Associations of Serum Uric Acid Level With Liver Enzymes, Nonalcoholic Fatty Liver Disease, and Liver Fibrosis in Korean Men and Women: A CrossSectional Study Using Nationally Representative Data

Background@#This study aimed to determine whether serum uric acid (SUA) levels are associated with various indices of liver damage in the adult Korean population. @*Methods@#We used the Seventh (VII) Korean National Health and Nutritional Examination Surveys. Our study population comprised 6,007 men and 8,488 women. Levels of SUA were divided into four groups (≤ 5.3, 5.3–6.0, 6.0–7.0, and > 7.0 mg/dL for men and ≤ 4.0, 4.0–4.8, 4.8–6.0, and > 6.0 mg/dL for women). Elevated liver enzyme levels were defined as > 35 (men) and > 31 (women) IU/L for aspartate aminotransferase (AST), > 45 (men) and > 34 (women) IU/L for alanine aminotransferase (ALT). Hepatic steatosis index and fibrosis (FIB)-4 index was used to determine nonalcoholic fatty liver disease (NAFLD) and liver FIB, respectively. Adjusted odds ratios (aORs) were calculated by logistic regression analysis for liver enzymes, NAFLD, and liver FIB, according to the SUA level. @*Results@#Among women, the 4.8–6.0 and > 6.0 mg/dL SUA groups showed higher ORs of elevated AST (aOR, 1.78 and 2.03; 95% confidence interval [CI], 1.37–2.32 and 1.40–2.96, respectively; P 6.0 mg/dL SUA groups showed a higher ORs of ALT elevation (aOR, 1.35, 2.26, and 2.37; 95% CI, 1.02–1.79, 1.72–2.97, and 1.60–3.50, respectively; P 6.0 mg/dL SUA group showed higher OR of NAFLD status (aOR, 1.52; 95% CI, 1.06–2.19). Among men and women with NAFLD, hyperuricemia showed higher ORs of liver FIB (aOR, 2.25 and 1.89; 95% CI, 1.21–4.19 and 1.09–3.27, respectively) than the lowest level SUA group. @*Conclusion@#High SUA levels may be associated with elevated liver enzymes and NAFLD, mainly in women. Even in women with normal ALT levels, SUA levels may predict the NAFLD status. Hyperuricemia may predict advanced liver FIB in both men and women with NAFLD. Further studies investigating the causal effects of SUA on liver damage are required.

Impact of Masticatory Discomfort on Daily Living Difficulties in Korean Elderly with Cognitive Decline / 치위생과학회지

Background@#Cognitive impairment has been reported to be closely associated with poor oral health, and the relationship is bidirectional, as older adults with poor oral health and chewing function are at a higher risk of cognitive decline (CD). This cross-sectional study aimed to determine whether masticatory discomfort in Korean elderly increases the risk of daily living difficulty (DLD) related to CD and whether there is a difference in risk according to gender and age. @*Methods@#The data used were obtained from the Korean Community Health Survey (2019). The final analysis included 22,154 people aged 65 years and older who completed the survey and responded to all items on the variables used in the study. Chi-square test, trend test, and complex sample logistic regression were performed for statistical analysis, to clarify the purpose of this study. @*Results@#As masticatory discomfort increased, the elderly’s DLD tended to increase (p-for trend, p＜0.001). For logistic regression, adjusting for all covariates, participants who reported masticatory discomfort as “discomfort” (adjusted odds ratio [AOR]=2.45, 95% confidence interval [CI]=2.11∼3.50) and “severe discomfort” (AOR=2.95, 95% CI=2.49∼3.50) had a more than a two-fold increased risk of CD-related DLD compared to participants who reported “no discomfort at all.” In age-stratified analyses, elderly men aged 75∼84 years and elderly women aged 65∼74 years had the highest risk of developing CD-related DLD. @*Conclusion@#Oral care interventions to improve masticatory function in older adults may slow CD and improve CD-related DLD. We hope that this study will raise awareness among caregivers and clinical professionals regarding the importance of oral care for older adults with CD.

Preventive Effects of Fluoride Gel Application on Dental Caries in the Permanent Tooth: A Systematic Review of Randomized Controlled Trials / 치위생과학회지

BACKGROUND: The purpose of this systematic review was to investigate the effects of topical fluoride gel application on dental caries prevention in the permanent teeth of children and adolescents. METHODS: We searched the EMBASE, PubMed, and Cochrane Library databases for randomized controlled trials (RCTs) assessing the effects of self-applied or professionally applied topical fluoride gels in patients <18 years of age; the search was completed on April 1, 2018. All included trials involved an experimental group (fluoride gel application) and a control group (placebo or no treatment). The outcome measures were the D(M)FS and D(M)FT indices, which were compared between the two groups. Review Manager software was used for quantitative synthesis of the final selected articles, and a forest plot was generated via a meta-analysis conducted using a random effects model. RESULTS: The results showed that the D(M)FS and D(M)FT indices were lower in the fluoride application group than in the control group, thus indicating that fluoride gel application was effective in dental caries prevention. We also performed a subgroup analysis to determine whether the effects of fluoride application differed if patients received oral prophylaxis (self or professional) before fluoride gel application. Therefore, the two groups showed slightly larger differences when studies without oral prophylaxis before fluoride gel application were considered; however, the difference was not statistically significant. CONCLUSION: These findings should be utilized to raise awareness about the caries-prevention effects of topical fluoride application among patients and guardians. Further RCTs should evaluate the effects of fluoride application with or without preceding oral prophylaxis, and appropriate fluoride application guidelines should be developed to maximize the effects of fluoride application in clinical practice.

Relationship between Periodontal Disease and Chronic Kidney Disease: A Systematic Review of Cohort Studies / 치위생과학회지

The purpose of this systematic review was to investigate the association between periodontal disease and chronic kidney disease. A search of Embase, PubMed and The Cochrane Library databases was performed up to April 17, 2016. Article selection was based on cohort study design and the study subjects were patients with periodontal disease or severe periodontal disease. The final result was development of chronic kidney disease and kidney function decrease based on the estimated glomerular filtration rate values. The quantitative synthesis of the final selected articles was assessed using Review Manager statistical analysis software. A fixed-effects model meta-analysis was performed to estimate the degree of association between periodontal disease and chronic kidney disease. The search strategy identified 3,018 potentially eligible articles, of these, four studies were finally selected for meta-analysis, revealing that periodontal disease was significantly associated with the risk of developing chronic kidney disease (odds ratio, 1.65; 95% confidence interval, 1.44~1.90; p<0.001). In order to prevent the development of chronic kidney disease and kidney function decrease it is important to prevent periodontal disease, as well as minimizing the traditional risk factors known to reduce the quality of life of patients and increase disease burden.

Relationship between Sleep Duration and Periodontitis in Korean Adult Women: Data from Korea National Health and Nutrition Examination Survey 2014 / 치위생과학회지

This study aimed to investigate the relationship between sleep duration and periodontitis in adult Korean women. This cross-sectional study was based on the 2014 Korea National Health and Nutrition Examination Survey (KNHNES). We selected the data from 3,292 women (over 19 years of age) out of 7,550 participants for analysis, after excluding data from men. Complex logistic regression analysis was performed to determine the effect of sleep duration on the risk of periodontitis; the crude and adjusted odds ratios (ORs) were calculated. The risk of periodontitis was higher in participants who had a sleep duration of 7 hours or more, than in those with less than 7 hours (crude OR) by 1.37 times (95% confidence interval [CI], 1.13∼1.65). The adjusted OR of the participants after adjusting for the sample characteristics of the participants (age, education level, income level, diabetes, hypertension, obesity) was 1.04 times (95% CI, 0.82∼1.32), but the risk for periodontitis was slightly higher, though not statistically significant. This study confirmed the relationship between sleep duration and the risk of periodontitis in Korean women. Therefore, it is necessary to develop and implement a comprehensive health promotion program that can improve the proper sleeping habits of adult women in Korea and to combine oral hygiene management programs to prevent periodontal disease.

Association of Anxiety and Depressive Symptoms with Periodontal Disease in Korean Women / 치위생과학회지

Periodontal diseases occur from the interplay between increased bacterial response and the response of the host immune system over time. Anxiety and depression can impair immunological defense mechanisms, causing accumulation of periodontopathogens and thus exacerbating periodontal disease. We investigated the relationship of anxiety and depression to periodontal diseases in Korean women. In this study, 3,551 women aged ≥19 years were evaluated based on data from the first year (2010) of the Fifth Korea National Health and Nutrition Examination Survey. The analysis of the factors that caused periodontal diseases revealed that dental floss or interdental toothbrush nonuse behaviors have been shown to increase the risk of periodontal disease (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.14~1.95). After adjusting for conditions such as age, marital status, income, educational level, economic activity, diabetes mellitus, smoking, drinking, and frequencies of toothbrushing and interdental cleaning, we found that anxiety and depression increased the risk of developing periodontal diseases (OR, 1.47; 95% CI, 1.04~2.09). People with anxiety and depression have a higher prevalence of periodontal diseases than people without anxiety and depression. Thus, periodic periodontal care and effective self-care education are needed to manage periodontal diseases.

Impact of Health Risk Factors on the Oral Health of Korean Adolescents: Korea Youth Risk Behavior Web-Based Survey, 2013 / 치위생과학회지

The objective of this study was to investigate the relationship between health-risk factors and oral health in Korean adolescents. This cross-sectional study was based on the 9th Korea Youth Risk Behavior Web-Based Survey (2013). The final participation rate in the survey was 96.4%. of a Total of 72,435 adolescents (age, 12∼18 years) who had participated in the survey, 66,951 adolescents (33,777 boys and 33,174 girls) were selected for analysis, after excluding those with missing data. The key variables were oral health factors (one or more of the six oral symptoms), general characteristics (five factors), and health-risk factors (five factors). After adjusting for the general characteristics, frequency analysis, χ2-test using PASW Statistics ver. 18.0, and logistic regression analysis were performed to understand the effects of health risk-factors on the oral symptoms experienced by the study subjects. Subjects who answered ‘Yes’ for alcohol consumption had a 1.33 times higher risk of experiencing oral symptoms. Further, subjects who smoked were at a 1.2 times higher risk of experiencing oral symptoms. With regard to internet use, the risk of experiencing oral symptoms was 1.25 times higher for subjects who used the internet for 7 hours or more than for those who used it for less than 1 hour. Compared to those subjects who had not experienced violence in school, the odds ratio of subjects who had experienced it 3∼4 times was 1.54-fold higher. The study found that health-risk factors were associated with oral symptom experience. Therefore, programs to understand health-risk factors and interventions should be developed for Korean adolescents and provided on a regular basis along with oral health education.