Low relative muscle mass and left ventricular diastolic dysfunction in middle-aged adults.

OBJECTIVES: The association between low skeletal muscle mass and left ventricular diastolic dysfunction (LVDD), a predictor of future heart failure, is largely unexplored. We investigated the relationship between relative muscle mass and LVDD. METHODS: We conducted a cross-sectional study in 67,106 Koreans who underwent an echocardiography as part of a comprehensive health examination between January 2012 and December 2014. Skeletal muscle mass index (SMI) [SMI (%)=total skeletal muscle mass (kg)/body weight (kg)×100] was estimated using a bioelectrical impedance analyzer. The presence of LVDD was determined using echocardiographic findings. RESULTS: In 67,106 participants, 19,232 subjects (28.7%) and 1553 subjects (2.3%) had LVDD and left ventricular (LV) hypertrophy, respectively. SMI was positively associated with E/A ratio and septal E', whereas E/E' ratio and LV mass index were negatively associated with SMI. Lower SMI was associated with increased presence of LVDD. In a multivariable-adjusted model controlling for potential confounders including physical activity, insulin resistance, and LV mass, the odds ratios for LVDD in SMI quartiles 1, 2, and 3 compared with quartile 4 were 2.11 (1.97-2.25), 1.79 (1.68-1.90), and 1.45 (1.36-1.55), respectively (P for trend<0.001). CONCLUSIONS: In a large sample of young and middle-aged Korean adults, low relative muscle mass was independently associated with increased risk of LVDD, indicating an independent role of skeletal muscle mass in the pathogenesis of LVDD.

Irisin and leptin concentrations in relation to obesity, and developing type 2 diabetes: A cross sectional and a prospective case-control study nested in the Normative Aging Study.

OBJECTIVE: To investigate the associations between irisin and leptin levels in obesity and insulin resistance in a cross sectional study. To assess the potential role of irisin and leptin as a predictive marker of T2DM using a nested case-control study. METHODS: Both studies were designed within the longitudinal VA NAS cohort. The cross sectional study involved 111 non obese and 105 obese subjects who were subdivided into two groups based on their fasting glucose tolerance. In the nested 1:3 case-control study, 47 subjects with T2DM and 140 non-diabetic controls were selected. Serum samples collected 3-5 years before the diagnosis of T2DM were analyzed. Irisin and leptin concentrations were measured using a validated ELISA and radioimmunoassay respectively. RESULTS: In the cross-sectional study, irisin did not differ between groups based on their fasting glucose tolerance. When subjects were grouped based on obesity status, both irisin and leptin concentrations were significantly higher in obese compared to the non-obese group (p=0.03 and <0.001, respectively). Irisin concentrations positively correlated with leptin concentrations (r= 0.392, P < 0.001). In the nested case control study, leptin concentrations were a significant predictor of developing diabetes (p=0.005) in unadjusted models, but not after correcting for BMI, whereas irisin concentrations did not play a role of comparable significance. CONCLUSIONS: Leptin concentrations are higher in the obese group irrespective of their glucose tolerance. Obese individuals with impaired fasting glucose have higher concentrations of circulating irisin compared to non-obese subjects with normal glucose tolerance. Irisin concentrations do not predict risk of developing diabetes prospectively.

Dietary acid load and chronic kidney disease in elderly adults: Protein and potassium intake.

BACKGROUND: Dietary net endogenous acid production (NEAP), which represents total dietary load of nonvolatile acid, may affect kidney function. Estimated NEAP (eNEAP) is calculated indirectly by the ratio of protein and potassium intake. A few studies are available assessing the association between eNEAP and chronic kidney disease (CKD), and its relation to dietary protein and potassium intake in the elderly. METHODS: A total 1,369 community-dwelling elderly Koreans in the Kangbuk Samsung Cohort Study (KSCS) were evaluated using a food frequency questionnaire (FFQ) and comprehensive health examination. We evaluated the association between eNEAP and the CKD. We also examined their relation to protein and potassium intake. RESULTS: eNEAP was correlated with potassium intake (r = -0.410, P < 0.001), but was not correlated with protein intake (r = -0.004, P = 0.879). In a full multivariate adjustment for sociodemographic factors, dietary factors, and comorbidities, the participants with higher eNEAP quartiles (Q2, Q3, Q4) had higher odds of CKD compared to the lowest eNEAP quartile (Q1); OR (95% CI) were 1.47 (0.78-2.72), 1.66 (0.85-3.23), and 2.30 (1.16-4.60) respectively (P for trend = 0.019). The odds of CKD decreased for participants with higher potassium intake quartiles (Q2, Q3, Q4) compared to the lowest potassium intake quartile (Q1); OR (95% CI) were 0.52 (0.28-0.95), 0.50 (0.26-0.96), and 0.50 (0.21-0.99) respectively (P for trend = 0.050). Protein intake was not associated with CKD. The association between eNEAP and CKD was similar in subgroup analysis. CONCLUSION: Dietary acid load was associated with CKD. Among the nutrients related to dietary acid load, potassium intake was negatively associated with CKD, but protein intake was not associated with CKD in elderly adults.

Sleep duration and quality in relation to chronic kidney disease and glomerular hyperfiltration in healthy men and women.

BACKGROUND: It is unclear whether sleep duration and quality are associated with chronic kidney disease (CKD) and glomerular hyperfiltration. The aim of this study was to examine the association of sleep duration and quality with CKD and glomerular hyperfiltration in young and middle-aged adults. METHODS: We conducted a cross-sectional study of men and women who underwent a health checkup examination, including assessment of sleep duration and quality (n = 241,607). Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2, and glomerular hyperfiltration was defined as eGFR above the age-/sex-specific 95th percentile. RESULTS: In a multinomial logistic regression analysis adjusting for relevant confounders, the adjusted prevalence ratios for CKD (95% confidence interval) comparing sleep durations of ≤ 5, 6, 8, and 9 hours with 7 hours were 1.22 (0.95-1.55), 0.93 (0.75-1.14), 0.97 (0.75-1.26), and 1.56 (1.06-2.30) in men and 0.98 (0.68-1.43), 1.03 (0.72-1.46), 1.39 (0.97-2.00), and 1.31 (0.78-2.22) in women, respectively. The corresponding prevalence ratios (95% confidence interval) for glomerular hyperfiltration were 1.00 (0.93-1.08), 0.97 (0.91-1.03), 1.03 (0.94-1.13), and 1.39 (1.13-1.72) in men and 1.04 (0.95-1.14), 0.96 (0.90-1.04), 1.11 (1.02-1.20), and 1.28 (1.14-1.45) in women, respectively. Poor subjective sleep quality was associated with glomerular hyperfiltration in men and women. CONCLUSION: In this large study of young and middle-aged adults, we found that long sleep duration was associated with CKD and glomerular hyperfiltration. Additionally, poor subjective sleep quality was associated with increased prevalence of glomerular hyperfiltration, suggesting the importance of adequate quantity and quality of sleep for kidney function.

Waist Gain Is Associated with a Higher Incidence of Nonalcoholic Fatty Liver Disease in Korean Adults: A Cohort Study.

BACKGROUND: We examined the relationship between changes in waist circumference (WC) and the incidence of nonalcoholic fatty liver disease (NAFLD). METHODS: A cohort study of 37,130 men and women were followed-up annually or biennially. Differences in WC between baseline and subsequent measurements were categorized in quartiles: first (WC loss), second (no change in WC as the reference), third and highest quartiles (WC gain). The presence of fatty liver was determined using ultrasound. Parametric Cox modeling was used to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) of the incidence of NAFLD. RESULTS: During 127,324.4 person-years of follow-up, 6249 participants developed NAFLD. Despite adjusting for possible confounders, the risk of development of NAFLD increased with increasing quartiles of WC change in a dose-response manner (p for trend < 0.001). Compared with the reference, WC loss was associated with a lower risk of NAFLD (men: aHR 0.79 [95% CI: 0.73-0.87]; women: 0.72 [0.63-0.81]), and the highest quartile (WC gain) was associated with a higher risk of NAFLD (men: 1.30 [1.19-1.42]; women: 1.48 [1.31-1.67]). CONCLUSION: Waist gain appears to increase the risk of developing NAFLD, independently of the baseline body mass index and WC.

Short-term administration of the GLP-1 analog liraglutide decreases circulating leptin and increases GIP levels and these changes are associated with alterations in CNS responses to food cues: A randomized, placebo-controlled, crossover study.

BACKGROUND: GLP-1 agonists, including liraglutide, have emerged as effective therapies for type 2 diabetes (DM) and obesity. Here, we attempted to delineate how liraglutide, at doses approved for DM, may impact circulating hormones influencing energy homeostasis in diabetics. BASIC PROCEDURES: Using a randomized, placebo-controlled, double-blind, cross-over trial of 20 patients with type 2 diabetes, we examined the effects of liraglutide as compared to placebo on fasting levels of circulating hormones important to energy homeostasis, including leptin, ghrelin, PYY, and GIP. After 17days (0.6mg for 7days, 1.2mg for 7days and 1.8mg for 3days) of treatment, we also studied changes in fMRI responses to food cues. MAIN FINDINGS: By design, to avoid any confounding by weight changes, subjects were studied for 17days, i.e. before body weight changed. Participants on liraglutide had significantly increased GLP-1 levels (p<0.001), decreased percent change in leptin levels (p<0.01) and increased GIP levels (p<0.03) in comparison to placebo treated subjects. Whole brain regressions of functional activity in response to food cues reveal that increased GIP levels were associated with deactivation of the attention- and reward-related insula. Decreases in leptin levels were associated with activations in the reward-related midbrain, precuneus, and dorsolateral prefrontal cortex (DLPFC), and sensorimotor-related motor cortex and with deactivations in the attention-related parietal cortex and the cognitive control-related thalamus and pre-SMA. PRINCIPAL CONCLUSIONS: We demonstrate herein short-term changes to circulating levels of GIP and leptin in response to GLP-1 agonist liraglutide therapy. These findings suggest that liraglutide may alter the circulating levels of hormones important in energy homeostasis that, in turn, influence CNS perception of food cues. This could possibly lead to compensatory changes in energy homeostasis that could over time limit the efficacy of liraglutide to decrease body weight. These novel findings, which, pointing to the potential advantages of combination therapies, may have therapeutic implications, will need to be confirmed by larger and longer-term trials.

Relationship Between Low Relative Muscle Mass and Coronary Artery Calcification in Healthy Adults.

OBJECTIVE: Sarcopenia or low muscle mass is related to cardiovascular risk factors; however, the association between low muscle mass and subclinical atherosclerosis has been largely unexplored. We investigated whether muscle mass is related to coronary artery calcification (CAC) in a large sample of middle-aged asymptomatic adults. APPROACH AND RESULTS: We performed a cross-sectional study of 31 108 asymptomatic adults without cancer, diabetes mellitus, or known cardiovascular disease who underwent a health checkup examination including cardiac tomography estimation of CAC scores between 2012 and 2013. Skeletal muscle mass index (SMI) [SMI (%)=total skeletal muscle mass (kg)/body weight (kg)×100] was estimated using a bioelectrical impedance analyzer. We assessed the relationship between SMI and CAC scores using both multivariate-adjusted Tobit models and multinomial logistic regression models. Of the 31 108 subjects, 3374 subjects (10.9%) had a CAC score 1 to 100, and 628 subjects (2.0%) had a CAC score >100. SMI was inversely associated with CAC score ratios. Specifically, in a multivariable-adjusted model adjusting for potential confounders, CAC score ratios (95% confidence intervals) of SMI for quartiles 1, 2, and 3 compared with quartile 4 were 2.27 (1.70-3.05), 1.46 (1.15-1.85), and 1.24 (0.98-1.55), respectively (P for trend <0.001). Adjusting for insulin resistance reduced the magnitude of the associations, but they remained statistically significant. CONCLUSIONS: Relative muscle mass was negatively associated with the prevalence of coronary calcification, supporting low muscle mass as an independent risk factor of coronary heart disease.

GLP-1 receptors exist in the parietal cortex, hypothalamus and medulla of human brains and the GLP-1 analogue liraglutide alters brain activity related to highly desirable food cues in individuals with diabetes: a crossover, randomised, placebo-controlled trial.

AIMS/HYPOTHESIS: Liraglutide is a glucagon-like peptide-1 (GLP-1) analogue that has been demonstrated to successfully treat diabetes and promote weight loss. The mechanisms by which liraglutide confers weight loss remain to be fully clarified. Thus, we investigated whether GLP-1 receptors are expressed in human brains and whether liraglutide administration affects neural responses to food cues in diabetic individuals (primary outcome). METHODS: In 22 consecutively studied human brains, expression of GLP-1 receptors in the hypothalamus, medulla oblongata and parietal cortex was examined using immunohistochemistry. In a randomised (assigned by the pharmacy using a randomisation enrolment table), placebo-controlled, double-blind, crossover trial, 21 individuals with type 2 diabetes (18 included in analysis due to lack or poor quality of data) were treated with placebo and liraglutide for a total of 17 days each (0.6 mg for 7 days, 1.2 mg for 7 days, and 1.8 mg for 3 days). Participants were eligible if they had type 2 diabetes and were currently being treated with lifestyle changes or metformin. Participants, caregivers, people doing measurements and/or examinations, and people assessing the outcomes were blinded to the medication assignment. We studied metabolic changes as well as neurocognitive and neuroimaging (functional MRI) of responses to food cues at the clinical research centre of Beth Israel Deaconess Medical Center. RESULTS: Immunohistochemical analysis revealed the presence of GLP-1 receptors on neurons in the human hypothalamus, medulla and parietal cortex. Liraglutide decreased activation of the parietal cortex in response to highly desirable (vs less desirable) food images (p < 0.001; effect size: placebo 0.53 ± 0.24, liraglutide -0.47 ± 0.18). No significant adverse effects were noted. In a secondary analysis, we observed decreased activation in the insula and putamen, areas involved in the reward system. Furthermore, we showed that increased ratings of hunger and appetite correlated with increased brain activation in response to highly desirable food cues while on liraglutide, while ratings of nausea correlated with decreased brain activation. CONCLUSIONS/INTERPRETATION: For the first time, we demonstrate the presence of GLP-1 receptors in human brains. We also observe that liraglutide alters brain activity related to highly desirable food cues. Our data point to a central mechanism contributing to, or underlying, the effects of liraglutide on metabolism and weight loss. Future studies will be needed to confirm and extend these findings in larger samples of diabetic individuals and/or with the higher doses of liraglutide (3 mg) recently approved for obesity. TRIAL REGISTRATION: ClinicalTrials.gov NCT01562678 FUNDING : The study was funded by Novo Nordisk, NIH UL1 RR025758 and 5T32HD052961.

Relationship Between Bariatric Surgery and Bone Mineral Density: a Meta-analysis.

BACKGROUND: A meta-analysis regarding bone loss after bariatric surgery, designed to compare surgical and nonsurgical groups, has not yet been performed. Therefore, we performed a meta-analysis to compare the differences between bariatric surgical groups and nonoperated controls with regard to bone mineral density. METHODS: In March 2015, we performed a review of the literature using PubMed, EMBASE, and the Cochrane Library. The search focused on retrospective and prospective studies, including but not limited to randomized studies published in English. RESULTS: Among 1299 studies that were initially screened, ten met the selection criteria. For all types of bariatric surgery, bone density at the femoral neck was lower in the surgical group than in the nonsurgical control group (mean difference [MD] -0.05 g/cm(2); 95 % confidence interval [CI], -0.07 to -0.02; p = 0.001); no difference in bone density was found between the two groups at the lumbar spine (MD -0.01 g/cm(2); 95 % CI -0.07 to 0.05; p = 0.661). The analysis of Roux-en-Y gastric bypass showed similar results. CONCLUSION: Bone density at the femoral neck decreased after bariatric surgery, compared to that in nonsurgical controls, whereas bone density at the lumbar spine did not show a difference between groups. Further larger scale studies with comparative nonsurgical controls are warranted to overcome the heterogeneity among studies in this analysis and to add evidence of possible bone loss subsequent to bariatric surgical procedures.

Self-reported eating speed in relation to non-alcoholic fatty liver disease in adults.

PURPOSE: Non-alcoholic fatty liver disease (NAFLD), known to be related to insulin resistance, has been the focus of intensive research efforts due to its increasing prevalence and clinical significance. Rapid eating behavior is another emerging health issue associated with insulin resistance. We aimed to clarify the correlation between self-reported eating speed and NAFLD, both known to be related to insulin resistance. METHODS: A cross-sectional study was conducted during routine medical checkups on 7,917 consecutively enrolled participants. Anthropometric, biochemical, nutritional, and social parameters were checked. The self-reported eating speed per their usual meal (<5, 5-10, 10-15, and more than 15 min) was recorded by a registered dietitian. RESULTS: The faster eating groups had a higher proportion of NAFLD, and the grade of NAFLD was advanced. After controlling for anthropometric, cardiometabolic, social, and nutritional parameters, the fastest eating group (<5 min) showed an increased risk of NAFLD compared with the lowest eating speed group (≥15 min) both in total [odds ratio (OR) 1.81, 95% confidence interval (CI) 1.24-2.63] and the participants with BMI < 25 kg/m(2) (OR 1.79, 95% CI 1.22-2.61). As the self-reported eating speed increased, the risk of NAFLD also increased in total and those with BMI < 25 kg/m(2) (P for trend <0.001). CONCLUSIONS: Fast eating is associated with an increased risk of the presence and grade of NAFLD in Korean adults, especially those with BMI < 25 kg/m(2), since presence of overweight or obesity may be overwhelming the effect on NAFLD.

Diet quality and diet patterns in relation to circulating cardiometabolic biomarkers.

BACKGROUND & AIMS: We examined the effects of diet quality and dietary patterns in relation to biomarkers of risk including leptin, soluble intracellular adhesion molecule 1 (sICAM-1), C-reactive protein (CRP), and irisin. METHODS: We analyzed data from 196 adults cross-sectionally. Dietary patterns were identified by factor analysis and diet quality scores were generated using a validated food-frequency questionnaire. RESULTS: Both the alternate healthy eating index-2010 (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) scores were negatively related to CRP, even after controlling for body mass index and total energy intake. Similarly, the prudent diet pattern was negatively related to leptin, sICAM-1, and CRP, whereas the Western diet pattern showed positive associations with these markers; however, after adjusting for all confounders, the associations only remained significant for leptin and sICAM-1. Irisin was positively associated with DASH and the prudent diet after controlling for all confounders (standardized ß = 0.23, P = 0.030; standardized ß = 0.25, P = 0.021, respectively). Irisin showed positive associations with increasing fruit consumption, whereas the levels of irisin decreased as meat consumption increased. CONCLUSIONS: Irisin was directly associated with healthy diet types and patterns. Further studies regarding these mechanisms are warranted. This trial is registered at http://www.clinicaltrials.gov. Identifier: NCT01853332.

Fast Eating Speed Increases the Risk of Endoscopic Erosive Gastritis in Korean Adults.

BACKGROUND: Fast eating or overeating can induce gastrointestinal diseases such as gastritis. However, the association between gastritis and speed of eating is unclear. The aim of this study was to determine whether eating speed is associated with increased risk of endoscopic erosive gastritis (EEG). METHODS: We carried out a cross-sectional study involving 10,893 adults who underwent a general health checkup between 2007 and 2009. Two groups, EEG patients and EEG-free patients, were compared by using the t-test and the chi-square test. Multiple logistic regression analyses were performed to investigate the association between eating speed and EEG. RESULTS: The group with EEG had a higher proportion of males, average age, body mass index, and percentages of current smokers and risky drinkers than those without EEG. After adjusting for anthropometric, social, and endoscopic parameters, the group with the highest eating speed (<5 min/meal) had 1.7 times higher risk for EEG than the group with the lowest eating speed (≥15 min/meal) (odds ratio, 1.71; 95% confidence interval, 1.20-2.45). CONCLUSION: High eating speed is an independent risk factor for EEG. Our results indicate the need for further studies to clarify the role of eating speed in gastritis.

Dietary walnut suppression of colorectal cancer in mice: Mediation by miRNA patterns and fatty acid incorporation.

Colorectal cancer, unlike many other malignancies, may be preventable. Recent studies have demonstrated an inverse association between nut consumption and incidence of colon cancer; however, the underlying mechanisms are not fully understood. An emerging concept suggests that microribonucleic acids (miRNAs) may help explain the relationship between walnut consumption and decreased colorectal neoplasia risk. Seven days after HT-29 colon cancer cell injection, mice were randomized to either control or walnut diets for 25 days of diet treatment. Thirty samples of tumor and of omental adipose were analyzed to determine changes in lipid composition in each dietary group. In the tumors of the walnut-containing diet, we found significant increases in α-linolenic, eicosapentaenoic, docosahexaenoic and total omega-3 acids, and a decrease in arachidonic acid, as compared to the control diet. Final tumor size measured at sacrifice was negatively associated with percentage of total omega-3 fatty acid composition (r=-0.641, P=.001). MicroRNA expression analysis of colorectal tumor tissue revealed decreased expression of miRNAs 1903, 467c and 3068 (P<.05) and increased expression of miRNA 297a* (P=.0059) in the walnut-treated group as compared to control diet. Our results indicate that changes in the miRNA expression profiles likely affect target gene transcripts involved in pathways of anti-inflammation, antivascularization, antiproliferation and apoptosis. We also demonstrate the incorporation of protective fatty acids into colonic epithelium of walnut-fed mice, which may independently alter miRNA expression profiles itself. Future studies of the mechanism of widespread miRNA regulation by walnut consumption are needed to offer potential prognostic and therapeutic targets.

Socioeconomic status and other related factors of seasonal influenza vaccination in the South Korean adult population based on a nationwide cross-sectional study.

PURPOSE: We investigated the association between seasonal influenza vaccination in South Korea and socioeconomic status (SES) as well as other potential related factors. METHODS: The study was based on data obtained in the Korea National Health and Nutrition Examination Survey from 2010 to 2011. Education level and household income were used as indicators for SES. Univariate and multiple logistic regression analyses were used to evaluate SES and other demographic variables as related factors for influenza vaccination, the primary outcome. RESULTS: Higher household income was positively associated with higher vaccine uptake in the younger (19-49 years) group [adjusted odds ratio (aOR) 1.55, 95% confidence interval (CI) 1.08-2.23], whereas the low-income and low-education group had increased vaccination coverage than the middle-income and middle-education group in the older (≥ 50 years) group (aOR 1.36, 95% CI 1.09-1.69). Current smokers tend to be unvaccinated in all age groups. Among individuals aged ≥ 50, older age, mild to moderate alcohol consumption, regular exercise, and having co-morbidities were positively associated with vaccination, while those who self-reported their health status as good were less likely to be vaccinated. CONCLUSIONS: The relationship between SES and seasonal influenza vaccination coverage differed between the age groups throughout the adult South Korean population. Public health policies need to address these inequalities.

Trends in lipid profiles among South Korean adults: 2005, 2008 and 2010 Korea National Health and Nutrition Examination Survey.

BACKGROUND: This study aimed to investigate recent trends in the prevalence and parameters of dyslipidemia and rates of lipid-lowering medication use in Korean adults. Trends in lipid profiles in subjects with hypertension, diabetes or obesity were also studied. METHODS: Data from the Korea National Health and Nutrition Examination Survey in 2005, 2008 and 2010 were used in this study. A total of 17 009 subjects participated in this study. RESULTS: There was a declining trend in the prevalence of dyslipidemia and an increasing trend in the rates of use of lipid-lowering medication among Korean adults. In both men and women, the age-adjusted mean high-density lipoprotein cholesterol level linearly increased. There was a significantly decreasing trend in the age-adjusted mean triglycerides in women and age-adjusted mean lipid-related ratios in both sexes. The age-adjusted mean total cholesterol level showed a slightly increasing trend and the age-adjusted mean low-density lipoprotein cholesterol level was not changed in both sexes. These patterns persisted among subjects not taking lipid-lowering medication. The favorable trends were also observed in subjects with hypertension, diabetes and obesity. CONCLUSIONS: Our study showed favorable trends in the prevalence of dyslipidemia and in several lipid profiles among Korean adults.

Atrophic gastritis: a related factor for osteoporosis in elderly women.

PURPOSE: Osteoporosis poses a great threat to the aging society. Hypochlorhydric or achlorhydric conditions are risk factors for osteoporosis. Atrophic gastritis also decreases gastric acid production; however, the role of atrophic gastritis as a related factor for osteoporosis is unclear. We investigated the relationship between atrophic gastritis and osteoporosis in postmenopausal women over 60 years of age. SUBJECTS AND METHODS: A total of 401 postmenopausal women were included in this cross-sectional study, which was conducted during their medical check-ups. Bone mineral densitometry was measured using a dual energy X-ray absorptiometry. Atrophic gastritis was defined endoscopically if gastric mucosa in the antrum and the body were found to be atrophied and thinned and submucosal vessels could be well visualized. RESULTS: The proportion of people with atrophic gastritis was higher in the osteoporotic group than in the group without osteoporosis. A linear relationship was observed in the proportion of atrophic gastritis according to the categories of normal, osteopenia, and osteoporosis at the lumbar spine (p for trend = 0.039) and femur (p for trend = 0.001). A multiple logistic regression analysis revealed that the presence of atrophic gastritis was associated with an increased odds of osteoporosis after adjusting for age, body mass index, triglyceride, high-density lipoprotein cholesterol, alcohol consumption, and smoking status (odds ratio 1.89, 95% confidence interval 1.15-3.11). CONCLUSIONS: Atrophic gastritis is associated with an increased likelihood of osteoporosis in Korean elderly women.

Dose-related association between urinary cotinine-verified smoking status and dyslipidemia among Korean men: the 2008-2010 Korea National Health and Nutrition Examination Survey.

This cross-sectionally designed study was based on data collected during the 2008-2010 Korea National Health and Nutrition Examination Survey. A total 3231 South Korean men aged more than 19 years were included. Urinary cotinine concentrations were measured. Smoking status was defined using questionnaire responses and urinary cotinine concentrations. Hierarchical multivariate logistic regression analyses were used to assess the association of urinary cotinine concentrations with the prevalence of dyslipidemia and various parameters of dyslipidemia. There is a significant dose-related association between smoking as assessed by urinary cotinine concentration and dyslipidemia and various parameters of dyslipidemia among South Korean men.

Parathyroid hormone, vitamin D levels and urine albumin excretion in older persons: the 2011 Korea National Health and Nutrition Examination Survey (KNHANES).

OBJECTIVE: Persistent elevation of urinary albumin excretion (UAE), even within normal range, is an independent predictor for cardiovascular disease. Accumulating research suggests that low levels of vitamin D and high levels of parathyroid hormone (PTH) also increase cardiovascular disease risk. This study is intended to investigate the relationship between PTH, vitamin D levels and UAE. METHODS: We examined 2897 adults aged 50 and above, participating in the second year of the fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2). Anthropometric and laboratory measurements were performed. Elevated UAE was defined as spot urinary albumin creatinine ratio equal or above 10. RESULTS: The proportion of elevated UAE (21·8%, 23·2%, 23·2%, 31·8%; P for trend = 0·002) rose with increasing quartiles of PTH. The odds ratio for elevated UAE in the highest quartile of PTH was 72% higher than the lowest quartile group. There was no relationship between vitamin D and elevated UAE. CONCLUSIONS: Elevated PTH levels are associated with elevated UAE in Korean adults aged 50 and above. Additional studies are needed to clarify this relationship.

Oral health behaviors and metabolic syndrome: the 2008-2010 Korean National Health and Nutrition Examination Survey.

OBJECTIVES: This study examined whether oral health behaviors are associated with metabolic syndrome (MetS) in Korean adults involved in the 2008-2010 Korea National Health and Nutrition Examination Survey (KNHANES). MATERIALS AND METHODS: A total of 18,742 subjects (8,034 men and 10,708 women) were included. MetS was defined according to the criteria of the American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement for Asians. Oral health behavior was assessed using a questionnaire included in the KNHANES. RESULTS: Subjects with MetS brushed their teeth less frequently and used fewer secondary oral products than subjects without MetS (p < 0.01). As frequency of toothbrushing and number of secondary oral products increased, body mass index, waist circumference, diastolic blood pressure, fasting plasma glucose, triglyceride, and white blood cell count decreased, but high-density lipoprotein-cholesterol increased (all p for trend <0.01). In the multivariable logistic regression models, as frequency of toothbrushing increased, the odds ratios (ORs) for MetS, abdominal obesity, and hyperglycemia are more than one after adjusting for age, gender, education, income, alcohol and tobacco use, physical activity, and the components of MetS. The ORs for MetS, abdominal obesity, and high blood pressure were more than one in subjects who do not use dental floss after adjusting for all covariates. CONCLUSION: MetS is associated with infrequent daily toothbrushing and disuse of dental floss in South Korean. CLINICAL RELEVANCE: Dentists may recommend evaluation for MetS in the patients with infrequent daily toothbrushing and disuse of dental floss.

25-Hydroxyvitamin D insufficiency is associated with cardiometabolic risk in Korean adolescents: the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES).

OBJECTIVE: Vitamin D insufficiency is known to be related to cardiometabolic disorders; however, the associations among serum 25-hydroxyvitamin D (25(OH)D) concentration and metabolic syndrome and cardiometabolic risk factors in children and adolescents have not yet been clearly delineated. For this reason, we investigated the relationship among serum 25(OH)D concentration and metabolic syndrome and cardiometabolic risk factors among Korean adolescents. DESIGN: We performed a cross-sectional analysis and used hierarchical multivariate logistic regression analysis models to adjust for confounding variables. SETTING: We used the data gathered during the 2008-2009 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS: Our subjects included 1504 Korean adolescents aged 12-18 years who participated in the KNHANES. RESULTS: Vitamin D insufficiency, defined as 25(OH)D concentration <50 nmol/l, was found in 75·3% of Korean adolescents and was associated with an increased risk of the prevalence of metabolic syndrome. Waist circumference and BMI were the most closely correlated cardiometabolic components of metabolic syndrome according to serum 25(OH)D status, but no significant relationship was found between serum 25(OH)D concentration and insulin resistance or for the risks for high blood pressure, hyperglycaemia, reduced HDL-cholesterol or hypertriacylglycerolaemia, with or without adjustment for confounding variables. CONCLUSIONS: Low serum 25(OH)D concentration appears to be associated with several cardiometabolic risk factors and an increased risk of the prevalence of metabolic syndrome in Korean adolescents.