Appropriate waist circumference cutoff points for central obesity in Korean adults

Risk factors for atraumatic isolated subscapularis tear: glenoid retroversion

BACKGROUND

Subscapularis tendon (SSC) tears have recently become an area of current research focus. However, the risk factors for atraumatic isolated SSC tears, particularly anatomical factors, remain poorly determined. Therefore, the purpose of this study was to identify the associated factors contributing to isolated SSC tears.

METHODS

This study involved single shoulders of 605 subjects drawn from a cohort of rural residents. The inclusion criteria required each subject to sign an informed consent document and to have a complete clinical evaluation. The exclusion criteria comprised the absence of a complete magnetic resonance imaging study, current medication use that might have affected serum lipid levels, a history of shoulder trauma or surgery, and the presence of osteoarthritis, calcific tendinitis, frozen shoulder, or superior or posterosuperior rotator cuff tear. Diagnoses of isolated SSC tear were based on magnetic resonance imaging findings. Logistic regression analysis was conducted using demographic, physical, social, anatomical, comorbidities, and serological parameters. Anatomical variables included the supraspinatus fossa glenoid angle on axial (SGAX), a method to measure glenoid version, coracohumeral distance on axial and sagittal plans, and coracoid index. When multicollinearity among studied variables was detected, separate multivariable analyses were performed to address this issue, with each analysis including only one of those multicollinear variables along with the other significant variables obtained from univariate analyses.

RESULTS

Among anatomical variables, coracohumeral distance on axial and sagittal planes, as well as the coracoid index, did not show significant associations. However, SGAX, an index of glenoid version, was found to be significantly associated with atraumatic isolated SSC tears. Greater glenoid retroversion is significantly associated with atraumatic isolated SSC tears, along with age, waist circumference, dominant side involvement, manual labor, diabetes, metabolic syndrome, and biceps tendon injury (P ≤ .013).

CONCLUSIONS

The SGAX, serving as an index for glenoid version, is an independently associated factor for atraumatic isolated subscapularis tendon tears, with greater glenoid retroversion being an anatomical risk factor for these tears, along with overuse-related factors such as dominant-side involvement and manual labor, as well as metabolic factors such as obesity, diabetes, metabolic syndrome, and biceps tendon injury.

Association between muscular strength, abdominal obesity, and incident nonalcoholic fatty liver disease in a Korean population

This study aimed to examine the association between relative handgrip strength (rHGS) and nonalcoholic fatty liver disease (NAFLD) incidence, considering abdominal obesity (ABO) status. This nationwide Korean cohort included 24,297 participants without NAFLD at baseline. Participants were categorized into sex-specific tertiles of rHGS (low, mid, and high). Multivariate Cox proportional hazards regression models were used to evaluate NAFLD incidence in relation to rHGS levels and/or ABO status. Over 100,381 person-years of follow-up, 1,735 participants (10.81% men and 6.01% women) developed NAFLD. High rHGS was associated with a 29% and 60% risk reduction for incident NAFLD in men and women, respectively, compared with low rHGS, despite men having significantly higher rHGS than women. Conversely, ABO increased NAFLD risk by 2.3 and 3.8 times in men and women, respectively. Even among women with ABO, mid and high rHGS were associated with a 23% and 36% risk reduction in incident NAFLD, respectively, compared with low rHGS. However, there was no significant relationship between rHGS levels and NAFLD incidence in men with ABO. Higher rHGS levels may prevent NAFLD, particularly in women. In individuals with ABO, high rHGS markedly decreased NAFLD risk in women but not in men.

Assessing the association of multi-environmental chemical exposures on metabolic syndrome: A machine learning approach

Metabolic syndrome (MetS) is a major global public health concern due to its rising prevalence and association with increased risks of cardiovascular disease and type 2 diabetes. Emerging evidence suggests that environmental chemical exposures may play a significant role in the development of MetS by disrupting metabolic pathways. This study used data from 2,960 participants in the Korean National Environmental Health Survey (KoNEHS) cycle 4 (2018-2020) to examine associations between environmental exposures and MetS risk through machine learning (ML) approaches. Eight ML algorithms were applied, with the multilayer perceptron (MLP) and random forest (RF) models identified as optimal predictors. The MLP achieved an AUC of 0.79, and the RF achieved the highest F1 score of 0.82. Both models highlighted PFOA and PFOS, alongside age and BMI, as key predictors. SHapley Additive exPlanations (SHAP) and partial dependence plots (PDP) revealed both linear and nonlinear exposure-response patterns, suggesting threshold effects for key chemicals. These findings underscore the importance of incorporating environmental exposures into MetS risk assessments. The ML models provided robust predictive performance and novel insights into chemical and metabolic interactions, advocating for regulatory measures to reduce harmful exposures and integrate environmental factors into MetS prevention strategies.

Association between dietary folate and hyperuricemia based on inflammation and cardiovascular disease status

BACKGROUND AND AIMS

The impact of dietary folate intake on serum uric acid is not yet conclusive. This study aims to investigate the association between dietary folate intake and the risk of hyperuricemia according to inflammatory status and comorbidities in Korean adults.

METHODS AND RESULTS

The cross-sectional analysis was conducted on 14,445 subjects aged ≥19 years enrolled in the Korea National Health and Nutrition Examination Survey (KNHNES) from 2016 to 2021. Dietary folate intake was assessed using the 24-h recall method. Dietary folate consumption was positively associated with the intake of beans, vegetables, and fruits, and negatively associated with cereals and meat intake. After adjusting for potential confounders, increased folate intake was found to be associated with a decreased risk of hyperuricemia (odds ratio for the highest tertile compared to the lowest tertile = 0.71 (95 % CI: 0.62-0.82)). The protective effect of folate intake against hyperuricemia was higher in individuals with normal inflammatory status compared to those with low-grade inflammation. Furthermore, the protective effect was greater in individuals without hypertension, dyslipidemia, and cardiovascular disease compared to those with these conditions.

CONCLUSION

These results suggest that dietary intake may help mitigate hyperuricemia, and individuals with inflammatory condition or cardiovascular diseases may require higher intake levels to achieve similar protective effects compared to healthy individuals.

General and central obesity were significantly correlated with blood lead level in non-smoking, general population aged 30-50, without hypertension

INTRODUCTION

To investigate the association between obesity and blood lead level (BLL) in the general population after controlled for menopause, blood pressure, calcium, and smoking; we assessed the relationship between BMI, WC (Waist Circumference), and blood lead levels in the non-smoking middle-aged subjects without hypertension among 2018 KNHANES. All data were recategorized into S1 (BMI<25 kg/m2 & WC<90 cm), S2 (intermediate), and S3 (BMI>25 kg/m2 & WC>90 cm).

METHODS

We made the log transformation of blood lead levels to bring them closer to a normal distribution. Logarithmic transformed BLL was closely related to BMI (p=.010) and WC (p=.020) after adjusting for sociodemographic, energy, working factors, and cardiometabolic variables. The prevalence of ratios of S3, S2, and S1 was comparable according to the quarterly group of BLL.

RESULTS AND CONCLUSIONS

Blood lead levels might increase oxidative stress on triglycerides and low high-density lipoprotein (HDL)-cholesterol; consequently, lead exposure might form peroxynitrite, a reactive oxygen substrate (ROS) susceptible to destroying lipids. Consequently, obesity was significantly correlated with logarithmic blood lead levels irrespective of sociodemographic, energy, working, and cardiometabolic factors in the non-smoking middle-aged population without hypertension. Further controlled clinical trials would be considered.

The Effect of Eating Speed on Sarcopenia, Obesity, and Sarcopenic Obesity in Older Adults: A 16-Year Cohort Study Using the Korean Genome and Epidemiology Study (KoGES) Data

Background: Sarcopenia and obesity are age-related conditions associated with dietary habits. However, the relationship between eating speed and sarcopenia, particularly in older adults >65 years of age remains unclear. Methods: To investigate the effect of eating speed on the occurrence of sarcopenia, obesity, and sarcopenic obesity, we examined eating speed, socioeconomic factors, and disease history of 6202 patients at baseline and their changes over a 16-year follow-up period. Results: A fast eating speed was significantly associated with a higher risk of developing sarcopenia (normal eating: HR 1.284, 95% CI 1.107-1.490; slow eating: HR 1.583, 95% CI 1.279-1.958). Slower eating was associated with a reduced risk of obesity (normal eating: HR 0.865, 95% CI 0.786-0.952; slow eating: HR 0.680, 95% CI 0.577-0.802). These trends were consistent among participants aged <65 years. Among participants aged ≥65 years, fast eating was associated with a higher incidence of sarcopenia (HR 1.603, 95% CI 1.119-2.298), but no significant relationship existed with obesity (normal eating: HR 0.846, 95% CI 0.623-1.150; slow eating: HR 0.792, 95% CI 0.537-1.168). Conclusions: Slow eating speed decreased the incidence of obesity but increased that of sarcopenia in adults aged <65 years. However, in adults aged ≥65 years, slow eating speeds increased the incidence of sarcopenia but did not reduce the incidence of obesity.

Association between mothers' working hours and metabolic syndrome in children and adolescents: data from the Korea National Health and Nutrition Examination Survey, 2016-2020

BACKGROUND

Prevention and management of metabolic syndrome (MetS) during childhood are crucial. Recently, obesity among children and adolescents has increased with an increase in mothers' working hours. The present study was conducted to determine the relationship between mothers' working hours and MetS in their children.

METHODS

Data from the 2016-2020 National Health and Nutrition Examination Survey were used, and 2,598 children and adolescents aged 10-18 years were included. Logistic regression analysis was conducted to confirm the association between MetS and mothers' working hours for each risk factor. Linear regression analysis was conducted to confirm the association between mothers' working hours and the number of risk factors for MetS.

RESULTS

Abdominal obesity in children was higher when the mothers' working hours were 53 hours or more (odds ratio [OR], 2.267; 95% confidence interval [CI], 1.21-4.25). In the trend analysis, the OR of children's abdominal obesity increased significantly as mothers' working hours increased (P-value <0.05). Additionally, sex-stratified analysis revealed a significant trend between maternal work hours and the presence of MetS in female children (P=0.016). The adjusted OR of the presence of MetS in female children with mothers working 53 hours or more weekly was 6.065 (95% CI, 1.954-18.822).

CONCLUSION

Mothers' working hours were highly correlated with the risk of abdominal obesity in their children. The OR of the presence of MetS significantly increased in female children with mothers having longer working hours compared with those with stay-at-home mothers.

Sex-specific impact of the COVID-19 outbreak on the incidence of metabolic syndrome: a comparative study of 2018-2019 and 2020-2021

BACKGROUND/AIMS

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted global health, exacerbated metabolic health issues, and altered lifestyle behaviors. This study examined the sex-specific impact of the COVID-19 outbreak on the incidence of metabolic syndrome using data from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

Data from the KNHANES VII (2018) and VIII (2019-2021), including 15,499 participants, were analyzed. The study population was stratified by sex, and further subdivisions were conducted based on the timeframe relative to the COVID-19 outbreak. Variables such as age, education level, household income, smoking status, and high-risk drinking were analyzed to assess their influence on the prevalence of metabolic syndrome.

RESULTS

The overall prevalence of metabolic syndrome significantly increased from 28.11% before the outbreak to 29.69% after the outbreak. Both males and females reported significant increases in waist circumference and fasting glucose levels. Age and education level differentially influenced the prevalence of metabolic syndrome between the sex. Smoking was significantly associated with increased prevalence in males, whereas high-risk drinking was associated with increased prevalence in males and decreased prevalence in females.

CONCLUSION

The COVID-19 pandemic has significantly increased the prevalence of metabolic syndrome with notable sex-specific differences. These findings highlight the need for sex-specific public health interventions to mitigate the impact of the pandemic on metabolic health.

Associations of four obesity indices with diabetes mellitus in Korean middle-aged and older adults using the Korean Genome and Epidemiology Study (KoGES)

BACKGROUND

Obesity is associated with a high risk of diabetes mellitus (DM); therefore, obesity-related indices are strongly associated with DM. This study evaluated the association of obesity indices, including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and a body shape index (ABSI), with DM in Korean middle-aged and older adults.

METHODS

Data from three population-based cohorts (Ansan and Ansung, Health Examinee, and Cardiovascular Disease Association Study, derived from the Korean Genome and Epidemiology Study) were analyzed. Logistic analysis was used to evaluate the association of BMI, WC, WHR, and ABSI with DM, after adjusting for covariates according to sex and age. The integrated discrimination index (IDI) and category-free net reclassification improvement (cfNRI) and area under the curve (AUC) of the receiver operating characteristic (ROC) curve were analyzed by age group to investigate index-specific model performance.

RESULTS

Among the 160,585 participants, 13,846 had DM (6,837; men [11.86%] and 7,009 women [6.81%]). Age increase was associated with an increased prevalence of DM: 2,339 (4.01%), 5,313 (8.74%), and 6,194 (14.93%) in the 40-49, 50-59, and ≥ 60 years age groups. After adjusting for covariates, the odds ratios (OR) for DM of WHR and WC were higher than those of the other indices in every age group. However, the OR for WHR, WC, and BMI decreased with age in both sexes. ABSI showed steady and slightly increasing ORs with increasing age although the ORs in both sexes were generally low for DM. For IDI and cfNRI, WHR had the highest values among all age groups. The AUC of the ROC curve showed that the WHR had the highest value in all age groups.

CONCLUSION

The WHR had the strongest association with DM, but was not a good DM index in older people. Therefore, age-related index criteria for DM, especially in women, were needed for the effective prevention and management of DM.

Association of sleep timing, sleep duration, and sleep latency with metabolic syndrome in middle-aged adults in Korea: A cross-sectional and longitudinal study

OBJECTIVE

Sleep is a potential risk factor for metabolic syndrome. We investigated the associations of various sleep characteristics with the status and incidence of metabolic syndrome in middle-aged Koreans.

METHODS

Using data from a community-based Korean Medicine Daejeon Citizen Cohort study on participants aged 30-50years, cross-sectional (n = 1984) and longitudinal (n = 1216, median follow-up: 2.1years) analyses were performed. To study the association of metabolic syndrome and five components with various sleep characteristics, measured using the Pittsburgh Sleep Quality Index, we used Poisson and logistic regression and Cox proportional hazard regression analyses, adjusting for covariates.

RESULTS

Of 1984 participants, 66%, 19%, and 15% belonged to the non-metabolic syndrome, pre-metabolic syndrome, and metabolic syndrome groups, respectively. After covariate adjustments, the pre-metabolic syndrome group was associated with late mid-sleep time (≥5:00; prevalence ratios 1.61, 95% confidence interval 1.01-2.54) and late bedtime (≥2:00; prevalence ratios 1.55, 95% confidence interval 1.03-2.34), and the metabolic syndrome group was associated with long sleep latency (prevalence ratios 1.33, 95% confidence interval 1.03-1.73), poor sleep quality (prevalence ratios 1.38, 95% confidence interval 1.07-1.78), and early wake time (<6:00; prevalence ratios 1.29, 95% confidence interval 1.01-1.63). Longitudinal analysis of participants without metabolic syndrome at baseline indicated a significant increase in metabolic syndrome risk associated with very short sleep duration (<6 hours; hazard ratio 1.72, 95% confidence interval 1.06-2.79), long sleep latency (>30 minutes; hazard ratio 1.86, 95% confidence interval 1.1-3.12), and early wake time (<6:00 o'clock; hazard ratio 1.73, 95% confidence interval 1.01-2.97).

CONCLUSION

Sleep characteristics, such as short duration, long latency, and early wake time, were associated with an increased risk of metabolic syndrome in middle-aged adults.

Artificial intelligence-based body composition analysis using computed tomography images predicts both prevalence and incidence of diabetes mellitus

AIM/INTRODUCTION

We assess the efficacy of artificial intelligence (AI)-based, fully automated, volumetric body composition metrics in predicting the risk of diabetes.

MATERIALS AND METHODS

This was a cross-sectional and 10-year retrospective longitudinal study. The cross-sectional analysis included health check-up data of 15,330 subjects with abdominal computed tomography (CT) images between January 1, 2011, and September 30, 2012. Of these, 10,570 subjects with available follow-up data were included in the longitudinal analyses. The volume of each body segment included in the abdominal CT images was measured using AI-based image analysis software.

RESULTS

Visceral fat (VF) proportion and VF/subcutaneous fat (SF) ratio increased with age, and both strongly predicted the presence and risk of developing diabetes. Optimal cut-offs for VF proportion were 24% for men and 16% for women, while VF/SF ratio values were 1.2 for men and 0.5 for women. The subjects with higher VF/SF ratio and VF proportion were associated with a greater risk of having diabetes (adjusted OR 2.0 [95% CI 1.7-2.4] in men; 2.9 [2.2-3.9] in women). In subjects with normal glucose tolerance, higher VF proportion and VF/SF ratio were associated with higher risk of developing prediabetes or diabetes (adjusted HR 1.3 [95% CI 1.1-1.4] in men; 1.4 [1.2-1.7] in women). These trends were consistently observed across each specified cut-off value.

CONCLUSIONS

AI-based volumetric analysis of abdominal CT images can be useful in obtaining body composition data and predicting the risk of diabetes.

An Analysis of Age-Related Body Composition Changes and Metabolic Patterns in Korean Adults Using FDG-PET/CT Health Screening Data

BACKGRUOUND

F-18-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) can be used to measure bone mineral density (BMD), cross-sectional muscle area (CSMA), Hounsfield units (HU) of liver and muscle, subcutaneous adipose tissue (SAT), abdominal visceral adipose tissue (VAT), and glucose metabolism. The present study aimed to identify age-related changes in body composition and glucose metabolism in Korean using opportunistic FDG-PET/CT imaging.

METHODS

We analyzed FDG-PET/CT, clinical history, and laboratory data abstracted from the medical records of patients who underwent health screening at a single institute between 2017 and 2022.

RESULTS

In total, 278 patients were included in the analysis (male:female=140:138). Age and body mass index were positively correlated in female, but negatively correlated in male. BMD decreased with age more in female, and CSMA decreased with age more in male. Muscle HU decreased with age for both sexes. In female, SAT and VAT increased with age; and in male, SAT decreased slightly while VAT remained stable. Muscle glucose metabolism showed no association with age in male but increased with age in female. CSMA correlated positively with BMD overall; and positively correlated with VAT and SAT in male only. In female only, both SAT and VAT showed negative correlations with glucose metabolism and correlated positively with muscle glucose metabolism. Liver HU values were inversely correlated with VAT, especially in female; and positively correlated with muscle glucose metabolism in female only.

CONCLUSION

FDG-PET/CT demonstrated distinct patterns of age-related changes in body composition and glucose metabolism, with significant differences between sexes.

The association of fatty liver index and metabolic syndrome with cardiovascular outcomes, liver-related mortality, and all-cause mortality: a nationwide cohort study

We investigated the risk of cardiovascular events, all-cause mortality, and liver-related mortality according to the presence of metabolic syndrome (MetS) and fatty liver index (FLI). In this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2009 to 2012. Nonalcoholic fatty liver disease (NAFLD) was defined as FLI ≥ 60. Risk of all-cause mortality, liver-related mortality, and major adverse cardiovascular events (MACE) including myocardial infarction (MI), stroke, heart failure (HF), and cardiovascular disease (CVD)-related mortality was assessed according to the presence of MetS and FLI among adults (aged 40 to 80 years) who underwent health examinations (n = 769,422). During a median 8.59 years of follow up, 44,356 (5.8%) cases of MACE, 24,429 (3.2%) cases of all-cause mortality, and 1114 (0.1%) cases of liver-related mortality were detected in the entire cohort. When the FLI < 30 without MetS group was set as a reference, the FLI ≥ 60 with MetS group had the highest risk of MACE (adjusted hazard ratio [aHR] 2.05, 95% confidence interval [CI] 1.98-2.13) and all-cause mortality (aHR 1.96, 95% CI 1.86-2.07). The risk of liver-related mortality (aHR 10.71, 95% CI 8.05-14.25) was highest in the FLI ≥ 60 without MetS group. The FLI ≥ 60 with MetS group had a higher risk of MACE (aHR 1.39, 95%CI 1.28-1.51), a lower risk of liver-related mortality (aHR 0.44, 95%CI 0.33-0.59), and no significant difference in all-cause mortality compared with the FLI ≥ 60 without MetS group. The FLI ≥ 60 with MetS group was associated with the highest risk of MACE and the FLI ≥ 60 without MetS group had the highest risk liver-related mortality, but there was no significant difference in all-cause mortality between two groups. In conclusion, as FLI levels increase, the risk of MACE increases, and the risk increases additively in the presence of MetS. The risk of liver-related mortality increases with higher FLI levels, the effect of high FLI on increased risk is more significant in groups without MetS compared to those with MetS.

Rebound of Reflux-Related Symptoms After Helicobacter pylori Eradication in Patients With Gastroesophageal Reflux Disease: A Prospective Randomized Study

BACKGROUND/PURPOSE

We aimed to assess the effects of Helicobacter pylori (H. pylori) eradication on the rebound of reflux-related symptoms among gastroesophageal reflux disease (GERD) patients.

METHODS

This prospective randomized study recruited patients with typical reflux symptoms and reflux esophagitis on esophagogastroduodenoscopy (NCT02934152). Patients positive for H. pylori via a urea breath test (UBT) were randomly assigned to receive bacterial eradication with triple therapy for 2 weeks either before or after proton-pump inhibitor (PPI) treatment for 4 weeks. Follow-up was implemented with serial GerdQ evaluation and a subsequent UBT. The primary outcome was the incidence rates of symptom rebound between patients with and without H. pylori infection. The secondary outcomes included the severity of symptom rebound, incidence rates of symptom rebound, and successful eradication rates between the early and late eradication groups.

RESULTS

A total of 248 patients were enrolled, of whom 107 (43.1%) tested positive for H. pylori infection. All patients with and without concurrent H. pylori infection had significant symptom improvement over the entire treatment. Patients with H. pylori infection had significantly lower rates of symptom rebound (19.8% vs. 34.2%, p = 0.034) and rebound severity (1.8 ± 0.7 vs. 2.8 ± 1.6, p = 0.031) 4 weeks after eradication and PPI treatment than those without. The incidence rates of symptom rebound and successful eradication rates were not significantly different between the early and late eradication groups.

CONCLUSIONS

GERD patients with concurrent H. pylori infection were less susceptible to symptom rebound after H. pylori eradication compared to those without.

TRIAL REGISTRATION

ClinicalTrial.gov (NCT02934152).

Association between body mass index and chronic obstructive pulmonary disease in young individuals: a nationwide population‑based cohort study

Body mass index (BMI) is associated with chronic obstructive pulmonary disease (COPD) risk. We investigated the association between BMI and the risk of COPD among young individuals. Using the Korean National Health Information Database, we screened individuals aged 20-39 years who participated in the national health examination between 2009 and 2012. We identified 6,304,769 eligible individuals, and 13,784 had newly developed COPD. BMI was categorized according to the Asian BMI criteria. We performed multivariate Cox proportional hazards models to estimate the adjusted hazard ratio (aHR) of risk factors for COPD development. Their mean age was 30.8 ± 5.0 years, and 3,732,656 (59.2%) were men. The incidence rate for developing COPD was 0.22/1,000 person-years. Compared to individuals with normal BMI (18.5-22.9 kg/m2), those who were underweight (< 18.5 kg/m2) had higher risks of COPD development (aHR: 1.37, 95% confidence interval [CI]: 1.29-1.46). Meanwhile, overweight or obese individuals (23-24.9 or 25-29.9 kg/m2) had lower risks for COPD development (aHR 0.90, 95% CI 0.86-0.95, and aHR 0.90, 95% CI 0.85-0.94, respectively). Although males showed tendencies similar to those of the total population, the risk was increased with increasing BMI among females. In the subgroup analysis, the risk reduction was not observed among non-smokers as BMI increased. In young individuals, being underweight was associated with an increased risk for COPD development, whereas being overweight and obese were associated with a decreased risk for COPD.

Association and interaction effect of shift work and the risk for obstructive sleep apnea on diabetes mellitus in middle-aged Korean workers

PURPOSE

To investigate the association of shift work and the risk for obstructive sleep apnea (OSA) with diabetes mellitus (DM), and the interaction effect of shift work and the risk for OSA on DM.

METHODS

Data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2019-2021 were used. The participants were 3012 employees aged 40 to 59 years. Shift work was assessed using self-reporting questionnaires. The risk for OSA was assessed by STOP-BANG score. The distribution of demographic factors was calculated using the chi-square test. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. An interaction effect between shift work and the risk for OSA on DM was evaluated using relative excess risk owing to interaction (RERI) and attributable proportion (AP) with 95% CIs. The synergic index (SI) was also calculated.

RESULTS

Shift work and the risk for OSA were each significantly associated with DM. There was also a significant interaction effect between shift work and the risk for OSA on DM. The RERI was 0.543 (95% CI 0.205-1.361) and the AP was 0.230 (95% CI 0.145-0.342). The SI was 1.662 (95% CI 1.481-1.843).

CONCLUSIONS

There was an association and a significant interaction effect of shift work and the risk for OSA on DM. The management of OSA in shift workers should be implemented to prevent DM.

The association of obesity and the risk of rheumatoid arthritis according to abdominal obesity status: a nationwide population-based study in Korea

OBJECTIVES

This study aimed to assess the association between obesity or changes in body mass index (BMI) and the risk of RA considering the abdominal obesity status.

METHODS

We included individuals aged 23 to 60 who underwent a national health examination in 2012-2013 (baseline) and four years prior. Obesity was defined by a BMI  ≥ 25 kg/m2. The change in BMI over 4 years was divided into quartiles. Cox proportional hazard analysis was performed to assess the association of obesity and BMI change with the risk of RA.

RESULTS

A total of 6,207,246 subjects were included, and 7,859 incident cases of RA were identified. Obesity was associated with a reduced risk of RA in males (HR 0.78, 95% CI 0.71-0.85) and females (HR 0.91, 95% CI 0.85-0.97). In subgroup analysis according to abdominal obesity status, the associations were observed for obesity with normal waist circumference (WC) in males (HR 0.75, 95% CI 0.67-0.84) and females (HR 0.88, 95% CI 0.81-0.95). In terms of BMI change, compared to the stable BMI group (quartile 2), the third (HR 0.92, CI 0.85-0.99) and highest quartile (HR 0.89, CI 0.83-0.96) showed an inverse association with the risk of RA in females, particularly in those with normal WC.

CONCLUSION

Obesity was associated with a lower risk of RA, especially among individuals with a normal WC. Increased BMI was also associated with a lower risk of RA, but this association was mainly observed in females and specifically for those with normal WC.

Protein source associated with risk of metabolic syndrome in adults with low and adequate protein intake: A prospective cohort study of middle-aged and older adults

OBJECTIVES

Metabolic syndrome is associated with an increased risk of diabetes, cardiovascular disease, and all-cause mortality. Some evidence suggests that the cardiometabolic health benefits of protein intake may vary by the source (animal or plant); however, the evidence is inconsistent. This study aimed to assess the risk of developing metabolic syndrome according to the protein source.

PARTICIPANTS

Among a total of 3,310 participants aged 40 years or older in the Ansan and Ansung population based prospective cohort, 1,543 incident cases of metabolic syndrome were identified between 2007 and 2018.

MEASUREMENTS

Dietary intake was assessed using a validated food frequency questionnaire. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) by quintile (Q), adjusting for demographics and health-related lifestyle factors.

RESULTS

Higher intake of animal protein (HRquintile5 (Q5) vs quintile1 (Q1) [95% CIs]: 0.76 [0.59-0.96], P-trend ≤ 0.0307) and a higher relative intake of animal protein (HRQ5 vs.Q1: 0.78 [0.64-0.95], P-trend ≤ 0.0017) were associated with a significantly decreased risk of developing metabolic syndrome. In subgroup analyses, associations between the risk of metabolic syndrome and the relative intake of animal and plant protein differed according to whether the total protein intake was within the recommended nutrient intake (RNI). Specifically, significant associations were observed only among those with a total protein consumption below the RNI (HRQ5vs Q1 [95% CIs]: 0.72 [0.56-0.93] for the relative intake of animal protein), but not among those consuming above the RNI. This association was more significant in women than in men.

CONCLUSION

A higher absolute and relative intake of animal protein were associated with a significantly decreased risk of metabolic syndrome, particularly among those who consumed less than the RNI of protein.

Adherence to the Cancer Prevention Recommendations from World Cancer Research Fund/American Institute for Cancer Research After Cancer Diagnosis on Mortality in South Korea

BACKGROUND/OBJECTIVES

The World Cancer Research Fund/American Institute for Cancer Research recommends following the recommendations for cancer prevention even after cancer diagnosis. To provide evidence on the potential benefits of adherence on improved survival, we investigated the effects of post-diagnostic adherence to the recommendations regarding diet, physical activity, and body weight on all-cause mortality among Korean cancer survivors.

METHODS

Among the total number of cancer survivors (n = 173,195) recruited from 2004 to 2013 for the Health Examinees study, 5485 were selected for the analyses and classified by tertiles according to the adherence score. The Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) and their 95% confidence intervals (CI) of the adherence groups on all-cause mortality.

RESULTS

Although no clear association was observed overall during a mean follow-up of 10.1 (standard deviation = 3.0) years, reduced mortality was observed for the middle (HR = 0.74 [95% CI = 0.51-1.08]) and highest adherent group (0.66 [0.43-0.99]) in comparison to the lowest adherent group among long-term survivors (>5 years after cancer diagnosis).

CONCLUSIONS

Among the cancer prevention recommendation items, "be physically active" and "limit consumption of fast foods" were inversely associated with mortality. Adhering to the WCRF/AICR cancer prevention recommendations may help improve the prognosis of long-term cancer survivors.

Body composition-derived abdominal circumference, waist-to-hip ratio, and waist-to-height ratio cut-offs for Ethiopian adults in Northwest Ethiopia, 2023

BACKGROUND

Central and general obesity are commonly measured using tools like waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). However, the universally recognized cutoffs for these measures may be inadequate for individuals of Ethiopian descent. Due to the lack of universally applicable cutoffs, studies recommend tailoring the optimal screening thresholds to each population's specific characteristics. Therefore, this study aimed to determine body composition-based WC, WHR, and WHtR cutoffs for the healthy adult population of Ethiopia.

METHOD

A population based cross-sectional study was conducted in the Amhara region of Ethiopia from June to August 2023, collecting anthropometric and body composition data from 838 adult participants. Data were analyzed using Stata, and MedCalc software. The cut-off values were determined using ROC analysis, and performance was assessed using area under the curve (AUC), Youden index, sensitivity, and specificity.

RESULT

The optimal cut-off values for WC, HC, WHR, and WHtR to define obesity in men were 85.0 cm, 93.5 cm, 0.89, and 0.53 respectively. Correspondingly, these values in women were 81.1 cm, 97.2 cm, 0.84, and 0.5. These cutoff values showed the highest effectiveness in defining obesity especially for WC and WHtR. The new proposed cutoff values for waist circumference, hip circumference, and waist-to-height ratio had sensitivity ranging 76-93% and specificity of 83-94% in accurately identifying obesity. The current study also determined the cut-off values for underweight, normal weight, and overweight body weight categories. Accordingly, for men, the WC cut-offs were: ≤ 74.55 cm (underweight), 74.56-78.95 cm (normal), and 79.0-85.0 cm (overweight). For women, the cut-offs were: ≤ 68.25 cm (underweight), 68.26-79.59 cm (normal), and 79.60-81.10 cm (overweight). The WHtR thresholds were: ≤0.43 (underweight), 0.44-0.47 (normal), and 0.48-0.53 (overweight) in men; ≤0.43 (underweight), 0.44-0.50 (normal), and 0.50-0.51 (overweight) in women.

CONCLUSION

The findings indicate that the WC, WHR, and WHtR cutoff values for defining obesity in Ethiopian adults are lower than international standards. The newly proposed cutoff values showed improved sensitivity and specificity, suggesting their potential diagnostic relevance. Considering these country-specific cutoffs may be beneficial for clinical practice and obesity-related research in Ethiopia.

Association between weight perception and perceived stress among Korean adults from the Korea National Health and Nutrition Examination Survey

Although several studies showed a correlation between weight perception and depression, the association between weight perception and perceived stress is unclear. This study explored this association using the Korea National Health and Nutrition Examination Survey with 37,022 participants. Participants were grouped based on how they perceived their body versus real body mass index (BMI) and waist circumference: accurate, underperception, or overperception. Stress was assessed through a questionnaire. The logistic regression analysis was performed, and odds ratio (OR) with 95% confidence intervals (CIs) was presented. The results showed a correlation between overperception and higher perceived stress. This correlation was especially apparent in women with significant OR and 95% CIs of 1.15 (1.07-1.23) for BMI and 1.15 (1.07-1.23) for waist circumference. In the subgroup analysis according to the real obese status, all misperceptions were associated with higher perceived stress in normal participants. In comparison, underperception showed a correlation with lower perceived stress in obese participants. The results suggest weight perception as a potential marker for many stress-related diseases and an important factor in treating mental disorders. Further research is needed to understand the relationship between stress and weight perception.

Dietary Patterns Associated with Body-Composition Phenotype in a Middle-Aged and Elderly Population: A Population-Based Cross-Sectional Study

BACKGROUND/OBJECTIVES

There is currently limited understanding of the intricate dynamics between fat and muscle mass and the potential effect of dietary patterns. This study aimed to investigate the effects of overall dietary patterns on four body composition phenotypes associated with central obesity and low muscle mass in the middle-aged and elderly population of Korea.

METHODS

We examined data from 6120 adults aged ≥ 50 years, collected during the 4th (2008-2009) and 5th (2010-2011) Korea National Health and Nutrition Examination Survey. Participants were classified into four groups according to their combined status of central obesity and low muscle mass: healthy control, central obesity, low muscle mass, and sarcopenic obesity. Using factor analysis on the twenty-two pre-defined food groups, we identified three distinct dietary patterns: the "Healthy dietary pattern", "Convenience-based dietary pattern", and "Alcohol and side dish pattern". Multivariate analysis included potential confounders such as age, sex, place of residence, marital status, educational level, occupation, household income, and physical activity level.

RESULTS

Higher scores in the "Healthy dietary pattern" were associated with lower odds of sarcopenic obesity (OR = 0.61, 95% CI = 0.40-0.92, p for trend = 0.018). For the "Convenience-based dietary pattern", individuals in the third tertile of the dietary pattern score showed a marginal association with low muscle mass (OR = 1.18, 95% CI = 0.99-1.41, p for trend = 0.056). The "Alcohol and side dish pattern" was linked to higher odds of central obesity (OR = 1.22, 95% CI = 1.03-1.44, p for trend = 0.016) and low muscle mass (OR = 1.21, 95% CI = 1.01-1.45, p for trend = 0.043).

CONCLUSIONS

The drinking practice of consuming foods high in saturated fats and salt alongside alcoholic drinks may negatively affect fat accumulation and muscle composition among older adults. Adopting a healthy eating pattern characterized by grains, vegetables, legumes, fruits, fish, and seaweed could be notably advantageous for promoting and maintaining healthy body composition and optimal skeletal muscle health.

Assessment of heart rate measurements by commercial wearable fitness trackers for early identification of metabolic syndrome risk

Metabolic syndrome increases the risks of cardiovascular diseases, type 2 diabetes, and certain cancers. The early detection of metabolic syndrome is clinically relevant, as it enables timely and targeted interventions. In the current study, we aimed to investigate the association between metabolic syndrome and heart rate measured using wearable devices in a real-world setting and compare this association with that for clinical resting heart rate. Data from 564 middle-aged adults who wore wearable devices for at least 7 days with a minimum daily wear time of 20 h were analyzed. The results showed significantly elevated all-day, sleeping, minimum, and inactive heart rates in men with pre-metabolic or metabolic syndrome compared with those in normal individuals, whereas sleeping heart rate and heart rate dips were significantly increased and decreased, respectively, in women with metabolic syndrome. After adjusting for confounders, every 10-beats-per-minute increment in all-day, sleeping, minimum, and inactive heart rates in men corresponded to odds ratios of 2.80 (95% confidence interval 1.53-5.44), 3.06 (1.57-6.40), 4.21 (1.87-10.47), and 3.09 (1.64-6.29), respectively, for the presence of pre-metabolic or metabolic syndrome. In women, the association was significant only for heart rate dips (odds ratio = 0.49 [95% confidence interval 0.25-0.96] for every 10% increment). Models incorporating inactive or minimum heart rate in men and heart rate dip in women demonstrated better fits, as indicated by lower Akaike information criterion values (170.3 in men and 364.9 in women), compared with models that included clinical resting heart rate (173.4 in men and 369.1 in women). These findings suggest that the heart rate indices obtained from wearable devices may facilitate early identification of metabolic syndrome.

Dynamic Changes in Metabolic Status Are Associated With Risk of Ocular Motor Cranial Nerve Palsies

BACKGROUND

To investigate whether recovery from or development of metabolic syndrome (MetS) in a population is associated with an altered risk for ocular motor cranial nerve palsy (CNP).

METHODS

This cohort study included 4,233,273 adults without a history of ocular motor cranial nerve palsy (ocular motor CNP) who underwent 2 consecutive biennial health screenings provided by the Korean National Health Insurance System between 2009 and 2011. They were followed up until December 31, 2018. Participants were categorized into a MetS-free, MetS-developed, MetS-recovered, or MetS-chronic group. A multivariable Cox proportional hazard regression model was used. Model 3 was adjusted for age, sex, smoking status, alcohol consumption, and physical activity.

RESULTS

Compared with the MetS-free group, the MetS-chronic group had the highest risk of ocular motor CNP (hazard ratio [HR]: 1.424; 95% confidential interval [CI]: 1.294-1.567, Model 3), followed by the MetS-developed group (HR: 1.198, 95% CI: 1.069-1.343), and the MetS-recovered group (HR: 1.168, 95% CI: 1.026-1.311) after adjusting for potential confounders. The hazard ratio of ocular motor CNP in men with chronic MetS was 1.566 (95% CI, 1.394-1.761) while that of women with chronic MetS was 1.191 (95% CI, 1.005-1.411). Among age groups, those in their 30s and 40s showed the highest association between dynamic MetS status and ocular motor CNP.

CONCLUSIONS

In our study, recovering from MetS was associated with a reduced risk of ocular motor CNP compared with chronic MetS, suggesting that ocular motor CNP risk could be managed by changing MetS status.

Combined effects of smoking and alcohol consumption on the risk of liver cancer according to metabolic syndrome: A nested case-control study in South Korea

Tobacco and alcohol may interact to increase the risk of liver cancer, which might be modified by other risk factors. Their combined effects in the context of metabolic syndrome (MetS) remain unclear. Given the increasing prevalence of MetS, this nested case-control study was conducted to evaluate the combined effects of smoking and alcohol consumption on liver cancer risk with stratification by MetS. We included 15,352 liver cancer patients and 92,112 matched controls who attended the nationwide general health examination during 2009-2019, using a customized database (N = 5,545,835) from the Korean National Health Insurance Service. Liver cancer risk according to smoking and alcohol consumption was estimated using conditional multivariable logistic regression. Additive and multiplicative interactions between these two factors were assessed. Results showed that in men, dual current users were at a significantly higher risk of liver cancer compared with dual nonusers, adjusted odds ratio (aOR) = 1.61, 95% confidence interval: (1.50, 1.72). Interactions were detected between light-to-moderate alcohol consumption (0.1-28 g/day) and heavy smoking (>20 pack-years) on additive scale, relative excess risk due to interaction = 0.34 (0.16, 0.51), attributable proportion = 0.22 (0.11, 0.33), synergy index = 2.75 (1.85, 3.66), and multiplicative scale, aOR for the product term = 1.28 (1.11, 1.49). An additive interaction was also revealed between light-to-moderate drinking and light-to-moderate smoking in the MetS subgroup. In women, light-to-moderate drinking/nonsmoking was negatively associated with the risk in the non-MetS subgroup. In conclusion, a holistic health promotion program should target male dual users of tobacco cigarettes and alcohol, including light-to-moderate users, especially those with MetS.

Association between high-sensitivity C-reactive protein and renal function in Korean adults: A sex-specific analysis of Korea National Health and Nutrition Examination Survey 2015 to 2018 data

This study aimed to investigate the association between high-sensitivity C-reactive protein (hs-CRP) levels, as a surrogate marker of systemic inflammation, and renal function among Korean adults grouped by age, sex, and body mass index. This study analyzed data obtained from the Korea National Health and Nutrition Examination Survey 2015 to 2018, a cross-sectional and nationally representative survey conducted by the Korean Centers for Disease Control and Prevention. Of the 22,451 subjects included in this study, 19,607 (87.3%) and 2844 (12.7%) had normal kidney function and incident chronic kidney disease, respectively. Reduced renal function was more frequently observed in subjects with high hs-CRP levels than in those with low hs-CRP levels (odds ratio [OR], 1.438; 95% confidence interval [CI], 1.234-1.674). In the group aged ≥ 65 years, the odds of reduced renal function were higher among subjects with a high hs-CRP level compared to those with a low hs-CRP level (OR, 1.528; 95% CI, 1.191-1.960). The association between hs-CRP level and renal function was observed only in women (OR, 2.485; 95% CI, 1.779-3.470) and further stratified by age and sex, the odds of reduced renal function were likely higher in women aged ≥ 65 years with a high hs-CRP level (OR, 2.338; 95% CI, 1.622-3.369). Moreover, reduced renal function was more observed in subjects aged ≥ 65 years and those with a body mass index < 25 kg/m2 (OR, 1.502; 95% CI, 1.087-2.075). This study showed that a high hs-CRP level likely contributes to the increased prevalence of reduced renal function. This association may aid the identification of individuals at high risk for reduced renal function, especially elderly women, in clinical or public health practice.

Gut microbiome and metabolic pathways linked to sleep quality

Sleep quality is a vital determinant of human health as sleep disorders are associated with cognitive deficits, and chronic sleep deprivation is associated with a broad range of health complications. Previous studies on the association between the gut microbiome and sleep quality have been constrained by small sample sizes or have focused on specific sleep disorders, thus yielding inconsistent results. Herein, we investigated the relationship between microbial composition and sleep quality in a cohort of 159 Koreans. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), determined through a self-administered questionnaire. Gut microbiome analyses were performed using 16S rRNA amplicons. We found no direct correlation between microbial alpha diversity metrics and sleep; however, we identified differences in beta diversity among sleep quality groups (with a PSQI score > 5 indicating poor sleep quality and PSQI ≤5 indicating good sleep quality). We also found differential microbial signatures (Bacteroides, Prevotella 9, and Faecalibacterium) among the groups. Furthermore, functional metabolic pathway profiles revealed significant linear correlations of the L-arginine and L-tryptophan biosynthetic pathways as well as 4-aminobutanoate degradation with sleep status. In particular, Faecalibacterium prausnitzii, which harbors these metabolic pathways, showed differences between sleep quality groups and a linear association with sleep quality scores and was thus identified as the species most strongly associated with sleep status. This study provides a significant advance in our understanding of the relationship between gut microbiota and sleep regulation. The current findings provide a basis for further research into potential therapeutic strategies for sleep disorders targeting the gut microbiome.

A cohort study of the effects of social support on cerebral cardiovascular disease in subjects with metabolic syndrome

INTRODUCTION

Previous studies have extensively examined the relationship between social support and various health outcomes. However, little is known about the distinct longitudinal associations between perceived social support and the development of cardiovascular events in patients with metabolic syndrome. In this cohort study, we investigated whether the levels of perceived social support in patients with metabolic syndrome were associated with an increased risk of cerebrovascular and cardiovascular events.

METHODS

The level of social support was assessed using the Medical Outcomes Study-Social Support Survey (MOS-SSS) in 2,721 individuals living in Wonju and Pyeongchang, South Korea. The presence of metabolic syndrome was determined by physical measurements and blood tests, and the occurrence of cerebral cardiovascular disease in relation to the presence of metabolic syndrome and the level of social support was analyzed using Cox proportional-hazards models.

RESULTS

The median follow-up period was 2,345 days (2,192-2,618). Overall, in the group with metabolic syndrome and low social support, low social support was associated with an increased risk of later cerebral cardiovascular events; in this group, the hazard ratio after adjusting for confounding variables was 1.97 times (95% confidence interval, 1.01-3.85) higher than that in the group without metabolic syndrome and low social support.

CONCLUSION

This study shows, for the first time, that the level of social support is a risk factor for preventing cerebral cardiovascular disease in patients with metabolic syndrome and suggests that social support status should be incorporated into multifactorial risk assessment and intervention procedures to prevent metabolic syndrome and cerebral cardiovascular disease.

Association between endocrine-disrupting chemical mixtures and non-alcoholic fatty liver disease with metabolic syndrome as a mediator among adults: A population-based study in Korea

Endocrine-disrupting chemicals (EDCs) may play a role in non-alcoholic fatty liver disease (NAFLD); however, studies on the combined effects of EDC mixtures on NAFLD development are limited. Here, we explored the association between exposure to EDC mixtures and NAFLD and investigated the potential mediating role of metabolic syndrome (MetS). We included participants from the Korean National Environmental Health Survey Cycle 4 (2018-2020) and quantified the urinary concentrations of various EDCs-eight phthalate metabolites, three phenols, one antibacterial compound, four parabens, four polycyclic aromatic hydrocarbons, and one pyrethroid pesticide metabolite-as well as serum concentrations of five perfluorinated compounds (PFCs). NAFLD was defined as a hepatic steatosis index (HSI) ≥36 or a fatty liver index (FLI) ≥60. Weighted quantile sum (WQS) regression was employed to evaluate the associations between EDC mixtures and the risk of MetS or NAFLD. Causal mediation analysis was conducted to explore the potential mediating effect of MetS on the association between mixtures of EDCs and NAFLD risk. All estimates were adjusted for age, sex, educational level, physical activity, smoking status, involuntary smoking, and drinking habits. A total of 2942 adults were included in the analysis. Moderate-to-high positive correlations were identified between phthalate metabolites and PFCs. Higher WQS scores were associated with an elevated risk of MetS and NAFLD. The sex-stratified WQS regression model showed that the interactions between the WQS index and sex were significant for MetS and NAFLD. According to the causal mediation analysis, both the direct and indirect effects of EDC mixtures on NAFLD, with MetS as a mediator, were significant in females. Collectively, these findings highlight the need for interventions that could address both EDC mixture exposure and metabolic status to effectively reduce the risks associated with NAFLD and its related complications.

Association of Body Mass Index and Waist Circumference with Osteoarthritis among Korean Adults: A Nationwide Study

BACKGROUND

Evidence on the association between obesity parameters, including body mass index (BMI) and waist circumference (WC), and osteoarthritis is limited. This study aimed to investigate these associations in Korean adults.

METHODS

This nationwide cross-sectional study used data from 24,101 adults aged ≥19 years who participated in the Korea National Health and Nutrition Examination Survey 2016-2020. Odds ratios (ORs) and 95% confidence intervals (CIs) for osteoarthritis according to BMI and WC were analyzed using multivariable logistic regression analyses.

RESULTS

The prevalence of osteoarthritis was higher in individuals with general (10.0%) and abdominal obesity (12.8%) compared with those without. Greater BMI and WC were associated with a higher prevalence (P<0.001) and risk of osteoarthritis (Model 3, P for trend <0.001). Individuals with general and abdominal obesity were associated with a 1.50-fold (OR, 1.50; 95% CI, 1.35-1.67) and 1.64-fold (OR, 1.64; 95% CI, 1.47-1.84) increased risk of osteoarthritis, compared with those without. Similar associations were observed in subgroups according to age, sex, smoking status, and presence of diabetes mellitus. The odds of osteoarthritis 1.73-fold increased (OR, 1.73; 95% CI, 1.53-1.95) in individuals with both general and abdominal obesity compared with those without any of them.

CONCLUSION

Greater BMI, WC, and general and abdominal obesity were associated with an increased risk of osteoarthritis in Korean adults. Appropriate management of abdominal and general obesity may be important to reduce the risk of osteoarthritis.

Using propensity score matching analysis to compare between cardiometabolic risk factors and physical activity type in Korean adults: findings from a nationwide population-based survey

PURPOSE

We aimed to assess the effects of different exercise modalities on cardiometabolic risk factors within a comprehensive, representative sample of the Korean population.

METHODS

We categorized 13,971 adult participants into aerobic exercise (AE), resistance exercise (RE), combined aerobic and resistance exercise (TE), insufficient exercise, and inactive groups. Multivariable regressions were conducted to compare the incidence of chronic diseases across the groups before and after propensity score matching (PSM).

RESULTS

The TE and RE groups had significantly lower waist circumference (WC), mean blood pressure (BP), glucose and insulin-related indices, and white blood cell count (WBC) measures, with TE showing the most significant differences. The TE group had significantly lower triglyceride levels and higher high-density lipoprotein-cholesterol levels. Post-PSM, the TE group had the lowest risk for metabolic syndrome, hypertension, and diabetes, closely followed by the RE group when compared with the inactive group. In a subgroup analysis, RE consistently exhibited benefits including lower body mass index, WC, BP, total cholesterol, glucose and insulin-related indices, and WBC count when compared with AE. RE may be associated with reduced incidence of cardiometabolic diseases compared to AE alone.

CONCLUSION

TE appears to be associated with significant reduction in cardiometabolic risk in Korean adults. RE possibly provides a more favorable cardiometabolic effect than AE.

Water intake and obesity: By amount, timing, and perceived temperature of drinking water

Water intake has been suggested to be associated with weight control, but evidence for optimal water intake in terms of amount, timing, and temperature is sparse. Additionally, genetic predisposition to obesity, which affects satiety and energy expenditure, might interact with water intake in regulating individual adiposity risk. We conducted a cross-sectional study recruiting 172 Korean adults. Information on water intake and lifestyle factors was collected through self-reported questionnaires, and height, weight, and waist circumference (WC) were measured by researchers. The oral buccal swab was performed for genotyping of FTO rs9939609, MC4R rs17782313, BDNF rs6265 and genetic risk of obesity was calculated. Linear regression was performed to estimate mean difference in body mass index (BMI) and WC by water intake and its 95% confidence interval (95% CI). As a sensitivity analysis, logistic regression was performed to estimate odds ratio (OR) of obesity/overweight (BMI of ≥23kg/m2; WC of ≥90cm for men and of ≥80cm for women) and its 95% CI. Drinking >1L/day was significantly associated with higher BMI (mean difference: 0.90, 95% CI 0.09, 1.72) and WC (mean difference: 3.01, 95% CI 0.62, 5.41) compared with drinking ≤1L/day. Independent of total water intake, drinking before bedtime was significantly associated with lower BMI (mean difference: -0.98, 95% CI -1.91, -0.05). The results remained consistent when continuous BMI and WC were analyzed as categorical outcomes. By perceived temperature, drinking >1L/day of cold water was associated with higher BMI and WC compared with drinking ≤1L/day of water at room-temperature. By genetic predisposition to obesity, a positive association between water intake and WC was confined to participants with low genetic risk of obesity (P interaction = 0.04). In conclusion, amount, timing, and perceived temperature of water intake may be associated with adiposity risk and the associations might vary according to genetic predisposition to obesity.

Relationship Between Asymptomatic Hyperuricemia and the Hypertriglyceridemic-Waist Phenotype in Korean Adults: A Cross-Sectional Study

Purpose

Visceral fat accumulation can negatively affect uric acid metabolism in healthy adults. The hypertriglyceridemic-waist (HTGW) phenotype is a predictor of diabetes and cardiometabolic risk. This study aimed to investigate the association between the HTGW phenotype and asymptomatic hyperuricemia in Korean adults.

Patients and Methods

The study included 23,240 adults, aged 20-80 years who underwent comprehensive health examinations at a general hospital in Gyeonggi Province, Korea, from January 2020 to December 2022. The HTGW phenotype was defined as the simultaneous presence of elevated serum triglyceride (TG) levels and increased waist circumference (WC). The diagnostic capability of the HTGW phenotype for hyperuricemia and its association with the condition were assessed using the receiver operating characteristic (ROC) curve and logistic regression analysis.

Results

The prevalence of hyperuricemia in the HTGW phenotype was 3.44 times higher than that in the normal TG normal waist (NTNW) phenotype. Compared with those in the NTNW group, the hazard ratios for developing hyperuricemia in the HTGW group were 2.887 (2.566-3.249, P <0.001) for men and 7.341 (5.139-10.487, P <0.001) for women, and these values remained significant after adjusting for potential confounders. The stratified analysis revealed that the HTGW phenotype, coupled with diabetes, had the highest probability of developing asymptomatic hyperuricemia (2.55 times). ROC curve analysis revealed that the area under the curve values of the WC*TG index for hyperuricemia diagnosis were 0.702, 0.627, and 0.685 for all participants, men, and women, respectively.

Conclusion

Among Korean adults, the HTGW phenotype was closely related to hyperuricemia in both men and women and showed a particularly strong association in patients with diabetes. It may be used in combination with an indicator that can complement its accuracy for identifying individuals at high risk of hyperuricemia.

Sex-Specific Effects of Dietary Factors on Sarcopenic Obesity in Korean Elderly: A Nationwide Cross-Sectional Study

This study aimed to compare the dietary factors related to sarcopenia and obesity status in 5458 elderly individuals (2391 men and 3076 women) aged ≥65 years from the Korean National Health and Nutrition Examination Survey (2016-2019). Participants were categorized into normal, sarcopenia, obesity, and sarcopenic obesity groups. Sarcopenic obesity showed a higher prevalence of diabetes and lower HDL cholesterol levels compared to obesity. Sarcopenic obesity exhibited a lower total KHEI score and lower adequacy, including meat/fish/eggs/beans, than normal or obesity. In women, sarcopenic obesity scored lower than obesity on the total KHEI, adequacy for most foods, and balance of energy intake, and lower than sarcopenia on the adequacy of breakfast and milk/milk products. Sarcopenic obesity showed no significant difference in energy intake compared to sarcopenia, and less physical activity compared to sarcopenia and obesity, with a BMI/waist circumference comparable to that of obesity. Low total KHEI scores and scores for meat/fish/eggs/beans were most closely associated with sarcopenia in men and with sarcopenic obesity in women. In conclusion, low dietary quality and inadequate protein-rich foods are possibly associated with the prevalence of sarcopenic obesity in elderly Koreans, especially in women. Adequate energy intake and dietary diversity may be effective in managing sarcopenic obesity.

2023 Obesity Fact Sheet: Prevalence of Obesity and Abdominal Obesity in Adults, Adolescents, and Children in Korea from 2012 to 2021

Background

The 2023 Obesity Fact Sheet aims to present an updated overview of obesity prevalence across all age groups, including children and adolescents.

Methods

This study included individuals aged ≥20 years (n=16,941,423 in 2021) who underwent health checkups provided by the Korean National Health Insurance Service between 2012 and 2021. The prevalence of obesity and abdominal obesity was standardized by age and sex using data from the 2010 population and housing census. For children and adolescents (6 to 18 years) (n=884 in 2021), we used the Korea National Health and Nutrition Examination Survey (2012 to 2021), and obesity was defined by the corresponding sex- and age-specific body mass index percentile of 95th or greater based on the 2017 Korean National Growth Chart for Children and Adolescents.

Results

The overall prevalence of obesity in 2021 is 38.4% (49.2% in men and 27.8% in women), which is a 1.27-fold increase from 30.2% in 2012. The prevalence of obesity has increased across all age groups, particularly among those aged 20, 30, and 80 years. The prevalence of class III obesity substantially increased from 0.35% (men) and 0.42% (women) in 2012 to 1.21% and 0.97% in 2021, with 3.46- and 2.31-fold increases, respectively. This increase was particularly pronounced in young adults. The prevalence of obesity in children and adolescents has surged from 9.7% in 2012 to 19.3% in 2021, with a greater increase among boys.

Conclusion

Our study provides information on the current status of obesity prevalence based on the 2023 Obesity Fact Sheet, emphasizing the urgency of implementing timely strategies to reverse this increasing trend.

Association of Combining Diet and Physical Activity on Sarcopenia and Obesity in Elderly Koreans with Diabetes

This study aimed to identify the combined factors of physical activity and diet associated with non-sarcopenic non-obese status in 1586 diabetic patients aged ≥65 years from the Korean National Health and Nutrition Examination Survey (2016 to 2019). Participants were categorized into non-sarcopenic non-obesity (NSNO), sarcopenia non-obesity (SNO), non-sarcopenic obesity (NSO), and sarcopenic obesity (SO) groups. NSNO had lower insulin, HOMA-IR, and triglycerides compared to NSO and SO. NSNO had lower perceived stress, higher nutrition education and dietary supplement intake. As assessed by the Korean Healthy Eating Index, NSNO scored higher total than SNO and SO, in breakfast and energy balance compared to SO, and in the adequacy of vegetables and meat/fish/egg/bean compared to SNO. NSNO had significantly higher energy and protein intake and physical activity, with BMI/waist circumference lower than NSO, SO, and comparable to SNO. Physical activity was positively associated with NSNO. Low Total KHEI score and protein intake level reduced the odds ratio (OR) of NSNO, particularly when physical activity was insufficient, with OR = 0.38 for KHEI Q1 and OR = 0.32 for protein T1. In conclusion, physical activity, diet quality, and protein intake are associated with NSNO prevalence in Korean elderly with diabetes, and energy balance through active intake and expenditure may be effective.

Risk prediction and interaction analysis using polygenic risk score of type 2 diabetes in a Korean population

Joint modelling of genetic and environmental risk factors can provide important information to predict the risk of type 2 diabetes (T2D). Therefore, to predict the genetic risk of T2D, we constructed a polygenic risk score (PRS) using genotype data of one Korean cohort, KARE (745 cases and 2549 controls), and the genome-wide association study summary statistics of Biobank Japan. We evaluated the performance of PRS in an independent Korean cohort, HEXA (5684 cases and 35,703 controls). Individuals with T2D had a significantly higher mean PRS than controls (0.492 vs. - 0.078, p ≈ 0 ). PRS predicted the risk of T2D with an AUC of 0.658 (95% CI 0.651-0.666). We also evaluated interaction between PRS and waist circumference (WC) in the HEXA cohort. PRS exhibited a significant sub-multiplicative interaction with WC (ORinteraction 0.991, 95% CI 0.987-0.995, pinteraction = 4.93 × 10-6) in T2D. The effect of WC on T2D decreased as PRS increased. The sex-specific analyses produced similar interaction results, revealing a decreased WC effect on T2D as the PRS increased. In conclusion, the risk of WC for T2D may differ depending on PRS and those with a high PRS might develop T2D with a lower WC threshold. Our findings are expected to improve risk prediction for T2D and facilitate the identification of individuals at an increased risk of T2D.

Lifestyle and Health Behaviors Associated with Metabolic Syndrome and Cardiovascular Disease

Background: As the prevalence of cardiovascular disease increases, the socioeconomic burden is expected to increase further. This study aimed to investigate lifestyle and health behaviors related to metabolic syndrome (MetS), myocardial infarction (MI), and stroke prevalence in men and women 50-79 years of age to assess clustering of risk factors. Methods: This study used raw data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES) in 2021. Collected data were analyzed using SPSS 29.0 program. Complex Samples General Linear Model procedure and Complex Samples Logistic Regression procedure were performed. Results: Body mass index of more than 25.0 kg/m2, being a woman, having a middle school education or less, reporting a lower middle economic status, and performing exercise for less than 150 min a week were associated with MetS prevalence. Stress was associated with MI prevalence in men and women. Depression was associated with stroke prevalence in men. Conclusions: This study found that an education on obesity control in men and women is needed to reduce the prevalence of MetS. To reduce the prevalence of MI, stress management is required for men and women. To decrease stroke prevalence, depression management is needed for men.

Obesity, Physical Performance, Balance Confidence, and Falls in Community-Dwelling Older Adults: Results from the Korean Frailty and Aging Cohort Study

Obesity affects physical functions in numerous ways. We aimed to evaluate the association between obesity and falls, physical performance, and balance confidence in community-dwelling older adults. Using first-year baseline data from the Korean Frailty and Aging Cohort Study, 979 older adults were included. General obesity was defined based on the body mass index and body fat percentage, whereas central obesity was classified based on the waist circumference and waist-to-height ratio. Data regarding fall history and balance confidence were acquired using self-questionnaires, and a timed up-and-go test was performed to measure balance-related physical performance. Overall, 17.3% of participants experienced falls in the previous year. Central obesity, as determined by waist circumference (odds ratio, 1.461; 95% confidence interval, 1.024-2.086; p-value, 0.037) and by waist-to-height ratio (odds ratio, 1.808; 95% confidence interval, 1.015-3.221; p-value, 0.044) was significantly associated with falls. Interestingly, general obesity, measured by body fat percentage, was protective against fall-related fractures (odds ratio, 0.211; 95% confidence interval, 0.072-0.615; p-value, 0.004). Participants with central obesity had poorer physical performances in the timed up-and-go test (odds ratio, 2.162; 95% confidence interval, 1.203-3.889; p-value, 0.010) and lower balance confidence according to the Activities-specific Balance Confidence scale (odds ratio, 1.681; 95% confidence interval, 1.153-2.341; p-value 0.007). In conclusion, assessment of central obesity, particularly waist circumference, should be considered as a screening strategy for falls, and older adults with a high waist circumference should receive advice on fall prevention.

Dietary intake is associated with the prevalence of uterine leiomyoma in Korean women: A retrospective cohort study

OBJECTIVE

Uterine leiomyoma (UL), the most prevalent benign gynecologic tumor among reproductive-aged women, lacks sufficient research on the potential association between dietary intake and its occurrence in Korean women. Addressing this research gap, this study aims to evaluate the potential link between dietary intake and the prevalence of UL in Korean women.

METHODS

In this cross-sectional study, a cohort of 672 women, aged 23 to 73, were enrolled, with 383 (57%) being premenopausal. Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and UL presence was determined through ultrasonography. The analysis focused exclusively on items within ten categories, including vegetables/fruit, vegetables, fruits, red meat, processed meat, poultry, fish, dairy product, milk, and alcohol. Multiple logistic regression models were employed to explore the relationship between dietary intake and the prevalence of UL, calculating odds ratios (ORs) and 95% confidence intervals (CIs) while adjusting for confounding factors.

RESULTS

Within the total cohort, 220 (32.7%) women were diagnosed with UL. High intakes of fish and poultry showed an association with higher UL prevalence. Odds ratios (95% CIs) for the upper quartiles compared to the lower quartiles were 1.68 (1.01-2.81; p trend = 0.05) for fish intake and 1.87 (1.11-3.17; p trend = 0.06) for poultry intake. Conversely, an inverse relationship emerged between dairy product intake and UL prevalence, with an odds ratio of 0.58 (95% CI 0.35-0.96; p trend = 0.05). Stratifying the analysis by menopausal status revealed a parallel pattern, with heightened UL prevalence with fish intake and reduced prevalence with dairy product intake. However, the link between poultry intake and UL prevalence was primarily observed among postmenopausal women. Among premenopausal women, elevated vegetable intake was linked to a decreased UL prevalence (OR 0.45, 95% CI 0.21-0.97 for top vs. bottom quartiles; p trend = 0.01).

CONCLUSION

We found that high consumption of fish and poultry, coupled with low intake of dairy products, correlated with an elevated prevalence of UL. Furthermore, vegetable intake exhibited an inverse relationship with UL prevalence, particularly among premenopausal women.

Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: based on the 2009-2011 Korea National Health and Nutrition Examination Survey

OBJECTIVES

This study investigated whether the lower extremity muscle mass index (LMI) mediates the relationship between general obesity, central obesity, and knee osteoarthritis in middle-aged and elderly women in Korea.

METHODS

Data of 2,843 women aged ≥50 years were collected from the Korean National Health and Nutrition Examination Survey conducted between 2009 and 2011. General obesity and central obesity were evaluated based on body mass index (BMI) and waist circumference (WC), calculated through anthropometric measurements and body composition assessments. LMI was calculated by dividing the muscle mass in both legs-measured using the dual-energy X-ray absorptiometry-by body weight. Knee osteoarthritis was defined as a Kellgren-Lawrence scale (KL) grade of ≥2 as assessed through radiographic images.

RESULTS

Knee osteoarthritis prevalence, indicated by KL grades, was significantly higher in the general obesity and central obesity groups compared to the normal group, and conversely, lower with varying LMI levels. Using mediation analysis with bootstrapping and adjusting for covariates, we found that LMI mediated the relationship between BMI and KL (β, 0.005; 95% confidence interval [CI], 0.000 to 0.010) and WC and KL grade (β, 0.002; 95% CI, 0.001 to 0.003), explaining 4.8% and 6.7% of the total effects of BMI and WC on KL grade, respectively.

CONCLUSIONS

The study suggested that LMI partially mediates the link between general obesity and/or central obesity and knee osteoarthritis, proposing that a higher proportion of lower limb muscle mass relative to body weight can alleviate the increased risk of knee osteoarthritis caused by obesity.

Trends in obesity, leisure-time physical activity, and sedentary behavior in Korean adults: Korea national health and nutritional examinations survey from 2014 to 2021

OBJECTIVES

This study aimed to investigate trends in obesity by dividing it based on body mass index (BMI) and waist circumference indicators, sedentary behavior, and leisure-time physical activity (LTPA) in Korean adults from 2014 to 2021. This study also aimed to determine the adherence rate of people with obesity to physical activity.

METHODS

Data from the Korea National Health and Nutritional Examination Survey (KNHANES) from 2014 to 2021 were used. A total of 42,676 participants 19 years or older were included in the final analysis. Sociodemographic characteristics, anthropometric measurements, and physical activity levels were recorded. Physical activity levels were assessed using the Global Physical Activity Questionnaire, a self-reported questionnaire. Multivariable logistic regression analysis adjusted for covariates was used to investigate the prevalence of obesity and sitting time or adherence to meeting the physical activity guidelines for each survey year.

RESULTS

This study included 42,676 adults. The weighted prevalence of obesity in all ages significantly increased from 30.8% (29.1%-32.5%) in 2014 to 34.5% (32.9%-36.2%) in 2017 and 37.3% (35.5%-39.1%) in 2021 (p for trend < 0.004). The weighted adherence rate to LTPA ranged from 25.5% (95% confidence interval [CI], 23.7%-27.2%) in 2014 to 20.5% (95% CI, 18.7%-22.2%) in 2021(p for trend < 0.001). The weighted prevalence of sitting time for 8 h/day or more significantly increased from 46.7% (44.4%-49.0%) in 2014 to 56.2% (54.4%-58.0%) in 2017 and 63% (60.7%-65.3%) in 2021 (p for trend < 0.001). According to this study, the LTPA level among women with obesity was significantly low.

CONCLUSION

From 2014 to 2021, obesity and sedentary behavior significantly increased and adherence to LTPA decreased among Korean adults. Given these concerning trends, comprehensive interventions are needed at the national level to encourage healthy lifestyle behaviors.

Risk of asthma and/or wheezing in obese individuals with or without metabolic syndrome: From the Korea National Health and Nutrition Examination Survey data

Introduction: Obesity increases the risk of asthma; however, whether metabolic syndrome (MS), with obesity being one of its five components, is also associated with increased asthma risk remains unclear. Objective: To investigate the association between the risk of asthma and obesity, MS, and each component of MS. Methods: We performed a cross-sectional study of 41,480 Korean adults by using data from the 2007-2016 Korean National Health and Nutrition Examination Survey. Asthma was defined as a history of physician-diagnosed asthma or wheezing sound within the past 12 months. Results: The adjusted odds ratio (OR) for asthma was significantly increased in participants with obesity (OR 1.30 [95% confidence interval {CI}, 1.27-1.33]; p < 0.0001) and MS (OR 1.23 [95% CI, 1.20-1.25]; p < 0.0001). Obesity and MS showed an additive effect (OR 1.38 [95% CI, 1.34-1.41]; p < 0.001), followed by obesity(+)MS(-) (OR 1.28 [95% CI, 1.25-1.31]; p < 0.001) and obesity(-)MS(+) (OR 1.14 [95% CI, 1.10-1.18]; p < 0.001). Among each metabolic component, only abdominal obesity (OR 1.28 [95% CI, 1.24-1.32]; p < 0.001) and hypertension (OR 1.16 [95% CI, 1.12-1.20]; p < 0.001) significantly increased the risk of asthma. Unlike the female patients (OR 1.39 [95% CI, 1.35-1.43]; p < 0.001), having MS showed a lower risk of asthma in the male patients (OR 0.79 [95% CI, 0.75-0.82]; p < 0.001). Conclusion: The risk of asthma was highest when both obesity and MS were present, followed by obesity alone and MS alone. Abdominal obesity and hypertension were associated with an increased asthma risk, and there was a sex difference that MS lowered the risk of asthma in Korean male patients.

Associations of normal fasting glucose levels and of insulin resistance with degenerative rotator cuff tear : Normoglycemia and rotator cuff tear

BACKGROUND

The upper normoglycemic range has been proposed as a risk factor for degenerative rotator cuff tendon tear (RCT), and insulin resistance has been suggested as a risk factor for tendinopathy. However, no research has established their association with degenerative RCT in the general population. This study aimed to determine whether fasting glucose levels and insulin resistance are risk factors for degenerative RCT in the normoglycemic population and identify the risk range for fasting glucose.

METHODS

This study included 418 normoglycemic participants from a rural cohort. Participants completed questionnaires, physical exams, blood tests, and MRI evaluations of both shoulders. Insulin resistance was assessed using a triglyceride/high-density-lipoprotein (TG/HDL) ≥ 3.5. Logistic regression analysis was used to determine the association between fasting glucose level, TG/HDL ≥ 3.5, and other factors and degenerative RCT. The study calculated the areas under the receiver operating characteristic curve (AUC) to determine the more appropriate predicting value between the scale and categorical values of fasting glucose levels, and compared the AUCs using the DeLong method.

RESULTS

In the multivariable analyses, both scale and categorical values of fasting glucose levels, and TG/HDL ≥ 3.5 were significantly associated with degenerative RCT. Fasting glucose levels ≥ 90.5 mg/dL (OR: 3.87, 95% CI: 2.10-7.06) in scale value and 90-99 mg/dL (OR: 4.13, 95% CI: 2.87-8.12) in categorical value were significantly associated with degenerative RCT (P < .001). The AUC of the scale value of fasting glucose levels ≥ 90.5 mg/dL was 0.68. The AUC of the categorical value of fasting glucose levels of 90-99 mg/dL was 0.70. Because of the significantly larger AUC of the categorical value of fasting glucose levels of 90-99 mg/dL, those fasting glucose levels were determined to be independently associated with degenerative RCT (P < .001).

CONCLUSIONS

High fasting glucose levels within the normal range may link to increase insulin resistance and risk of degenerative RCT. Normoglycemic levels of 90-99 mg/dL and insulin resistance may be risk factors for degenerative RCT.

LEVEL OF EVIDENCE

Level III, prognostic study.

Association between Neck Circumference and Chronic Kidney Disease in Korean Adults in the 2019-2021 Korea National Health and Nutrition Examination Survey

Chronic kidney disease (CKD) is a major public health problem and a leading cause of cardiovascular disease and death. Early recognition and management of CKD risk factors are necessary to prevent its onset and progression. Neck circumference (NC) is a non-invasive and easily accessible anthropometric measure associated with central obesity and subcutaneous fat accumulation in the upper body. Our study aimed to explore the relationship between NC and the prevalence of CKD using data from the nationally representative Korea National Health and Nutrition Examination Survey (2019-2021). We analyzed data from 10,219 subjects (age > 19 years, no missing values). CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Logistic regression analysis was performed, which revealed a significant association between NC and CKD prevalence even after adjusting for confounding factors, both when NC was considered a continuous variable (OR [95% CI], 1.11 [1.03-1.19]) and in quartiles (Q1 as reference; Q2 OR [95% CI], 1.23 [0.91-1.67]; Q3 OR [95% CI], 1.59 [1.16-2.18]; Q4 OR [95% CI], 1.70 [1.16-2.50]). Our findings suggest that NC could be a simple and effective anthropometric measurement for identifying individuals at risk for CKD.

Differential Impact of Obesity on the Risk of Diabetes Development in Two Age Groups: Analysis from the National Health Screening Program

BACKGRUOUND

The effect of obesity on the development of type 2 diabetes mellitus (DM) in different age groups remains unclear. We assessed the impact of obesity on the development of DM for two age groups (40-year-old, middle age; 66-year-old, older adults) in the Korean population.

METHODS

We analyzed Korean National Health Insurance Service data of 4,145,321 Korean adults with 40- and 66-year-old age without DM, between 2009 and 2014. Participants were followed up until 2017 or until the diagnosis of DM. We assessed the risk of DM based on the body mass index and waist circumference of the participants. Multiple confounding factors were adjusted.

RESULTS

The median follow-up duration was 5.6 years. The association of general and abdominal obesity with the risk of DM development was stronger in the 40-year-old group (general obesity: hazard ratio [HR], 3.566, 95% confidence interval [CI], 3.512 to 3.622; abdominal obesity: HR, 3.231; 95% CI, 3.184 to 3.278) than in the 66-year-old group (general obesity: HR, 1.739; 95% CI, 1.719 to 1.759; abdominal obesity: HR, 1.799; 95% CI, 1.778 to 1.820). In the 66-year-old group, abdominal obesity had a stronger association with the development of DM as compared to general obesity. In the 40-year-old group, general obesity had a stronger association with the risk of DM development than abdominal obesity.

CONCLUSION

The influence of general and abdominal obesity on the development of DM differed according to age. In older adults, abdominal obesity had a stronger association with DM development than general obesity.

Differences in the Impact of Obesity and Metabolic Unhealthiness on the Risk of Gallbladder Polyp

PURPOSE

Differences in the impact of obesity and metabolic health status on the risk of gallbladder polyp (GBP) remain uncertain. Herein, we aimed to compare the risk of GBP ≥5 mm among individuals with different phenotypes based on obesity and metabolic health status.

MATERIALS AND METHODS

A cohort of 253485 asymptomatic adults who underwent abdominal ultrasonography screening were categorized into the following four groups according to obesity and metabolic health status: 1) metabolically healthy non-obese (MHNO), 2) metabolically unhealthy and non-obese (MUNO), 3) metabolically healthy but obese (MHO), and 4) metabolically unhealthy obese (MUO).

RESULTS

The prevalences of GBP ≥5 mm were 2.4%, 3.1%, 3.7%, and 4.0% in the MHNO, MUNO, MHO, and MUO groups, respectively. The multivariable-adjusted odds ratio (OR) values for prevalence of GBP ≥5 mm by comparing the MUNO, MHO, and MUO with the MHNO group were 1.11 [95% confidence interval (CI), 1.04-1.19], 1.30 (95% CI, 1.15-1.47), and 1.37 (95% CI, 1.28-1.45), respectively. The risk of GBP ≥5 mm in the MHO group was significantly higher than that in the MUNO group, but not significantly different from that in the MUO group.

CONCLUSION

Obesity and metabolic unhealthiness appear to be independent risk factors for the prevalence of GBP, and the impact of obesity is greater than that of metabolic unhealthiness, suggesting that maintaining both normal weight and metabolic health may help reduce the risk of GBP.

Association with Combined Occupational Hazards Exposure and Risk of Metabolic Syndrome: A Workers' Health Examination Cohort 2012-2021

Background

This study aimed to evaluate the association between exposure to occupational hazards and the metabolic syndrome. A secondary objective was to analyze the additive and multiplicative effects of exposure to risk factors.

Methods

This retrospective cohort was based on 31,615 health examinees at the Pusan National University Yangsan Hospital in Republic of Korea from 2012-2021. Demographic and behavior-related risk factors were treated as confounding factors, whereas three physical factors, 19 organic solvents and aerosols, and 13 metals and dust were considered occupational risk factors. Time-dependent Cox regression analysis was used to calculate hazard ratios.

Results

The risk of metabolic syndrome was significantly higher in night shift workers (hazard ratio = 1.45: 95% confidence interval = 1.36-1.54) and workers who were exposed to noise (1.15:1.07-1.24). Exposure to some other risk factors was also significantly associated with a higher risk of metabolic syndrome. They were dimethylformamide, acetonitrile, trichloroethylene, xylene, styrene, toluene, dichloromethane, copper, antimony, lead, copper, iron, welding fume, and manganese. Among the 28 significant pairs, 19 exhibited both positive additive and multiplicative effects.

Conclusions

Exposure to single or combined occupational risk factors may increase the risk of developing metabolic syndrome. Working conditions should be monitored and improved to reduce exposure to occupational hazards and prevent the development of the metabolic syndrome.

Hypertriglyceridaemic waist phenotype and waist circumference triglyceride index are associated with higher incidence of acute pancreatitis: a nationwide population-based retrospective cohort study

OBJECTIVES

The hypertriglyceridaemic waist (HTGW) phenotype, an indicator to assess metabolic syndrome, could be a useful predictive marker for the risk of acute pancreatitis. This study aimed to evaluate the association between the HTGW phenotype and the risk of acute pancreatitis with a nationwide population-based cohort.

DESIGN

A retrospective, nationwide cohort study.

SETTING

Registry of health check-up result from Korean National Health Insurance Service.

PARTICIPANTS

A total of 3 912 551 adults who underwent health checkups under the National Health Insurance Service in 2009 were enrolled in this study.

INTERVENTIONS

Subjects with both increased waist circumference (WC) and elevated blood triglyceride concentrations were defined as the HTGW phenotype. The participants were divided into four groups, classified as NWNT (normal WC-normal triglycerides), EWNT (elevated WC-normal triglycerides), NWET (normal WC-elevated triglycerides) and HTGW. The WC triglyceride index (WTI) is a quantitative indicator of the HTGW phenotype which is calculated by multiplying WC (cm) by triglyceride levels (mmol/L).

PRIMARY OUTCOME MEASURE

The subjects were followed until 31 December 2018. The adjusted HRs of acute pancreatitis in each group were estimated.

RESULTS

During the follow-up, there were a total of 8933 of acute pancreatitis occurrences. The incidence of acute pancreatitis in all subjects was 0.278 per 1000 person-year. The HTGW group had the highest incidence (0.444), followed by the NWET (0.381), and EWNT (0.316) groups. The HTGW group had a significant higher incidence of acute pancreatitis than the NWNT groups (HR 1.364 (95% CI 1.279 to 1.454)). The risk of acute pancreatitis steadily increased as the WTI increased (HR 1.847 (95% CI 1.657 to 2.058) in 10th decile).

CONCLUSIONS

The HTGW phenotype is confirmed to be an independent risk factor that increases the risk of acute pancreatitis.