Does Better Diet Quality Offset the Association between Depression and Metabolic Syndrome?

Several studies have shown that depression increases the risk of metabolic syndrome (MetS), which is often exacerbated by the fact that both exist concurrently. People with depression are more likely to have unhealthy eating habits, which can eventually trigger the development of MetS. This study was to investigate whether diet quality modifies the association between depression and MetS in a total of 13,539 Korean adults aged 19 to 80 from 2014, 2016 and 2018 Korean National Health and Nutrition Examination Surveys. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9) and subjects were divided into subgroups according to the PHQ-9 scores: normal (<5), mild (5-9), and moderate-to-severe (≥10) groups. Diet quality was measured by the Korean Healthy Eating Index (KHEI). A complex sample multiple logistic regression stratified by tertiles of KHEI scores was used to explore whether diet quality modifies an association between depression severity and metabolic syndrome. Depression severity was positively associated with the risk of MetS (p trend = 0.006) after adjustment for potential confounders. Only the lowest diet quality, moderately-to-severely depressed group, showed a higher risk of MetS (OR: 1.72, 95% CI: 1.24-2.40) compared to the normal group. Our results suggest that healthy diet quality could offset the positive relationship between depression and MetS in the general Korean adult population. Encouraging a healthy diet regime can improve not only physical health but also the mental state of the general public.

Dietary Reference Intakes for Koreans with special consideration to older adults.

BACKGROUND/OBJECTIVES: The Dietary Reference Intakes for Koreans (KDRIs) were revised in 2020. Due to the rapidly aging Korean population, special consideration was given to reclassify the KDRI age group categories of older adults. This article examines the evidence for modifying the current KDRI age group ranges of older adults (65-74 and ≥ 75 yrs). SUBJECTS/METHODS: We first reviewed the domestic and international data on the elderly, following which we received expert opinions on age classification from the KDRI Advisory Committee. Finally, the 6th and 7th (2013-2017) Korea National Health and Nutrition Examination Survey (KNHANES) data were used to analyze the nutritional intake statuses by considering the age of older adults. RESULTS: According to the review results of domestic and international data and the inputs received from the expert advisory committee, the minimum age considered for the elderly was maintained at 65 yrs. However, the KNHANES data was analyzed to review whether there was a need to subdivide the later periods. Examining the differences in nutrient intakes by age group through the interaction effect term of the piecewise linear regression model revealed the interaction effect was maximum in the groups divided by 65 yrs (50-64 and 65-80), as compared to the groups divided by 70 yrs (50-69 and 70-80) and 75 yrs (50-74 and 75-80). The mean adequacy ratio was calculated per 1 yr of age, and a 3-yr (age) moving average analysis was performed to examine the change in the trends of overall nutrient intake. However, it was challenging to secure a scientific basis for subdivision into age groups in older adults from the results obtained. CONCLUSIONS: This study could not find any scientific evidence for modifying the KDRI age groups for older adults.

Development of the Korean Healthy Eating Index for adults, based on the Korea National Health and Nutrition Examination Survey.

BACKGROUND/OBJECTIVES: The objective of this study was to describe the development process of the Korean Healthy Eating Index (KHEI) based on the Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS: The components of KHEI were selected based on Dietary Guidelines for Koreans, domestic and overseas dietary quality indices, and results of the analysis of association with chronic diseases. The standards for scoring of KHEI were selected based on the 2015 Dietary Reference Intakes for Koreans (KDRI). The KHEI scores of Korean adults were calculated using a 1-day 24-h recall data in the 2013-2015 KNHANES. RESULTS: The KHEI included eight adequacy components evaluating the proper intake of recommended foods such as fruit, vegetable, and milk and three moderation components evaluating the consumption of food that limit intake such as sodium and saturated fatty acid. In addition, three balance components assessing the balance of energy intake were included. The KHEI score was defined to range from the minimum of 0 point to the maximum of 100 points. Among Korean adults, the total KHEI score was 63.2 out of 100. Gender and age differences were found in the average of total KHEI scores. Women showed higher score than men (61.7 in men and 64.7 in women, respectively). By age group, 20s and 30s showed the lowest scores with 57.4 and 61.1 respectively, and the scores increased with age by peaking at 67.8 in ages 60-69 and slowed down again in ages 70 or over. CONCLUSIONS: The KHEI can be useful for establishing and assessing national nutritional policies and in epidemiological studies to assess the relationship between overall dietary quality and chronic diseases. KHEI will need to be continuously updated to reflect changes in dietary guidelines and the KDRI.

Is It What They Eat or How Much They Eat That Matters More in Adults with Food Insecurity in a Wealthy-Country Context?

This study aimed to investigate whether dietary quantity and/or quality differ according to food security levels in the Korean adult population. Dietary adequacy and quality were evaluated by the Korean Dietary Reference Intake and the Korean Healthy Eating Index (KHEI) for adults, respectively, according to three food security levels, i.e., food security, low food security, and very low food security. A total of 7144 Korean adults (aged 19 to 64 years) were selected from cross-sectional data from the 2013-2015 Korean National Health and Nutrition Examination Surveys. The risk of inadequate nutrient intakes of protein (p trend = 0.021) and phosphorus (p trend = 0.002) increased according to food insecurity levels after adjustment for putative risk factors. The total KHEI scores (p < 0.001) as well as scores of having breakfast (p < 0.001) were lowest in the very low food security group. Among KHEI components, adults with food insecurity were less likely to get full scores from intakes of mixed grains (p trend = 0.016), total fruit (p trend = 0.039), fresh fruit (p trend = 0.043), and breakfast (p trend < 0.001). In addition, food-insecure adults were more likely to get zero score from intakes of fresh fruit (p trend = 0.020), milk and dairy products (p trend = 0.049), breakfast (p trend < 0.001), % of energy from sweets and beverages (p trend = 0.002), and total energy (p trend = 0.033). In conclusion, food security levels were associated with how much they ate, as well what they ate, in adults in South Korea. These results implied that the diet adequacy as well as moderation and balance could be carefully treated with food assistance or nutrition intervention once nutritional adequacy has mostly been met. In addition, targeted intervention programs tailored to diverse contexts for improving food insecurity may prevent unintended consequences due to easy access to inexpensive obesogenic foods in adults with food insecurity.

Neutral Position Facilitates Nasotracheal Intubation with a GlideScope Video Laryngoscope: A Randomized Controlled Trial.

The optimal head position for GlideScope facilitated nasotracheal intubation has not yet been determined. We compared the neutral and sniffing positions to establish the degree of intubation difficulty. A total of 88 ASA I-II patients requiring nasotracheal intubation for elective dental surgery with normal airways were divided into two groups according to head position, neutral position (group N), and sniffing position (group S). The primary outcome was the degree of intubation difficulty according to the Intubation Difficulty Scale (IDS): Easy (IDS = 0), mildly difficult (IDS = 1 to 4), and moderately to severely difficult (IDS ≥ 5). Eighty-seven patients completed the study and their data were analyzed. The degree of intubation difficulty was significantly different between the two groups (p = 0.004). The frequency of difficult intubation (IDS > 0) was 12 (27.9%) in group N and 28 (63.6%) in group S (difference in proportion, 35.7%; 95% confidence interval [CI], 14.8 to 52.6%; p = 0.001). The neutral position facilitates nasotracheal intubation with GlideScope by aligning the nasotracheal tube and the glottis inlet more accurately than the sniffing position.

Effects of Coffee Intake on Dyslipidemia Risk According to Genetic Variants in the ADORA Gene Family among Korean Adults.

Current evidence on the effects of coffee intake on cardiovascular diseases is not consistent, in part contributed by the genetic variability of the study subjects. While adenosine receptors (ADORAs) are involved in caffeine signaling, it remains unknown how genetic variations at the ADORA loci correlate the coffee intake with cardiovascular diseases. The present study examined the associations of coffee intake with dyslipidemia risk depending on genetic variants in the ADORA gene family. The study involved a population-based cohort of 4898 Korean subjects. Consumption of more than or equal to a cup of coffee per day was associated with lower dyslipidemia risk in females carrying the ADORA2B minor allele rs2779212 (OR: 0.645, 95% CI: 0.506-0.823), but not in those with the major allele. At the ADORA2A locus, male subjects with the minor allele of rs5760423 showed instead an increased risk of dyslipidemia when consuming more than or equal to a cup of coffee per day (OR: 1.352, 95% CI: 1.014-1.802). The effect of coffee intake on dyslipidemia risk differs depending on genetic variants at the ADORA loci in a sex-specific manner. Our study suggests that a dietary guideline for coffee intake in the prevention and management of dyslipidemia ought to consider ADORA-related biomarkers carefully.

Objective and perceived food environment and household economic resources related to food insecurity in older adults living alone in rural areas.

BACKGROUND: Limited attention has been paid to an association between food environment and household economic resources related to food expenditure in food-insecure seniors. The aim of the study was to investigate the relationship between factors of economic resource, food environment, and food insecurity in single seniors residing in rural areas of South Korea. METHODS: A cross-sectional study was conducted in 170 single senior households aged 65 years or over residing in rural areas. Face-to-face interviews were performed to collect data on demographic characteristics, household economic resources/expenditure, food environmental factors, and food insecurity. RESULTS: Among economic resources, generally limited food expenditures due to housing fees and heating costs during the winter were positively related to food insecurity. Among food environmental factors, food accessibility at community level such as food stores located far from home and inconvenient bus routes was related to food insecurity. The most explainable economic and food environment factors related to food insecurity by stepwise logistic regression analysis were the percentage of total expenditure on housing fee (OR = 1.021, 95% CI: 1.008-1.034), foods purchasing at super supermarket (OR = 0.398, 95% CI: 0.166-0.951), having difficulties in food purchasing due to food stores being located far from home (OR = 14.487, 95% CI: 5.139-40.842) and inconvenient bus routes (OR = 0.083, 95% CI: 0.015-0.460). CONCLUSION: Inadequate community food environment as well as limited household food resources were an important risk factor for food insecurity in Korean single rural seniors. Findings of this study could help us better understand how characteristics of household food resources and community food environment can serve as barriers or facilitators of food security among single older adults residing in rural areas.

Diet quality, physical activity, and their association with metabolic syndrome in Korean adults.

OBJECTIVE: The aim of ths study was to investigate the combined association of overall diet quality and physical activity (PA) on the risk for metabolic syndrome (MetS) in Korean adults. METHODS: This cross-sectional study extracted the data on 1008 adults (384 men and 624 women) 20 to 64 y of age. Dietary quality was assessed using a recommended food score (RFS) modified for a Korean diet. The total PA was summed to obtain a metabolic equivalent task score. Participants were classified according to the recommended levels of PA and RFS. Multiple logistic regression analysis was applied to determine the associations of RFS and PA with the prevalence of MetS after adjustment for potential confounders. RESULTS: About 21% of men and 19% of women were reported to have MetS. Nearly 5% of both sexes reached the recommended level of diet quality and PA. In men, a significantly reduced odds ratio (OR) for MetS (OR, 0.16; 95% confidence interval [CI], 0.09-0.93) and hypertriglyceridemia (OR, 0.25; 95% CI, 0.04-0.99) was found in those with better diet quality, within the strata of high PA. In women, compared with inactive individuals with poor diet quality, the OR for abdominal obesity in those with a better diet quality and who were active was 0.21 (95% CI, 0.05-0.86). CONCLUSIONS: Both diet quality and PA are associated with a lower risk for hypertriglyceridemia in men and abdominal obesity in women. These findings suggest that a sex-specific pattern of association between MetS and lifestyle factors (diet and PA) should be considered in clinical practice.

Fruit and vegetable intakes in relation to behavioral outcomes associated with a nutrition education intervention in preschoolers.

BACKGROUND/OBJECTIVES: Although a lot of effort has been put into increasing fruit and vegetable intakes in preschool children, vegetable intake in this group is still low. This study investigated whether nutrition education focusing on fruit and vegetable intakes can affect preschoolers' fruit and vegetable intakes as well as their behavioral outcomes. SUBJECTS/METHODS: Thirty-five preschoolers (54.3% boys, n = 19) aged 4-6 years residing in Seoul underwent weekly nutrition education intervention (8 sessions) between May and July 2016. Intakes of fruits and vegetables were measured during pre and post-intervention. At snack time, fresh fruit (150 g) and vegetable (120 g) snacks were distributed to each child by teachers. The remaining portions of the snacks were weighed and recorded for each child. Behavioral outcomes were measured by applying Child behavior checklist 1.5-5 and the Diagnostic and statistical manual of mental disorders. RESULTS: During post intervention, vegetable intake increased from 36.15 ± 30.64 g to 48.01 ± 31.23 g (P = 0.010). Among the emotional and behavioral problems measured by parents, levels of total problems (P = 0.001), internalizing (P = 0.004), externalizing (P = 0.003), anxiety and depression (P = 0.001), and aggressive behavior (P = 0.005) decreased. Anxiety (P = 0.026) score, as measured by teachers, also decreased. CONCLUSIONS: Nutrition education of preschoolers regarding the intakes of fruits and vegetables had a positive effect on preschoolers' vegetable intake as well as on their emotional and behavioral outcomes. A long-term, large-scale study with a broader study design is warranted to further investigate the role of fruit and vegetable intake in cognitive development and behavior of preschoolers.

Spatial Disparity in Food Environment and Household Economic Resources Related to Food Insecurity in Rural Korean Households with Older Adults.

Different contextual factors of a household and a community, such as access to resources and transportation, may influence the level of food insecurity. The objective of this study was to identify how food environmental factors and economic resources were related to food insecurity in Korean older adults residing in different contexts of rural areas. Face-to-face interviews with 248 older adults residing in land (n = 149) and mountain (n = 99) rural areas were performed. In both areas, risk of food insecurity was increased for households with limited community food accessibility measured by having difficulties in food purchasing due to food stores far from home. There were discrepancies in factors related to increased risks of food insecurity between households in land and mountain areas. The experience of reducing food expenditure resulting from burden of heating costs during the winter in households in a mountain area whereas the percent proportion of housing fee and household cook's physical disability in households residing in the land area were found to be factors associated with increased risks of food insecurity. For households residing in mountain areas, the risk of food insecurity was decreased when economic resources measured by average monthly income for the last one year was increased and there was farming or home gardening activity. Such spatial disparity might affect household food insecurity in rural areas. In addition, food environmental factors and economic resources may affect household food insecurity differently according to the diverse contexts of rural areas. Better understanding of spatial challenges in food insecurity faced by seniors in a large rural area would help prepare programs or policy change to strengthen and improve their food environments.

Development of tailored nutrition information messages based on the transtheoretical model for smartphone application of an obesity prevention and management program for elementary-school students.

BACKGROUND/OBJECTIVES: Easy access to intervention and support for certain behaviors is important for obesity prevention and management. The available technology such as smartphone applications can be used for intervention regarding healthy food choices for obesity prevention and management in elementary-school students. The transtheoretical model (TTM) is comprised of stages and processes of change and can be adopted to tailored education for behavioral change. This study aims to develop TTM-based nutrition contents for mobile applications intended to change eating behaviors related to weight gain in young children. SUBJECTS/METHODS: A synthesized algorithm for tailored nutrition messages was developed according to the intake status of six food groups (vegetables, fruits, sugar-sweetened beverages, fast food and instant food, snacks, and late-night snacks), decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. The messages in this study were developed from December 2014 to April 2015. After the validity evaluation of the contents through expert consultation, tailored nutrition information messages and educational contents were developed based on the TTM. RESULTS: Based on the TTM, stages of subjects are determined by their current intake status, decision to make dietary behavioral changes, and self-confidence in dietary behavioral changes. Three versions of tailored nutrition messages at each TTM stage were developed so as to not send the same messages for three weeks at most, and visual materials such as figures and tables were developed to provide additional nutritional information. Finally, 3,276 tailored nutrition messages and 60 nutrition contents for applications were developed. CONCLUSIONS: Smartphone applications may be an innovative medium to deliver interventions for eating behavior changes directly to individuals with favorable cost-effectiveness. In addition, using the TTM for tailored nutrition education for healthy eating is an effective approach.

Intake of antioxidants and B vitamins is inversely associated with ischemic stroke and cerebral atherosclerosis.

BACKGROUND/OBJECTIVES: This study was conducted to examine relationships between dietary habits and intakes of antioxidants and B vitamins and the risk of ischemic stroke, and to compare dietary factors according to the presence of cerebral artery atherosclerosis and stroke subtypes. SUBJECTS/METHODS: A total of 147 patients and 144 control subjects were recruited consecutively in the metropolitan area of Seoul, Korea. Sixty participants each in the case and control groups were included in analyses after 1:1 frequency matching. In addition, 117 acute ischemic stroke patients were classified into subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) guidelines. Dietary intake was measured using a semi-quantitative food frequency questionnaire composed of 111 food items and plasma lipid and homocysteine levels were analyzed. RESULTS: When compared with control subjects, stroke patients had unfavorable dietary behaviors and lower intakes of fruits (73.1 ± 83.2 g vs. 230.9 ± 202.1 g, P < 0.001), vegetables (221.1 ± 209.0 g vs. 561.7 ± 306.6 g, P < 0.001), and antioxidants, including vitamins C, E, B6, ß-carotene, and folate. The intakes of fruits, vegetables, vitamin C, and folate were inversely associated with the risk of ischemic stroke after adjusting for confounding factors. Intakes of vegetables, vitamins C, B6, B12, and folate per 1,000 kcal were lower in ischemic stroke with cerebral atherosclerosis than in those without. Overall vitamin B12 intake per 1,000 kcal differed according to the TOAST classification (P = 0.004), but no differences among groups existed based on the post-hoc test. CONCLUSIONS: When compared with control subjects, ischemic stroke patients, particularly those with cerebral atherosclerosis, had unfavorable dietary intake, which may have contributed to the development of ischemic stroke. These results indicate that proper dietary recommendations are important for the prevention of ischemic stroke.

Dietary intake of fats and fatty acids in the Korean population: Korea National Health and Nutrition Examination Survey, 2013.

BACKGROUND/OBJECTIVES: The aim of this study was to estimate average total fat and fatty acid intakes as well as identify major food sources using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI-1 (2013). SUBJECTS/METHODS: Total fat and fatty acid intakes were estimated using 24-hour dietary recall data on 7,048 participants aged ≥ 3 years from the KNHANES VI-1 (2013). Data included total fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), n-3 fatty acid (n-3 FA), and n-6 fatty acid (n-6 FA) levels. Population means and standard errors of the mean were weighted in order to produce national estimates and separated based on sex, age, income, as well as residential region. Major food sources of fat, SFA, MUFA, PUFA, n-3 FA, and n-6 FA were identified based on mean consumption amounts of fat and fatty acids in each food. RESULTS: The mean intake of total fat was 48.0 g while mean intakes of SFA, MUFA, PUFA, n-3 FA, and n-6 FA were 14.4 g, 15.3 g, 11.6 g, 1.6 g, and 10.1 g, respectively. Intakes of MUFA and SFA were each higher than that of PUFA in all age groups. Pork was the major source of total fat, SFA, and MUFA, and soybean oil was the major source of PUFA. Milk and pork were major sources of SFA in subjects aged 3-11 years and ≥ 12 years, respectively. Perilla seed oil and soybean oil were main sources of n-3 FA in subjects aged ≥ 50 years and aged < 50 years, respectively. CONCLUSIONS: Estimation of mean fatty acid intakes of this study using nationally represented samples of the Korean population could be useful for developing and evaluating national nutritional policies.

Analysis of Self-Adhesive Resin Cement Microshear Bond Strength on Leucite-Reinforced Glass-Ceramic with/without Pure Silane Primer or Universal Adhesive Surface Treatment.

OBJECTIVE: To evaluate the microshear bond strength (µSBS) of self-adhesive resin (SA) cement on leucite-reinforced glass-ceramic using silane or universal adhesive. MATERIALS AND METHODS: Ceramic blocks were etched with 9.5% hydrofluoric acid and divided into three groups (n = 16): (1) negative control (NC) without treatment; (2) Single Bond Universal (SBU); (3) RelyX Ceramic Primer as positive control (PC). RelyX Unicem resin cement was light-cured, and µSBS was evaluated with/without thermocycling. The µSBS was analyzed using one-way analysis of variance. The fractured surfaces were examined using stereomicroscopy and scanning electron microscopy (SEM). RESULTS: Without thermocycling, µSBS was highest for PC (30.50 MPa ± 3.40), followed by SBU (27.33 MPa ± 2.81) and NC (20.18 MPa ± 2.01) (P < 0.05). Thermocycling significantly reduced µSBS in SBU (22.49 MPa ± 4.11) (P < 0.05), but not in NC (20.68 MPa ± 4.60) and PC (28.77 MPa ± 3.52) (P > 0.05). PC and NC predominantly fractured by cohesive failure within the ceramic and mixed failure, respectively. CONCLUSION: SBU treatment improves µSBS between SA cement and glass ceramics, but to a lower value than PC, and the improvement is eradicated by thermocycling. NC exhibited the lowest µSBS, which remained unchanged after thermocycling.

Real-Time Analysis of Temperature Changes in Composite Increments and Pulp Chamber during Photopolymerization.

OBJECTIVE: The aim of this study was to evaluate the temperature change at various sites within the composite and on the pulpal side of dentin during polymerization of two composite increments. MATERIALS AND METHODS: Class I cavities prepared in third molars were restored in two composite increments (n = 5). Temperatures were measured for 110 s using eight thermocouples: bottom center of cavity (BC), top center of 1st increment (MC), top center of 2nd increment (TC), bottom corner of cavity (BE), top corner of 1st increment (ME), top corner of 2nd increment (TE), pulpal side of dentin (PD), and center of curing light guide tip (CL). RESULTS: Maximum temperature values (°C) measured during polymerization of 1st increment were MC (59.8); BC (52.8); ME (51.3); CL (50.7); BE (48.4); and PD (39.8). Maximum temperature values during polymerization of 2nd increment were TC 58.5; TE (52.6); MC (51.7); CL (50.0); ME (48.0); BC (46.7); BE (44.5); and PD (38.8). CONCLUSION: Temperature at the floor of the cavity was significantly higher during polymerization of 1st increment compared to 2nd increment. Temperature rise was higher at the center than at the corner and at the top surface than at the bottom surface of each increment.

Performance of universal adhesives on bonding to leucite-reinforced ceramic.

BACKGROUND: This study aimed to investigate the microshear bond strength of universal bonding adhesives to leucite-reinforced glass-ceramic. METHODS: Leucite-reinforced glass-ceramic blocks were polished and etched with 9.5% hydrofluoric acid for 1 min. The specimens were assigned to one of four groups based on their surface conditioning (n = 16): 1) NC: negative control with no further treatment; 2) SBU: Single Bond Universal (3M ESPE); 3) ABU: ALL-BOND Universal (Bisco); and 4) PC: RelyX Ceramic Primer and Adper Scotchbond Multi-Purpose Adhesive (3M ESPE) as a positive control. RelyX Ultimate resin cement (3M ESPE) was placed on the pretreated ceramic and was light cured. Eight specimens from each group were stored in water for 24 h, and the remaining eight specimens were thermocycled 10,000 times prior to microshear bond strength evaluation. The fractured surfaces were examined by stereomicroscopy and scanning electron microscopy (SEM). RESULTS: After water storage and thermocycling, the microshear bond strength values decreased in the order of PC > SBU and ABU > NC (P < 0.05). Thermocycling significantly reduced the microshear bond strength, regardless of the surface conditioning used (P < 0.05). Cohesive failure in the ceramic and mixed failure in the ceramic and resin cement were observed in the fractured specimens. The percentage of specimens with cohesive failure after 24 h of water storage was: NC (50%), SBU (75%), ABU (75%), and PC (87%). After thermocycling, the percentage of cohesive failure in NC decreased to 25%; however, yet the percentages of the other groups remained the same. CONCLUSIONS: Although the bond strength between resin and hydrofluoric acid-etched glass ceramic was improved when universal adhesives were used, conventional surface conditioning using a separate silane and adhesive is preferable to a simplified procedure that uses only a universal adhesive for cementation of leucite-reinforced glass-ceramic.

Evidence-based estimation of health care cost savings from the use of omega-3 supplementation among the elderly in Korea.

BACKGROUND/OBJECTIVES: By the year 2050, thirty-eight percent of the Korean population will be over the age of 65. Health care costs for Koreans over age 65 reached 15.4 trillion Korean won in 2011, accounting for a third of the total health care costs for the population. Chronic degenerative diseases, including coronary heart disease (CHD), drive long-term health care costs at an alarming annual rate. In the elderly population, loss of independence is one of the main reasons for this increase in health care costs. Korean heath policies place a high priority on the prevention of CHD because it is a major cause of morbidity and mortality. SUBJECTS/METHODS: This evidence-based study aims to the estimate potential health care cost savings resulting from the daily intake of omega-3 fatty acid supplementation. Potential cost savings associated with a reduced risk of CHD and the medical costs potentially avoided through risk reduction, including hospitalizations and physician services, were estimated using a Congressional Budget Office cost accounting methodology. RESULTS: The estimate of the seven-year (2005-2011) net savings in medical costs resulting from a reduction in the incidence of CHD among the elderly population through the daily use of omega-3 fatty acids was approximately 210 billion Korean won. Approximately 92,997 hospitalizations due to CHD could be avoided over the seven years. CONCLUSIONS: Our findings suggest that omega-3 supplementation in older individuals may yield substantial cost-savings by reducing the risk of CHD. It should be noted that additional health and cost benefits need to be revisited and re-evaluated as more is known about possible data sources or as new data become available.

Comparison of photopolymerization temperature increases in internal and external positions of composite and tooth cavities in real time: Incremental fillings of microhybrid composite vs. bulk filling of bulk fill composite.

OBJECTIVES: This study evaluated temperature increases in the composite and pulpal side of dentin from incremental and bulk fillings in composite restorations. METHODS: Class-1 cavities (5 mm × 4 mm × 3 mm) were prepared in ten extracted third molars, filled with composite, and restored with two separate horizontal layers of Filtek Z250 (3M ESPE) in the incremental group or a single layer of SureFil SDR Flow (Dentsply) in the bulk-fill group (n=5). After placing the specimens in a 36.5°C water bath, temperatures were measured with eight thermocouples at the bottom center (BC), middle center (MC), top center (TC), bottom corner (BE), middle corner (ME), and top corner (TE) of the cavity, at the pulpal side of the dentin within the pulp chamber (PD), and in the curing light (CL) tip during light curing at 750 mW/cm(2) for 20s and then analyzed with one-way analysis of variance and Tukey's HSD tests (α=0.01). RESULTS: Maximum temperatures ranged from 39.0°C (PD 1st increment) to 60.0°C (MC 1st increment) in the incremental group and from 42.0°C (PD) to 74.9°C (TC) in the bulk-fill group. In the incremental group, temperatures were similar between the 1st and 2nd increments, except at MC and BC. CONCLUSIONS: Bulk-fill group exhibited a greater increase in temperature during composite restoration. Regardless of the filling technique, more heat was generated at the center than at the corner and at the top than at the bottom of the composite. PD temperatures increased by 3.1°C and 5.5°C in the incremental group and bulk-fill group, respectively. CLINICAL SIGNIFICANCE: Although bulk fillings save clinical chair time, clinicians should be aware of the greater heat that is generated with increasing amounts of composites during polymerization, which can jeopardize the pulpal health, especially when a large and deep cavity is being restored.

Epigenetics: general characteristics and implications for oral health.

Genetic information such as DNA sequences has been limited to fully explain mechanisms of gene regulation and disease process. Epigenetic mechanisms, which include DNA methylation, histone modification and non-coding RNAs, can regulate gene expression and affect progression of disease. Although studies focused on epigenetics are being actively investigated in the field of medicine and biology, epigenetics in dental research is at the early stages. However, studies on epigenetics in dentistry deserve attention because epigenetic mechanisms play important roles in gene expression during tooth development and may affect oral diseases. In addition, understanding of epigenetic alteration is important for developing new therapeutic methods. This review article aims to outline the general features of epigenetic mechanisms and describe its future implications in the field of dentistry.

Cytotoxicity of four denture adhesives on human gingival fibroblast cells.

OBJECTIVE: The purpose of this study was to compare the cytotoxicity of four denture adhesives on human gingival fibroblast cells. MATERIALS AND METHODS: Immortalized human gingival fibroblasts were cultured with one of four different denture adhesives, Polident, Protefix, Staydent or Denfix-A, which was placed in insert dishes (10% w/v concentration) for 48 h. The MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay and flow cytometric apoptosis assay were used to evaluate cell viability and apoptosis rates. The fibroblasts were also examined under a scanning electron microscope. RESULTS: The MTT assay showed that all denture adhesives resulted in a significantly lower cell viability compared to the control cells propagated in normal culture medium (p < 0.05), with Staydent demonstrating the lowest cell viability. According to the flow cytometric apoptosis assay, Staydent and Protefix showed significantly higher apoptosis rates than the control group (p < 0.05), whereas Polident and Denfix-A did not demonstrate any significant differences (p > 0.05). Staydent showed the highest apoptosis rate. Scanning electron microscopy showed that the cells of the Staydent group underwent cytoplasmic membrane shrinkage, with cell free areas containing residual fragments of the membrane of dead cells. CONCLUSIONS: The four denture adhesives evaluated in this study imparted cytotoxic effects on human gingival fibroblast cells. Staydent showed the highest toxicity.