conventional tobacco, and the use of e-cigarettes is affected by existing tobacco control policies. E-cigarettes, which are electronic devices designed to allow the user to inhale nicotine as a vapor, are controversial in terms of their harm reduction claims as it can undermine existing tobacco control policies and has the potential to re-normalize smoking behavior. Currently, many of the chemicals used in e-cigarettes have not been comprehensively disclosed, and there is no adequate data on their emissions. Furthermore, the benefits of e-cigarettes have not been adequately shown. To date, a small number of studies have evaluated e-cigarettes as a harm reduction and cessation aid and have found conflicting findings. Meanwhile, e-cigarette or vaping product use associated lung injury has been identified, and an increased use of e-cigarettes in the youth has also been reported recently in the United States. These raise a great social concern around how to regulate e-cigarettes for the protection of public health. A range of current and proposed legislative and regulatory options exists. Some countries have banned e-cigarettes entirely, while others are ready to regulate e-cigarettes as a type of medicine. A lack of consensus on whether e-cigarettes facilitate or threaten existing tobacco control strategies is driving a discussion on how to regulate e-cigarettes in terms of the protection of public health.

Tobacco control policy on the electronic cigarette

E-cigarettes, or electronic nicotine delivery systems, are popular among smokers who are looking for a less harmful alternative to conventional tobacco, and the use of e-cigarettes is affected by existing tobacco control policies. E-cigarettes, which are electronic devices designed to allow the user to inhale nicotine as a vapor, are controversial in terms of their harm reduction claims as it can undermine existing tobacco control policies and has the potential to re-normalize smoking behavior. Currently, many of the chemicals used in e-cigarettes have not been comprehensively disclosed, and there is no adequate data on their emissions. Furthermore, the benefits of e-cigarettes have not been adequately shown. To date, a small number of studies have evaluated e-cigarettes as a harm reduction and cessation aid and have found conflicting findings. Meanwhile, e-cigarette or vaping product use associated lung injury has been identified, and an increased use of e-cigarettes in the youth has also been reported recently in the United States. These raise a great social concern around how to regulate e-cigarettes for the protection of public health. A range of current and proposed legislative and regulatory options exists. Some countries have banned e-cigarettes entirely, while others are ready to regulate e-cigarettes as a type of medicine. A lack of consensus on whether e-cigarettes facilitate or threaten existing tobacco control strategies is driving a discussion on how to regulate e-cigarettes in terms of the protection of public health.

Tobacco control policy on the electronic cigarette

E-cigarettes, or electronic nicotine delivery systems, are popular among smokers who are looking for a less harmful alternative to conventional tobacco, and the use of e-cigarettes is affected by existing tobacco control policies. E-cigarettes, which are electronic devices designed to allow the user to inhale nicotine as a vapor, are controversial in terms of their harm reduction claims as it can undermine existing tobacco control policies and has the potential to re-normalize smoking behavior. Currently, many of the chemicals used in e-cigarettes have not been comprehensively disclosed, and there is no adequate data on their emissions. Furthermore, the benefits of e-cigarettes have not been adequately shown. To date, a small number of studies have evaluated e-cigarettes as a harm reduction and cessation aid and have found conflicting findings. Meanwhile, e-cigarette or vaping product use associated lung injury has been identified, and an increased use of e-cigarettes in the youth has also been reported recently in the United States. These raise a great social concern around how to regulate e-cigarettes for the protection of public health. A range of current and proposed legislative and regulatory options exists. Some countries have banned e-cigarettes entirely, while others are ready to regulate e-cigarettes as a type of medicine. A lack of consensus on whether e-cigarettes facilitate or threaten existing tobacco control strategies is driving a discussion on how to regulate e-cigarettes in terms of the protection of public health.

Clinical Characteristics Associated with Electrocardiographic Left Ventricular Hypertrophy in Clinical Normotensives without a History of Hypertension: a Cross-Sectional Study / 가정의학회지

BACKGROUND: This study evaluated factors independently associated with electrocardiographic left ventricular hypertrophy (ECG-LVH) in subjects who were normotensive on clinical measurement and had no prior history of hypertension. METHODS: This cross-sectional study analyzed cases and controls in the Comprehensive Medical Examination Center of Hallym University Sacred Heart Hospital. Eligible case participants presented ECG-LVH according to the Sokolow- Lyon or Cornell criteria, were normotensive on clinical measurement, and had never received a diagnosis of hypertension. The control group comprised subjects with normal sinus rhythm who were normotensive on clinical measurement with no history of hypertension. RESULTS: A multiple logistic regression model showed male sex, age and systolic blood pressure to be positively related to the presence of ECG-LVH. A positive relation of smoking and regular exercise; an inverse relation of pulse rate to the presence of ECG-LVH were found only in men. An inverse relation of uric acid level was found only in women. Detailed analyses of relatively healthy and young men according to whether or not to exercise regularly showed that positive relations of age and systolic blood pressure; an inverse relation of obesity to the presence of ECG-LVH were apparent in the non-regular exercise group but not in the regular exercise group. In the regular exercise group, only pulse rate showed significant (inverse) association with the presence of ECG-LVH. CONCLUSION: The varying risk factor profiles associated with ECG-LVH according to sex and the participation in regular exercise may help to elucidate the ECG-LVH in clinical normotensives with no prior history of hypertension.

Association between Physical Fitness and Cardiometabolic Risk of Children and Adolescents in Korea / 가정의학회지

BACKGROUND: This study aimed to investigate the association between physical fitness and cardiometabolic health of Korean children and adolescents. METHODS: In total, 168 participants (89 boys and 79 girls) aged 10–16 years were recruited for the Intervention for Childhood and Adolescent Obesity via Activity and Nutrition Study in 2016. The subjects were categorized into two groups using the definition of metabolic syndrome by the International Diabetes Federation: metabolically unhealthy (with at least two of the five criteria) and healthy groups (with less than one criterion). Correlation analysis of the participants' general characteristics was performed. Odds ratios (ORs) of physical fitness for cardiometabolic risk were evaluated via logistic regression. RESULTS: Metabolically unhealthy children showed greater weight, height, and body mass index, higher Children's Depression Inventory score, and longer screen time than did the metabolically healthy children. Metabolically healthy children showed greater upper and lower extremity muscular strength than did the metabolically unhealthy children (P=0.04 and P<0.001, respectively). In the multiple logistic regression analysis, lower extremity muscle strength was inversely related to the clustered cardiometabolic risk of the children and adolescents with or without adjustment for confounders (OR, 4.32; 95% confidence interval [CI], 1.87–9.97; OR, 7.64; 95% CI, 1.55–37.74, respectively). CONCLUSION: Physical fitness, especially lower extremity muscle strength, is significantly inversely associated with individual and clustered cardiometabolic risks in Korean children and adolescents.

A Structured Literature Review on the Role of Mindfulness Intervention in Weight Control

Mindfulness training is growing in popularity as an adjunctive intervention in disordered eating and weight loss. Lifestyle modification, pharmacologic treatment, and surgical intervention have been widely used for weight reduction in obese persons, but these modifications are sometimes insufficient. In particular, stress-induced eating and binge-eating disorder have been frequently associated with increased risk of regaining weight. Initial research suggests that mindfulness training may be an effective intervention for binge eating. In this article, we reviewed 19 studies that investigated mindfulness training as an intervention for weight change and/or emotional eating. Results suggest that mindfulness training effectively decreases emotional eating in persons with good adherence to the training; evidence for its effect on weight reduction, however, is mixed. Further large-scale studies are warranted to explore the effectiveness of mindfulness training on long-term weight loss and emotional eating in persons with obesity.

A Structured Literature Review on the Role of Mindfulness Intervention in Weight Control

Mindfulness training is growing in popularity as an adjunctive intervention in disordered eating and weight loss. Lifestyle modification, pharmacologic treatment, and surgical intervention have been widely used for weight reduction in obese persons, but these modifications are sometimes insufficient. In particular, stress-induced eating and binge-eating disorder have been frequently associated with increased risk of regaining weight. Initial research suggests that mindfulness training may be an effective intervention for binge eating. In this article, we reviewed 19 studies that investigated mindfulness training as an intervention for weight change and/or emotional eating. Results suggest that mindfulness training effectively decreases emotional eating in persons with good adherence to the training; evidence for its effect on weight reduction, however, is mixed. Further large-scale studies are warranted to explore the effectiveness of mindfulness training on long-term weight loss and emotional eating in persons with obesity.

Smoking cessation services provided by the National Health Insurance Service

Smoking cessation services are an important component of preventive medicine. Physicians can help smokers quit smoking by assessing their dependence and motivating them during their clinic visits. Brief advice provided by doctors is a simple and very cost-effective method of smoking cessation. The most effective method of helping smokers stop smoking is combining pharmacotherapy with counseling and behavioral interventions. In early 2015, the National Health Insurance Service started a smokingcessation support program that covered consultation and drug fees across the country. More than 400,000 smokers registered in this program and received assistance from doctors in 2016. The success rate at 6 months after registration was approximately 40%, which is comparable with that of smoking cessation clinics run by public health centers in local areas. Additional efforts are needed to increase the coverage levels of smoking cessation services in Korea.

Smoking cessation services provided by the National Health Insurance Service

Smoking cessation services are an important component of preventive medicine. Physicians can help smokers quit smoking by assessing their dependence and motivating them during their clinic visits. Brief advice provided by doctors is a simple and very cost-effective method of smoking cessation. The most effective method of helping smokers stop smoking is combining pharmacotherapy with counseling and behavioral interventions. In early 2015, the National Health Insurance Service started a smokingcessation support program that covered consultation and drug fees across the country. More than 400,000 smokers registered in this program and received assistance from doctors in 2016. The success rate at 6 months after registration was approximately 40%, which is comparable with that of smoking cessation clinics run by public health centers in local areas. Additional efforts are needed to increase the coverage levels of smoking cessation services in Korea.

Updated information on smoking cessation management

Smoking is a leading cause of premature death, and the World Health Organization estimates 8 million deaths per year are due to smoking-related diseases. Most smokers want to quit smoking, which is not easy because of nicotine dependence. Physicians can help smokers quit smoking by assessing their dependence and motivating them on their clinic visits. Brief advices provided by doctors is a simple and very cost-effective methods of smoking cessation. The most effective method of helping smokers stop smoking is combining pharmacotherapy with advice and behavioral intervention. Sometimes, intensive counseling, either individual or group, is needed to promote smoking cessation. Health care providers also need to be familiar with pharmacotherapy. Additionally, other sources of support, such as written materials, a telephone quit-line, and strategies for preventing relapses should be integrated into the treatment. Future research could contribute to further understanding about the effects of various intensities of treatment, particular settings for treatment, or a treatment's effect among specific populations. This could include identifying the optimal amount of behavioral support to use with pharmacotherapy.

Differences in Factors Associated with Albuminuria according to Gender and Comorbidities of Hypertension and Diabetes / 가정의학회지

BACKGROUND: This study examined the differences in factors associated with albuminuria according to gender and comorbidities of hypertension (HTN) and diabetes mellitus (DM). METHODS: We included 3,859 participants aged 20 to 79 years (55% female) from the 5th Korea National Health and Nutrition Examination Survey. Participants were excluded if they took antihypertensive or anti-diabetic medication, had chronic renal failure, had malignant tumor, were pregnant or menstruating during the health examination, or had missing urine albumin data. Albuminuria was defined by the participant's urine albumin-creatinine ratio (uACR). Relationships between dependent and independent variables were analyzed using the Pearson's correlation test and simple linear regression. Due to possible muticollinearity, multiple linear regression analysis was used to determine whether the association between the dependent and independent variables of interest remained significant after adjustment for other potentially confounding independent variables. RESULTS: The variables significantly correlated with uACR were different between the genders and between subjects with HTN or DM as a comorbidity. In the multiple linear regression models, hemoglobin A1c (P=0.01) was positively associated with uACR in men without HTN and DM. In men with HTN or DM, systolic blood pressure and fasting glucose (P<0.01) were positively associated with uACR. In women with HTN or DM, waist circumference (P=0.011) and gamma-glutamyl transpeptidase (P<0.001) were positively correlated with uACR (P<0.05) and glucose level (P=0.019) was negatively correlated with uACR. CONCLUSION: The study suggested factors correlated with albuminuria were different for men and women according to comorbidities such as HTN and DM.

Time to First Cigarette and Hypertension in Korean Male Smokers / 가정의학회지

BACKGROUND: Morning blood pressure surge affects to cardiovascular disease risk. Short time to first cigarette (TTFC) after waking can enhance morning blood pressure surge, and accelerate atherosclerosis METHODS: We investigated that the relationship between TTFC and blood pressure. The study subjects included male current smokers (n=211) who had health check-up in Hallym University Sacred Heart Hospital from July to September, 2014. We categorized the subjects into 2 groups according to TTFC; early TTFC (TTFC or =30 minutes), and the subjects who were taking antihypertensive medications or had a high blood pressure (>140 mm Hg or 90 mm Hg) were defined as hypertensive group. Multivariate logistic regression was performed to estimate the odds ratio and 95% confidence interval to investigate the association between TTFC and hypertensive group. RESULTS: Compared with late TTFC, early TTFC had higher odds (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.89-7.94) for hypertensive group. After adjusting confounding factors, early TTFC was significantly associated with an increased risk of hypertension (OR, 4.43; 95% CI, 1.84-10.70). CONCLUSION: early TTFC after waking is associated with hypertension. It suggests delaying TTFC might help to control of blood pressure among the current smokers who are not ready to immediately quit smoking.

Clinical Characteristics and Metabolic Health Status of Obese Korean Children and Adolescents / 가정의학회지

BACKGROUND: This study aimed to determine the prevalence of metabolically healthy and unhealthy obesity (MHO and MUO, respectively) and examine the demographic, anthropometric, and lifestyle predictors of metabolic health status in Korean children and adolescents. METHODS: This study was based on data collected from the Korean Children-Adolescent Study in 2010. A total of 1,700 children (846 boys and 854 girls) were included in the primary cohort and classified into metabolically healthy and unhealthy groups according to factors related to the metabolic syndrome. Demographic and biochemical features were evaluated in study participants. Logistic regression estimated the odds ratios of having more fat mass among MUO compared with MHO children after adjusting for confounding factors. RESULTS: Mean body mass index was higher in the MUO group than in the MHO group (24.83 vs. 23.02 kg/m2, respectively). The proportion of obese participants was also higher in the MUO group (59.4%) than in the MHO group (20.7%). MHO children were more likely to have parents with better socioeconomic status and a higher fruit and vegetable intake compared with MUO children. Higher fat mass and percent fat was associated with MUO according to multiple logistic regression analysis. CONCLUSION: Fat mass and percent fat are associated with metabolically healthy phenotypes of obesity among children and adolescents.

Cross-sectional Study of the Relation between Ultraviolet Radiation, Body Fat Distribution, and Metabolism in Health-screening Subjects / 대한피부과학회지

BACKGROUND: The age-associated loss of subcutaneous fat with the accumulation of visceral fat consequently leads to several deleterious health outcomes such as dyslipidemia, insulin resistance, and metabolic syndrome. A recent research has shown that acute ultraviolet (UV) irradiation can reduce subcutaneous fat. OBJECTIVE: The purpose of our study is to investigate whether chronic UV radiation can reduce subcutaneous fat, increase visceral fat, and lead to additional metabolic changes. METHODS: We analyzed the abdominal computed tomography images of the 98 subjects attending our health examination center to calculate the amount of subcutaneous fat and visceral fat. Questionnaire surveys were conducted to analyze the degree of daily UV exposure, sunscreen use, and physical activity. Weight, height, blood pressure (BP), liver function test, lipid profiles, and glucose metabolism were also assessed. RESULTS: In the analysis of covariance adjusted for age, sex, and physical activity, the visceral fat amount in the high UV exposure group was significantly higher than that in the low UV exposure group (p=0.043), and the subcutaneous/total fat ratio in the high UV group was significantly lower than that in the low UV group (p=0.048). The high UV group had higher levels of fasting insulin, homeostasis model assessment of insulin resistance, systolic BP, and diastolic BP than the low UV exposure group (p=0.039, 0.012, 0.004, and 0.002, respectively). CONCLUSION: Our results suggest that chronic UV radiation could change body fat distribution and lead to additional changes, including changes in glucose metabolism and BP.

Aspirin in the prevention of cardiovascular disease and cancer

Cardiovascular disease (CVD) is the one of the leading causes of death in Korea. Aspirin, well known for its antiplatelet function, has been used for the secondary prevention of CVD during the first few several decades. However, whether or not to have a protective effect on the primary prevention of CVD in apparently healthy people is still controversial. In addition, accumulating data suggest aspirin may have a favorable possibility on cancer incidence and mortality. We reviewed the literature, focusing on new evidence on the benefits and risks of aspirin for the prevention of CVD and cancer. Aspirin modestly decreases the risk of non-fatal myocardial infarction and cancer incidence in patients without overt CVD and at average cancer risk, but increase the risk of major bleeding. Several guidelines on the use of aspirin for the primary prevention of CVD stated the need for the prudent assessment of individual CVD risks in the target population. Currently there's no CVD risk assessment tools based on domestic data available in Korea. Also the bleeding risk and relatively high incidence of hemorrhagic stroke in Koreans make a difficult decision. Clinicians should give the patients a balanced information and discuss the effects or harms of taking aspirin on the prevention of CVD and cancer according to the updated evidence. Patient education for the prevention of CVD is more important and life style change including smoking cessation, weight reduction, and a healthy diet should be emphasized before considering aspirin.

Effects of Tai Chi Exercise Program for Health Promotion in Middle Aged Women with Osteoarthritis

BACKGROUND: The purpose of this study was to identify the effects of Tai Chi exercise program on physical symptoms (pain, stiffness) and physical function (difficulty with physical function) related to joint, stress, depression, and sleep disturbance in middle aged women with osteoarthritis. METHODS: The study was conducted with a nonequivalent control group pretest-posttest design. Forty participants were assigned to either the experimental group (20) or control group (20). Tai Chi exercise program was administered twice a week for 12 weeks to participants in experimental group. Data were collected from October 4 to December 24, 2011 and analyzed using chi2-test and t-test. RESULTS: There were significant differences between groups in joint pain score (z=-2.029, P=0.047) of Korean-Western Ontario and McMaster University Osteoarthritis (K-WOMAC) index and depression score (z=-2.566, P=0.010). However, there were no significant differences in stiffness score and physical function score of K-WOMAC index, stress score and sleep disturbance score. CONCLUSIONS: Findings from this study indicate that Tai Chi exercise program are effective in reducing joint pain and depression in osteoarthritis women. It could be regarded as positive program for health promotion of self-care skills in middle-aged women with osteoarthritis.

Effects of Tai Chi Exercise Program for Health Promotion in Middle Aged Women with Osteoarthritis

BACKGROUND: The purpose of this study was to identify the effects of Tai Chi exercise program on physical symptoms (pain, stiffness) and physical function (difficulty with physical function) related to joint, stress, depression, and sleep disturbance in middle aged women with osteoarthritis. METHODS: The study was conducted with a nonequivalent control group pretest-posttest design. Forty participants were assigned to either the experimental group (20) or control group (20). Tai Chi exercise program was administered twice a week for 12 weeks to participants in experimental group. Data were collected from October 4 to December 24, 2011 and analyzed using chi2-test and t-test. RESULTS: There were significant differences between groups in joint pain score (z=-2.029, P=0.047) of Korean-Western Ontario and McMaster University Osteoarthritis (K-WOMAC) index and depression score (z=-2.566, P=0.010). However, there were no significant differences in stiffness score and physical function score of K-WOMAC index, stress score and sleep disturbance score. CONCLUSIONS: Findings from this study indicate that Tai Chi exercise program are effective in reducing joint pain and depression in osteoarthritis women. It could be regarded as positive program for health promotion of self-care skills in middle-aged women with osteoarthritis.

Effects of Tai Chi Exercise Program for Health Promotion in Middle Aged Women with Osteoarthritis

BACKGROUND: The purpose of this study was to identify the effects of Tai Chi exercise program on physical symptoms (pain, stiffness) and physical function (difficulty with physical function) related to joint, stress, depression, and sleep disturbance in middle aged women with osteoarthritis. METHODS: The study was conducted with a nonequivalent control group pretest-posttest design. Forty participants were assigned to either the experimental group (20) or control group (20). Tai Chi exercise program was administered twice a week for 12 weeks to participants in experimental group. Data were collected from October 4 to December 24, 2011 and analyzed using chi2-test and t-test. RESULTS: There were significant differences between groups in joint pain score (z=-2.029, P=0.047) of Korean-Western Ontario and McMaster University Osteoarthritis (K-WOMAC) index and depression score (z=-2.566, P=0.010). However, there were no significant differences in stiffness score and physical function score of K-WOMAC index, stress score and sleep disturbance score. CONCLUSIONS: Findings from this study indicate that Tai Chi exercise program are effective in reducing joint pain and depression in osteoarthritis women. It could be regarded as positive program for health promotion of self-care skills in middle-aged women with osteoarthritis.