Relationship between Decreased Estimated Glomerular Filtration Rate and Sarcopenic Obesity among Postmenopausal Women: Korea National Health and Nutrition Examination Survey (2008–2011) / 가정의학회지

Background@#Previous studies have shown that body composition is associated with chronic kidney disease (CKD), and perimenopause is associated with increased fat mass and decreased lean body mass. Muscle wasting is common among patients with CKD. Sarcopenic obesity (SO) refers to excess adiposity with decreased muscle mass. However, little is known about the relationship between SO and renal function decline. Here, we identified the relationship between SO and decreased estimated glomerular filtration rate (eGFR) in postmenopausal women. @*Methods@#We conducted a cross-sectional study based on the data from the Korea National Health and Nutrition Examination Survey (2008–2011). We analyzed 4,560 postmenopausal women who underwent dual energy X-ray absorptiometry. Sarcopenia was defined based on weight-adjusted appendicular skeletal muscle mass. Obesity was defined based on body mass index. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Subjects were classified into four groups: normal, obese, sarcopenic, and sarcopenic obese. Logistic regression analysis was performed to examine the association between SO and decreased eGFR. The results were adjusted for variable confounders. @*Results@#In the unadjusted model, the odds ratio (OR) of decreased eGFR for SO was 1.67 (95% confidence interval [CI], 1.23–2.26). The obese and sarcopenic groups had ORs of 0.67 (95% CI, 0.44–1.03) and 0.70 (95% CI, 0.44–1.10), respectively. After controlling for confounding variables, there was also a significant association between SO and decreased eGFR (adjusted OR, 1.48; 95% Cl, 1.05–2.07). @*Conclusion@#SO was independently associated with decreased eGFR in postmenopausal Korean women.

Factors Influencing Electronic Cigarette Use for Smoking Cessation among Adolescents in South Korea: The 13th Korea Youth Risk Behavior Web-Based Survey

BACKGROUND@#This study used the data of Korea Youth Risk Behavior Web-based Survey (KYRBS) to confirm the relationship between electronic cigarette use for smoking cessation among Korean adolescents and demographic, health behavior, and school-life factors.@*METHODS@#Data were taken from the 13th KYRBS in 2017. In this study on 62,276 adolescents, characteristics of 1,244 electronic cigarette users were compared with those of non-electronic cigarette users. The 1,244 adolescent electronic cigarette users were evaluated for characteristics related to smoking cessation. Among the related characteristics, demographic factors comprised sex, grade, economic status, weekly allowance, and residence type. Health status-related factors comprised physical activity, lifetime drinking experience, smoking amount, subjective health perception, and stress perception. School characteristics included school type, academic performance, and smoking cessation education. Chi-square test and logistic regression analysis were performed using complex sample analysis.@*RESULTS@#The proportion of current electronic cigarette users was 2.2% (boys, 3.3%; girls, 0.9%). Of the 41.5% of cigarette users willing to quit smoking, 11% used electronic cigarettes for this purpose. Among the electronic cigarette users, characteristics related to smoking cessation were grade, weekly allowance, and residence type, but logistic regression analysis revealed that increases in grade (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.21–3.35) and living with family (OR, 4.17; 95% CI, 1.89–9.18) were associated with smoking cessation.@*CONCLUSIONS@#According to the 13th KYRBS in 2017, adolescents were likely to use electronic cigarette for smoking cessation when they are older and live with their families.

Factors Influencing Electronic Cigarette Use for Smoking Cessation among Adolescents in South Korea: The 13th Korea Youth Risk Behavior Web-Based Survey

BACKGROUND: This study used the data of Korea Youth Risk Behavior Web-based Survey (KYRBS) to confirm the relationship between electronic cigarette use for smoking cessation among Korean adolescents and demographic, health behavior, and school-life factors. METHODS: Data were taken from the 13th KYRBS in 2017. In this study on 62,276 adolescents, characteristics of 1,244 electronic cigarette users were compared with those of non-electronic cigarette users. The 1,244 adolescent electronic cigarette users were evaluated for characteristics related to smoking cessation. Among the related characteristics, demographic factors comprised sex, grade, economic status, weekly allowance, and residence type. Health status-related factors comprised physical activity, lifetime drinking experience, smoking amount, subjective health perception, and stress perception. School characteristics included school type, academic performance, and smoking cessation education. Chi-square test and logistic regression analysis were performed using complex sample analysis. RESULTS: The proportion of current electronic cigarette users was 2.2% (boys, 3.3%; girls, 0.9%). Of the 41.5% of cigarette users willing to quit smoking, 11% used electronic cigarettes for this purpose. Among the electronic cigarette users, characteristics related to smoking cessation were grade, weekly allowance, and residence type, but logistic regression analysis revealed that increases in grade (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.21–3.35) and living with family (OR, 4.17; 95% CI, 1.89–9.18) were associated with smoking cessation. CONCLUSIONS: According to the 13th KYRBS in 2017, adolescents were likely to use electronic cigarette for smoking cessation when they are older and live with their families.

Association between Sarcopenic Obesity and Metabolic Syndrome in Postmenopausal Women: A Cross-sectional Study Based on the Korean National Health and Nutritional Examination Surveys from 2008 to 2011

BACKGROUND: Menopause contributes to an increase in visceral fat mass and a decrease in muscle protein synthesis. Therefore, we performed this study to examine their relationship how effect the changes of body composition as obesity and sarcopenia on metabolic syndrome (MS) as a predictor of cardiovascular disease in postmenopausal women. METHODS: Using data from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011, we estimated that 4,183 postmenopausal women underwent dual energy X-ray absorptiometry scans. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight that was less than 1 standard deviation below the sex specific mean for the young reference group. After classification into four groups, the results were adjusted with menopausal age and hormonal treatment. The relationship between sarcopenic obesity (SO) and MS in postmenopausal women was analyzed by logistic regression analysis in a complex sampling. RESULTS: In an unadjusted model, the odds ratio (OR) of MS for sarcopenia was 1.94 (95% confidence interval [CI], 1.52-2.49); the obesity group had an OR of 4.55 (95% CI, 3.63-5.71); and distinctly, the SO group had an OR of 6.26 (95% CI, 5.10-7.70). Even though there was controlling for variable adjustment, no definite difference was seen in the results. CONCLUSIONS: Sarcopenia and obesity were associated with MS independent of other metabolic impairment risk factors in both early menopausal and postmenopausal women. The results showed that, in particular, the prevalence of MS has increased more in postmenopausal women compared with previous research.

The Association between Chronic Diseases and Active Patient Participation

BACKGROUND: Active patient participation in health care decision-making can results in better medical outcomes. This study's purpose is to investigate the association between the patient participation and the diseases often encountered in primary care. METHODS: We used the data from the Korean National Health and Nutrition Examination Survey conducted in 2015 which included 4,158 adults aged older than 19 and who had no missing data. The association between the presence of disease or the number of accompanying diseases and the active patient participation in the treatment decision was studied. Logistic regression analysis was conducted using complex sampling design in each sex. RESULTS: After adjusting for confounding variables, the relationship between active patient participation and the diagnosis of hypertension, odds ratio (OR) was 1.95 (95% confidence interval [CI], 1.25-3.04) for men and 1.83 (95% CI, 1.27-2.65) for women. In women diagnosed with diabetes, OR was 0.58 (95% CI, 0.35-0.97). Between active patient participation and increasing number of accompanying diseases have positive tendency but not statistically significant. CONCLUSIONS: This study suggests that active patient participation is related to the diagnosis of hypertension, and the number of accompanying diseases and active patient participation were not significantly associated. This is a rare study related to the active patient participation in the Korean population, that it may be helpful in establishing further relevant research and strategies to increase the patient participation rate.

The Relationship between Smoking and Suicidal Behavior in Korean Adolescents: 12th Korea Youth Risk Behavior Web-based Survey

BACKGROUND: Suicide is the first leading cause of death among teenagers in Korea, and smoking is reported to be one of the risk factors for suicide. The purpose of this study is to investigate the relationship between smoking and smoking amount and suicidal behavior using data from the Korea Youth Risk Behavior Web-based Survey (KYRBS). METHODS: Using the 12th KYRBS 2016, we surveyed smoking, smoking amount, suicidal ideation, suicidal planning, and suicidal attempt of adolescents. And a total of 65,528 respondents were divided into current smoker, former smokers, and non-smoker, and 4,012 smokers were classified into ≤9 cigarettes/day group, 10–19 cigarettes/day group, and ≥20 cigarettes/day group according to the amount of smokers. We analyzed the relationship between smoking and smoking amount and suicidal ideation, suicidal planning, and suicidal attempt using multivariate logistic regression analysis. RESULTS: As a result of adjusting for all confounding variables, the current smoker has an odds ratio of 1.143 (confidence interval 1.020–1.281) with suicidal ideation compared to non-smoker and the odds ratio of suicidal planning and suicidal attempt is also statistically significant, respectively. And the odds ratio of all suicidal behaviors was significantly higher in ≥20 cigarettes/day group than in ≤9 cigarettes/day group, respectively. CONCLUSIONS: We found that smoking and smoking amount was related to suicidal ideation, suicidal planning, and suicidal attempts in adolescents. Therefore, suicidal prevention strategies considering this relationship should be established.

Secular Trends for Body-shape Perception, Weight-loss Efforts, and Weight-loss Behaviors in Korean Adults Using the Korea National Health and Nutrition Examination Survey from 2001 to 2014

BACKGROUND: The objective of study was to investigate secular trends for body-shape perception, weight-loss efforts, and weight-loss behaviors from 2001 to 2014 in Korean adults and factors related to those weight-related attitude. METHODS: Self-reported body-shape perception, weight-loss efforts, and weight-loss behaviors were used in 26,480 men and 35,051 women aged 19 or older using the Korean National Health and Nutrition Survey from 2001 to 2014 (from 2005 to 2014 for weight-loss behaviors). Multivariable logistic regression analysis was conducted using complex sampling design in each sex. RESULTS: Body-shape misperception tended to decrease from 2001 to 2014 and weight-loss efforts tended to increase over the period in all subjects, whereas unhealthy weight-loss behaviors tended to increase over the period in women. In multivariable logistic regression model, body-shape misperception in men was inversely associated with survey year, while positively associated with age and weight status. In women, body-shape misperception was inversely associated with survey year, education, and income, while positively associated with age and weight status. Weight-loss efforts in both sexes were inversely associated with age, while positively associated with survey year, education, income, and weight status. Healthy weight-loss behaviors were positively associated with education but inversely associated with age in men. In women, those behaviors were positively associated with education and weight status, while inversely associated with survey year. CONCLUSIONS: We found decreased body-shape misperception and increased weight-loss efforts in Korean men and women from 2001 to 2014, and decreased healthy weight-loss behaviors in women from 2005 to 2014.

Procalcitonin as a Diagnostic and Prognostic Factor for Tuberculosis Meningitis

BACKGROUND AND PURPOSE: We investigated the potential role of serum procalcitonin in differentiating tuberculosis meningitis from bacterial and viral meningitis, and in predicting the prognosis of tuberculosis meningitis. METHODS: This was a retrospective study of 26 patients with tuberculosis meningitis. In addition, 70 patients with bacterial meningitis and 49 patients with viral meningitis were included as the disease control groups for comparison. The serum procalcitonin level was measured in all patients at admission. Differences in demographic and laboratory data, including the procalcitonin level, were analyzed among the three groups. In addition, we analyzed the predictive factors for a prognosis of tuberculosis meningitis using the Glasgow Coma Scale (GCS) at discharge, and the correlation between the level of procalcitonin and the GCS score at discharge. RESULTS: Multiple logistic regression analysis showed that a low level of procalcitonin (≤1.27 ng/mL) independently distinguished tuberculosis meningitis from bacterial meningitis. The sensitivity and specificity for distinguishing tuberculosis meningitis from bacterial meningitis were 96.2% and 62.9%, respectively. However, the level of procalcitonin in patients with tuberculosis meningitis did not differ significantly from that in patients with viral meningitis. In patients with tuberculosis meningitis, a high level of procalcitonin (>0.4 ng/mL) was a predictor of a poor prognosis, and the level of procalcitonin was negatively correlated with the GCS score at discharge (r=-0.437, p=0.026). CONCLUSIONS: We found that serum procalcitonin is a useful marker for differentiating tuberculosis meningitis from bacterial meningitis and is also valuable for predicting the prognosis of tuberculosis meningitis.

Association between Obesity and Neighborhood Socioeconomic Status in Korean Adolescents Based on the 2013 Korea Youth Risk Behavior Web-Based Survey / 가정의학회지

BACKGROUND: An increase in the obese adolescent population is being recognized as a serious medical and social problem. The present study aimed to examine the association between neighborhood socioeconomic status (SES) and obesity in Korean adolescents based on total available resources and local social inequality models. METHODS: The present study used data from the 2013 Korea Youth Risk Behavior Web-based Survey in analyzing 72,438 Korean adolescents aged 12-18. The analysis investigated obesity odds ratio (OR) according to neighborhood SES adjusted for age and individual SES indices, which included family affluence scale (FAS), education level of parents, cohabitation with parents, and weekly allowance. Obesity OR was investigated according to neighborhood SES by FAS, and according to FAS by neighborhood SES. RESULTS: After adjusting for age and individual SES variables, there was no significant association between neighborhood SES and adolescent obesity for either boys or girls. However, girls in the high FAS group showed a pattern of lower neighborhood SES being associated with a significant increase in risk of obesity; in the high neighborhood SES group, boys showed a pattern of higher FAS being associated with a significant increase in risk of obesity, whereas girls show a pattern of decrease. CONCLUSION: Although limited, the present study demonstrated that some girl groups exhibited a pattern of lower neighborhood SES being associated with an increase in risk of obesity, as well as a gender-based difference in risk of obesity by individual SES. Therefore, measures to prevent adolescent obesity should be established with consideration for differences in risk according to individual and neighborhood SES.

The Relationship between Daily Sodium Intake and Obesity in Korean Adults

BACKGROUND: World health organization (WHO) recommended daily sodium intake less than 2 g. To assess the validity of WHO recommendation, we investigated the relationship between daily sodium intake and obesity. METHODS: A total of 14,694 participants aged > or =19 years who had no missing data for nutrition, chronic disease, health behavior, economic status and laboratory findings from the 5th Korean National Health and Nutrition Examination Survey (KNHANES-V), which was performed from 2010 to 2012. Obesity was defined as having a body mass index of 25 kg/m2 or higher. Daily sodium intake was calculated from 24 hour recall and divided into five categories ( or =8 g). The association between daily sodium intake and obesity was analyzed using multiple logistic regressions. RESULTS: Higher sodium intake in men had an increased risk of obesity with odds ratios (ORs) of 1.27 for 2-4 g intake (95% confidence interval [CI], 0.97-1.67), 1.40 for 4-6 g intake (95% CI, 1.07-1.85), 1.41 for 6-8 g intake (95% CI, 1.05-1.89), and 1.61 for > or =8 g intake (95% CI, 1.19-2.18), compared to men with less than 2 g intake, after adjusting for confounding factors. The P value for trend of ORs in each group for men was 0.020. In women, compared to the lesser than 2 g intake, only > or =8 g intake group had an OR of 1.28 (95% CI, 1.02-1.62) without showing significant P for trend (P value for trend=0.221) CONCLUSIONS: We found that sodium intake more than 2 g per day was independently related to the increased risk of obesity in men. Therefore, to minimize the risk of obesity, we suggest taking sodium less than 2 g per day.

The Relationship between Body Fat Percent and Bone Mineral Density in Korean Adolescents: The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1), 2010 / 가정의학회지

BACKGROUND: The relationships of total and regional body fat percent with bone mineral density (BMD) in Korean adolescents were examined using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1), 2010. METHODS: Body fat percent at whole body (WBFP), trunk (TBFP), and extremities (both upper and lower extremities fat mass/body weight, EBFP), ratio of trunk fat mass to extremities fat mass (TEFR), and BMD at whole body, total femur, and lumbar spine were measured by dual energy X-ray absorptiometry in a population-based sample of 433 boys and 362 girls, aged 12 to 18 years. The analyses were conducted using linear regression analysis with complex sampling design. RESULTS: After adjusting for confounders such as age, height, weight, serum 25-(OH) vitamin D concentration, energy intake, calcium intake, physical activity, and menarche status for girls, WBFP, TBFP, and EBFP were inversely associated with whole and regional BMD in both sexes (P < 0.05). TEFR was positively associated with whole and regional BMD in boys after adjusting for confounders, while it was negatively associated in girls (P < 0.05). However, the associations were non-significant when bone mass-free lean mass was adjusted instead of bodyweight except for a positive association between TEFR and BMD in boys. CONCLUSION: In Korean adolescents, total and regional body fat percent is not independently associated with BMD after adjusting for bone mass-free lean mass but higher fat in trunk as compared to extremities may be protective for BMD in boys.